Quote:
Originally Posted by amee200
In the US a diagnosis is necessary in order to receive any insurance coverage for psychiatry and psychotherapy. Without one, most insurance companies will only pay for about 12 sessions a year. And then clients are forced to pay out of pocket, most of whom can't afford to, and therefore end up with nothing.
I don't see why a diagnosis is a negative though. Yes it is based on the medical model, so a personality disorder diagnosis won;t get you the best coverage, but since MDD usually accompanies a PD, then the addition of this to your diagnosis means access to comprehensive care. A psychiatrist will usually recommend therapy with counselor or social worker. A good one will assess the whole picture - health, social factors, work and education, financial needs, etc when devising a treatment plan. All this is essentially what you're describing as a formulation. The diagnosis is a necessary part of the picture, but used my most clinicians as means to an end - as a way to ensure their clients get insurance coverage.
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I think one problem with diagnosis is that doctors often try hard to squeeze a patient into a diagnosis rather than use appropriate descriptors to try to capture what is going on for the patient. As many have mentioned, they are often forced to do this for documentation and billing purposes but maybe we should question that too. Often diagsoses take that form of checklist (eg "at least four of the following eight symptoms") and it can be hard to figure out where someone's symptoms truly fit. What if they only have three symptoms? It reduces a person's entire life to a quick label.
I enjoyed the article for the most part but thought that the idea (last few sentences) that one can subscribe either to a psychosocial model or to a medical/biological one to be simplistic, misleading and really not rooted in evidence. The best evidence out there suggests that of course all of it (genes, in utero environment, parenting, schooling etc.), makes up who we are and how we feel, that medication can be a lifesaver and that babies are not simply blank slates but people with personalities.