There is a curious movement growing amongst some psychologists, mental health professionals, and doctors. We’re calling it the ‘Anti-Diagnosis Movement’ – a catchy name for the idea (led by these experts) that labelling mental illness or psychological disorders with a clinical diagnosis is at best unhelpful, and at worse causes more harm. Is diagnosis empowering or stigmatising? Should treatment and support still be tied to unreliable and inconsistently applied labels? We asked Sahra O’Doherty, Director of the Australian Association of Psychologists about why the discourse around diagnosis is changing
The Diagnostic Process
Dissatisfaction with the diagnostic tools and processes is not at all a new phenomenon. Doctors, psychologists, academics and other professionals have been debating the usefulness of the Diagnostic and Statistical Manual of Psychiatric Disorders for decades. It’s important context for the current anti-diagnosis movement.
Australia primarily trains with the DSM-5, which is made by the American Psychiatric Association and can only be updated or expanded by their committees. It gets mixed reviews: on on hand, critics say it is too “focuse[d] on overt symptoms, rather than underlying causes or surrounding social context”; on the other, it’s considered a useful tool “designed to be used by medical professionals who understand its limitations.”
Sahra says the historical context of diagnosis must be factored in too. “It’s very white, Western and English language-focused,” she said. The range of people used to set the ‘norms’ for diagnostic criteria is also much more narrow than you might expect. “For instance, a lot of diagnoses are normed on inpatient populations which represent a very severe or complex set of diagnostic symptoms. And on the research side of things, a lot of research is conducted within universities, and a lot of those research participants are undergraduate psychology students. So you have predominantly female cohorts from largely wealthier, English-speaking backgrounds – there is not a huge amount of diversity within those populations.”
Why people benefit from a diagnosis
Yes, diagnostic tools, criteria and processes are imperfect – but there are still reasons why it can be helpful, including:
Access to Mental Health & Medical Services: Right now, psychological diagnosis is still the gateway to mental health services in Australia. It unlocks treatment through the public healthcare system and private practitioners, educational support, social welfare supports and more. It’s most evident for people who need to seek NDIS funding for mental health supports – they technically don’t have to name their mental health diagnosis, but do have to report how the mental health condition impacts everyday life. According to Sahra and many in the psychology community, you are more likely to gain NDIS support with a formal diagnosis as it’s “literally ticking a box for them”.
Knowledge and Understanding: The knowledge that comes with a diagnosis can also be empowering, giving people a clear understanding of their mental health condition and making sense of their thoughts, emotions, and behaviors. Even partially answering the question “why am I like this?” can be a relief. Then, armed with this understanding, they can actively participate in a treatment journey.
Agency & Community: People can gain a renewed sense of agency over their mental health and wellbeing through the diagnostic process. A diagnosis helps you collaborate with healthcare providers in an informed way to choose treatment options and can give a sense of ownership over treatment and management. “It can be a way of understanding yourself,” Sahra explains. “We want to have that sense of reassurance or certainty that ‘Yes, I fit into this particular category. I can connect with other people who might have similar diagnoses. And maybe I can have a sense of belonging and community where previously I might have felt excluded or bullied.’”
Why diagnosis is unhelpful
Which brings us to the anti-diagnosis movement. Why are medical and mental health professionals warning that getting a formal diagnosis may not be as helpful as you expect?
Labelling and Increased Stigma: While diagnosis can absolutely help reduce stigma, it can also contribute to labeling and stigmatization – particularly for severe mental disorders. Individuals may face discrimination or negative perceptions due to their diagnosis, impacting their self-esteem and relationships. The consequences of this can be long lasting. “Let’s say a teenager is given the diagnosis of borderline personality disorder. That may continue to follow them around in their adult life, in their career and in their relationships, even though they might have actually left behind a lot of those symptoms in their adolescence. That can have a damaging psychological effect on them later on.”
Diagnosis can come with a feeling of permanence – while that explanation can be empowering for some, to others it can feel limiting. “They might feel as though, ‘This is just a part of me’, and maybe it doesn’t feel like they can change it. So it creates that sense of hopelessness,” Sahra explains.
