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‘Blue’ by Nevova Zdravka

As you saw in the preceding chapters, a medical framework is one of the dominant ways of understanding the kinds of psychological distress and behaviours that are collectively referred to as ‘mental health problems’, ‘mental disorders’ and ‘mental illnesses’. This chapter will focus on the assessment and categorisation of mental health problems via the medical practice of diagnosis, using the sets of categories and criteria found in diagnostic manuals. In the UK, service users are given a psychiatric diagnosis from the International classification of diseases (ICD), currently in its eleventh revision (ICD-11; World Health Organization (WHO), 2018). This international manual covers both mental and physical health. Another manual, published by the American Psychiatric Association (APA), is also extensively used internationally: the Diagnostic and statistical manual of mental disorders (DSM), currently in its fifth edition (DSM-5; APA, 2013). This chapter will focus on the latter manual because it has a significant international impact (e.g. on research and on other manuals, such as the ICD) and because it has been the focus of significant scholarship and research.

In medicine, a diagnosis is used to:

 categorise the type of problem a person has

 identify treatment options and their likely outcome

 provide access to other kinds of support

 inform research

 inform the planning of health services.

The following quotations are from two people who received a psychiatric diagnosis. The first, Mike Shooter, is a psychiatrist who chose to speak openly about his experiences of depression, while the second is a mental health service user.

When I was told that I was depressed it gave me a framework of understanding and a first grip on what was happening, not just for me but for my wife and children who had been equally frightened by my behaviour.

(Shooter, 2010, p. 366)

You only have to look at the definitions given in ICD 10 and DSM IV and read comments such as ‘limited capacity to express feelings … callous unconcern for others … threatening or untrustworthy’ … [o]ne thing that these comments have in common is that they are not helpful in any way.

(Castillo, 2003, p. 128)

This chapter explores why such opposing opinions exist, outlining why some service users find diagnosis helpful and why others find it unhelpful.

This chapter aims to:

 provide a basic explanation of psychiatric diagnosis and the systems of psychiatric classification found in diagnostic manuals

 explain what medicalisation is and understand its role in the categorisation of certain problems in living as ‘illnesses’ and ‘disorders’

 understand the ways in which diagnoses have changed over time and some of the reasons for these changes

 evaluate some of the conceptual, ethical and practical problems involved with diagnosis.