Psychiatry’s Moral Dilemma: The Pros and Cons of a Mental Health Diagnosis

mental health diagnosis

The decision to provide a mental health diagnosis to someone experiencing psychological distress – a range of troubling emotions, thoughts, and behaviours – often presents a moral dilemma. Of course, there may be an assumption among psychiatrists that diagnoses are, generally speaking, in a patient’s best interest, since they are intended to pinpoint what condition it is exactly that needs treating, allowing the most effective recommendations for treatment to be made. (You can read more about the rationale behind diagnoses here.)

However, there are also potential downsides to mental health diagnoses that should not be ignored, one of them being (in the patient’s eyes) a self-stigmatising mental disorder for life – a label – that radically alters who they think they are as a person and what they feel capable of. The opposite could be true, though; rather than feeling limiting and shameful, a diagnosis can feel liberating and validating. 

These days, self-diagnosis has become more and more popular, as people feel that self-diagnosing can even be a useful tool in understanding yourself better. Self-diagnoses, especially when it comes to mental disorders, are criticised for being inaccurate (leading people to believe they have certain conditions when they don’t); although the field of psychiatry, despite being heralded as scientific and objective, is likewise troubled by critiques of being inaccurate (given that no objective tests for mental health conditions exist). 

This post will delve into the pros and cons of getting a diagnosis for your symptoms, with the aim of highlighting how diagnosing is frequently a moral dilemma in the psychiatric profession, even if a psychiatrist doesn’t perceive it as one. This is because it is difficult to know if such a decision will ultimately benefit or harm the person who is seeking relief from emotional distress. 

The Advantages of Getting a Mental Health Diagnosis

Here are some of the advantages that come with getting a diagnosis for a mental health condition.

You Gain Access to More Treatment

One of the benefits of getting your diagnosis is the doors it can open for certain treatment methods. For example, you may not be considered for a certain medication with side effects unless it can be proven that you truly need the medication through a diagnosis.

In other circumstances, there are treatments for certain conditions that can only be given with a diagnosis. This fact also applies to getting accommodations and services in a school or work setting. For example, a child with attention deficit hyperactivity disorder (ADHD) does need an official diagnosis to be given an Individual Education Plan or 504 at school (in the United States).

An adult diagnosed with anxiety who wants accommodations from their workplace will also need to provide a doctor’s note stating that they have a mental health diagnosis that requires the accommodation requested.

Moreover, if someone wanted to benefit from government-funded mental health services, these services would be reserved for those with a medically recognised mental illness; the government does not fund services for demedicalised distress. This is not to say that this situation is necessarily justified. Profound suffering may warrant support and care from government-funded services whether the suffering is medicalised or not. However, because of how funding for these services works, it will be easier to access certain treatments if you have an official diagnosis of, say, autism or schizophrenia, as this can be a signal that you’re in need of some kind of support.

Others May Take You More Seriously

Getting a diagnosis can also help you be taken seriously by medical professionals. For example, a doctor may not believe you when you state you have something that’s not on your file. In those cases, having a diagnosis from a psychiatrist can get you the help and understanding needed from other doctors, especially during a visit to the ER or if you go to a professional for additional testing.

Other people in your life may also start to understand your behaviours and emotions better, which can encourage others to treat you with respect, understanding, compassion, and kindness. This does not mean that psychological distress without a diagnosis attached to it is any less deserving of these responses from other people (be they loved ones or medical professionals), but a diagnosis may still, nonetheless, encourage others to treat your suffering more seriously.

You Know Which Treatments Are Best for Your Condition

All mental health conditions have recommended treatments. For example, certain medications for bipolar disorder would be disastrous if given to someone with depression. In other cases, certain medications that might help someone with ADHD focus can cause another person to become hyperactive.

Knowing your diagnosis can make sure you get the proper treatment and that you have access to it. It can also open your eyes to certain specific treatments that are made for one type of condition, such as treatment for trauma. There are many types of therapy, and they aren’t suitable or effective for everyone. Receiving eye movement desensitisation and reprocessing (EMDR), which is designed for the treatment of trauma, could end up being a waste of time and money for someone who does not have trauma underlying specific states of emotional suffering. 

Meanwhile, cognitive behavioural therapy (CBT) may benefit someone whose main issue is getting caught in ingrained and interrelated patterns of negative thoughts, emotions, and behaviours, but it may not get to the root of the problem for someone else, such as someone whose pain relates to deep-seated trauma.

