What is wrong with psychiatry?
Jonathan Fishman
What Is Wrong With Psychiatric Diagnosis and Labeling? 60 points.
Psychiatric Diagnosis:- Validity, Reliability, Harmful Consequences.
1) Psychiatric Diagnoses
are
applied to people who have been discredited as "Not Normal!" or whose
thoughts, feelings and actions have deviated from social standards of
normality.
The concepts of "Normal" and "Abnormal" are suspect.
What are the criteria for normality?
Who defines "normal" and according to which value system?
Can we really distinguish between "normal" and "abnormal"?
Does "normal" refer to a statistical norm? Is "abnormal" medically and
functionally abnormal, a violation of our value system, or the
designation of a disapproved social status, a "spoiled identity"?
2) Psychiatric diagnoses implies "Mental Illness".
The alleged concept of "mental illness", used to describe real
phenomena of emotional distress and suffering, is itself in doubt. There
is a vast literature about this, challenging the paradigm of the
Medical Model.
There are many alternative approaches to
psychological distress and suffering including e.g. Developmental models
dealing with early childhood and the Trauma Model.
Other alternative approaches include:- psycho-spiritual crises, relationship overwhelm and situational overwhelm.
The sociologists of 'deviance' and 'social problems' have given us
labeling-social reaction theory, the medicalisation of non-illness
phenomena, and social constructionism.
3) When establishing the
categories and classifications of alleged mental illnesses, i.e. the
DSM-5, and ICD10, the drafters already assumed ideological positions,
and are defining categories through vested interests. The results are
neither scientific nor value free.
e.g. amongst many other IDEOLOGICAL POSITIONS:
4) There is a removal of the alleged "patient" from his communal,
social, economic, political context. There is a bias as regards
positions between collectivism and individualism.
5) Psychiatric
diagnosis uses alleged illnesses to obscure and hide injustices and
human conflicts. There is victim blaming. It needs to be clarified, to
what extent so-called symptoms are actually realistic responses to
external circumstances.
6) Psychiatric diagnosis disguises the
vested interests of others e.g. Schools and universities, employers,
communities, congregations, spouses and families to seek a diagnosis in
order to justify dealing with the alleged "patient".
7)
Psychiatric Diagnosis may serve the interests of social control. Any
disliked or undesirable behaviour could be declared a mental illness and
be set up for control.
8) Psychiatric diagnosticians are taking a
materialist postion, rather than an idealist or dualist position. They
assume that the mind is the brain.
When a diagnosis sources thoughts, feelings and actions as caused by the brain, we have to ask, "What is "The Person"?
9) During the process of psychiatric diagnosis, biomedical explanations
are chosen over psycho-social approaches. The choice of a genetic,
biomedical model serves the interests of those who wish to avoid family
and community activity and the possibilities of change.
By
calling problems, biological illnesses, it appears that they are fixed
in nature, immune to socio-economic or personal change.
10)
Psychiatric description tends to assume a causal-deterministic rather
than a choice/free will/agency philosophy. "The Person" as agent tends
to be lost.
The preference for a causal-deterministic approach
(not only biological but also social and psychological causation) rather
than a choice-agency approach serves the interests of those who do not
want to feel responsible.
Both those causing distress as well as
the recipients of a psychiatric diagnosis may have vested interests in
the deterministic diagnosis. They may wish to escape blame and feelings
of guilt.
The alleged causal-deterministic nature of the
psychiatrically diagnosed "an illness like any other illness" pretends
to remove shame and embarrassment.
11) A biomedical model also
serves the interests of the pharmaceutical industry, whose role in
creating the categories of psychiatric diagnosis cannot be ignored.
Obviously the sale of drugs brings in enormous profits for
pharmaceutical companies. Pharmaceutical company reps bearing gifts are a
common feature in doctors offices and medical conferences. Research is
sponsored.
12) Psychiatrists, being doctors have a predominantly
biomedical rather than psychotherapeutic training .To stay in the market
and be able to practice a medical approach, a medical style diagnosis
and treatment is needed.
13) Medical Aid insurance requires that
something is defined as an illness before they'll pay for it. Here is a
financial incentive for a psychiatric diagnosis.
14) Psychiatric diagnosis, and claimed illness, conflates behaviours with lesions.
