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BABCP Response - NICE Consultation January 2022

Self-Diagnosis Rules – Should It?

The main provider of psychological treatment, NHS Talking Therapies,  says that  its’ clinicians are not trained to diagnose [IAPT Manual 2018)]. But the full name of the Service is ‘NHS Talking Therapies for anxiety and depression’ so how can they possibly not diagnose! Alice, in Alice in Wonderland thought words could mean whatever you wanted them to mean, a view apparently shared by NHS Talking Therapies. 

 

Many CBT practitioners see diagnosis as anathema. Sufferers are left to make sense of their difficulties themselves. In this vacuum people often affix a diagnostic label themselves, conferring a sense of identity and they hope direction. 

Recently I met a 17 year old, in a social context, who told me he was autistic and also had ADHD. He was being helped with interview skills and how to apply for jobs. We chatted amiably for 20 mins and I thought it was not impossible he had the self-identified disorders but it seemed unlikely. He had not enjoyed secondary school, skitted for his religious beliefs and thought animals were a better bet job-wise than humans. I was not wearing a professional hat at the time and followed my usual dictum of not revealing my professional identity because of its capacity to sabotage all social occasions. [This can have a downside, once told a taxi-driver that I worked in banking, unfortunately he was very interested in banking and asked searching questions. I was so relieved when the journey came to an end!]. Locally the waiting list for an autism/ADHD diagnosis is as long as a piece of string and for the foreseeable future he was likely to operate with the said ‘diagnoses’. 

Many professionals do not see the above as problematic, it is simply about accepting neurodiversity.  A way of people coping with their ‘lived experience’. They might add that mental health diagnosis is meaningless anyway, so people can choose their diagnostic label just as NHS Talking Therapies can choose any diagnostic code ( problem descriptor) based on the presenting problem.  It is open season for diagnostic labels for the public and routine psychological therapists. 

But there is no way in which the above 17-year old could come up with an alternative hypothesis about his difficulties e.g that he was by nature  introvert, part of an out-group, had difficulties concentrating at school because the academic subject matter did not interest him. Most plausibly he had adjustment difficulties and this was likely a better explanation than autism/ADHD. Self-diagnosis carries with it an inability to generate and the means to falsify an alternative hypothesis, as such it is inherently unscientific. The danger is the self-diagnosers and their fellow travellers operate unknowingly with a confirmation bias, only seeking information that confirms their hypothesis. 

Dr Mike Scott

8 replies on “Self-Diagnosis Rules – Should It?”

When I did my degree we were told that we couldn’t make a diagnosis, only those with medical training could do that.

That has long since passed, the ‘gold standard’ diagnostic interviews are not limited to usage by medics. Medico-legal work has accepted psychologists making diagnoses for at least 30 years.

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