A critique of current psychological diagnosis and treatment methods

Labels are the expression of categories; a process that the human mind uses in order to make sense of the external world. Labels have been adopted vigorously by the medical community in order to classify patients according to their presenting symptomatology. While labels are a useful tool in such situations, they must be used appropriately if the patient is to see any improvement in their condition. Specifically,the field of psychology seems to hold an over-reliance on the use of diagnostic labelling, making them a requirement prior to the progression of treatment. I intend to show that the overuse of labelling is not only dangerous for the patient, but also for the field as a respected scientific discipline.

The usefulness of labelling stems from their ability to classify a wide range of similar cases into one over-arching category. This enables health professionals to discuss the case with meaning (convey to others in an efficient way what is wrong) and develop appropriate treatments (by grouping remedies according to their effects). These advantages can also be construed as weaknesses, if the label is used haphazardly and inappropriately.

Medical professionals utilise the power of labelling in their diagnoses in order to gain insight into the patient’s condition. Using a graduated method, information is gathered initially using broad techniques that narrow down to the specific (and eventual classification). For example, a patient suffering from a psychological disorder will be interviewed with a focus on history and presenting symptoms. Over a number of sessions the therapist will narrow their diagnosis to one main possibility. This then acts as the guide for future treatment and to an extent, ultimately decides the fate of the patient. The label is statistical in nature; generalisation procedures are constantly running in the background of the therapist’s mind. Each individual symptom is compared against their knowledge and experience to see if it fits the mold of a previous case they have encountered. Obviously this can cause problems if a) the case is unique, b) underlying problems are the root cause or c) the patient/therapist are inaccurate in their information exchange.

Casting aside individual differences in medical ability (interviewing technique, medical knowledge, experience) it seems that many variables still remain to influence the diagnostic process. Perhaps the main factor (especially in the case of psychiatric illness) in obtaining an accurate classification stems from the patient’s willingness to co-operate; the therapeutic relationship. The patient must be made to feel comfortable and at ease with the professional if accurate and meaningful information is to be exchanged. A patient that is uneasy and uncooperative will only hinder the flow of information that can be used to their benefit. Additionally, a lack of patient insight into their illness can be detrimental. If the patient lacks sufficient command over their ability to communicate clearly and accentuate their thoughts and feelings with any degree of objectivity the professional’s job will be made harder. Not only will an objective ‘truth’ have to be discerned, but the professional must also ensure that they themselves remain objective in their judgments and take steps to minimise automatic processes that could cloud the decision making process (stereotyping, assumptions etc).

The tendency for the health profession to over-emphasise the importance of labels can also lead to problems with the patient’s road to recovery. Such professionals may feel pressured to demonstrate their knowledge and aptitude, therefore quickly jump to a diagnosis without giving it sustained thought. Of course, many other variables may also influence the diagnosis such as time constraints, mood, external stimuli (distractors); in short, anything that may prevent a clear and rational consideration of the evidence both for and against arriving at a particular conclusion. The threshold where this becomes dangerous is quickly reached in medical settings, due to the often serious nature of illnesses and the cacophony of distracting environmental factors (emergency wards in a busy hospital).

In psychological settings, the pace is more relaxed, however the pressure to label is greater. How is this the case? I believe it arises from the professional mentality in this field (heavy research background, opinionated therapists subscribing to paradigms they have had experience with), coupled with the highly theoretical nature of psychological treatment. Empirical and therapeutic psychology is still a relatively new field, having its origins in the late 19th century. As such, and in combination with the medium with which it deals (intangible, consciousness), psychological training involves large amounts of theory. This introduces an element of uncertainty and opinionated debate over what is the ‘correct’ treatment and diagnosis. A tension may develop in the therapist as their theoretical training interacts with their therapeutic intuition and experience. The lack of one definitively ‘correct’ answer can hinder treatment and influence the initial diagnosis of the illness.

I believe that psychology suffers more-so than medicine due to this ambiguity. Unlike medicine, which has ancient roots as a scientific discipline, psychology lacks a secure framework and free exchange between the various paradigms. Psychology seems to have a very academic mentality, with research continually revolving the stock of common knowledge. Theories are reversed, expanded and forgotten based on the results of research. Paradigms clash when battles erupt between them over disputed research findings or the more effective course of treatment (eg Psychoanalysis vs Behaviourism vs Neuropsychology). Fortunately this tendency has lapsed in modern psychology, as the field looks to establish itself on secure footing and introduces better systems and regulation.

The problem with labelling in the field of psychology is that there is too much choice, and too little consensus between therapists. The field is dynamic, with changes to theory and treatment occurring rapidly as new evidence comes to light. Therapists need to stay on top of their game if they are to remain at the forefront of their profession. The Scientist-Practitioner model assists in this task, as it incorporates a mindset of combining best practice with the latest research; a process of self-evaluation and self-improvement that requires a life-long dedicated commitment if it is to succeed.

Due to the inherent difficulty in successfully diagnosing mental illness and the tendency for co-morbid conditions to exist alongside the target ailment, psychology as a field is in dire need of consistency. With time, the field will mature. A possible solution would be a more thorough integration with Psychiatry, the medically oriented parent of psychology. By taking the pieces that work (such as biological, materialistic and reductionist mindsets) and combining them with a strong research component that emphasises objectivity, the field as a whole can move forward. Patients will stand a better chance of receiving a more accurate diagnosis as therapists move away from the specialist fields that they adopt based on elective subjects and research projects taken at university. They will begin to look at the whole picture, pulling together a vast reservoir of knowledge from a myriad of paradigms.

Psychology should be united under one banner, rather than splitting into separate warring factions each explaining the same phenomenon from a different perspective. Such variation is useful in a field that is in its infancy and academic creativity flourishes. Now that at least some of the basic underlying processes of the human mind are known, perhaps each paradigm should look at working cooperatively and meshing their ideas. Just as the physical sciences search for M, the theory to unite the quantum with the relative, so too should psychology aim to provide a framework theory that can explain the secrets of the brain using common terminology and ideology. This is not advocating the demolition of the various offshoots of psychology, but rather removing the restrictions currently imposed. For instance, this unification aims to remove practices such as an educational psychologist can only talk about X, Y and Z while evolutionary psychologists are only qualified to comment on A, B and C. Psychology would remain a diverse discipline, however the treatment and diagnosis would be much more attenuated that it is currently.

Therapists need to relax their reliance and servitude to labels, removing these crutches (because it is easier to label someone than arrive at an independent conclusion based on objective evidence). The future of psychology as an effective method of treating mental illness, which is only going to increase as the world becomes busier and more stressful, depends on it.