A psychiatric system without a label

This sounds a bit silly right? It's become assumed that a diagnostic
label of phenotype is the only way to have a mental healthcare system.
It allows communication. It also is fundamental. The label means what
the problem is and how to fix it: prognosis and treatment.

The problem is that the system doesn't work in practice. How is it
possible that black men are labelled with schizophrenia 9 times more
than white men in the US and 7 times more in the UK but equally in the
Caribbean. This was noted in the New Horizons consultation document.
Supposed brain illness identified by the cluster of symptoms approach
while valid and reliable in academic research breaks down to absurdity
in clinical practice. This is irrespective of the criticism made by
Professor Richard Bentall in Madness Explained. This is the point made
in the UK documentary How mad are you?

So the problem of identifying the type described by the label in
clinical practice makes the cluster of symptoms approach and operational
definitions without biomarkets a totally insane system. In the
discussions in DSM-V schizoaffective disorder is being considered for
removal. It exists. There is evidence to support a discrate group with
different outcomes to schizophrenia and bipolar (and when I say evidence
I mean what constitutes evidence in mental health). Psychiatrists
couldn't use it properly though. The diagnostic criteria is precise to
identify this specific nuance in the schizophrenias, a distinct illness
rather than a sub-type of schizophrenia or a inbetween the symptoms of
schizophrenia and bipolar.

There is a change to the dimensional model of mental health in DSM-V. If
I understand it right, and I'm not sure I do, it creates individual
pathology measures rather than discrete illnesses. Even those who oppose
it's introduction, noteably the chairperson of the DSM-IV taskforce who
is doing a great job of ranting the next revision to a better state of
science, agree that this is the future of diagnosis. Psychopathology can
be measured and quantified either as individual problems rather than the
Kraeplin idea (think it goes back to him) that every illness could be
classified as one thing.

So in the future a 'diagnosis' will look a bit like a Meyers-Briggs
types evaluation. People score on different measures. Individual
diagnostic labels disappear. A person might still think I'm a
schizophrenic but it wouldn't have any relevance. Everyone's a bit
psychotic. Everyone's a little bit depressed. Or most people are. Some
have more than others. Treatment aims at the different measures of
psychopathology but individually. I might have got this all wrong but it
sounds like a sensible idea. Think Bentall might have suggested
something similar but I only got half way through Madness Explained.

Whatever the dimensional model is it's seen as a step forward in
psychiatric care (again, whatever that means). IT breaks down the
fundamental concepts of illness and the label and that's why it's one of
the most significant changes in the history of psychiatric treatment.
Looking at it from a really mad perspective it could be the first step
towards a better application of science and the end of the traditional
idea of mental illness diagnosis.