Blocking Opportunities & Access: Unfortunately, just as a psychological diagnosis can unlock access to services, it can unfairly block opportunities too. Both Australia and New Zealand reserve the right to turn people away on the basis of health, and that includes those who are diagnosed with autism and intellectual disabilities. Recently the Lim family in Cairns, originally from Korea, was denied a RSMS subclass 187 visa because one of their children was diagnosed with autism. Thankfully, Immigration Minister Andrew Giles intervened granting the family their visa, after 30,000 people signed an online signature campaign. The Lim family were lucky to have support from their community to push their case, but not everybody is.
Lack of Cultural Nuance: Mental health issues within marginalised and ethnic communities are often influenced by the historical trauma stemming from colonization, dispossession, and forced assimilation. A failure to understand and appreciate these cultural aspects can lead to misinterpretation of symptoms and feelings of mistrust with the diagnostic process. Mental health challenges disproportionately affect Aboriginal and Torres Strait Islander communities, with suicide rates almost twice as high than non-Indigenous peoples.
Despite marginalised groups struggling the most, the tools available aren’t designed to help them. Too many important factors are missing, like values of collectivism, spirituality, or specific gender roles and identities. How complete and useful can a diagnostic conclusions be if it ignore these factors?
Asking ‘why’ not ‘what’
A good example of the tension between these pros and cons is the phenomenon of adult ADHD diagnosis in women. Many women have spoken about how affirming it was to realise they may have ADHD, and how validating it felt to advocate for a diagnosis that finally explained their lifelong struggles. Of course, the reason none of these women had been diagnosed in childhood is because ADHD was normed on boys under the age of nine, creating a huge gap in research. It ultimately leaves many women with ADHD in the dark about what treatments and supports will actually help them. When the diagnosis was so unreliable in the first place, how helpful can the label itself really be?
The ‘anti-diagnosis’ movement isn’t trying to ditch formalities altogether, but wants to shift the focus to understanding the person’s reasons for seeking treatment. “There’s a lot of mental health support out there that really does concentrate on assessment and assessment is absolutely a vital part of demonstrating that a person meets the criteria for a diagnosis,” Sahra says. “But when I first started out as a psychologist, a mentor taught me to think about why diagnose, not what diagnosis.”
“If it supports that person to get NDIS funding, or social welfare support, or educational support, or whatever it might be – then absolutely. We’re literally checking a box so that they can access the things that they need. If it’s for personal reasons, or because it is affirming to them – yeah, that’s absolutely fine if they want it. But part of the diagnostic process is actually going through that with the client and saying, ‘Okay, what are we doing here? Why are we doing it? How will this be valuable to you?'”
Moving away from relying on “unreliable diagnosis” could look like the Power Threat Meaning Framework (PTMF), developed by the British Psychological Society. It asks four questions:
- What has happened to you? (How is power operating in your life?)
- How did it affect you? (What kind of threats does this pose?)
- What sense did you make of it? (What is the meaning of these situations and experiences to you?)
- What did you have to do to survive? (What kinds of threat response are you using?)
The answers to those questions guide what treatments and supports are necessary – which may or may not be medicalised solutions. If formal diagnosis is required to access the solutions, then it can still be explored if that’s what the person wants… but it may never be needed. For heavily stigmatised diagnoses like borderline personality disorder and schizophrenia; people who have experienced trauma; and those from culturally and linguistically diverse backgrounds, it can unlock the benefits of treatment while minimising many of the risks.
“It validates that one person’s experiences. It allows this one person to say, ‘They experienced the same thing as me, but they’re fine and I’m not. And these are the factors that have contributed to me not being fine in this particular circumstance’,” Sahra says.
Of course, because our entire medical, mental health and psychological support networks are tied to the current system, it will be a long time before the concept of diagnosis is discarded. For now, promoting the idea that any person should be able to access what they need to survive and (hopefully) thrive regardless of their ‘label’ should be the next stage of evolution for public discourse on mental health.
Smart people read more:
Why mental health diagnoses don’t work – The Institute of Art and Ideas
How Do We Move Beyond Mental Health Awareness To… Real Action?
America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse? – TIME Magazine
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