The Pros and Cons of Diagnostic Labels in Clinical Psychology

Label's aren't exactly unique to the practice of psychology, or even the field of health care for that matter. Humanity had been labeling items and individuals for decades as a means of simplifying life and communication. It seems that labels make understanding a little easier, even when they're unwanted labels on a particular group of people. For example, we often label groups of people based on their music and clothing choice. Often these groups don't care for the label associated with their style, however, when we refer to this particular label it is generally understood what type of clothing and music that person is into. While psychological and stylistic labels may seem worlds apart, the principle behind both is the same; and this is why diagnostic labels are used, and have worked in psychology, and other health fields so well.

One of the biggest advantages of using diagnostic labels in the practice of psychology is the label's ability to convey a large amount of information within it. Hearing the term "bipolar disorder" gives a clinician, or anyone familiar with bipolar disorder, a good picture of what is going on with the patient. Trull (2005), refers to diagnostic labels as a sort of "verbal shorthand for representing features of a particular mental disorder" (pp 126). Think how difficult it would be to convey bipolar disorder with psychotic features to each and every physician or psychologist. Moreover, think of how hard it would be for a psychologist to communicate with a psychologist from another practice that used different terminology. Diagnostic labels put all psychologist on the same footing as far as terminology for symptom sets go, and this helps both psychologist and client.

Another advantage of using diagnostic labels comes about during the research into psychopathological syndrome's etiology. Researching into the background of a particular mental disorder would be nearly impossible to do without a standard by which to choose participants for the study, and assess individuals. Without diagnostic labels, it seems hard to understand what exactly a psychologist would be looking for when assigning subjects to different groups for the study.

Similarly, researchers often use diagnostic groups (based on the DSM-IV-TR) to "define experimental groups" (Trull, 2005, pp 126). The use of particular groups strategically placed using diagnostic labels enables the researcher to draw conclusions and comparisons between different research groups. Without such a tool, it would be difficult to draw comparisons between illnesses, investigate co-morbidity, and distinguish variations in psychopathology.

However, despite the strong advantages to using diagnostic labels and grouping, like any system, there are also disadvantages to it. The first of these disadvantages is the tendency to use "all or nothing" thinking when making a diagnosis or considering an individual's problems. When can we call an individual schizophrenic? How many of the symptoms listed in the DSM-IV-TR must be exhibited before action for schizophrenia is taken? A clinician must remember that individuals exhibit symptoms to varying degrees, and the lack of one or two symptoms, or the exhibition of one or two symptoms may still signal the presence of the disorder. Thus, the goal of classification must be a form of communication, but not an explanation of the problem. There is always something behind the terminology, and this must be determined in order to gain full understanding of a client's condition.

Another concern is the way in which one is diagnosed. There are multiple systems used in the process of diagnosing an individual. The most important thing concerning these is that two different psychologists would still come up with the same diagnosis of the client. This is called reliability, and it very important when it comes to methods of diagnosis and the clinicians thoughts on the client's condition. It is important to use proven reliable methods in diagnosis, as well as reduce any factors that may cause unreliability in assessment of the client.

Along similar lines is the arbitrary nature that is often associated with classification systems. By this, I mean that classifications made in the DSM-IV-TR were decided by a group of psychiatrists and other qualified individuals. They can choose to elaborate or eliminate any particular disorder at any time based on their professional (or possibly biased) beliefs. This can leave individuals doubtful over the authority behind the entire psychological classification system, and another reason why reliability is so important when making a diagnosis. If a clinician can show reliability, doubts over the arbitrary nature of initial classification through the DSM-IV-TR may be satiated. Furthermore, creators of the DSM-IV-TR need be sure to remain unbiased, and use descriptive terms within the text to enhance the reliability of their decisions.

Lastly, the use of diagnostic labels may open up some serious civil violations or lapses in treatment. As mentioned earlier, it is easy to know about a person purely by hearing their label; however, that label may also cause a clinician to feel that they have found the problem and they no longer need to treat it. This simply isn't true. Determining the problem is one thing, and treating it is another. A good clinician will not only determine the problem, but use the diagnosis as a tool in determining and providing treatment. A diagnostic label is not a crutch to use in society, and not a reason to provide pills. A diagnostic label is merely a means to being the long, and often arduous, process of providing treatment and care.

The second civil violation that may occur is the stigmatizing of the patient due to their diagnostic label. How many retail shops will want to hire a schizophrenic? If one's sees the label "schizophrenic," it hardly seems to matter that the individual is on medication and stable, and has been so for nearly a year. Instead, the public tends to think only of the label and serious civil rights violations may arise (Trull, 2005, pp 135).

While there are ups and downs to the diagnostic classification system, it seems clear that something must be in place to create virtually universal understanding if the best care is to be provided. At this point in time, the DSM (Diagnostic and Statistical Manual of Mental Disorders)has been revised on six different occasions in order to enhance reliability and usefulness to a clinician. Although there are surely still hurdles to cross, this system of classification has also aided in hundreds of thousands of individual's diagnosis and treatment. Without such a classification system from which to draw information, communication, and research, it is possible that the mental health field might still have found itself stuck in the dark ages of mental illness treatment and prevention.

References:

Trull, T. (2005). Clinical Psychology, 7^th Edition. Belmont, CA. Thomson Wadsworth.