I heard a discussion on BBC Radio 4’s In the Mind programme over Christmas about Nathan Filer’s book The Shock of the Fall, which won a number of awards last year. It is a novel about a young man called Matt who becomes mentally unwell following the death of his brother, and draws on the life and work experiences of the author who was a mental health nurse. You can listen to this discussion and find out more about the author by following the links on his website. One of the interesting points about the radio discussion was the fact that the writer, though describing in detail the descent into mental illness, does not give a label or title to the problems, apart from a mention of the diagnosis in a letter to an auntie. In the discussion the author says that the central character in the book probably has schizophrenia, but there are reasons why the term schizophrenia hardly features in the book. This got me thinking about some of the pros and cons of a diagnosis.
More than the name of the illness
What Nathan Filer says is that for someone who has schizophrenia, their illness is not the most important thing about them. That’s absolutely right, the problem with diagnoses like this, is that this comes to define the person and everything about them. Clearly it is significant, but does not govern everything about the person.
The effect of stigma
One of the problems about diagnosis is the potential stigmatising effects. Some people have a picture of someone with schizophrenia, perhaps that they’ve got from a sensationalising newspaper headline, and think everyone else is like that. For example, the campaigning clinical psychologist Rufus May says: “I’ve got a diagnosis, I’ve had a diagnosis, of schizophrenia. People stopped seeing Rufus, they started seeing ‘schizophrenia’.”
Helpful diagnosis
Interestingly, I read that in Japan the diagnostic term for schizophrenia has been changed from meaning a ‘split mind’ to ‘integration disorder’ to try and counter the stigma associated with it, and as a consequence the rate of diagnosis has gone up. Is that a good thing? Well clearly there are advantages to giving a name to a major mental health problem:
- It provides a guide to treatment – an accurate diagnosis helps inform clinicians as to what should be the best treatment and help for the person.
- It can help families – families often struggle to come to terms with mental health issues, having an explanation can be reassuring, and be a source of education and information about coping strategies.
- It can be a key to accessing services – having a diagnosis can help in securing access to specialist services in mental health teams such as crisis services.
David Beckingham – QCS Expert Mental Health Contributor
