This New York Times article, entitled
Many Diagnoses of Depression May Be Misguided, Study Says
brings up a valid point about diagnosis. As I’ve said before, since we base “diagnosis” in the mental health field on self reports from clients, often checking off boxes on a form, the term “diagnosis” is misleading. In the medical field, the word generally has some physical, empirical basis. An observable bacteria, a lesion, specific physical symptoms. Of course we even misuse the term “empirical” in the field of psychology, using this word when the “empirical” data we are referencing are really subjective self report survey data.
So this article discusses the idea that depression may be over-diagnosed because recent life events that could make someone temporarily sad are not taken into account. The opposing view says that the diagnostic criteria clearly differentiate between short term depression and long term depression. And of course the DSM does have such distinctions.
The key is, however, “What difference does it make?” If those with the appropriate credentials prescribe anti-depressants for either condition (which they do) what difference do the DSM categories make?
I was working with a recovering addict who was withdrawing from Oxycontin, pot, and who knows what else. He was in a long term residential treatment program. He saw a psychiatrist at one point within the first 30 days of recovery, who saw him for 10 minutes and prescribed Effexor. For someone in their first 30 days of withdrawal from drugs, being a bit blue (to put it mildly) is normal. Anti-depressants might be a valid treatment at some point, but don’t you think we should allow some time to find out what life is like without drugs first?
Have we tried an exercise program? A meditation program? A proper diet? Can we charge money for these things? No. Have they been shown to be as effective as medication? Yes. How many people who are prescribed anti-anxiety drugs have been asked by the prescriber how much caffeine they consume on a daily basis? Is it on the check list? No. Does the check list ask about exercise, diet, vitamin supplements, sleep patterns, relationships, major life events, etc.? No.
What is the point of “diagnosing” in these situations? Why are we not doing thorough assessments? Well, maybe some of us are doing these types of assessments. But my impression, based on the drugs being sold, and based on the time constraints of those who have the prescription pads, is that we are getting more 10 minute prescriptions than we are thorough life assessments.
I don’t think the question is whether we are “over-diagnosing” or not. I think the question is “Why are we diagnosing, instead of assessing, talking, and helping?