In light of the rising prevalence of poor mental health and its high economic toll in Singapore, it is especially crucial to understand mental health and its complexities.
Despite growing information and dialogue on platforms like social media, there remains a significant stigma attached to mental health diagnoses. Many individuals still cautiously navigate how they share their experiences with mental illness, wary of labels like ‘attention seeking’, and concerned about how their diagnoses might impact their employment or social standing. This pervasive fear of social rejection often holds people back from taking steps toward receiving the necessary care and guidance from mental health professionals.
To foster a healthier environment for mental wellbeing, it’s essential for everyone to more fully grasp what a diagnosis involves. In this article, we take a look at how mental health diagnoses are currently viewed in Singapore, and the common tendency to pigeonhole. We then offer a more nuanced perspective on what a mental health diagnosis really means, including a look at a spectrum of mental health, an explanation of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and how diagnoses can be beneficial to us.
Table of Contents
How are Mental Health Conditions Perceived?
“I don’t want people to think that I’m crazy… I’m scared they don’t want to be around me because I have a disorder.”
“I’m still very careful about the term ‘bipolar disorder’ because people tend to freak out and make their own assumptions about the condition. … I’ve had friends completely wash their hands off me. They decided they didn’t really understand it and couldn’t support me in this part of my journey”
These sentiments, expressed in a Channel NewsAsia interview, concisely painted a picture of the pervasive stigma that still surrounds mental health conditions today. Individuals with mental health issues are often perceived as incompetent, irresponsible, and unpredictable (Yuan et. al., 2016). Many people still believe that conditions like depression are simply a matter of poor willpower, or that individuals with schizophrenia are dangerous. Particularly in the Asian cultural context of Singapore where there is a strong sense of social responsibility, having a mental health diagnosis can carry deep feelings of shame and failure.
The Pigeonhole Effect
Pigeonholing or labelling happens when individuals diagnosed with mental health conditions are stereotypically categorised based on their diagnosis, often reducing their entire identity to the symptoms or characteristics of a disorder (Corrigan & Watson, 2002).
Mental health diagnoses are meant to provide individuals with a way to understand and get specific support for experiences and behaviours that interfere with daily functioning. However, they are often misunderstood, both by individuals themselves and by others, to represent a major part of the person’s identity. After receiving a mental health diagnosis, individuals may also expect that their behaviour should match with the common symptoms listed in their diagnosis, feeling doubt and confusion when they do not.
For example, consider someone diagnosed with Obsessive-Compulsive Disorder (OCD). Commonly, OCD is associated with excessive hand-washing or an overwhelming need to organise objects in a specific manner. However, if an individual diagnosed with OCD doesn’t display these particular symptoms but instead has intrusive thoughts or checks locks repeatedly, they might feel invalidated or confused about their diagnosis. This mismatch between their experiences and the stereotypical behaviours associated with OCD can lead to self-doubt and anxiety, compounding the distress they already feel from their symptoms.
When a person becomes increasingly defined by their mental health label, they also limit their ability to express and develop beyond the confines of their diagnosis (Corrigan & Rao, 2012). This can result in several negative repercussions. For instance, labelling can reinforce internalised stigma, making individuals feel as though they are fundamentally different or even flawed compared to others. This stigma can lead to isolation, where they hide their feelings or withdraw from social interactions for fear of judgement or misunderstanding about their condition.
Moreover, the misguided labels that come with a diagnosis can have practical consequences in areas like employment and education. Employers or educators might have preconceived notions about what someone with a specific mental health diagnosis can or cannot do, which can lead to discriminatory practices like not offering opportunities for advancement or appropriate support. These actions not only limit the individual’s personal and professional growth but also reinforce societal biases against mental health conditions.
Ultimately, it’s crucial for mental health professionals, those diagnosed with mental health conditions, and society at large to recognise that while diagnoses are useful for treatment planning and understanding general patterns of behaviour, they should not constrain our understanding of an individual’s capabilities and identity. Emphasising the uniqueness of each person’s experience with mental health can help reduce the negative impacts of the pigeonhole effect, fostering a more inclusive and supportive environment.
To begin shifting the narrative from viewing mental health diagnoses as generalised pathology to recognising them as unique human experiences, let us first deepen our understanding of what a mental health diagnosis involves.
Understanding Mental Health Diagnoses
The Mental Health Spectrum
Before diving into what a diagnosis entails, it is helpful to lay out the range of how mental health is experienced.
Mental health can be understood as existing on a spectrum that ranges from optimal wellbeing to severe impairment, with a multitude of experiences in between. Mental health is thus not a binary state of either being mentally ill or not, but rather a continuum where an individual’s mental state can shift in different life stages and challenges.
