D For Diagnosis

Title

First
Broadcast

Repeated

Comments

Ever Changing Labels

20190726

20200122 (R4)

Treatment for most mental health problems is designed for the 'unicorns'; people who have just one clear-cut diagnosis. But in reality, many people experience more than one problem and their symptoms can be shared across different formal diagnostic categories. The true picture is one of cross-cutting, porous diagnostic boundaries.

In this third and final programme in her series, Claudia looks at how new science is adapting to this new reality, making links between and within the traditional boundaries of different conditions in order to develop new treatments. The hope is that the end result will be more personalised, individualised treatments rather than a one-size fits all approach to care.

Researchers at the MRC's Cognition and Brain Sciences Unit at the University of Cambridge are working across boundaries with a new strategy called the transdiagnostic approach. They are testing new treatment modules where the person needing help, whether they have anxiety, depression, OCD or PTSD, is supported to select from a menu of treatments, like a pick and mix choice, to target the symptoms that are most affecting them. This transdiagnostic approach, Professor Tim Dalgleish says, better matches how people experience mental health difficulties in real life. Pat and Emily tell Claudia how the transdiagnostic treatments have given them new tools to cope with their difficulties and clinical psychologists and research scientists Dr Melissa Black and Dr Caitlin Hitchcock describe how this approach could be adapted for many other mental health problems.

Also in Cambridge, how the diagnostic category of depression could be broken down into lots of differently identified conditions. Professor of Psychiatry at the University of Cambridge, Ed Bullmore, tells Claudia that in the future, there are likely to be many sub-types of depression with different causes and potential treatments. He is currently researching depression caused by inflammation in the body and although it's very early days, the possibility is that 'inflamed depression' could be standalone diagnosis in the future.

And in London, researchers at the Institute of Psychiatry at Kings College, London, are working to dissolve the diagnostic boundaries for three very different neurodevelopmental conditions: autism, epilepsy and schizophrenia. There are already recognised overlaps and genetic links between these conditions and teams led by Declan Murphy, Professor of Psychiatry and Grainne McAlonan, Professor of Translational Neuroscience, are working to identify these common pathways in order to develop treatments that work for particular groups of people.

How a diagnosis of depression could be broken down into lots of different conditions

What's In A Label?

20190719

20200115 (R4)

Suzy built her life around a diagnosis of bipolar disorder, joining a support group, even writing a book about it, only to be given a completely different diagnosis not once, but twice. She lost her support group and a big part of her identity when her diagnosis was changed.

In this second programme in the series, Claudia considers the value and the accuracy of diagnoses in mental health. Unlike a broken wrist, diabetes or anaemia, where you can be fairly hopeful that the testing makes the diagnosis watertight, there is not a single x-ray, blood test or biopsy that can give a definitive diagnosis of a mental health problem. Instead the symptoms that a person describes are assessed and a diagnoses given based on how they cluster and fit with diagnostic categories. The whole process is much more fluid, with many symptoms shared or absent both within and between different disorders and conditions.

As Suzy describes, a mental health diagnosis can be seismic for the person concerned. In a positive way it can bring recognition, relief, treatment and recovery and in a negative way it can bring judgement, prejudice, discrimination and isolation. Because a diagnosis in mental health is above all, intensely personal. It can feel aimed at the very centre of you and your identity.

Claudia explains the backdrop to the classification of mental health conditions. She looks at the Psychiatrists' Bible, a.k.a. the DSM or the Diagnostic and Statistical Manual and considers the enormous growth in each of five volumes published over the past 70 years (it's said the last edition is big enough to stop a bullet). How does this American framework affect how we view, assess and treat mental health difficulties in this country?

There are some who disagree profoundly with formal classification framed by the DSM, describing it an inappropriate 'medical model' for mental health problems. Claudia talks to clinical psychologist, Dr Lucy Johnstone, who has never, in her 30 year career, given a diagnosis and believes the starting point should be not 'what's wrong with me?' but 'what's happened to me?'. But Claudia also hears from others, including the former President of the Royal College of Psychiatrists, Professor Sir Simon Wessely, who maintain diagnoses are accurate, valuable and flexible enough so that good clinicians can use them as the starting point for care.

Rose tells Claudia how her diagnosis for Obsessive Compulsive Disorder gave her the key to understanding years of troublesome and persistent thoughts and Jane, diagnosed with a developmental condition, Autism Spectrum Disorder, describes how getting a formal diagnosis gave her the knowledge and confidence to change careers and find work in a more supportive environment.

