In South Africa, the most common system used to diagnose mental health conditions is a book called the Diagnostic and Statistical Manual (DSM). The manual is divided into various sections e.g. Mood Disorders, Anxiety Disorders, Personality Disorders, etc. and each section is further divided into subsections with each representing a particular diagnosis e.g. Major Depressive Disorder, Dysthymia, etc. The way the book works is that it provides a list of symptoms for each disorder and indicates the number of signs that someone would require before they qualify for the diagnosis. To have a diagnosis means that you have a certain number of ticks under a particular heading. This is different to other medical diagnostic systems since it clusters symptoms rather than diagnoses underlying conditions. This is like saying you have the flu “because you have a runny nose” as opposed to “because you have contacted a virus.” There are reasons for this approach, but it is not without difficulty.

Psychoanalysis has shown that the same psychological symptom can have very different causes in different people (I might avoid people because I don’t like them or because I think they won’t like me). Since the DSM aims to classify symptom clusters, the same diagnosis in two people doesn’t necessarily point to the same underlying condition (a runny nose can indicate allergy in one person and a cold in another). This makes it difficult to answer questions such as “What causes schizophrenia?” since the label schizophrenia may turn out to be an umbrella covering different underlying things with similar symptoms.

Bearing this in mind, a detailed exploration is always more meaningful than a diagnostic label when it comes to making sense of someone’s situation. Unfortunately, this approach takes time, is never certain, and involves considering a complex interaction between society, social history, family history, family relations, personal history, personality dynamics, choices, chance events, genetics, biology, neurology, health, nutrition and a whole lot more.

This is not to say that a DSM diagnosis is not helpful. A staggering amount of research goes into exploring things like; what treatments seem to help particular diagnosis, what does this mean for a person’s future, how long will they carry the diagnosis, what impact does it have on one’s relationships, etc. Because of this, an accurate diagnosis can be helpful in guiding a way forward and for informing your expectations for the future, but it should be seen for what it is i.e. a label for a set of symptoms and not necessarily some specific underlying physical illness.