Diagnosing Mental Illness: We Have a Long Way to Go

By Liz Greene

diagnosing mental illness - ADHDAs much as I’d love to say otherwise, the stigma surrounding mental illness is very much alive and well. Without physical symptoms to prove the presence of a disease or disorder, society seems intent on refusing to accept mental illness as a valid medical condition. This misconception continues to flourish, despite years of medical science that prove mental illness is not only genuine, but can prove to be fatal if left untreated.

Unfortunately, much of what contributes to this stigma is the current limitations to how mental illnesses are diagnosed.

Contemporary Methods for Diagnosing Mental Illness

As it currently stands, there aren’t many reliable (or infallible) lab tests to diagnose mental illness. While diseases such as cancer, HIV, and diabetes can be identified via blood tests or medical imaging, mental illness is a far trickier beast. While brain imaging, such as MRIs, can reveal the effects of some mental illnesses on the brain, it’s not used for diagnosis.

Barry Southers, Professor at the University of Cincinnati Blue Ash, explains, “MRIs shouldn’t be viewed as a miracle diagnosis imaging modality — instead, it should be viewed as a critical tool in the fight against mental illness stigmas. An MRI scan, for instance, can effectively document potent physical changes that occur when a patient suffers from a particular mental illness, efficiently portraying that mental illness is, in fact, concrete and directly related to changes that occur within the body.”

Despite the evidentiary power of brain scans, it often takes months before doctors are able to accurately diagnose a mental illness. Why? There are two main reasons. One, symptoms of mental illnesses regularly overlap. For instance, irritability can be symptomatic of both bipolar disorder and generalized anxiety disorder. Difficulty concentrating can indicate either depression or ADHD.

Two, doctors and psychologists use one of two manuals to diagnose mental illness, the Diagnostic and Statistical Manual of Mental Disorder (DSM) or the International Classification of Diseases (ICD). Though the criteria and symptoms for every mental disorder is provided by these guides, there are individual differences in mental illness — no two people are affected in exactly the same manner. What anxiety, depression, obsessive compulsive disorder, etc., is like for one person is not necessarily what it’s like for another.

This means that, sometimes, the initial diagnosis is wrong — which can be incredibly troublesome. A diagnosis is incredibly important for people with mental illnesses, as it’s only the first step towards finding the right treatment. Patients often have to cycle through multiple prescriptions before they find one that works well for them. Furthermore, a diagnosis from a medical professional is necessary to qualify for Social Security disability support or for job protection under the Americans with Disabilities Act.

The Future of Diagnosis

As medical science marches forward, the way mental illnesses are diagnosed is sure to see improvement. Even as we speak, researchers are working on a number of possible solutions to the problems surrounding mental disorder diagnosis.

Charles Marmar, chair of the psychiatry department at NYU’s Langone Medical Center, believes  post traumatic stress disorder and traumatic brain damage will eventually be easily identifiable through biomarkers in blood, urine, and cerebrospinal fluid. But biomarkers aren’t the only possible future for mental illness diagnosis. In an interview with Scientific American, Stanford psychiatrist Amit Etkin talked about what he considered to be the future of both diagnosis and treatment.

“We understand behavior is essentially underpinned by brain circuits. That is, there are circuits in the brain that determine certain types of behaviors and certain types of thoughts and feelings. That’s probably the most useful way of organizing brain function. If you can start characterizing circuit disruptions for compensatory symptoms at an individual subject level and then link that to how you can provide interventions, then you can get away completely from diagnoses and can intervene with brain function in a directed way.”

Artificial intelligence (AI) might also have an interesting role to play. Researchers recently designed an AI model that analyzed transcripts from a group of young people and correctly predicted which members would develop psychosis — a notable feature of schizophrenia. How? By homing in on the verbal tics that frequently point to psychosis, such as short sentences, disjointed speech patterns, and confused meaning from one sentence to the next.

Jim Schwoebel, CEO of NeuroLex Diagnostics, is ready to take this research a step further by creating a tool physicians can use to screen their patients for schizophrenia. After combing through a transcript of the patient’s speech for lingual cues, the AI would display its findings as a number that a psychiatrist could then consider when making a diagnosis.

It may be years before such technologies are properly researched and vetted, but it’s reassuring to know that there’s hope on the horizon. The closer scientists get to understanding what causes mental illnesses, the easier it will be for physicians and psychologists to accurately diagnose them. For now, the best we can do is work with the tools we have and support the foundations that fund scientific research.