Psychiatric diagnoses frequently involve behaviours which are
violations of social norms or failure to meet communal expectations. .
However, Medical diagnoses involve Lesions. Lesions are - tissue
damage, deviations in anatomy, histology, physiology and biochemistry,
and the presence of microorganisms.These lesions are usually absent in
psychiatry unless we go into the grey area between psychiatry and
neurology.
There is a conceptual leap from behaviour to
"illness". No underlying biological mechanism or lesion has been
demonstrated to confirm that the behaviour involved in a psychiatric
diagnosis pertains to a real illness.
Since psychiatric
diagnoses are based on behaviours not lesions, there clearly may be
non-medical, moral, ethical, religious, political, communal, marital or
interpersonal conflict sources for the issue. i.e. The phenomena under
discussion are "problems of living" not illnesses.
A diagnosis is not appropriate for a non-illness phenomenon.
Tackling the problem as an illness with a diagnosis is fighting the battle on a false front.
15) A psychiatric diagnosis subscribes to The Medical Model. This model
regards complex challenges of living as an underlying disorder with
symptoms.
So -called 'symptoms' may not be 'just symptoms', but
may be profound, authentic feelings emotions and moods which are an
integral part of a person's relationships to other people as well as his
struggle with actualizing his authentic life.
To dismiss these profound, authentic feelings as 'just symptoms' is to dehumanise the Person.
16) The cognitive status of a psychiatric diagnosis is unclear. Is a
psychiatric diagnosis a description or an explanation? Is a psychiatric
diagnosis a collection of behaviours, "symptoms", or the name of an
illness, or the cause?
17) Psychiatric diagnoses are
abstractions. Just because something has a name or descriptive phrase
does not mean that it correlates with anything in the real, concrete
world.
18) There may be differences in orientation between
psychiatrists and alleged patients regarding atheist, religious or
mystical positions, and the use of diagnostic actions to implement these
positions.
Mystical thinking and discussion may appear to be
irrational and even psychotic to the uninitiated and may even lead to a
psychiatric diagnosis.
Intentional or inadvertent missionary
activity may be involved, to convert the patient to the therapist's
religion, or the reverse, to remove the patient's religion.
Religious or atheist conversion intentions are an ulterior motive in diagnosis and therapy i.e. religious abuse in therapy.
19) Gender, age, race, religion and social economic class affect
psychiatric description and diagnosis. Diagnostic concepts and
practitioners' judgments may have an ethnocentric bias.
20) The description and diagnosis will reflect the theoretical background of the practitioner.
Different schools of thought produce different diagnoses, or non-illness descriptions of problems.
e.g. A practitioner from the psychodynamic tradition involving early
childhood experiences may produce a developmental or trauma flavoured
diagnosis. A psychologist trained in behaviourism will define people's
problems in terms of learning and conditioning. A biological medical
background could produce an organic disease diagnosis. Religiously
orientated counsellors may attribute the problem to sin or lack of faith
and an existentialist may cite alienation or meaninglessness. A
socialist background would suggest socio-economic conditions as causing
distress, a political activist blaming poverty.
21) Some of the
many other philosphical, political and sociological positions involved
in the concept of "mental illness", the creation of diagnostic
categories, nosology-classification, and application of psychiatric
diagnoses which need explication include e.g, positivism, reductionism
and the mind-body-soul problem.
22) While the diagnostic process
may be largely descriptive, there is a strategic element involved, i.e.
the doctor, community, family and client himself may be trying to
achieve something. There is an agenda.
E.g. removing a disliked person, escaping responsibility, facilitating a divorce, accessing care.
The diagnostic process may involve scapegoating and 'Gaslighting'.
Gaslighting is a dishonest, abusive technique causing a person to doubt
his own perceptions, judgements and memories and may lead to a
psychiatric diagnosis.
23) A psychiatric diagnosis may serve as
an Ad Hominem mechanism. An opinion, political or religious position ,
personal argument or claim, may be fallaciously refuted by invalidating
the speaker. By denigrating someone by means of a psychiatric diagnosis,
anything the recipient now says loses its credibility.
24) The
very limited nature of the diagnostic categories into which the rich and
complex aspects of human behaviour are simplified, forced, pigeon
holed, and named is restricting. By accepting labels, someone accepts
limitations to his nature and potential. Psychiatric diagnoses and
labels create falsely perceived boundaries.
