Five years ago in 2020, the pandemic forced us into our homes in isolation, where one of the only things that we could do was to reflect upon ourselves, our feelings, thoughts, and struggles. Naturally, the pandemic gave rise to mental health awareness and in many ways, redefined its place on society's list of priorities. Post-pandemic, a more conscious world emerged, with increased emphasis on taking care of our mental health and well-being. While these still remain evolving concepts, their progress in being integrated into different aspects of our lives has been accelerated by the COVID-19 lockdown. Mental health and well-being are now buzzwords: we find them across schools, universities, offices, and even social media. We have TikTok psychologists and remote, web-based therapy sessions. Tools to improve our mental health have never, ever been more accessible. What does this mean for us as a society? Firstly, if this is true we would expect increased numbers of diagnoses- and the numbers agree. Statistics from the US show that there has been an incredible 40% increase in mental health problem diagnosis from 2019 to 2023. The World Health Organization reports that rates of people suffering from depressive disorders and anxiety disorders increased by 26% and 28% respectively during 2020. The first step to treating any problem is recognizing it exists. As many people who like to consider mental health and physical health equally would say, “What do you do when you have a cold? You go to the GP, and let them diagnose you so that they can prescribe you medicine to cure your cold. That is what you have to do.” While this line of thinking is probably informed by positive intentions of equally prioritizing mental health and physical health, it is extremely misleading. Getting a diagnosis for a cold or any physical issue is not the same as being diagnosed with a mental health problem. This applies on several levels: the process of diagnosis itself, the labels society attaches, and the kind of treatment the diagnosis leads to. While being diagnosed with a mental health problem is a prerequisite to any treatment process, it may not necessarily be a comfortable journey for the person being diagnosed.
So then, why even discuss this if a diagnosis is important for treatment? Everything needs a holistic evaluation and while mental health problems are standardized, the experience of each person living with them is unique and can be varied due to several factors like culture, geography, and the accuracy of the diagnosis among other things. Keeping in mind that although psychology advances with cutting-edge research and mental health and well-being continue to gain recognition, the normalization of mental health problems in society moves at a much slower pace, or worse, in the opposite direction through continued use of misrepresentative labels and oversimplification. In fact, we can argue that the gap between what the mental health problem is clinically and how society views it continues to grow, fed by misinformation and a dismissive attitude that prevents true and total integration of mental health disorders in a wider societal narrative. Therefore, each individual should be able to make well-informed decisions about their mental health journey by understanding the cons of receiving a diagnosis. Firstly, how exactly are mental health problems classified and diagnosed? There are two accepted manuals used for the diagnosis of mental health problems today: the International Classification of Diseases (ICD-11) by the WHO and The Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR). In the UAE, the DSM is used for diagnosis. The DSM 5 lists over 70 mental health problems and the basic principle of diagnosis remains the same. There are two types of symptoms – positive and negative – and depending on the condition, a certain number of both symptoms – usually 3-5 – must be observed over a relative period of a few weeks. However, these are not enough as ultimately it is the expertise of the licensed mental health practitioner that decides whether the diagnosis is positive or not. There have been multiple validity concerns raised when it comes to using the DSM-5 as a diagnostic tool, especially about the high number of false positives. The DSM diagnoses a mental health problem where there is not one. Feeling a little uncomfortable? There is more. Studies testing the consistencies between the two tools DSM-5 and ICD-11 show that the two arrive at very different numbers of positive and negative diagnoses while diagnosing the same mental health problem for the same sample of patients. This means that really, it is a bit of a toss-up if someone is actually diagnosed with a mental health problem or not, and the differences have nothing to do with the patient itself but external factors like the diagnostic book being used or the psychiatrist’s expertise. Even more, there are many disorders that have major overlaps in symptoms, which makes misdiagnosis common. For example, schizophrenia, depression, and OCD are commonly misdiagnosed. Note that treatment plans, already complex in variety for the same mental health disorder, differ greatly between these. So, in the case of a misdiagnosis or lack of a complete diagnosis, the treatment will have no effect or it might worsen symptoms. Diagnostic tools for mental health problems are constantly being reviewed and revised which means that since this is a relatively new field, it might take a while before something consistent is developed. However, it is also entirely possible that such a tool may never be developed because contextual factors seem to be important in increasing the validity of the diagnosis and preventing false positives and misdiagnosis. It is very, very difficult to make objective interpretations of a patient’s context. If the diagnostic process becomes mainly subjective, there will be even greater concerns about accuracy. Despite all the progress that has been made in de-stigmatizing mental health, we cannot confidently say that this progress is even throughout countries or with groups in a country. In fact, mental health literacy can vary drastically within a city or even a classroom or workplace because our beliefs are shaped by various aspects of our lives outside of our control. So, even if large meta-analysis studies show that mental health literacy has improved in recent years, this is not a guarantee that people diagnosed with mental health problems will be free from negative labeling in society. But hold on – for labeling to have a negative impact, the label does not even have to be negative. It can be perfectly neutral – it can just be a “mental health problem” – and patients may already feel excluded because of the lack of openness and understanding. It is still rare to formally discuss mental health problems in many of our home countries. That is not to say, people do not discuss mental health. Names of mental health disorders like depression and anxiety have bled into popular culture and are used on a daily basis. The oversaturation of people using formal mental health problem names casually without diagnosis overgeneralizes mental health disorders and reduces their significance to people. This has many disparaging effects. People might no longer feel a reason to seek professional help because serious mental health disorders are normalized, a part of living in a capitalist society, one might argue. The people who do end up seeking professional help might suffer from lowered self-esteem and increased insecurity because they are unable to “deal with it themselves” like their peers, who have never actually gotten a formal diagnosis but still assert their claim. Labels used in place of formal names of mental health to reduce their impact to “make things easier” can cause people to overcompensate, or over-accommodate the patient to the point where they feel removed from groups and society. Having a label always has consequences whether intended, unintended, or just ignorant. Say the person continues taking detours until they finally reach treatment- the final destination in this journey. What next? Treatment plans for mental health problems can come in many different forms: drug medication, cognitive behavioral therapies, and other schools of counseling. These are generally offered together. Treatments depend specifically on diagnosis, but as brought to your attention, mental health problems can be misdiagnosed, so it is possible that the disorder being treated is not the one you have. Furthermore, behavioral therapies and other forms of therapy require participation and initiative from patients to truly be successful. In order to be active members of their treatment, it is important for patients to feel supported and this can be blocked due to the negative effects of labeling discussed above. So, does a diagnosis make life easier? In many ways, and for many people it can provide relief and make it much easier to follow routine and live life. But – and this is a really big one – if not handled properly during any step of the journey, the process may cause further damage to a person’s overall well-being and self-esteem. This is why, while people are increasingly encouraged to seek professional help for mental health concerns, we must hold ourselves responsible and make strides to refine diagnostic tools, create awareness about misusing formal mental health terms, and eradicate labeling so that patients with mental health problems can feel safe, supported and thrive in their journeys to improving mental health.