Rather than bumping one of, for example the two threads below, I am opening a new thread to share an interesting bit in today’s NYT (gift link) on the subject.
Previous threads related:
The NYT piece:
I write this as someone who is responsible for attaching diagnostic labels to lots of kids, who observes lots of what I perceive as magical thinking that naming something gives us power over it, and who spends a fair amount of energy trying to frame the condition labels as very arbitrary things, not who or what a person is, just a limited shorthand communication tool, an aspect of a person at most. But I count myself among those who are concerned that the power of labels has downsides as well as upsides.
The article’s main thesis is the positive value of labeling. The relief that many experience to be able to give something a name:
While diagnosis can lead to concrete benefits like treatment and accommodations, its psychological benefit “seems to go beyond” either of these, said Dr. Aftab, a clinical associate professor of psychiatry at Case Western Reserve University. It resembled the placebo effect — an improvement, generally attributed to positive expectation, that occurs after receiving an inert treatment, and which doctors have employed for centuries.
“To us, this is a version of the placebo effect that has gone, essentially, unnoticed,” Mr. Levinovitz said. “Here is this thing that is cross-cultural and trans-historical — the power of an official name to gain control over pathology of some kind — and it is almost entirely unstudied.”
Other researchers spotted this as well. When Cliodhna O’Connor’s research team at University College Dublin analyzed 1,848 accounts from adults who had received autism diagnoses, they found that the adults “overwhelmingly” reported that the benefits of diagnosis outweighed the costs. A word that came up frequently was “revelation.” Often, their only regret was that they had not been diagnosed earlier, sparing them years of feeling “wrong” or “broken.”
And the ability to find their people as helpful. Noted in those other threads.
Most importantly, she plunged into a local neurodiversity and autism support group. Her new community supported her through a divorce and eventually helped her find a job.
But the negative side is addressed as well:
Dr. O’Connor, an associate professor of psychology at University College Dublin, tested this balance by comparing large cohorts of people who met diagnostic criteria for a disorder like depression or A.D.H.D. — one group that received a diagnosis, and one that did not.
What her team found, after controlling for symptom severity and socio-demographic factors, is that the diagnosed groups did somewhat worse. Young adults who were diagnosed with depression in adolescence had worse depression symptoms later, despite getting treatment; children who had been diagnosed with A.D.H.D. had worse peer relationships, worse self-image and worse emotional well-being.
Often, Dr. O’Connor said, adults feel some regret that they did not receive their diagnosis as children. “But the objective evidence we have suggests that might not actually have been the case,” she said.
Bottom line is that I completely concur with this person but fear the message is not landing.
what he tells them is not to take the exact label too seriously; he has seen what can go wrong when people build their identity around a diagnosis. Psychiatric problems are fuzzy and fluid, he tells them. They exist in a mesh of temperament and life story — “one thread,” he said, “in a much larger story of who you are.”
As for his fellow clinicians, he wants them to stop seeing diagnosis as a neutral, procedural step, and to understand the power that their words command
The only difference of opinion I have there is the phrase “psychiatric problems” … my view is that these are not exclusively “problems”; they are variations that have positives as well as negatives and we both undersell the positives and oversell the pathologizing of variation.