You probably know what a diagnosis is when it comes to medical health. When you see your primary care doctor with a concern, they’ll ask you about symptoms, do an exam, maybe run some tests, and then let you know what they think is wrong (your diagnosis). Hopefully that diagnosis also comes with a treatment plan - antibiotics to kill an infection, exercises to strengthen a strained muscle, etc.
What you may not be as clear on is what a diagnosis means in the mental health world. To be sure, it’s a confusing topic and one that many mental health professionals disagree on.
For one thing, there are no biological tests for mental health diagnoses - no blood tests to spot depression or anxiety, for example. Instead, we have the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders Fifth Edition), a book published by the American Psychiatric Association, which outlines symptoms of various diagnoses. The DSM-5 is meant to be a guide for mental health workers, but it is controversial itself, with lots of disagreements about how best to describe and categorize the different kinds of emotional struggles that people face.
There are also a lot of mental health workers who disagree with the entire concept of “diagnosis,” arguing that the system of looking at symptoms, categories, and disorders is inaccurate and misleading.
In this post, I want to walk you through some of the pros and cons to using a diagnosis when it comes to mental health services. With this in mind, you’ll be prepared to make the best decision for yourself when seeking a therapist.
There are three main reasons a mental health diagnosis can be a positive thing.
First, a diagnosis means insurance may pay for mental health care. Insurance is based on a medical model, meaning it sees mental illness as a medical problem. Mental and emotional difficulties that fit into certain categories (like depression or anxiety) may meet what insurance companies call “medical necessity criteria.” Insurance will then pay for appropriate treatment, which often includes psychotherapy or counseling.
Second, a diagnosis gives you and your providers an idea of what kinds of interventions might be helpful for you. If what you’re experiencing matches up with the criteria for Major Depressive Disorder, for example, then you and your therapist can draw on the history of millions of other people who have also been diagnosed with MDD and have found relief through certain treatments. You can quickly hone in on potentially useful tools, such as cognitive behavioral therapy or psychodynamic therapy, to give you the best chance at finding relief.
Third, a diagnosis can show you that you’re not alone. Diagnoses in the DSM-5 were developed after decades of study and reflect the millions of people who have sought counseling. If your experiences fit the criteria for a DSM diagnosis, you can be assured that many, many people before you have had similar struggles. You might even connect with a community of people with similar experiences, like a support group for people with OCD or an online group for people with social anxiety, for example.
Diagnosis can be a powerful tool to help drive mental health care and even help you feel less alone. It does have drawbacks, though.
One thing many therapists do not like about diagnosing our clients is that it reduces a person to a set of symptoms, rather than the whole person who we see in our offices. You are far more than the sum of your struggles and one of the most powerful parts of therapy can be learning to value yourself as a whole, unique person. This self-acceptance is at the heart of a lot of good therapy and can be the most important thing you get from going to counseling.
Likewise, some people feel labeled or “boxed in” by a diagnosis. They know that they are so much more than this, but if you are seen as “depressed” or “anxious,” for example, you can start to internalize those ideas and see yourself only in those terms. Too much focus on a diagnosis, and you (and your therapist) can lose sight of what makes you a unique, creative, capable individual.
The medical model and its focus on treating specific symptoms also limits the deep creativity that is possible in therapy. When we focus only on the symptoms listed in the DSM, we aren’t looking at the rest of your life. We may miss areas of great strength and resiliency that could help you more than a technique from a textbook. Your way forward may look similar in some ways to other clients who have had the same diagnosis, but in a lot of ways, it will be unique to you and your life. The best solutions tend to be the ones you develop yourself through working in partnership with your therapist, and they are the ones that fit your life and your unique self to a T.
Finally, for some folks a mental health diagnosis on record can cause problems down the line with buying life insurance, seeking security clearance, or getting a job in the financial sector.
When it comes to diagnosis, I ask my clients to think about whether a particular diagnosis is a useful lens for them to think about their experiences and seek out solutions. If it is, then great - we’ve got a starting point. If not, then that’s not the best place for us to focus our work.
If you’re looking for a therapist, you may want to give some thought to the issue of diagnosis. Using your insurance means that you will have a mental health diagnosis on your record. If you prefer to avoid this, a good option is to seek out private pay therapy (therapy paid for in cash rather than by insurance). Whatever you choose, know that the most important thing is finding a therapist who listens to and understands you as an individual. even if they must diagnose you for insurance purposes.