Hearing Voices Movement Media Watch compartilhou a publicação de Jonathan Fishman.
What is wrong with psychiatry?
Jonathan FishmanWhat 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.
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.
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