Are Diagnoses Misleading? How the Health Industry Shapes Diagnosis

The Meaning of a Diagnosis

There's a topic we often discuss and debate in psychology that somehow rarely leaves academia, and which I think is widely misunderstood: the meaning of a diagnosis.

Yes, we start from certain diagnoses in order to understand a patient and their difficulties, and to shape the right and useful treatment plan in line with that understanding. The meaning of these diagnoses and how to evaluate them requires expertise. But the purpose of diagnosing is not to reach a final verdict or to label the patient. Many diagnostic categories are not enough to understand a person fully; they are only guides to understanding them better. And belonging to a diagnostic category doesn't mean just one thing either; we don't talk about clear, direct "equals" signs as in mathematics. We always think of it as a spectrum, not a single point.

The Example of Depression

Let's take depression as a diagnosis. Depression is a word we hear all the time in daily life, one that's on everyone's lips. "I'm depressed, I've been forgotten, I've been cheated on, I broke up with my lover, I'm so lonely…" Remember the song? Or depression cardigans, depression films, ten things to do when you're depressed; the lists go on. We may feel symptoms of depression, but not every depressive symptom means we would be diagnosed with depression. Even so, there seems to be a story that took the word depression out of the realm of psychopathological diagnosis and put it on everyone's lips. To understand this better, we need to look at the other side of the coin: the market function of healthcare.

The Dark Side of the Health Industry, and Medication

If we understand the economic, market function of human health as an industry, some pieces fall into place. Modern societies, led especially by capitalist countries like the United States, share a mindset of 'turning everything into material profit' and cutting certain costs as much as possible. Over time this mindset created a health industry in which pharmaceutical and insurance companies have a strong say. And by health industry I don't only mean health workers or drug companies; from academia to the media, every link in the chain has come to speak a similar language: medications and treatments with proven effectiveness, similar categories and names, advertising, definitive and fast solutions… Psychological symptoms, too, began to be things that are immediately named, categorised, labelled and gotten rid of with a prescription. Yet a symptom is less something to be suppressed or gotten rid of right away than a tool trying to tell us something; it is, first of all, something we try to understand. Recovery, on the other hand, is a slow, effortful, sometimes long and costly process. As you can guess, insurance companies are not very keen to pay those costs. So rather than accepting treatment as it is, turning it into something sorted out in no time with medication and accelerated therapies is economically more convenient. I want to underline that there are many situations in which medication is necessary and effective; I'm not saying medication is unnecessary, or that every doctor who prescribes it supports this view. I'm saying that something may be wrong at a more systemic level, and that even the everyday words that have settled into our language may have a place in this system.

Sadness or Major Depressive Disorder? An Example from the DSM

Think about it: could the sadness, grief and bad feelings that are a normal part of life and of being human have started to be seen as things a person shouldn't feel? Should we, without ever feeling bad, immediately focus on the positive, take a pill and carry on with our lives productively? Let me give you a very clear example from the DSM. The DSM, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, is the manual health professionals use to make diagnoses, updated and revised as the field develops. Its most recent version, the DSM-5, contains an interesting change regarding the diagnosis of depression. Under this change, if you show symptoms of depression only 2 weeks after a loss, you can be diagnosed with Major Depressive Disorder. While the previous version, the DSM-4, at least allowed grief a humane margin of 2 months, the DSM-5 removed this contextual exemption and made grief itself a direct object of the diagnostic criteria. I think it's important to understand that such an approach can create risks such as the medicalization of normal life and excessive or unnecessary prescribing, and to act accordingly. Here, the responsibility to be careful falls on all of us, and first of all on health professionals.

So is this tendency to medicalize and label limited to psychological diagnoses? Unfortunately not. Labels that seep into everyday language, dating culture and pop psychology carry a similar risk. In my next article I'll look in detail at how concepts we often use in relationships, like 'lovebombing' and 'ghosting', can get in the way of our real experiences.

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