Here are some of the key points along this spectrum:
Optimal Mental Wellbeing
At one end of the spectrum is optimal mental wellbeing, where individuals feel capable, resilient, and able to handle the normal stresses of life. This state reflects more than just the absence of mental disorders; it includes aspects of flourishing such as feeling positive emotions, meaningfulness, having satisfying relationships, and coping effectively with daily stressors. Here, Positive Psychology plays a significant role with its research on what a flourishing life entails, and what practices can help us improve our life satisfaction. With this science of wellbeing, workplaces, schools, and even the military have harnessed the findings on resilience, strengths, and character development to facilitate individuals to go from functioning to thriving.
Mild to Moderate Mental Health Challenges
Moving along the spectrum, individuals may experience mild to moderate challenges to their mental health, which can include occasional mood fluctuations, feelings of stress, loneliness, and perhaps a sense of languishing. These states may not necessarily meet the clinical criteria for a mental health disorder, but if not addressed over time, can significantly impact one’s quality of life and functioning.
Clinical Mental Health Conditions
Further along the spectrum are diagnosable mental health conditions that require more formal intervention. This includes a wide range of disorders such as depression, anxiety disorders, bipolar disorder, schizophrenia, and more. These conditions are typically characterised by a combination of atypical thoughts, perceptions, emotions, behaviour, and relationships with others. They often require structured treatment such as psychotherapy, medication, or other interventions to manage symptoms effectively.
Severe and Persistent Mental Illness
At the other end of the spectrum are severe and persistent mental illnesses that cause significant impairment in daily functioning. These conditions, such as severe forms of schizophrenia, debilitating depression, or severe bipolar disorder, may require intensive treatment and support. Individuals with these diagnoses may struggle with basic life activities, requiring ongoing and sometimes lifelong treatment and support.
As physical health can fluctuate, so can our mental health. An individual’s position on the mental health spectrum can change over time due to a variety of factors including biological, environmental, and personal experiences. Some symptoms like low mood, insomnia, or anxiety can worsen if left unaddressed, potentially causing significant deterioration in quality of life and functionality.
It is therefore essential for individuals who are consistently facing struggles with their mental health to seek professional help. Mental health professionals are trained to accurately diagnose and treat a wide range of mental health conditions based on a detailed understanding of each person’s specific symptoms and experiences.
What does a Clinical Diagnosis Involve?
In Singapore, one can either consult a private mental health professional, seek advice from their General Practitioner, or visit a Polyclinic, which can provide referrals for subsidised care in hospitals. There are also community mental health providers that offer a range of services from consultations to treatments.
During a mental health assessment, the individual will be asked to describe their issues, and perhaps also their family background, previous experiences with similar problems, and any other medical conditions being faced.
The person’s symptoms are compared against known illness categories from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is a foundational tool used worldwide to standardise the diagnosis and classification of mental health disorders.
What is the DSM?
Often referred to as the “bible”of psychiatry, the DSM was first published in 1952 by the American Psychiatric Association (APA) as US veterans returning from World War II spurred an increased need to classify and define mental health conditions.
The DSM has since gone through a number of revisions as knowledge about mental health evolves. Today, the latest version DSM-5-TR is used by a broad range of mental health stakeholders, serving as a standardised framework for informing mental health research, diagnosis, and treatment. Insurance companies also use it as a reference for providing mental health coverage.
Most importantly, the DSM provides structured criteria that must be met for a person to be diagnosed with a mental health disorder. The severity of symptoms, their duration, and their impact on a person’s ability to function in daily life are key factors considered in these criteria.
However, here there is a risk that these categories can become a rigid lens through which individuals are viewed. It is important to remember that the DSM is a tool—not a definitive guide to the human psyche. Mental health is inherently complex, and many individuals may exhibit symptoms that span multiple diagnostic categories. The real-life experiences of individuals with mental health conditions often defy neat categorisation and require a flexible, nuanced approach to diagnosis and treatment.
By acknowledging the limitations of the DSM and emphasising personalised support, we can better address the unique challenges and needs of each individual, rather than forcing their experiences to fit within a strict diagnostic framework. This approach not only enhances treatment effectiveness but also respects the complexity and diversity of human mental health.
Is a Mental Health Diagnosis Helpful?
Receiving a mental health diagnosis can be a pivotal moment for many individuals. It often comes with mixed feelings—relief at having an explanation for one’s struggles, but also concerns about stigma and self-perception. However, there may be benefits of obtaining a formal diagnosis.
Early Intervention and Effective Treatment
One of the primary benefits of receiving a mental health diagnosis is the opportunity for early intervention. Identifying a mental health condition in its early stages can dramatically improve the effectiveness of treatment. Early intervention often means that less intensive treatment may be required, and it typically results in a quicker recovery compared to those whose conditions have reached a severe stage. Moreover, effective early treatment can set a foundation for managing the condition long-term, potentially reducing the frequency and severity of future episodes.
For instance, conditions like depression or anxiety disorders, when diagnosed early, can often be treated more effectively with a combination of psychotherapy and, if necessary, medication. This proactive approach prevents the condition from escalating into a more severe or chronic state, thus preserving the individual’s quality of life and productivity.