25) The selection and
groupings of patterns of human behaviour into labels is capricious.
There are myriads of possible ways of classifying and labeling ,and
these are arbitrary, and man made not divine nor fixed in nature. A
category, diagnosis and label may appear to be very real, but here the
cookie cutter analogy is appropriate.
Who choses the grid being imposed on nature for the classification of behaviour?
26) The subjectivity, and sometimes poor competence of some
psychiatrists who establish a diagnosis based purely on the slander of
others and a verbal interview, in the absence of any objective physical
examination or laboratory tests does not inspire confidence. There are
no objective tests like blood tests or X-rays involved in most
psychiatric diagnoses.
27) Projection:- In the process of
attributing a psychiatric diagnosis or description, the diagnosing
practitioner, or community may be projecting their own imperfections and
character flaws onto the patient/client. Some people may attempt to
invalidate others with their own denied flaws.
28) A great leap
is required by the psychiatric diagnostician over the gap between
theoretical textbook and DSM-5 descriptions and real life, applying a
theoretical concept to a unique individual with a name, a face, a mind,
heart, soul, and life. The categories are abstractions and do not
correspond to real concrete life.
It's questionable whether
psychiatric diagnosticians have the ability to accurately apply the
already invalid diagnostic categories.
Can psychiatrists really
apply the contrived checklists and categories of the DSM-5 to the rich
complexities of human, social and spiritual behaviours in the real
world?
So we need to ask, Is the illness itself real? Is the diagnostic category valid? and is the diagnostic process reliable?
29) The uneven power balance between the psychiatrist, applying the
diagnosis, and the alleged "patient"/client being diagnosed, is of
concern.
A psychiatrist or psychologist may have a desire for
power, and wish to control and "Fix" other people. The superior position
of the diagnostician, accompanied by feelings of importance has it's
counterpart in the shame and humiliation of the patient-client's
inferior position.
The psychiatrist may pull rank over the
"patient"/client and the psychiatric diagnosis may be at the expense of
the recipient's dignity.
The power balance between diagnosing
psychiatrist and labeled patient is even more awesome when we consider
that the psychiatrist may be an agent of mass society, or the prevaling
culture and ideology.
30) The involuntary, coercive context of
the diagnosis, where the alleged patient/client may not want to be
diagnosed and may be unable to disagree and defend himself is a
problematic aspect of psychiatric description and diagnosis. This
coercive aspect of psychiatric diagnosis may have behind it the power of
the law and police.
The practioner may be diagnosing on behalf
of a third party with ulterior interests in the diagnosis. e.g.
community, spouse, parents, school, or ideology. "He who pays the piper
calls the tune".
Often the diagnosis is unilateral and the client may be able to only minimally contribute.
In the legal context, when there is a legal charge, an accused client
may defend himself and have a defense attorney. However, in the
medical-psychiatric arena, someone accused of mental illness cannot
defend himself from having a psychiatric diagnosis being imposed on him.
31) During the psychiatric diagnostic process a "patient", especially
an involuntary one, may be forced to disclose very personal, private
information. This private information becomes part of a public
diagnosis, making a mockery of the proudly flaunted confidentiality
ethic of psychiatry. Stigmatisation and public shame may be a result.
32) Psychiatrists may be missing out on the presence of a real physical
illness when making their psychiatric diagnosis. E.g. depression may be
a symptom of hypothyroidism, influenza or a side effect of
tranquilizers. Very ironically these real illnesses have to be excluded
in a psychiatric diagnosis, while psycho-diagnosticians are claiming
that their diagnoses pertain to real "illnesses like any other"!
33) Psychiatrists may be missing out alternative explanations to the
medical e.g. a narrative life history, involving bereavement, abuse, bad
religious mystical experiences, turbulent romantic relationships and
break-ups, financial loss or other trauma.
Bereavement and heartbreak are lost and forgotten in the term 'Disorder'.
Humanity and Empathy towards heartbreak, are lost in a scientific, technological approach.
Sadly, when one loses a loved one, the grief experienced is part of being human. Calling grief an illness is dehumanising.
Attributing distress to an impersonal illness involves less empathy
than acknowdging a person's traumatic experiences and unbearable
situations.
