“Treat the disease, you win, you lose; treat the patient, I guarantee you’ll always win.”
Patch Adams, M.D.
Due to their use of medical language, psychiatric terms and diagnoses carry a weight of authority that result in their being perceived as reliable and exclusive descriptions of fixed problems of the order of physical illness. However, psychiatric diagnoses are quite different from the kinds of diagnoses conferred upon physical conditions, and rely upon the spurious notion that mental distress and emotional suffering require the interventions of a branch of medicine. The truth is you don’t need a psychiatric diagnosis – whether issued by a psychiatrist, psychologist or other mental health professional – in order to heal, recover and overcome your distress.
Here are some things you may want to know before seeking a psychiatric diagnosis:
- To the uninformed, psychiatric diagnosis can promise initial validation and recognition of our suffering as legitimate in the eyes of a powerful authority figure. For others it can bring access to support services, funding, financial and other benefits, providing a means by which patients can find peer support amongst fellow sufferers.
- Psychiatric diagnoses don’t guarantee you a cure. Some labels can help you gain access to services that can help you, and some can hinder your access to services. This can be dependent upon variables such as your local NHS service remit, attitudes and viewpoints of professionals within the service, funding rules, waiting lists, service capacity and design.
- Very often a psychiatric diagnosis serves as a guide for what types of medication you can be given to control your thoughts, feelings or behaviour. Many of these medications are toxic and can cause unpleasant ‘side effects’, withdrawal effects and other iatrogenic harm that effectively substitute your initial form of distress for another.
- Psychiatric diagnoses are often subjective and based on interpretation, practitioner skills, and opinion, not scientific or medical testing. The same person presenting with the same difficulties to different practitioners will often receive different diagnoses or none at all.
- Contrary to some claims, there are no fixed ways of ‘treating’ psychiatric conditions. No one therapy or treatment is exclusively better than another (some can be inappropriate). When we hear statements like ‘this particular therapy is recommended for this diagnosis’ it is often based on opinion, hearsay, vested economic interests, guidelines issued by quangos, and marketing strategy, not robust scientific evidence. The best evidence from the longest study done on the effectiveness of various psychotherapies showed that it is the empathy, insight/ understanding and acceptance of the practitioner in forming a trusting relationship with the patient that is the single most effective factor for success in psychotherapies.
- Psychiatric diagnoses are based on our social notions of ‘normal’ and ‘abnormal’ thoughts and behaviour. Some people believe that this is a philosophically flawed means of understanding human beings due to the fact that definitions of ‘normal’ and ‘abnormal’ vary from culture to culture, group to group, and also change over time. Homosexuality and ‘attempts by slaves to escape captivity’ (Drapetomania) were both classed as psychiatric conditions, for example.
- The human psyche is complex and thoughts, feelings and behaviour are variable, and our understanding of human beings must be made with consideration to each person’s unique responses to his or her life history, values, beliefs, political-, social-, family-, relationship-, physical health- and other contexts, and many other obscure and subtle factors that psychiatric diagnoses often ignore.
- Psychiatric labels can limit and obscure our understanding and ability to see the human being to whom the label is applied. Instead we see ‘symptoms’, ‘illness’ and ‘abnormality’
- Much mental distress is, for example, a legitimate and understandable response to external influences upon the person at some point in their life. The notion of ‘mental illness’, however, locates the defect or disorder exclusively within the individual sufferer, not the problematic external environment.
- You do not need a psychiatric diagnosis in order to heal, recover, engage in psychotherapy, or function better in life. You may be given the impression that a diagnosis is essential for treatment. But psychiatric diagnoses tend to be important to institutions, bureacracies, insurance companies and the judiciary for economic reasons. These bodies concern themselves with the legal and money implications of a person’s behaviours and potential risk to self or others. Where money and collective interests are concerned, insurance companies, funding and awarding bodies, and public mental health services often require psychiatric labels as a pre-condition required of the bureacrasy and power hierarchy, not as a prerequisite for effective help or support.
- Psychiatric diagnoses can be and have been used as a means of stigmatising and controlling dissenting, troublesome or non-conforming individuals since psychiatry as a field began. (psychiatry used against political prisoners)
- The so-called ‘mental illness’ model is only one of many conceptual models that can be used to understand our complex human experiences. Developmental models, trauma models, spiritual models, existential models, and many other ways of understanding can be relevant, valid ways of bringing clarity and support to your suffering. Due to the field of medicine’s power and influence within society, psychiatry and other fields that have allied themselves to it (e.g. psychology, social services etc), carries an authority in the public mind that allows it to dominate our understanding of mental distress as being more legitimate than other approaches.
