What do you think about mental illness?

But words are important. Some people do not want to discuss their experience in the context of an illness. For me personally, I find labels such as that dehumanising and discriminatory, so I would prefer that professionals would ask me how I would like them to discuss those experiences. E.g. some people don't like to talk about hallucinations, but prefer voices, or some people would even prefer to call them a personal name that has nothing to do with science. Also, doctors do disagree on whether a person is exhibiting such a symptom or not - for example, with individuals diagnosed with a personality disorder who hear things that others don't there can be a big debate around whether it is psychotic or dissociative. In that case, if doctors cannot decide on whether a person exhibits a symptom, or if it is something else - then I would argue that labelling a person with that symptom is problematic, as they may meet another doctor who completely disagrees with it. However, the individual's perception of the experience is unlikely to change between doctors.

I can only talk from my experience as a peer support worker, and from working in CMHTs and other services where we had PSWs in the team, but we did not get allocated to individuals by diagnosis. It was more to do with whether the individual would benefit from peer work, which was more to do with their goals, their current situation and their wishes. That could be someone diagnosed with treatment resistant schizophrenia on section 37/41 or someone visiting their GP complaining of mild low mood. In terms of severity, in some cases yes care coordinators may get allocated to those who are more unwell, however, in my experience, this is more to do with the severity of the impact on functioning rather than any symptoms.

I do understand that. My main concern is how it impacts the individual. My view is that diagnoses can do more harm than good. But if I'm working with someone and they want to use that model to understand themselves then I'm more than happy to work with them in that way. But I prefer to start from the other end which is probably influenced by my own experience and the training I have had.

Labels are indeed discriminatory yes. They discriminates between people who need help and those who do not!

I think we're talking across each other - giving someone a differential diagnosis doesn't mean you constantly ram that diagnosis down their throat every time you meet them. And both making and monitoring the diagnosis is inherently based upon patient experience - that is what you will be talking about in a psychiatry clinic. But to suggest that when it comes to making decisions about treatment, we can just do away with all of the structure that underlies everything we know about psychiatry, just because the patient desires it, is pure fantasy. It equates to just dismissing all medical knowledge we have to date and instead just dishing out treatments based on nothing. May as give homeopathy - at least the side effects would be better!

It's not dishing out treatments based on nothing! It's deciding on appropriate treatment by looking at the individuals experience, presentation and history. But it's just not using or relying on diagnostic labels. It's not totally getting rid of what we know, it's making changes - changes which groups of professionals and service users have welcomed.

Please explain how it would work.

Someone comes in saying they have persistent low mood and don't enjoy things they used to and you suspect depression. Except you can't label them as depression any more... well all antidepressants, psychotherapies, examination techniques, mood scoring systems, and criteria for admission to hospital are all based on having a diagnosis of depression so... what's left? What are you going to do?

You're going to make some excuse and use the depression treatments anyway that's what. The only difference is that you are going to lie to them about whether you've used a label or not.

Sorry but this is all semantic nonsense.

As I've mentioned it's about change throughout the system. You're right that changing one part of it wouldn't work. If the whole system does not rely on diagnoses then there is no issue around a lack of diagnosis.

Any professional worth their weight should be able to work with someone and decide on appropriate intervention without a diagnosis or needing to apply a diagnosis to help them decide.

It may be semantic nonsense to you and others but to many people with lived experience the words used matter a great deal. They can lead to discrimination and social exclusion which can be just as, if not more damaging than any symptom or experience they have.

Take for instance the discrimination that individuals with a diagnosis of BPD face from health care professionals just upon hearing that label.

It does indeed work for some people, however, it doesn't work for everyone. That is why I believe change is needed.


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I feel like those who don't think that they are have never actually experienced one or appreciated how they can affect a person's ability to live.
The 'mental illness is choice' theory is just ridiculous in my opinion. Why would anyone choose to put themselves in that much pain? Surely making the conscious decision to not be happy would mean they do not have a healthy mind anyway, which just counteracts that silly argument.

It took us decades to get to the complex web of disorders and treatments we have now. Again, I'm not sure you've thought through what your alternative is. You want each individual feeling to effectively be its own disorder? Or something else?

