Short reflection on psychiatric diagnoses and mental disorders

After three days at the psychiatric clinic I have already encountered some approaches and practices that makes me a bit uncomfortable. One thing that I expected is the focus on correct diagnosis, a focus that is based on the assumption that “bipolar disorder” or “attention deficit and hyperactivity disorder” or “emotionally unstable personality disorder” is something that people either “have” or “not have” and the task of the psychologist is to determine which one is true. In a embarrassingly unreflective way it is assumed that with the correct instruments and structured interviews, the psychologist can determine if a person have this or that disorder. And if a person have this or that diagnosis, that implies a certain treatment. Since psychiatry in Sweden is increasingly organised in line with diagnoses (I work at the “Anxiety Clinic”) the diagnose also determine what kind of help and treatment that is available for patients.

As a sociocultural psychologist, I take all human affairs being culturally and historically dependent, including mental illness. What people do when they suffer differs across cultures and through history. Why? Because people do what they know others do when they suffer. Why the incease in self-harm and cutting? Because the attention self-harm and cutting has gained over the last decades has made that a mainstrean repertoire of things to do when you are in emotional pain. So what are psychiatric diagnoses? They are culturally and historically dependent descriptions of what people do when they are in emotional pain or when their thoughts, feelings and/or actions diverge enough from cultural norms as to be named “mental disorder”.

This is not to fall into relativism and claim that diagnoses does not exist. It is simply an argument against the common misconception — even among psychologists — that autism or depression or obsessive compulsive disorder is not something that you either have or not have, but variations of human life forms on a continuum where the extreme ends are dysfunctional and bring significant suffering.

This has implications for psychological assessment and, in the end, how we as psychologist view the patient. That is another thing that bothers me a bit, but I'll write about that another day.