- The act of medicalising and pathologising emotions and the expression of emotions and distress can be ways of stigmatising and suppressing authentic human experience that is meaningful and purposeful for personal growth, survival and transformation.
- The DSM-5 and ICD-10 are both manuals written as diagnostic guides for psychiatric diagnoses by people holding fixed ideological and conceptual positions, where other ways of understanding are equally valid and possible. These manuals are not based on hard science, but on descriptions and interpretations of patterns of human behaviour agreed by committees of like-minded individuals holding the same vested interests.
- The notion of ‘mental illness’ implies a usurping of the patient’s free will, responsibility, power and agency in managing and recovering from distress and injury to the psyche under his or her own volition. Instead it invites the patient to submit him- or herself to the power and quasi-mystique of establishment authority within what is effectively a parent-to-child power dynamic rather than the reality of adult-to-equal-adult. Corporate pharmaceutical and other extrinsic means are also applied within this power dynamic, as the patient submits to a process in the interests of being externally managed and directed by ‘experts’ toward a collectivist definition of ‘mental health’.
- ‘Health’ and ‘illness’ are terms that are appropriate for the biomedical model, but are not readily transferrable to mental distress and emotional suffering due to the general absence of evidence that distress is caused by abnormal bio-physiological and disease processes normally supporting medical diagnosis and intervention. The terms ‘mental health’ and ‘mental illness’ thus become misnomers when properly understanding human suffering within the psyche.
- As in other areas of medicine, huge influence is brought upon the field of psychiatry by the commercial interests of the pharmaceutical industry and financial incentives given to practitioners for assigning psychiatric diagnoses and associated medications and treatments.
- Psychiatric, social work and psychological practitioners are rarely trained psychotherapists and thus rely upon their own, contrasting and variable paradigms of understanding the causes and meaning of mental distress e.g. the biomedical ‘illness’ model, abnormal, cognitive, behavioural, clinical psychology etc
- Psychiatric diagnosis and intervention can be and has been influenced by family and other social and political agendas that are not necessarily in the patient’s best interests.
- Psychiatric diagnoses are typically made on the basis of verbal interviews, multiple choice questionnaires and other highly subjective methods, not blood or tissue tests, or brain scans, for example.
- Understanding other human beings is limited by personal interpretation and bias, transference, counter-transference, power differences, and other interpersonal dynamics that typically go unmonitored and unregulated within psychiatric diagnostic and treatment practice. Projective identification and other interpersonal means of confusing and clouding our understanding of others can be strong factors mitigating against accurate understanding of the troubled person. By contrast, trained relationship-based, process-oriented psychotherapists go to great lengths to take these factors into consideration when working with their patients.
- It is crucial to rule out the possibility of real biomedical causes of mental distress and behavioural changes prior to classifying a problem as psychiatric or psychological.
- Not all psychiatrists, psychologists and psychotherapists hold the same views or beliefs about how to understand and help suffering people. It is crucial to research a practioners approach to mental distress, ideally prior to submitting yourself to their scrutiny. Peter Breggin, Thomas Szasz, Giorgio Antonucci, R. D. Laing, Franco Basaglia, Theodore Lidz, Silvano Arieti, and David Cooper are just a few psychiatrists who have challenged establishment views within the field.
- Psychiatric diagnoses have a powerful, often pejorative influence upon the ways we view, understand and relate to people who carry such labels. Their inclusion in our medical, vehicle licencing, police, government and insurance records can bring life-long personal stigma, vulnerability and disadvantage. They can be a means by which others negate, blame, exclude and pathologise legitimate behaviours and ideas with which they disagree.
Before submitting yourself to the process of being assessed for a psychiatric diagnosis, research what a particular diagnostic label can mean for you in terms of the help it may or may not bring, and the familial, social, work and insurance implications that having a psychiatric diagnosis can have upon your life. For some, it can be beneficial, bringing access to effective funding, relief and support. For others, it can mean the worsening and protracting of distressing life experiences, with permanent unforeseen consequences.
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