Importance

Diagnoses are important because of the information that they convey. They
are important in facilitating effective communication among professionals
as well as for effective treatment planning. The diagnostic terminology of
the DSM allows professionals to communicate clearly with one another
about their clients’ conditions. This communication helps to direct clients
to the proper treatment and also ensures continuity of care when clients switch treatment providers. For example, a client who is traveling or is outside
his or her regular locale may need assistance and seek out another
health care provider. The new provider would be greatly aided in helping
the client by communication with the regular provider about the individual
and his or her condition. A proper assignment could then be reached to create
a useful treatment strategy.
On another level, standard diagnoses are useful because they also allow
for important communication between clinicians and researchers in psychology.
This is most true when new symptoms are emerging and the need
arises for developing new treatment strategies. When the mental health
community uses the same language about signs and symptoms in the study
of specific conditions, medical and psychological knowledge can advance
much more efficiently.
More practically, diagnostic information is important to treatment because
diagnostic information is needed to justify treatment financially.
When a client meets formal diagnostic criteria for a disorder, the health care
provider can administer services and justify the treatment to insurance
agencies and others interested in the financial management of mental
health problems. Diagnoses may also help such agencies to discover trends
in which treatments work and where disorders tend to be developing (the
focus of the field of epidemiology) or to recognize gaps in services, such as
when people with certain disorders suddenly disappear from the mental
health care system.
Even more important, however, standard diagnoses and thorough diagnostic
procedures allow for good communication among professionals,
their clients, and the families of those affected by mental illness. Communicating
diagnostic information effectively to the client and family members
or significant others is likely to help with the management of the problem.
The better that all involved understand the symptoms and prognosis (expectations
for the effects of the condition on future functioning), the more
likely everyone is to assist with treatment compliance. Further, it can be very
helpful to families to learn that their loved ones have formal diagnoses.
Mental health conditions can create chaos and misunderstanding, and improvements
in relationships may occur if families and significant others are
able to place problematic symptoms in perspective. Rather than attributing
symptomatic behavior to personal irresponsibility or problems of character,
family members and friends can see the symptoms as reflecting the illness.
Although this understanding does not make everything perfect, it may help
facilitate a more effective problem-solving strategy for the affected person
and his or her significant others.
Context
Diagnosis is a process most often associated with a visit to a primary care physician.
However, professionals of many types gather diagnostic information
and render diagnoses. Psychiatrists and psychologists predominate in the area of mental health diagnoses, but social workers, educational counselors,
substance abuse counselors, criminal justice workers, social service professionals,
and those who work with the developmentally disabled also gather
mental health diagnostic information and use it in their work.
Over time, the process of assessment has been separated from the actual
diagnostic decision, so that assistants and helpers may be the ones gathering
and organizing the symptom-related information in order to present it to
the expert diagnostician who has the authority to render the diagnosis. This
shift has occurred as a matter of financial necessity in many cases, as it is
more expensive to use experts for time-intensive information gathering
than it is to use such assistants. Increasing effort has also been focused on
developing more accurate diagnostic screening and assessment instruments
to the same end. If time can be saved on assessment by using screening, so
that only very likely cases receive full symptom assessment, then valuable
medical resources will be saved. Further, if paper-and-pencil or other diagnostic
procedures can be used to better describe symptoms in a standardized
manner, then even the time of diagnostic assistants can be saved.
On one hand, such advances may allow more people to be treated in an
efficient manner. On the other hand, some complain that people can fall
through the cracks and be missed on a screening, and consequently continue
to suffer. This situation may be particularly likely for individuals who
are not often included in the research upon which the screening instruments
are designed, such as women and minorities. Similarly, others suggest
that these processes put too much paper between the client and the health
care provider, creating barriers and weakening therapeutic relationships.
In considering cultural practices and understandings of the doctorpatient
relationship, this effect is even more important, as many cultural
groups see the social nature of this relationship as a critical piece of the
treatment interaction. While efficiency and saving money are important, it
must be recognized that those goals are culturally bound and are choices
that are being made. They are not the only way for the art and science of diagnosis
to proceed.
