"Mother had lots of mood swings. She was bipolar."
"My therapist says that since my divorce, I'm suffering from post-traumatic stress."
"Joseph has these wild schizophrenic personality changes."
"Uncle Joe is a raging alcoholic."
"My nutty great aunt had a nervous breakdown and needed shock treatment."
"My crazy ex-wife was a real borderline."
Almost 60 years ago the American Psychiatric Association published it s first attempt to define mental health disorders. Over the decades there have been 4 major editions of a DSM (Diagnostic and Statistical Manual), developed by psychiatrists to establish descriptive criteria consistent with psychiatric disorders. These descriptions help professionals recognize and understand mental aberrations, and converse with colleagues about their patients. Research is also better organized when diagnostic criteria are established.
Medical diagnoses are always general labels that are devised to express a broad understanding of illness. "Diabetes" is a diagnosis inferring certain physiological processes in an individual, but does not describe causes, complications, or limitations related to the illness in every patient. A diagnosis is an approximation of understanding, which does not, in our current state of knowledge, fully describe the genetic, physiological, biochemical, environmental, and behavioral contributors to a disorder. A label does not define a complex human being.
Unfortunately, just as the whole concept of mental illness implies stigmatized dysfunction-i.e., "crazy"-psychiatric diagnoses have been adopted as pejorative slurs. Patients, themselves, sometimes demand a diagnosis from a clinician-"Am I bipolar?" "Am I borderline?"-as if the appellation itself will effect cure. Although a formal diagnosis aids in understanding and predicting behaviors and codifying research, its most significant aspect is to initiate treatment considerations. And the reason that many treatments don't work the way we predict is due to the complexity of the many interacting molecules that define each unique individual. Clinicians and patients must understand that a diagnosis is an artificial tag for an intricate web of biological interactions. It is not a condemnation, and certainly does not pretend a full understanding of a complex human being.