And Suzy, a peer researcher at the Institute of Health and Wellbeing at the University of Glasgow, whose diagnosis kept changing, gives tips about how to deliver and change diagnoses with compassion, care and understanding.

Why a mental health diagnosis can carry its own health warning.

What's In A Name?

20190712

20200108 (R4)

Ever since the 17th-century philosopher Ren退 Descartes introduced the concept of dualism; the idea that our psyche or minds are separate from our bodies, the mind-body split in healthcare has had an enormous impact on the way mental health problems are recognised and labelled.

In this first of three programmes, Claudia Hammond explores the history of classification for diagnoses of the mind and discovers that diagnostic labels are very much artefacts of the cultural and social preoccupations of the time.

At the Wellcome Library in London, historian of psychiatry Dr Jen Wallis charts the modern classification of mental health conditions and the development of psychiatry as a medical specialism. She highlights pseudoscientific classifications like drapetomania, a psychiatric diagnosis given to enslaved Africans fleeing captivity and neurasthenia, an all-encompassing diagnosis of fatigue very much linked to the rapid technological advances of the 19th Century, as evidence of the permanent flux in what counts as mental illness.

From the medical library of the UCL Queen Square Institute of Neurology, Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists, revisits original case notes of British soldiers in World War One who had been diagnosed with the newly emerged condition of shellshock. Shellshock affected hundreds of thousands of troops across Europe and Claudia discusses with Simon why this novel diagnosis became the predominant explanation for traumatic suffering at that particular time.

Of course homosexuality was in the past criminalised and pathologised as a medical or psychological condition. Once officially categorised, gay men were exposed to a range of behavioural and medical treatments to 'cure' them. And in the former Soviet Union, psychiatric diagnoses like 'sluggish schizophrenia' were used to target opponents of the state. Dr Sarah Marks from Birkbeck, University of London, specialises in the history of psychiatry and she tells Claudia the abuses of diagnoses through history should serve as cautionary warnings about psychiatric labels today.

Claudia Hammond investigates the constantly shifting nature of diagnostic labels.

