The more I chat with friends and clients, the more I realise so much of mental health is misunderstood. Understandably, we defer to medical experts. And they defer to assessment and diagnostic processes that are accepted as best practice. But are these processes helping? Or hindering?
Sometimes, occasionally, I feel anxious. Usually without much warning. It might last for mere seconds or several minutes. While it is happening, I want to run away from myself… classic “flight mode”.
Walk this way
I understand these feelings to indicate that something(s) in my life requires attention. I often talk to my clients about things ‘bubbling up’. Feelings, memories and experiences that were stuck to the side of the glass have shaken loose and popped into my conscious mind. Recently, I have sometimes felt disregarded. There's been Covid isolation from family and friends, periods of less communication and connection with my partner, and feelings triggered by insignificant events… Anxious feelings may be the pointy end of this unease, or maybe they are a sign of something deeper.
Every little step
The Australian health system allows some subsidised visits to a psychologist every year. Given my recent feelings and that I encourage others to get mental health plans, I went to get one. It took me three visits and two doctors, but I finally spoke with a GP who prioritised it.
In my 10 minute assessment, the GP chatted mostly about the music he plays in his surgery. I completed the Kessler 10 questionnaire (K10), which I’ll explain in a bit. We did not discuss any work stress, my relationships, the pandemic, or my mental health history beyond him asking if I had felt this way before. He had no access to my health records. After 10 minutes, about the same time it takes to get a burger from the local cafe, I had a mental health plan that identified me as having two disorders - Generalised Anxiety Disorder and Panic Disorder.
These ‘disorders’ exist in the DSM5, the fifth edition of the Diagnostic and Statistical Manual, which is considered the bible of mental health diagnostic tools. The DSMs have been around since 1952, and describe the current diagnostic criteria for collections of symptoms that have been labelled as disorders. With each subsequent edition, there have been concerns around the diagnostic creep drawing more of us into being pathologised. These concerns aside, there is merit in establishing criteria for grouping symptoms and funding some supports.
It is important to understand that the information I shared does not qualify me for those diagnoses. Both require these conditions to persist for periods of time to qualify for a diagnosis. So, both diagnoses are wrong according to the DSM5.
Break it down
The K10 is a handy tool for getting an overview of some psychological distress. It considers anxiety- and depression-related symptoms in the previous four weeks. It has ten questions with five columns of answers. If you have no distress, you would score 1 point each question, so 10 points. The responses indicating increasing distress adds another point per column, so those indicating the highest distress is 5 points, giving you a maximum score of 50 points. The scores are categorised into low, mild, moderate and high, with high being anything over 22/50 - but remember that no distress would give a score of 10/50 - so really, high is anything over 12/40. It feels like the odds are in favour of flagging as moderate or high. For me, the “moderate” score of 19/50 or 38% was enough to achieve a double diagnosis.
Take it slow
This quick diagnosis is not an isolated event. When my marriage broke up, I had two sessions with a Clinical Psychologist. At my second appointment, four or five weeks after the break up, he diagnosed me with an adjustment disorder. He felt that still grieving the loss was enough to qualify me for the diagnosis. According to the DSM5, it doesn’t.
A friend once shared about going to a psychiatrist for the first time and walking out after 20 minutes with a prescription for antidepressants. Soon after, they became more distressed at not feeling anything while medicated. After a wonderful public outburst, they sought out more nuanced mental health support.
Bueller?
What is the purpose of these hasty diagnoses? If they are as dodgy as they seem, how and why are they happening? Is it to allow people to access subsidised support? Possibly, but in the example of my marriage breakup, I was already receiving support. So, that raises the question of whether they have some other purpose. ...Anyone? ...Bueller?
One implication of my experience and experiences shared by friends, colleagues and clients, is that mental health statistics may be wildly inaccurate. If people can have a 10 minute chat with little context, get 19/50 in the K10 and walk out with a double diagnosis..., perhaps, there are flaws in the process.
This inaccuracy is an important consideration. These statistics become the evidence that medical, research, and public discussions are based on. They distort how we understand our feelings and pathologise our responses to life’s inevitable challenges. We are walking through a house of mirrors without knowing our reflected self isn’t reality.
Placing our emotional distress in an informed context of what humans go through is important, as is criteria for identifying who is eligible for support. We need baselines and guidelines. But is this the best we can do? Research on mental health stigma would suggest the way we hand out labels may be doing more harm than good. Some people are liberated by a diagnosis, but others are burdened by medication and the belief that their brain is broken.
As humans, we must be able to experience distress and difficulties, and reach out for help without being misled by the processes in place to support us. How can a 10 minute chat about background music possibly paint an adequate picture of my well-being? How can it be unreasonable to still be distressed five weeks after a long-term relationship breaks down? How can a 20 minute chat be sufficient to put someone on psycho-tropic drugs? Our inner and outer lives are far more complex than these assessment and diagnostic processes acknowledge.
I’m not sure how long it should take a clinician to get an understanding of what is happening inside of us. But, surely, it should take longer than 10 minutes to be labelled with a disorder or two, and more than 20 minutes to understand a person’s experiences of health, relationships and community enough to medicate them into numbness.
If we continue down our current path, how long will it be before clinicians are offering drive through diagnoses? Let’s just pop in on the way to Maccas. I’ll have some PTSD with a side of OCD, please.
*Mental health is far more complex than this article or our current approach suggests. This article seeks to broaden the discussion and empower those living it.
Dave Anthony is a Registered Music Therapist with 16 years of professional experience working in intergenerational trauma and mental health. He can be found at recreativ mind:health.
Images sourced online belong to their original owners.