Identifying experiences that could be identified as mental health symptoms is important for recognizing mental health conditions. For the person involved, it is the transition between isolated private suffering and recognition of a “condition” that could be shared with other people and potentially be treated.
The majority of mental health conditions are diagnosed largely based on symptoms, in contrast to the rest of medicine, where diagnosis also relies on information from physical examinations and laboratory investigations.
Source: Chen Yu Hai Eric
Mental Health Symptoms and Descriptive Psychopathology
It is of utmost importance that mental health symptoms are clarified and identified with appropriate skills and experience (the relevant field is “descriptive psychopathology”, a core skill in psychiatry). These skills are at risk of being neglected as some approaches oversimplify the process for the sake of economy. For example, the use of self-administered questionnaires in population surveys compromises depth in exchange for quantity.
Mental health symptoms are based on subjective experiences. Subjective experiences are ultimately private but are communicable to the extent that is intended by the patient. The communication is also limited by the language used, and by the clinician’s capacity to genuinely listen. The complex process of clarifying symptoms involves a dialogue between the clinician and the patient. This dialogue process is seldom unpacked and reviewed in detail.
Mental Health Symptoms and Body Symptoms
Are symptoms of mental health conditions different from those of body conditions? The latter are subjective experiences indicative of something going wrong in the body. In essence, the mechanics of clarifying symptoms is the same whether the experience originates from a problem in the body or a problem in the mind. For example, pain is a symptom of body conditions. Clinicians inquire about the experience of pain in terms of its characteristics in different dimensions: quality, frequency, changes with time, location, radiation, etc). Clinicians ascertain these details in the belief that they contain information that will facilitate identifying the underlying condition.
For mental health symptoms, the assumptions are similar, but the mapping to underlying conditions can be challenging, as the latter is not yet fully worked out. In addition, the experiences indicative of a mental health condition are often more complex. Examples include hallucinations, delusions, mood changes, loss of memory, lack of motivation, and personality changes. Are they really similar to a symptom like pain?
In medical conditions, when the site affected by the disease is remote from the brain, the brain can act as a distant observer and detect signals from the affected part of the body (eg pain). In mental health conditions, the brain itself is the site of pathological processes, and it is often difficult for the experiencing person to step aside and “observe” the signals. Often the psychopathological processes impact the mind directly in such a way that they are experienced without much room for reflection (eg hallucination, delusions, or major mood changes). The “immediacy” of psychopathological experiences may appear overwhelming for the person. As such the clinical dialogue is more tuned towards conveying a distressing experience than objectively describing a symptom. This demands a different sort of listening in mental health consultations. Mental health symptoms seek an empathic “listening to the experience” rather than a checklist approach to the symptom.
Encouraged by handbooks with detailed criteria for diagnosis (eg the DSM or the ICD), modern clinical practice unfortunately has often tended to adopt a checklist approach in checking off symptoms to reach a diagnosis. This checklist approach can yield simplistic thinking about mental health symptoms. It fails to recognise that the crux of the matter lies in clarifying the experience which constitutes the symptoms, which demands the fullest attention and openness in listening.
Phenomenology and Mental Symptoms
Psychiatry has learned from the discipline of phenomenology to focus on the “primary experience” of the patient, that is, to understand as best one can what the subject is experiencing, without trying to explain why he has that experience. In this approach, the clinician has to learn to set aside speculations and focus on clarifying the subjective primary experience as much as possible. This process involves the use of empathy which demands a genuine openness in the clinician’s mind. One could indeed consider the process of symptom clarification in psychopathology as primarily an empathic process.