Episodes

Title	First Broadcast	Repeated	Comments
Ever Changing Labels	20190726	20200122 (R4)	Treatment for most mental health problems is designed for the 'unicorns'; people who have just one clear-cut diagnosis. But in reality, many people experience more than one problem and their symptoms can be shared across different formal diagnostic categories. The true picture is one of cross-cutting, porous diagnostic boundaries. In this third and final programme in her series, Claudia looks at how new science is adapting to this new reality, making links between and within the traditional boundaries of different conditions in order to develop new treatments. The hope is that the end result will be more personalised, individualised treatments rather than a one-size fits all approach to care. Researchers at the MRC's Cognition and Brain Sciences Unit at the University of Cambridge are working across boundaries with a new strategy called the transdiagnostic approach. They are testing new treatment modules where the person needing help, whether they have anxiety, depression, OCD or PTSD, is supported to select from a menu of treatments, like a pick and mix choice, to target the symptoms that are most affecting them. This transdiagnostic approach, Professor Tim Dalgleish says, better matches how people experience mental health difficulties in real life. Pat and Emily tell Claudia how the transdiagnostic treatments have given them new tools to cope with their difficulties and clinical psychologists and research scientists Dr Melissa Black and Dr Caitlin Hitchcock describe how this approach could be adapted for many other mental health problems. Also in Cambridge, how the diagnostic category of depression could be broken down into lots of differently identified conditions. Professor of Psychiatry at the University of Cambridge, Ed Bullmore, tells Claudia that in the future, there are likely to be many sub-types of depression with different causes and potential treatments. He is currently researching depression caused by inflammation in the body and although it's very early days, the possibility is that 'inflamed depression' could be standalone diagnosis in the future. And in London, researchers at the Institute of Psychiatry at Kings College, London, are working to dissolve the diagnostic boundaries for three very different neurodevelopmental conditions: autism, epilepsy and schizophrenia. There are already recognised overlaps and genetic links between these conditions and teams led by Declan Murphy, Professor of Psychiatry and Grainne McAlonan, Professor of Translational Neuroscience, are working to identify these common pathways in order to develop treatments that work for particular groups of people. How a diagnosis of depression could be broken down into lots of different conditions
What's In A Label?	20190719	20200115 (R4)	Suzy built her life around a diagnosis of bipolar disorder, joining a support group, even writing a book about it, only to be given a completely different diagnosis not once, but twice. She lost her support group and a big part of her identity when her diagnosis was changed. In this second programme in the series, Claudia considers the value and the accuracy of diagnoses in mental health. Unlike a broken wrist, diabetes or anaemia, where you can be fairly hopeful that the testing makes the diagnosis watertight, there is not a single x-ray, blood test or biopsy that can give a definitive diagnosis of a mental health problem. Instead the symptoms that a person describes are assessed and a diagnoses given based on how they cluster and fit with diagnostic categories. The whole process is much more fluid, with many symptoms shared or absent both within and between different disorders and conditions. As Suzy describes, a mental health diagnosis can be seismic for the person concerned. In a positive way it can bring recognition, relief, treatment and recovery and in a negative way it can bring judgement, prejudice, discrimination and isolation. Because a diagnosis in mental health is above all, intensely personal. It can feel aimed at the very centre of you and your identity. Claudia explains the backdrop to the classification of mental health conditions. She looks at the Psychiatrists' Bible, a.k.a. the DSM or the Diagnostic and Statistical Manual and considers the enormous growth in each of five volumes published over the past 70 years (it's said the last edition is big enough to stop a bullet). How does this American framework affect how we view, assess and treat mental health difficulties in this country? There are some who disagree profoundly with formal classification framed by the DSM, describing it an inappropriate 'medical model' for mental health problems. Claudia talks to clinical psychologist, Dr Lucy Johnstone, who has never, in her 30 year career, given a diagnosis and believes the starting point should be not 'what's wrong with me?' but 'what's happened to me?'. But Claudia also hears from others, including the former President of the Royal College of Psychiatrists, Professor Sir Simon Wessely, who maintain diagnoses are accurate, valuable and flexible enough so that good clinicians can use them as the starting point for care. Rose tells Claudia how her diagnosis for Obsessive Compulsive Disorder gave her the key to understanding years of troublesome and persistent thoughts and Jane, diagnosed with a developmental condition, Autism Spectrum Disorder, describes how getting a formal diagnosis gave her the knowledge and confidence to change careers and find work in a more supportive environment. And Suzy, a peer researcher at the Institute of Health and Wellbeing at the University of Glasgow, whose diagnosis kept changing, gives tips about how to deliver and change diagnoses with compassion, care and understanding. Why a mental health diagnosis can carry its own health warning.
What's In A Name?	20190712	20200108 (R4)	Ever since the 17th-century philosopher Ren退 Descartes introduced the concept of dualism; the idea that our psyche or minds are separate from our bodies, the mind-body split in healthcare has had an enormous impact on the way mental health problems are recognised and labelled. In this first of three programmes, Claudia Hammond explores the history of classification for diagnoses of the mind and discovers that diagnostic labels are very much artefacts of the cultural and social preoccupations of the time. At the Wellcome Library in London, historian of psychiatry Dr Jen Wallis charts the modern classification of mental health conditions and the development of psychiatry as a medical specialism. She highlights pseudoscientific classifications like drapetomania, a psychiatric diagnosis given to enslaved Africans fleeing captivity and neurasthenia, an all-encompassing diagnosis of fatigue very much linked to the rapid technological advances of the 19th Century, as evidence of the permanent flux in what counts as mental illness. From the medical library of the UCL Queen Square Institute of Neurology, Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists, revisits original case notes of British soldiers in World War One who had been diagnosed with the newly emerged condition of shellshock. Shellshock affected hundreds of thousands of troops across Europe and Claudia discusses with Simon why this novel diagnosis became the predominant explanation for traumatic suffering at that particular time. Of course homosexuality was in the past criminalised and pathologised as a medical or psychological condition. Once officially categorised, gay men were exposed to a range of behavioural and medical treatments to 'cure' them. And in the former Soviet Union, psychiatric diagnoses like 'sluggish schizophrenia' were used to target opponents of the state. Dr Sarah Marks from Birkbeck, University of London, specialises in the history of psychiatry and she tells Claudia the abuses of diagnoses through history should serve as cautionary warnings about psychiatric labels today. Claudia Hammond investigates the constantly shifting nature of diagnostic labels.