You Can Receive Disability Benefits (in Some Cases)

If you want to apply for disability benefits due to your mental health condition, you do need to have an official diagnosis and documentation of your treatment for that condition to be approved. You also need to prove the severity, which can often be given or explained by the psychiatrist or doctor that diagnoses you.

The Disadvantages of Getting a Mental Health Diagnosis

Now, let’s look at the potentially negative side of getting a diagnosis and the ways it can harm you.

You May Miss Additional Symptoms

When looking at the symptoms of your diagnosed condition, you will likely be given the most popular treatment for that condition at the time you seek treatment. Nevertheless, some symptoms you deal with may be missed. For example, not every person with depression reacts well to an antidepressant. In fact, some cases of depression may actually be bipolar disorder, which reacts poorly to antidepressants.

On the other hand, many conditions are misconstrued as personality disorders or behavioural problems when they’re actually a trauma reaction or post-traumatic stress disorder (PTSD). Being given the wrong treatment for many years can do more harm than good.

There Are Stereotypes and Prejudices in the Mental Health Industry

For some conditions, stereotypes are prevalent in the mental health industry. For example, many personality disorders are still demonised to this day, with some psychiatrists now reluctant to give a diagnosis of borderline personality disorder (BPD), for instance, partly because they don’t want to confine someone to prejudice or to an idea that they can’t get help. Unfortunately, many psychiatrists and therapists share the general stigma that surrounds people with BPD, such as the belief that such people are “treatment-resistant”, “manipulative”, “demanding”, “drama queens”, and “attention-seekers”. 

Due to the biases and differing opinions that medical professionals may have, the best way to get help for a problem could be to treat your symptoms and your past first. Many mental health conditions are caused by trauma (this is seen as a common root of BPD), and more studies are starting to show that trauma therapy could help treat more conditions than previously thought.

Worsened Mental Health

Paradoxically, receiving a mental health diagnosis could worsen a person’s mental health. This can happen in a twofold manner. Firstly, because mental health stigma is so prevalent in society, if someone received a diagnosis of a stigmatised condition, then both the individual and the people around them could adopt a more negative perception of who that individual is as a person. 

A diagnosis may be taken as proof that the individual is wholly different from others, belonging to a separate class of people. Feelings of shame and embarrassment may accompany a diagnosis. Other people who don’t understand the condition may come to believe the person who has it is, therefore, more untrustworthy and dangerous. These limiting self-perceptions and public perceptions can end up compounding an individual’s suffering.

Secondly, the label of a mental health diagnosis may simply not be the best way for an individual to interpret their emotional distress, irrespective of public stigma or self-stigma. The very notion that one has a ‘disorder’ could add layers of shame and self-judgement, not because the condition is misunderstood and unfairly feared, but because it mischaraterises the problem. An individual’s suffering may be perfectly understandable given their personal circumstances, or the social and cultural influences in their lives, instead of there being something inherently wrong with their personality or brain. There is a risk, then, of pathologising normal human experience or variation, resulting in over-diagnosis. 

Misdiagnosis is a Problem

Finally, misdiagnosis is a problem that is rampant in the medical world, even in physical medicine. Many mental health conditions have similar symptoms, and you may be diagnosed based on the bias of opinion or area of expertise of the person you’re meeting with. For instance, if your diagnosing psychiatrist specialises in personality disorders, they’re more likely to diagnose you with one than someone who specialises in trauma disorders.

You may also develop new symptoms or stop experiencing certain symptoms over time, which could no longer qualify you for a previous diagnosis that is now on your record. This record of mental health diagnoses can make you look like you’ve been diagnosed with many things or even make it seem that you need more help than you need, especially if you’ve succeeded in treating your symptoms.

The Harms of Psychiatric Medication

Medication is not always the answer to people’s emotional suffering. In cases when it’s not, they may actually cause more harm than good, due to side effects, addiction, and withdrawal symptoms. These risks don’t mean that medications should be categorically dismissed and opposed, but they should give pause to people considering the process of psychiatric diagnosis, as being diagnosed with one or more mental disorders often results in a recommendation to regularly take a type of psychiatric medication (perhaps alongside psychotherapy).

In the end, it’s your decision whether or not to get a diagnosis for emotional distress. However, if you decide against a diagnosis, this doesn’t mean you can’t get help (including for severe and debilitating distress). Psychotherapy does not require an individual to have a diagnosis before being considered suitable for therapy. In fact, many individuals prefer to sidestep the process of psychiatric diagnosis completely and explore their inner world as it is, outside of the context of trying to neatly categorise and medicalise it.


This post was developed in partnership with BetterHelp. All views expressed are my own.

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