The dangers of diagnosis
Earlier this month (October 2019), the government announced a new service for gaming addicts aged 13-25 at the Centre for Internet and Gaming Disorders. According to the World Health Authority, Gaming Disorder is a pattern of persistent or recurrent gaming behaviour so severe that it 'takes precedence over other life interests'. This description could equally be applied to any addiction, be it an addiction to gaming, alcohol, dieting, exercise, drugs, or sex to name a few. New addictions and other mental health categories are being 'discovered' almost weekly. The current version of The Diagnostic and Statistical Manual of Mental Disorders - DSM-5, published in 2013 - contains 541 categories of mental disorders. This version replaced DSM-IV, published in 1994 and containing 383 disorders. That’s an increase of 158 categories in 19 years - just over eight new categories per year - a little more than one every couple of months.
GPs, psychiatrists, and other mental health clinicians use the DSM to diagnose their patients. Each category has a list of symptoms and, as long as the patient presents with a required number of symptoms within the category, a diagnosis is given. Alongside a diagnosis, there is a choice of treatment or treatments which will typically be a combination of medication and/or some form of psychotherapy to treat the symptoms.
So far, so good.
The limitations of a diagnosis
However, with new diagnostic categories based on surface symptoms springing up so regularly, the structural causes that lie beneath these symptoms are given less and less attention. Two people may present with the same surface behaviour; for example, a pattern of persistent or recurrent gaming behaviour. In both cases, the person might describe significant impairment in important areas of functioning, like work, relationships, their social life, education, or occupation, and so the label gaming addiction may be applied. Dialogue, however, may show that, for one, the symptom is linked to how they wish to escape from feelings of anxiety and depression, whereas for the other it is a consequence of the delusional belief that the gaming world they enter is, in fact, the real world, and one in which they have a real place. Similarly, we might consider two people who are persistently restricting what they eat leading to weight loss, or a failure to gain. Again, a discussion may show that for one person, the reason they are dieting is because they imagine that the thinner they are, the more lovable they will be, while another person may be refusing food because they believe it to be poisoned.
In this way, the same symptom covers two very different causes and psychological structure. In order for the symptoms to be reduced, the underlying cause needs to be explored. This is the work of long term psychotherapy, where the person is treated as a whole and is encouraged to speak about themselves and their relationships both as they are now, and also as they were in the past. Personal history and family dynamics are thought about so that the meaning behind the symptoms can slowly emerge.