'Diagnosis' implies 'Illness'. However a person's complex life narrative is NOT an illness.
34) A problem in medical diagnosis is the occurrence of false
positives. i.e. the diagnosing of healthy people as sick. This is even
more of a question regarding dubious psychiatric diagnoses. This is due
not only to misdiagnosis, or error which may occur in any profession,
but a result of what sociologists have termed the medicalisation of
normal life.
35) Inconsistency and reliability. A person
diagnosed with one mental disorder can see another psychiatrist and get a
totally different diagnosis. This doesn't only take place between
countries and cultures, but between individual psychiatrists. Many
inividuals begin a psychiatric career with one diagnosis only to have it
chaged later on. This doesn't inspire confidence in psychiatric
diagnoses and makes us question their reliability. Failures in therapy
also add to our doubts regarding the reliability of psychiatric
diagnoses.
36) It appears as if only an expert can make a
psychiatric diagnosis, the layman is fooled. Psychiatric description and
diagnosis may be tangential, ill-defined and miss the point. The real
issues are obscured in professional jargon. Instead of families,
friends and communities rallying around a distressed member,
professionals with psychiatric diagnoses and treatments rob the people
of human processes. An example is the comforting of mourners being
delegated to trained physicians.
37) Often care, welfare, and
assistance can only be accessed by someone with an officially
recocognised psychiatric diagnosis. An individual suffering from an
unlabelled emotional distress may find it more difficult to get help.
Some people may play fake sick roles in order to get attention. Some
may play fake sick roles in order to access care and kindnes.
38)
Describing the person's behahaviour as fixed, given, instead of
acknowledging that the person could behave differently is a feature of
psychiatric diagnosis.
The diagnosis imposes a static picture upon a dynamic person.
The diagnosis fixes in time what may be only a transient experience.
What should only be an episode may be turned into a life long career.
Emotional distress and intellectual confusion should be transient, episodic.
What turns an Episode into a life long career?
Chronic medication? Societal labeling? Self labeling?
Prejudiced community members blocking return? Unemployment? Social isolation? and financial dependance?
Something a child usually just "grows out of" is made into an issue,
labelled, given a psychiatric diagnosis and another ill person joins the
statistics.
39) The definers of diagnoses, may sometimes allow
treatment considerations to precede "illness", classification and
diagnosis.
e.g. Sometimes a pharmaceutical company may first
have the drug, and needing to market, secondarily promote and advertise a
use, "illness" and diagnosis.
A psychiatrist may have a
favourite diagnosis which biases his judgement. He may suggest symptoms
to the client putting words in his mouth.
40) There may be
cultural, historical and geographical bias in a diagnostic category, and
diagnosis application i.e. Relativism! Historicism means historical
relativism. Clearly psychiatric diagnoses have changed through time.
Recognised illnesses change with each new edition of the DSM.
Diagnostic criteria change frequently.
41) Mental illness concepts and psychiatric diagnostic categories may be socially constructed, invented not discovered.
42) In a capitalist system health may be defined in terms of being ready to work and produce.
43+ --
Psychiatric Diagnosis ignores the destructive consequences of the proceedings.
The physical, psychological and social harm of a psychiatric diagnosis.
PSYCHIATRIC DESCRIPTION AND DIAGNOSIS, INFLUENCING PERCEPTION.
43) The language of psychiatric diagnosis is frequently slanderous, dehumanising, demeaning and degrading.
The language used in a description or diagnosis affects how we see people.
The recipient of a psychiatric diagnosis is sometimes perceived as
another species, an inferior or non-human creature, when he really is a
fellow human being who has gone through difficult experiences and may
still be living in very difficult situations.
44) The language
used in a description or diagnosis affects A) how we see people. B) Our
way of seeing people affects how we treat them.
Picturing someone as less than human, makes it easier to treat him inhumanely.
Seeing someone as less than human may lead others to have less empathy for him. However, empathy may be what is needed.
A peaceful, innocent person may be unjustifiably regarded as dangerous
by the public, and be treated accordingly, losing his human rights,
simply on the basis of a psychiatric diagnosis.
The recipient of
a psychiatric diagnosis is subject to myths and superstitious
misrepresentation in the media and in street gossip.
