What is a diagnosis?

Humans are social beings. We define ourselves and find our identities in our relationships - to self and to others. But we are also mental beings; in that we all have minds – which function to help us navigate this social world. Finally, we are complex beings, tolerating high degrees of variability in how we do this; only at worst do we refer to mental health disorders. Making a formal diagnosis requires that the symptoms have a significantly negative impact on day to day functioning in this social world.

Opinions about mental illness vary, including a long and active history of refusals to accept prevailing ‘medicalised’ definitions of psychiatric diagnoses, even rejection of the very existence of mental illness at all (Szasz, 1960). These controversies are not expanded here, but we highlight the active debate. Of course in large parts of the world other non-medical descriptions and explanations (spirit possession, magic, etc) also predominate, so the practitioner in this field does well to maintain a degree of humility in relation to our current models for understanding mental health and ill-health.

What follows is a summary of where the main current of thinking currently stands.

All mental activity (thinking, hearing, feeling, seeing, believing, remembering, etc) rests on the firing of different nerves in the brain, and their connections. All mental disorders (or all disturbed or disturbing behaviour) must imply some ‘non-standard’ functioning in these networks in the brain, associated with day-to-day living becoming harder, even unbearable. However, these assumptions are not necessarily helpful in making diagnoses because the specific links between brain biology, experiences, and behaviours are by no means fully understood.

Rather than physical tests, most mental illnesses are diagnosed according to whether the reported/observed symptoms fit into one of a carefully defined series of descriptions, documented in large classifications. The most commonly used of these are the ICD (International Classification of Diseases) and the DSM (Diagnostical and Statistical Manual of Mental Disorders). Having these carefully-defined descriptions helps researchers to say something valid about the likely course, and predict more or less effective treatments, for people who share similar patterns of difficulties.

The fact that there are two such classifications, and that they differ - sometimes quite significantly - illustrates the point that this field is complex and imprecise. Receiving a psychiatric diagnosis can be a huge relief to many young people or parents (implying they are not to blame, and that their suffering has been taken seriously and recognised), but it can also be a source of extremely damaging stigma. How a diagnosis is discussed, explained, and shared can make all the difference.

Here we provide a diagnosis-based focus in the AMBIT manual, by producing 'diagnostic tags', which group together arrays of content that are particularly relevant to one of a selection of common Diagnoses, or symptom clusters (which may not fall strictly under a formal diagnostic category - such as the Acting Out behaviours common in emergent personality disorder, for instance) that any outreach service is likely to meet.

Health Warning!

It is important to avoid simply 'plugging in' a diagnosis and working solely from the revealed list of content, as if other aspects of the manual were of no further relevance.

Following a diagnostic tag may be a useful aide-memoire for the KeyWorker, but diagnoses in children and adolescents are not always easy to make, are liable to change, and whilst directing the clinician to evidence-based interventions they can also have unwanted effects such as the associated stigma (sometimes eliciting unhelpful responses from the wider matrix of family, social and educational relationships around the young person) or in 'closing down' the possibility of creative therapeutic responses that might usefully augment a framework of basic evidence-based approaches.

Diagnoses

Click to see a drop-down list of Diagnoses
Alternatively, explore via the Show references and info panel (the black box to right of this page title) to see sub-topics under this heading (Diagnoses, with content and suggested interventions attached.)