Clinical Judgement, Diagnosis, and Announcement RE: Submissions
Okay, so. A lot of the upcoming disorders in the Demystifying the DSM-V series can be misinterpreted or applied when someone doesn’t actually fulfill the criteria. So we need to have a quick discussion about what the criteria of a diagnosis are really looking at.
To do this, we gotta look at something called a ‘normal curve’.
Let’s pretend we took a survey of everyone in the world, asking them to rate their overall levels of happiness or sadness for the last month. We take every person’s happiness/sadness score and put it on a graph. It’d look something like this. (note - I’m highly, highly simplifying things)
It looks like this because, you know, most people aren’t super happy or super sad. For most people, the amount of happiness they feel is kinda balanced out by how much sadness they can also feel. That’s why there’s a big hump in the middle – this shows what is considered a normal range of happiness and sadness. Most people in the world fall inside that hump somewhere.
But even though there aren’t many people at the edges of the curve, there are still people who are extremely depressed, or happy to the point of manic. They are far enough to either extreme that they rarely, if ever, feel the opposite emotion.
Obviously, someone who’s just really happy doesn’t need to be hospitalized. But someone who’s manic can often be dangerous to themselves or others, and may require it. Someone who’s a little unhappy isn’t an emergency (though it sucks). Someone who’s extremely depressed, to the point that they are actively self-harming and about to attempt suicide, is an emergency.
Diagnosis is about finding the line between what’s within the normal range and what is considered extremely outside of the norm.
Some disorders are easier to see and diagnose than others - the lines between what is normal and extreme are very thick, metaphorically. It’s clear when someone is past the line, and thus diagnosible with a disorder.
For some disorders, a simple medical test virtually guarantees you a diagnosis, like certain sleep disorders. There are numbers on a page, generated while you sleep, and if you reach a certain number, you get diagnosed with a sleep disorder. The only clinical judgement made is knowing which number is the important one to look at.
Some disorders are essentially diagnosed via a survey, like depression. There’s almost no clinical judgement needed there. It’s pretty clear when someone’s struggling, and there aren’t lifelong consequences to being given a diagnosis. It’s not a complicated process, and it’s fairly easy to do.
But when you get to the disorders that have extreme, life-long consequences (and often carry a great deal of stigma), you need to make absolutely sure that you fulfill the criteria. For these disorders, you can’t always rely on your own interpretation of what checks the boxes in the DSM-V. You need to have someone objective, who knows what to look for, to make the call for sure. Most people don’t have the clinical judgement needed to make that call. It takes a lot of training and experience to get to that point. Hell, even the Shrink herself isn’t qualified to diagnose ANYONE with those kinds of disorders yet.
Please understand, I am not trying to invalidate people’s feelings or struggles here. I am not anti-self-diagnosis. I think self-diagnosis is a great starting point for recognizing one’s problems, and often the first step to getting much-needed treatment. You can absolutely accurately recognize traits of yourself that seem to fulfill the criteria, and these traits can absolutely cause you distress and make your life more difficult. I believe that you are suffering, and that you deserve to be taken seriously and given treatment. In fact, I believe that most of the time, your self diagnosis is likely correct.
I fully recognize that diagnosis is incredibly expensive, and full of hurdles that many people aren’t able to navigate their way through. We have an absolutely shitty, classist, ableist system in America, and it is the fucking worst. I also recognize that sometimes doctors or therapists are fucking idiots. If you are unhappy with what they say, try to get a second opinion if you can. I acknowledge that this is not possible for all people, even though in a perfect world, it would be.
I know this post is going to be controversial. I don’t want it to be. I repeat, I AM NOT AGAINST SELF-DIAGNOSIS.
But this blog is about helping people accurately portray mental illness in writing. I need to make sure that what I post will promote the accurate understanding of people with mental illness. Even if, out of 100 people, there’s 99 people who submit whose self-diagnosis is absolutely and completely true, if the remaining 1 person has inaccurately diagnosed themself, it would add to the misconceptions surrounding the mental illness in question.
I would prefer not to take that chance.
As such, I am going to request that in the future, people who submit their experiences have a professional diagnosis.
Thank you for understanding.