False,
negative stereotypes have been created regarding the so-called "mentally
ill" and psychiatric diagnoses are loaded with these.
Frequent false stereotypes attached to psychiatric diagnoses are those of violence, sexual deviance and financial burden.
45) The recipient of a psychiatric diagnosis may look at his own self in a different way to how he saw himself before.
A psychiatric description and diagnosis may produce self-stigmatisation with loss of feelings of self worth.
The public, including "patients", tend to believe psychiatric diagnoses
because of the authority and prestige of doctors in our culture.
46) A description and diagnosis should only be an alleged attribute of a
person not his entire identity. "You are not your diagnosis!"
47) A psychiatric description and diagnosis may tend to make the
recipient perceive himself as helpless, dependant, powerless, and
lacking control. A psychiatric diagnosis is infantilising and
disempowering.
48) Hope Versus Despair.
Psychiatric Description and Diagnosis takes away hope:
Descriptions and diagnoses such as schizophrenia and personality
disorder, seen as a life-long condition, can unnecessarily take away
people’s hope for a future life.
49) Painting someone with a
psychiatric diagnosis may be setting him up for social stigmatisation
with damage and losses in the worlds of employment, friendships,
relationships and marriage.
The recipent of a psychiatric label
becomes subject to loss of civil rights, discrimination, rejection,
exclusion or abandonment.
A psychiatric diagnosis may result in isolation and loneliness.
50) Once a psychiatric diagnosis has been dropped onto someone he is by definition, "not normal".
So-called 'normal' people may be perceived as superior to people with
an alleged psychiatric diagnosis. There may be a perceived, but not real
hierarchy.
Some so-called 'normals' may assert a right to
practice discrimination and abuse against those who are perceived as
ranking lower in the hierarchy.
Someone with an attributed
psychiatric diagnosis may become susceptible to identity politics, just
like the elderly (ageism), members of socio-economic classes (classism),
gender (sexism) and ethnic groups(racism). General collective concepts
like 'intersectionality' and 'rankism' have been formulated to include
all these types of prejudice and discrimination.
More specific
terms are 'ableism' - discrimination and prejudice against people with
disabilities, and 'mentalism' and 'sanism'- which are prejudice and
discrimination against people who are perceived to have a so-called
mental disorder.v
51) Some people, alienated by a psychiatric
diagnosis, are not only NOT inferior, but are superior in sensitivity,
consciousness and mystical insight.
52) Psychiatric diagnoses
have a "stickiness", once applied they are hard to get rid of. The
recipient may even overachieve to compensate but some prejudiced
communities find an episode of so-called emotional disorder very hard to
forgive.
53) A psychiatric diagnosis may act as a
self-fulfilling prophecy, and the client may behave according to its
expectations and stereotypes. The self-identity of those labeled may be
determined or influenced by the terms used to describe or classify them.
54) The concept of 'diagnosis' implies illness, resulting in the
recipient of a psychiatric diagnosis perceiving his task as getting
cured instead of seeing his task as living his life. Also, living of
one's life, should be authentic, personal, creative and free and not
being "fixed" by someone else.
55) The psychiatric diagnosing,
induction, orientation, and hospitalisation procedures are degrading and
demoralising. These are aspects of dehumanization.
56)
Psychiatric Diagnosing may lead to radical and undesirable treatments
such as incarceration, drugging, electric shocks and lobotomies. Therapy
itself may be filled with pitfalls, abuses and negative consequences.
57) Never mind any alleged "condition", "disorder", "syndrome" or
"illness", a psychiatric diagnosis is itself traumatising and produces
it's own distress.
58) A psychiatric diagnosis adds insult to
injury. First the person is traumatised, and then he or she, already
overburdened by the trauma, is now denigrated with a psychiatric
diagnosis, and all the consequences of being perceived as "mentally
ill"!
59) Words are not just words. Words have power often of a
destructive nature, and psychiatric diagnosis is amongst the most
destructive, whether professional, pseudo-scientific terminology, or
street slang and gossip.
60) Is a psychiatric diagnosis necessary, when it does not benefit, when it does more harm than good?
For thousands of years people have comforted and counselled each other
without resorting to the illness concept. We can listen to a person's
life story and description of distress, and offer help without making a
diagnosis.
