Psychiatric Diagnoses Don’t Explain ‘Why’—Only ‘How’

Source: bravomike1969 / Envato Elements

My neighbour glared at me when, recently, I suggested that she might like to join me in a litter pick being organised to help clear up our local park.

“I have depression,” she said icily, fixing me with a narrow-eyed stare.

I could have pointed out that it would do her a lot of good to be out and active in the open air, connecting with other people, doing something helpful for those in the neighbourhood—all these known to be factors associated with helping to lift mood. However, Marion already spends a lot of time being sociable when she wants to, engaging in activities she likes, such as shopping and painting, and going for coffee with friends.

But then, every so often, her depression descends "out of the blue." It is something she was diagnosed with 30 years ago and for which she still takes a low-dose antidepressant every day.

Talking to her a little longer, I learn that she is disappointed that her daughter has had to cancel her visit that day—something Marion was much looking forward to. Clearly, that disappointment had expanded amoeba-like, after prey, pulling all sorts of other negative thoughts into its ambit. “You don’t know what it is like to live all alone!” she snapped accusingly. “How am I going to manage when I can’t walk?” Marion is 55 and rather healthy.

But Marion doesn’t see it that way. She can’t do anything about her negativity right now because it is the depression doing it to her. The only option is to up her tablet dosage until something takes her out of herself and she can drop it down again.

New Study

So I was really pleased to read about a Finnish study calling out health professionals for perpetuating the myth that diagnoses such as depression explain anything; instead, they are merely descriptive.

According to psychiatrist Jani Kajanoja, one of the authors, “A diagnosis of depression does not explain the cause of depressed mood any more than a diagnosis of headaches explains the cause of pain in the head.”

The researchers analysed information on depression provided on the websites of the most influential English-language organisations, including the World Health Organization, the American Psychiatric Association, and the National Health Service. They found that “most websites used language that inaccurately described depression as a causal explanation to depressive symptoms.

“We argue that the scientifically inaccurate causal language in depictions of psychiatric diagnoses is potentially harmful because it leads the public to misunderstand the nature of mental health problems.”¹

It is strong stuff and long overdue. Psychologist and researcher Eiko Fried made the same sort of point nearly 10 years ago when he first looked for causal associations among individual symptoms of depression. Depression, he concluded, was not a distinct condition with highly specific symptoms indicating an underlying disorder—his team’s analysis of the experience of 3,700 depressed patients taking part in one study found more than 1,000 unique symptom profiles, with more than 80 percent of these experienced by five or fewer people and nearly half experienced only by one!

He argues that depression is a network of symptoms influencing each other—for instance, insomnia causing fatigue causing poor concentration and so on. “Symptoms do not cluster because of a shared origin,” he said. “They cluster because they trigger each other.”²

The Term "Disorder"

Faulty suggestion of causation is not restricted to depression. According to other researchers, the very word "disorder" at the end of psychiatric diagnoses erroneously implies cause: “Saying someone has ‘attention deficit’ leads us to search for the cause [‘why do they behave like this?’], whereas ‘attention deficit disorder’ implies the cause has been found.” In other words, “Oh, so that’s why they behave like this!”

The researchers have a very simple solution. “Drop the term disorder from all classifications. Just drop it.”³

Leaving out that one word does not detract from the actual challenges faced by people in which the problem behaviours are observed, they say, but provides the incentive to see someone in the round and explore all options for helping them make the best of their abilities. (After all, many of the "symptoms" listed for ADHD can be positive attributes as well.)

How different it might have been for Marion if, when she received her diagnosis of major depressive disorder 30 years ago, someone had thought it was relevant why she was depressed—her marriage had broken down and she hadn’t seen it coming. Instead of getting the chance to learn coping skills, and maybe some relationship skills, she had an "illness" bestowed on her, on which ever after she could blame anything that didn’t make her happy.

I think dropping the disorder is a great solution. It restores dignity to neurodivergence. And, instead of seeing mental ill health as set, permanent, and unavoidable, we can see it for what it is—something that fluctuates and often remits, which, with the right help, can often be stopped from recurring or managed quickly when it does.