In the realm of medicine, diagnoses and treatment plans often hinge on objective data. If your blood pressure is elevated, a hypertension drug is prescribed; if cancer cells are detected in a biopsy, chemotherapy might commence. Psychiatry, however, doesn’t operate within such clear parameters, despite persistent efforts. While various research projects pursued genetic or biological roots of mental illness under the guidance of former National Institute of Mental Health (NIMH) head, Thomas Insel, substantial progress was limited. Certain disorders, such as schizophrenia, exhibit more tangible genetic connections. Nonetheless, Insel highlights the absence of robust biomarkers, a key component in other medical fields.
Psychiatry, however, relies on its cornerstone publication, the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual outlines diagnostic criteria for mental health conditions, predominantly grounded in observable symptoms, their duration, and their disruptive effects. Unlike other medical sectors, this approach is notably subjective. Deciphering whether symptoms have transitioned from normal to disorder often hinges on individual clinicians’ assessments, which can be particularly challenging during brief teletherapy appointments where crucial details can be overlooked.
Critics, like Dr. Paul Minot, who possesses nearly four decades of psychiatric experience, believe the field hastens past the “ambiguity” inherent in mental health, often presenting diagnoses as definitive when uncertainty persists. Research underscores the prevalence of both misdiagnosis and overdiagnosis in psychiatry. A 2019 study even labeled the foundation of psychiatric diagnoses as “scientifically meaningless” due to inconsistent metrics, overlapping symptoms, and narrow scopes. This uncertainty is problematic as treatment pivots on accurate diagnosis.
Dr. Trestman compares incorrect psychiatric diagnoses to prescribing antibiotics for viral infections. Similarly, an antidepressant might be ineffective for someone with bipolar disorder, often confused with depression. This imperfect diagnostic system partly elucidates why antidepressants, though widely prescribed, don’t consistently yield positive outcomes.
Joseph Mancuso, known as Joman in his artistic pursuits, has navigated the mental health care system for years. He has received several diagnoses, including depression and bipolar disorder, which he feels don’t accurately represent his experience. Recently, a diagnosis of complex post-traumatic stress disorder resonated with him. Amid these diagnoses, numerous prescriptions were prescribed—some beneficial, others ineffective. He reflects, “I felt at times that I was just a dartboard and they were just throwing darts and seeing what would stick.”
Furthermore, some treatments appear to lack efficacy regardless of accurate diagnosis. A 2019 review article revisited data underpinning purportedly evidence-based mental health treatments. Some approaches, like exposure therapy, exhibited efficacy. However, the study revealed that half of the therapies lacked credible supporting evidence.
Co-author Alex Williams, who directs the psychology program at the University of Kansas, explains that the study’s results prompted practice changes, favoring therapeutic styles backed by robust data. The complexities of psychiatric diagnosis are not easily unraveled, emphasizing the ongoing challenge of aligning diagnosis with effective treatment.