However, it is important here to be aware of the risk of over-pathologising, where normal emotional experiences are labelled as mental health conditions. This can lead to unnecessary treatments and stigmatisation. Striking a balance between early intervention and recognising the natural fluctuations in mental health is crucial. By fostering an understanding that mental health exists on a spectrum, we can support individuals in seeking help when needed without fear of being wrongly categorised or stigmatised.
Increased Self-awareness and Management
Without a diagnosis, individuals may not understand what they are experiencing and why. A diagnosis not only helps in understanding what one is dealing with but also enhances self-awareness about one’s mental health. This increased awareness is vital in managing stressors and triggers. It equips individuals with the knowledge to recognise early warning signs of their condition worsening, allowing them to seek help promptly.
For example, someone diagnosed with Generalised Anxiety Disorder (GAD) can become more aware of the situations and thought patterns that trigger their anxiety. They might notice that their anxiety intensifies during periods of high work stress or when facing family conflicts. This awareness enables them to implement coping strategies learned through therapy, such as mindfulness exercises or cognitive restructuring techniques.
Furthermore, understanding one’s mental health condition fosters better communication with healthcare providers, family, and friends, who all play integral roles in the support network. It also empowers individuals to take an active role in their treatment process, from deciding on treatment options to making lifestyle changes that support overall wellbeing.
Connection with Professionals
Having a diagnosis often means regular contact with mental health professionals, who can provide ongoing support, monitoring, and adjustments to treatment as needed. This professional relationship can be a crucial component of long-term mental health management.
This is a key difference between receiving a formal diagnosis and self diagnosis through one’s own research, especially with the abundance of online resources and social media content, including unverified advice from influencers, anecdotal stories on forums, and viral trends on platforms like TikTok and Instagram.
Mental health professionals bring expertise, experience, and an objective perspective that self-diagnosis cannot match. They are trained to recognise the nuances and complexities of various mental health conditions, which ensures that the diagnosis is accurate and comprehensive. Professionals can also identify co-occurring conditions that might be overlooked in self-diagnosis, leading to a more holistic approach to treatment.
Furthermore, mental health professionals can tailor interventions to the individual’s specific needs, drawing on evidence-based practices and the latest research. They provide a structured support system, which includes scheduled appointments for therapy, check-ins for medication management, and emergency support when needed. This ongoing professional involvement helps to track progress, make necessary adjustments to the treatment plan, and address any new or evolving symptoms promptly.
Receiving a mental health diagnosis opens the door to specialised care and treatment that is essential for supporting someone struggling with their mental health. A diagnosis is not just about labelling an issue; it’s about starting a journey toward healing and understanding, armed with the tools from psychology and medical science.
We live in a neurodiverse society full of individual differences. Each person’s mental conditions are influenced by a complex combination of factors like genetic predisposition and cultural and family backgrounds. Embracing this diversity allows us to appreciate the unique strengths and perspectives each person brings, making the path to mental wellbeing not just about treatment, but also about fostering an inclusive and supportive community.
Conclusion
While mental health diagnoses undoubtedly play a pivotal role in guiding treatment and facilitating a deeper understanding of complex psychological conditions, it is crucial to scrutinise how society employs these diagnostic tools. Often, these labels are used beyond their clinical intent, shaping societal perceptions and the self-identity of those diagnosed. This encroachment of diagnoses into personal identity raises pertinent questions about the broader implications of our approach to mental health.
As we navigate the intricacies of mental health awareness, it is essential to critically evaluate whether our current practices might inadvertently reinforce stigmas or limit the potential of those diagnosed. Are we, as a society, relying too heavily on labels that could potentially restrict individual growth and perpetuate isolation? How does this practice influence the way we view and treat individuals with mental health issues, and what does it say about our societal values concerning health and normalcy?
It’s time for a paradigm shift in how we think about and engage with mental health. Instead of allowing diagnoses to define individuals, we should use them as starting points for dialogue and understanding, always remembering that each person’s experience with mental health is unique. By challenging the prevailing stereotypes and promoting a more nuanced appreciation of mental health, we encourage a society that not only supports but also enriches the lives of those experiencing mental health challenges.
From providing an active listening ear to friends who may be facing a distressing challenge, volunteering at a mental health related community service, or even taking up training to become a mental health professional, each person should not underestimate the impact they can have in creating a supportive environment for those struggling with mental health.
References
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self‐stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35-53. DOI: 10.1093/clipsy.9.1.35
Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57(8), 464-469. DOI: 10.1177/070674371205700804
Yuan, Q., Abdin, E., Picco, L., Vaingankar, J. A., Shahwan, S., Jeyagurunathan, A., Sagayadevan, V., Shafie, S., Tay, J., Chong, S.A., & Subramaniam, M. (2016). Attitudes to mental illness and its demographic correlates among general population in Singapore. PloS one, 11(11), e0167297.
