Psychiatric Diagnosis, the ICD-10

I want to collect a bit my thoughts on the Diagnostic System of Psychiatry, the ICD-10:

I think it does much more harm than it serves people. It implies an idea that these disorder categories – the diagnosis – people are put in, are clear-cut and distinct from each other. Yes, the system allows for comorbidity, but it still creates this idea – for example: “Ok this person has a social anxiety disorder, and then there is depression with such and such degree of severity and then this person has also a schizoid disorder.” To think of oneself or others this way, is anything but helpful. Mental health issues do not sort themselves in such neat categories, that exist independently of each other. This way of describing a person’s state of mental health only confuses and stands in the way of actual healing. We as persons are not these seperate entities from our mental health – mental health issues do not operate on the outside of who we are, but they permeate us and our personhood. Of course we are more as a person than just our mental health issues as well. It is just not so black-and-white. Furthermore different aspects of mental health issues (what the ICD-10 is ready to diagnose as distinct disorders) are not seperate from each other either. Of course it is very important and helpful, to look at the different aspects of someone’s mental health struggles, but this needs to be done in a more holistic way. Healing does not happen through cutting off and suppressing certain aspects of us, but through integration and processing ( in whichever form that happens).

Furthermore there stands the question of the scientificness of these categories. By which I mean: How random vs. how empiricism and theory based are these categories? How much are they routed in a causal understanding? These questions, I feel, are particularly relevant in connection with such diagnosis such as BPD (Borderline Personality Disorder), that is a conglomerate of many symptoms, of which only around 60% have to be present to be diagnosed as such. While furthermore at the same time the DSM-5 falls completely short in giving a causal or whatsoever explanation of why these symptoms belong with each other.

This of course is just a brief and thoroughly incomplete excursion into the topic. But I feel it is important to also point out within this discussion the economic reality of the ICD-10. The ICD-10 holds such a prominent position as a diagnostic tool only because it is used by therapists and psychiatrists to bill insurance companies. Insurance companies do not know how to cope with more holistic and therefore vague, unique diagnosis – it would cost a lot more money if the insurance companies had to study the intricate details of individual diagnosis for their internal statistics. The therapist/psychiatrist complex who want to get paid for their work, therefore perpetrate the story of mental health being such a neat categorizable realm, since this puts them in favor with the insurancy companies. And so they shake each others hand, since it works for them well, while patients are given unfitting diagnosis and a tool of self-conceptualization that stands in the way of their actual healing (and this is not because the therapists/psychiatrist “mis-diagnoses” them, but because the diagnostic system is in itself just crap).