The meaning of 'acceptance' of a psychiatric diagnosis: qualitative study of illness narratives with review of the literature

BACKGROUND: Although diagnosis acceptance is frequently discussed in psychiatric practice and research, both components - psychiatric diagnoses and the act of accepting them - are inherently unclear.

AIMS: The present study aimed to evaluate how well existing theoretical concepts of diagnosis acceptance align with patient experiences and to explore themes related to diagnosis acceptance.

METHOD: An iterative thematic analysis was conducted on 30 illness narratives from (former) psychiatric patients. The analysis proceeded through three phases: (a) review of transcripts for overall narratives and attitudes toward diagnoses, (b) extraction of detailed data using a narrative summary template and (c) refining and comparison of themes across narratives.

RESULTS: Existing acceptance theories insufficiently captured the lived experiences reflected in the narratives. Attitudes toward diagnoses were multidimensional, fluctuated over time and were often described using terms other than 'acceptance'. Participants emphasised the importance of sharing their stories without being defined by a diagnosis and conflated DSM-5 classifications with broader diagnostic terms, highlighting challenges in communication of psychiatric constructs. Disagreement with diagnoses did not necessarily hinder therapeutic relationships, emphasising the importance of collaboration over consensus.

CONCLUSIONS: Given the limited practical application of existing acceptance theories and our findings on contextual factors relevant to psychiatric diagnosis attitudes, the necessity of diagnosis acceptance as a stand-alone goal for positive outcomes should be questioned. Rather than imposing classifications, creating co-constructed narratives may be more effective. Researchers and clinicians are encouraged to adopt narrative approaches to better understand and support patients, thereby fostering reciprocal, patient-centred mental healthcare.