It is also important for diagnosticians to recognize cultural differences in
terms of the way in which symptoms are experienced, expressed, and understood.
For some, mental health disorders may be seen as expressions of underlying
spiritual problems; for others, they may be seen as disharmonies
among elements in the universe or environment; and for others, they may
be seen as extensions of physical problems. Each of these perspectives is a
valid way of understanding such conditions, and it is only good training that
includes attention to cultural variation in diagnostic procedures and practice
that will allow diagnosticians to function effectively.
It should also be noted that culture is not limited to a client’s racial background
or ethnicity; it also varies by characteristics such as gender, age, sexual
orientation, socioeconomic status, and locale. Increasingly, diagnosticians
are being forced to grapple with such diversity so as to improve diagnostic procedures and client care. Such characteristics are important to
diagnosis not only because of differences in perspectives on illness but also
because of differences in the prevalence of illnesses in various groups. This
distinction is particularly important when considering medical conditions
that might be associated with psychological disorders. In some cases, medical
problems may mimic psychiatric disorders; in other cases, they may
mask, or cover up, such disorders. Because some disorders are more common
in certain populations�"such as among women, people of color, and
elders�"knowledge of such prevalence is important to the process of differential
diagnosis.
Culture is also an important consideration in diagnosis because the information
gathered is transmitted socially. Knowledge of diagnoses is exchanged
among professionals, researchers, clients, and their families. Diagnoses
have social meaning and can result in those carrying the diagnosis
being stigmatized. As crucial differences exist in the degree of stigmatization
in different cultures, the delivery of such important mental health information
deserves thoughtful consideration, good planning, and followup
to ensure that all parties involved are properly informed.
Sources for Further Study
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders: DSM-IV-TR. Rev. 4th ed. Washington, D.C.: Author, 2000. The
standard text outlining the major mental health disorders diagnosed in
the United States.
Beutler, Larry E., and Mary L. Malik. Rethinking the DSM: A Psychological Perspective.
Washington, D.C.: American Psychological Association, 2002. Offers
some critiques of the DSM, the dominant diagnostic framework used
in the United States.
Castillo, Richard J. Culture and Mental Illness: A Client-Centered Approach. Pacific
Grove, Calif.: Brooks/Cole, 1997. Discusses how cultural issues fit
into the diagnostic process and the understanding of mental health and
illness.
Seligman, Linda. Diagnosis and Treatment Planning in Counseling. 2d ed. New
York: Plenum Press, 1996. Connections between diagnosis and treatment
planning are highlighted in this text, with case examples for illustration.
Shea, Shawn Christopher. Psychiatric Interviewing: The Art of Understanding�"
A Practical Guide for Psychiatrists, Psychologists, Counselors, SocialWorkers, and
Other Mental Health Professionals. 2d ed. Philadelphia: W. B. Saunders,
1998. The skills of interviewing as a means of establishing a therapeutic
relationship and the basis for forming diagnostic impressions are reviewed
from a perspective that is useful for a variety of mental health
practitioners. Also allows nonprofessionals to see how interviewing is
structured and leads to diagnoses.
Simeonsson, Rune J., and Susan L. Rosenthal, eds. Psychological and Developmental
Assessment: Children with Disabilities and Chronic Conditions. New York: Guilford Press, 2001. This text focuses on issues important to the diagnosis
of mental health and other behavioral disorders in children.
Trzepacz, Paula T., and Robert W. Baker. Psychiatric Mental Status Examination.
New York: Oxford University Press, 1993. The mental status examination
is one of the foundations of any psychiatric diagnosis. This book
describes these procedures for assessing the appearance, activity level,
mood, speech, and other behavioral characteristics of individuals under
evaluation.
Nancy A. Piotrowski
See also: Madness: Historical Concepts; Psychopathology; Survey Research:
Questionnaires and Interviews. 277