The Problem with Diagnoses (Part 1)

Let's picture what typically happens when you seek therapy. You call around various therapists, make an appointment with one of them who accepts your medical insurance, and you show up for the initial assessment. What you may or may not know is that your therapist will then have to diagnose you with a mental disorder and provide this, along with other information such as your treatment plan, to your insurance company in order to be paid for the services provided to you.

What's wrong with this picture?

To make a diagnosis of a mental illness, mental health professionals such as psychiatrists and therapists rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current manual (DSM-IV-TR) lists categorically 297 conditions ranging from schizophrenia to substance abuse, from panic disorder to paranoid personality disorder. Almost every disorder carries a set of criteria one needs to meet to justify its diagnosis.

Herein lies the problem: definitions of what is "normal" change with every new edition of the manual, as a result of new research findings and greater awareness, as well as lobbying efforts and political factors. A strong cultural bias exist. Case in point: "homosexuality" was considered a mental disorder (read: needs fixing) until 1987 edition of DSM.

A related problem is that it isn't always clear which diagnosis fits you best, so your therapist may have to do some guesswork or fill in some information gaps just to fit you into a diagnostic category.

Insurance companies also dictate what conditions they do and do not cover. Most do not cover treatment of relational problems such as that within a couple of between a parent and child. This means that if you're seeking couples therapy, chances are your therapist will have to diagnose you or your partner with a mental disorder such as depression or anxiety in order to fulfill insurance requirements.

Lobbying efforts from pharmaceutical companies can dictate the prevailing diagnoses. We saw how, beginning in the late 1990s, children formerly diagnosed with ADHD were increasingly being labelled bipolar, thanks in large part to aggressive marketing efforts by the makers of anti-psychotic and anti-depressant drugs to family doctors and child psychiatrists.

(On a separate note, I shudder to think that many of these drugs have not been shown to work on children; in fact emerging evidence suggests that they may cause more harm in the long run.
If you want to learn more about the controversy, I highly recommend watching the PBS documentary "The Medicated Child.")