Gray Matters: Self-diagnosis is not the problem

Because of their similarity but difference in approach, the fields of neuroscience and psychology often seem to be at odds with one another.

One example of this tension is observed in mental illness. Psychiatric disorders are characterized by both personal distress and impairment in multiple areas of life. 

Psychologists and psychiatrists often employ therapies that are based in the mind—the most common being cognitive behavioral therapy, which typically consists of a weekly meeting with a therapist to examine one’s behaviors, thought patterns, feelings and interactions.

I don’t mean to drag Freud, (just kidding, I totally mean to) but in the late 1800s and early 1900s, he employed psychoanalysis—a therapy where patients met with therapists up to five times a week for an extended amount of time, to talk about themselves. Based on the patterns between psychoanalysis patients, Freud came up with a number of theories related to people and their parents— the theories, I’m ashamed, we are all somewhat familiar with.

Neuroscientists, on the other hand, argue that since the brain seems to give rise to all conscious experience and thought, the mind and the brain are interchangeable, even though we don’t understand how just yet. Therefore, a neuroscientist may feel that it’s only a matter of time until medication for psychiatric disorders improves enough to replace therapy.

The subject of this piece is self-diagnosis of psychiatric disorders, in which someone who has not yet been diagnosed with a mental illness identifies with one or multiple of them, and so interprets their experiences under the lens of a psychiatric disorder.

People who take a mind-based view of mental illnesses and their treatments often take issue with others self-diagnosing.

Although self-diagnosis has its risks, including misinterpreting a medical illness for a psychiatric one, I don’t believe it is a horrible thing, or something that we should blame an individual for doing.

I think that we need to zoom way out when viewing mental illness by taking more of a neuroscientist’s approach to psychiatric disorders and becoming more critical of current mental illness diagnosis practices.

As it is, there is no clinical diagnosis of psychiatric disorders. Often, when one visits a psychiatrist, the doctor tries to rule out any medical issues that may affect mental health like insomnia, alcohol and drug use or thyroid malfunction.

Once someone is cleared of medical issues, they are given a psychological evaluation. This evaluation often involves statements like, “I find it difficult to control my own thoughts,” and then the taker needs to rate how much it applies to them on a scale.

After this, the psychiatrist decides whether the patient receives a diagnosis based on an arbitrary score.

This method of diagnosis, which is akin to diagnosing the mind by using the mind, has some faults.

First, it is behavioral. This means that it is based on self-reporting rather than quantitative data—opposite of the way diagnoses of other diseases are based on the presence of a certain virus or bacteria in someone’s system.

As far as we know, there is no anxiety or depression “bug”—nothing to effectively target with medical intervention. Rather, anxiety and depression are simply labels for clusters of symptoms that involve many parts of the brain.

Second, some believe that people lie on these questionnaires. Regardless of whether that actually happens often, the fact that it could should be unsettling. Some people might over-report their symptoms to affirm what they self-diagnosed and some people with more serious cases might under-report symptoms to avoid being institutionalized.

It is for these reasons that I don’t believe self-diagnosis is a horrible thing. Largely, it’s done by scared people that feel their thoughts or behaviors are not normal. 

The real, more systemic problem is that psychiatrists employ the same kinds of tests that people can find on the internet. In other words, the problem is that there is no clinical diagnosis, not that people are misusing the behavioral diagnosis.

Neuroscientists in the field of mental illness want to create a world where it isn’t possible to self-diagnose a psychiatric disorder because there exists a more clinical, standardized and effective diagnosis method than a questionnaire.

When we learn more about the brain mechanisms associated with certain symptoms, we can much more accurately use medical interventions to treat them, instead of lumping all of those who share similar symptoms under the same label and same treatment.

It may be possible, through advancements in neuroscience, for the view of psychiatric disorders to completely shift. With that, there will be better treatment for the predicted one in five people who will experience symptoms of a diagnosable psychiatric disorder every year.