Tell me exactly - you have a new drug. Say its similar to an SSRI. How are you going to test it to see if it works?



You seem to think that health professionals just issue treatments based on instinct or how the wind is blowing or something. Its not - its based on decades of scientific evidence. And by drawing on evidence that is based on diagnostic labels you are still using a label. For example, by using evidence from people with depression, but not telling the patient you are treating them as depressed, you are just lying to them. That is no better. In fact, its much worse.



Its semantic nonsense not because people don't think its important (although i will point out that your health is strictly confidential and need only be revealed under very specific circumstances). Its nonsense because any alternative uses labels just as much - its just less direct, more confusing and ultimately uses lies and manipulation to cover up the actual thought processes of the health professionals.



This is an issue, though i don't think its any more true than for stereotypes unrelated to diagnosis e.g. prisoners, alcoholics, the homeless, the obese, etc. Certainly, antisocial personality disorder has a much worse problem with this than BPD, though people tend not to talk about that one so much.

You have your own opinion and experiences and the system overall has many flaws, but it works.


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No, I definitely do not want each individual feeling to be a disorder at all. Right back at the beginning I said I believe that viewing experiences as a disorder is unhelpful. I'm not entirely familiar with how drugs are researched, so I don't think any answer I give is going to be well thought out, however, I would say that instead of counting up scores from a test, you can analyse effectiveness by looking at the changes in the target behaviour or experience e.g. Feeling low. I will admit that it is harder in research, but I do think it is entirely possible in practice.

Maybe because I wouldn't be treating them as depressed? I'm not treating them with depression treatment because of their label, I'm treating them with CBT because that is helpful for individuals with low mood and low self esteem. The difference is that the decision does not factor in a diagnosis.

What is more confusing for a service user? Talking in their language, or a psychiatric language that they may not understand? It may be easier for us to use diagnoses as we understand what it generally means, but that does not mean that everyone gets it.

Oh and your health being confidential does not stop all discrimination or exclusion. Sometimes you have to declare it and structural discrimination does exist.

All you've done is switch the label from 'depression' to 'low mood'. Someone can view that as just as much a label if they chose to.

And then the much bigger trouble is, you've now ignored the co-existent problems that come with low mood -things like loss of interest, low libido, reduced facial expression etc etc, so your research is going to miss loads of people you could have helped and be much, much less effective.



You've diagnosed low mood and prescribed a treatment that you know works for depression (most evidence for CBT is for depression, not just 'low mood'). Again - all you've done is be shoddy in your work by ignoring problems that tend to co-exist with low mood and given a label that is less accurate. Still a label though. And I'd argue still lying to your patient.



I meant more confusing for the diagnoser. The reason we group symptoms that tend to come together is in part because testing every single drug against every single feeling a human is capable of having is just impossible.



But it does limit it. And besides - you would still have to declare you were having CBT, or on medication, or had "low mood". No solution here.

That website provides no answers to any of my questions. They talk about providing help based on need, not diagnosis" but suggest no way to categorise who has need and who doesn't. The organisation contains no one with any training in any medical science whatsoever, unsurprisingly, and only one person trained in clinical psychology.

Low mood and anxiety is really quite different to depression - this is essentially why we have created these categories for different symptom presentations. It also allows us to create treatment guidelines - cbt isn't really the best treatment for depression. Certainly not in the long term and there are flaws in the way the approach is delivered in many institutions which compound that. Anyway 🙄 Having a label to distinguish collections of symptoms means that when we seen that out in the real world of patients, these treatments aren't as useful as we expected them to be for a particular patient group, it creates ease of communicating that with each other and ultimately relaying it back to the public.

There's also the point that many (and this increases) therapists across the spectrum of theories and from counsellor through to psychiatrist, many of them _are_ treating the person not the disorder. They do ask what has happened to you and they work hard to normalise patient experiences.

I think we will have to agree to disagree on this one.

I don't agree to that.

Sorry, it was lazy of me to compare them. There are some out there, you are correct, hopefully the amount will continue to grow.


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