Psychiatric diagnoses are good for only three purposes. They enable a shorthand communication among mental health professionals about their patients’ problems. They indicate to a psychiatrist which medications are most apt. And they justify reimbursements of claims by insurers for services rendered. That is the sum of their societal value. For reasons cited below and in my subsequent post, psychiatric diagnoses facilitate conventional treatment, mainly pharmaceutical treatment, but they prevent cure.
Why? Because they limit our minds. They hinder us from recognizing people’s strengths and deploying them to overcome their problems. After all, a diagnosis labels only an individual’s most serious problem(s), only the sickest part(s) of that person. And as it designates a part and not the whole, it refers to nothing that has the ability to solve the particular disorder. After all, if you are psychologically ill, in order to solve your problem you need to use your strong points (e.g. intelligence, persistence, courage, ability to relate to others, physical stamina, specific talents and interests, etc.) to overcome your difficulties. For this reason, psychiatric diagnoses prevent us from imagining an individual’s full recovery. And we achieve only what we can imagine. As a consequence, only people can be cured, not disorders alone.
We can further appreciate this problem if we look at how the American Psychiatric Association constructs its official diagnoses. Its designated members vote on whether particular constellations of symptoms and behavioral signs occur with sufficient consistency to represent valid disorders. But in that process, they cherry pick certain attributes (the signs and symptoms) of the (allegedly) disordered individuals, and disregard everything else about these individuals that characterizes them as unique human beings. And from those specified attributes the psychiatrists create diagnostic labels that masquerade as entities with bonafide, independent existence that these experts certify with DSM code numbers. But because these labels are only abstractions and not living reality, treating abstractions, or using them as justifications for particular treatments, cannot, and does not, cure real human beings. As they are not truly reflective of living reality, they constitute the delusions of contemporary psychiatry.
Let’s examine a physical analogy. If you break your leg, your fracture will remain unhealed unless your body mobilizes its self-healing resources delivered by your circulatory system, immune system, nervous system and musculoskeletal system, not to mention the panoply of biochemical elements and processes that populate these systems.
Similarly, since psychiatric treatment targets only the DSM disorder, then absent a mobilization of analogous self-healing resources, the cluster of symptoms so diagnosed will likely persist despite bombardment by the drugs and procedures that assault them. Or else the symptoms will initially appear to succumb, only to bounce back up again and again like a weighted Bozo the Clown pop-up toy.
Accordingly, conventional psychiatric diagnoses ensure the inevitability of chronicity, of incurability. Thus we have the styrofoam peanut effect of psychiatric diagnosis: After a psychiatrist has labeled you with a specific disorder, if you continue psychiatric treatment or even if you seek medical treatment from other physicians, you will never be rid of that diagnosis. It will cling to you with the static electrical charge generated by the limiting expectations and practices of my profession.
Say, for example, that you suffered in the past from severe anxiety attacks that prevented you from leaving your home, but you no longer have those symptoms. Then the psychiatrist you are now seeing for marital squabbles, an ostensibly unrelated problem, will likely include among the diagnoses she enters into your chart, Panic Disorder with Agoraphobia, in remission, with the italicized words implying that your problem is not really solved, cured, or gone; rather that it is hiding within you like a herpes virus, waiting to re-emerge sooner or later when conditions conduce. (Note also that unlike physical diagnoses such as pneumonia, sinusitis, or acne, official psychiatric diagnostic nomenclature is often capitalized, thus conveying the imprimatur of certifiable truth, of uncontestable authority, like the Bible or God. This practice is reminiscent of philosophers’ penchant for capitalizing their central concept–the Spirit, the One, the Forms, etc.–so as to emphasize the transcendence of their unprovable metaphysical speculations. But unlike psychiatric diagnoses, pneumonia needs neither capitalization nor periodic revisions of the medical nomenclature to certify its reality.)
Psychiatric labels have other unfortunate effects. They stigmatize individuals and, even worse, prompt individuals to stigmatize themselves so that they reduce expectations of themselves, as discussed further below. Another reason why psychiatric diagnoses are unhelpful is that they are nouns. If
you and your mental health professional perceive your problem to be a noun, cure will be more difficult to achieve. For maximum responsiveness to treatment, your problem should be reframed as a verb, a linguistic element that implies action, doing, or sometimes a state of being, instead of just a thing. A verb implies process and the potential for change whereas a noun implies stasis, sameness. Put differently, it is easier to change what you do or how you do it than it is to change what or who you are.
As an example, you could describe the problem for which you desire treatment as “anorexia nervosa.” Or your problem could be rephrased as “I starve myself whenever I am in new social situations.” See the difference? The latter statement of the problem implies the possibility of fundamental self-change. After all, now you will just have to learn how to deal with social situations better. There is nothing in that phrasing that indicates the problem to be immutable or refractory to the therapeutic mobilization of your inner resources. On the other hand, anorexia nervosa designates an illness, a thing that compels people to seek medical help so doctors can fix it through treatments that overpower the problem. If you think of your problem as an illness rather than a dysfunctional way of managing situations, you are less likely to view yourself as an instrument in your own cure.
Let us say Joe says to his new psychiatrist, “I want help with my depression.” Left unmodified as a treatment goal, the “depression” will resist cure through psychotherapy or pharmaceuticals. Joe cannot see, touch, hear, or visualize his “depression” because it is an abstract thing. Therefore, he can do nothing to fully and lastingly change it. But he can be aware of and change its manifestations, which include dysfunctional thoughts, feelings, and other behaviors. So instead he might state the problem as “in every relationship I start feeling down and hopeless because I expect people will always leave me once they get to know me.” Again, see the difference? If you have a mental health problem that you have heretofore identified as a noun and you rephrase it as a verb, you are more likely to sense new possibilities for its solution. Verbing a problem, as it were, opens it up from a dense, impenetrable ball into a pattern of occurrences that is inherently alterable.
Originally published at http://www.greenpsychiatrist.com.
Steven Goldsmith obtained his M.D. from the Columbia College of Physicians & Surgeons. After experience in general practice and internal medicine he completed a psychiatry residency at Boston University Hospital. Certified by the American Board of Psychiatry & Neurology, he has held faculty and staff positions with the Boston University, NYU, and Tufts Schools of Medicine. He has authored the books, The Healing Paradox: A Revolutionary Approach to Treating and Curing Physical and Mental Illness and Psychotherapy of People with Physical Symptoms: Brief Strategic Approaches. In addition, he graduated from the International Foundation for Homeopathy training program and the North American Homeopathic Master Clinician course and has been practicing homeopathic medicine since 1992. His private practice in Portland, Oregon emphasizes natural solutions to health problems.