When I was in graduate school I developed an intense interest in the many varieties of psychiatric diagnoses. I immersed myself in books, articles and filmed case examples of all the many types of so-called "mental illness". I gained a deep appreciation for the value of a proper diagnostic understanding in order to know what kind of help a person needs to recover good mental and emotional health. But I also agree with many authors who have written at length on the limitations of psychiatric diagnoses, such as the following:
Diagnoses are Political
Despite the appearance of formality that books such as the official "Diagnostic and Statistical Manual of Mental Disorders" present, the reality is that many diagnoses are vaguely defined and suffer from poor research controls. What this means is that many diagnoses are not as scientific as they may appear to be.
Literally billions of dollars (primarily in insurance payments and medicine prescriptions) are at stake in whether a certain set of symptoms is grouped together to form a diagnostic set. Factions for and against different diagnostic conceptualizations have fought each other to wrestle a consensus of what it means to have a certain illness. It's a process that's disturbingly similar to how the national budget or some laws are cobbled together: one faction will support another in exchange for similar favors in return.
The former Soviet Union used to house political prisoners in "psychiatric hospitals" which were nothing more than jails and torture chambers. Even in the United States, barely a generation ago homosexuality was officially labeled as a psychiatric disorder. The ability to determine what is normal and deviant contains the potential for exerting tremendous great social control. This aspect of the political nature of psychiatric diagnoses may seem far-fetched today but can have far-reaching consequences in some not too distant tomorrow.
Diagnoses Are Gender Biased
Our culture historically has valued traditionally male standards of mental health. Labels such as 'histrionic' and 'borderline' personality disorders are much more often applied to women than men. Male depression is typically under-diagnosed, as is attention-deficit disorder in females. Gender bias is insidious and often creeps into the assessment of what is normal or not.
Diagnoses Stigmatize
Diagnoses, once created, tend to have lives of their own, independent of the person to whom they are given. Like gum on the bottom of your shoe, it's hard to completely get free of it once it sticks to you. Many people who use insurance coverage for mental health counseling don't realize that their diagnosis enters the data base of the Medical Information Bureau and will be accessed by any prospective insurer where a client may seek coverage in the future. People are often denied life or health insurance coverage simply for having mental health-related diagnoses in their claims histories.
Diagnoses "Individualize" Problems
Most diagnoses locate the existence of problems exclusively within an individual, without acknowledging the relational and social aspect of many problems. Psychiatric diagnoses, with few exceptions, recognize sick people but ignore sick contexts. Family therapists often speak of an “identified patient” within a dysfunctional family system, recognizing that the entire system contains and expresses the problem that is the focus of treatment. Diagnoses, however, only apply to a person, not a relationship, and thus are very limited in their perspective.
Diagnoses "Medicalize" Problems
The concept of “medical necessity” has become the benchmark for determining whether an insurance company will reimburse a therapist for providing services. Therefore, there is a great incentive to label life problems as medical problems. This is another force behind the push to pathologize. It may sometimes be comforting to consider a life crisis as a medical problem subject to "treatment" and "prescriptions" rather than a problem of meaning, spirit, or relationship. I'm not trying to say that biochemical issues don't exist but that they are not the only or even the primary way to address what's wrong in a person's life.
So therapists must be exceptionally ethical, careful, experienced and cautious in the use of psychiatric diagnoses for the way they can influence definitions of what is normal and abnormal, good and bad, masculine and feminine, moral and immoral, functional and dysfunctional, healthy and sick. And people need to be careful about allowing therapists or insurance companies to use psychiatric diagnoses in the absence of a highly compelling reason.
Diagnoses are Political
Despite the appearance of formality that books such as the official "Diagnostic and Statistical Manual of Mental Disorders" present, the reality is that many diagnoses are vaguely defined and suffer from poor research controls. What this means is that many diagnoses are not as scientific as they may appear to be.
Literally billions of dollars (primarily in insurance payments and medicine prescriptions) are at stake in whether a certain set of symptoms is grouped together to form a diagnostic set. Factions for and against different diagnostic conceptualizations have fought each other to wrestle a consensus of what it means to have a certain illness. It's a process that's disturbingly similar to how the national budget or some laws are cobbled together: one faction will support another in exchange for similar favors in return.
The former Soviet Union used to house political prisoners in "psychiatric hospitals" which were nothing more than jails and torture chambers. Even in the United States, barely a generation ago homosexuality was officially labeled as a psychiatric disorder. The ability to determine what is normal and deviant contains the potential for exerting tremendous great social control. This aspect of the political nature of psychiatric diagnoses may seem far-fetched today but can have far-reaching consequences in some not too distant tomorrow.
Diagnoses Are Gender Biased
Our culture historically has valued traditionally male standards of mental health. Labels such as 'histrionic' and 'borderline' personality disorders are much more often applied to women than men. Male depression is typically under-diagnosed, as is attention-deficit disorder in females. Gender bias is insidious and often creeps into the assessment of what is normal or not.
Diagnoses Stigmatize
Diagnoses, once created, tend to have lives of their own, independent of the person to whom they are given. Like gum on the bottom of your shoe, it's hard to completely get free of it once it sticks to you. Many people who use insurance coverage for mental health counseling don't realize that their diagnosis enters the data base of the Medical Information Bureau and will be accessed by any prospective insurer where a client may seek coverage in the future. People are often denied life or health insurance coverage simply for having mental health-related diagnoses in their claims histories.
Diagnoses "Individualize" Problems
Most diagnoses locate the existence of problems exclusively within an individual, without acknowledging the relational and social aspect of many problems. Psychiatric diagnoses, with few exceptions, recognize sick people but ignore sick contexts. Family therapists often speak of an “identified patient” within a dysfunctional family system, recognizing that the entire system contains and expresses the problem that is the focus of treatment. Diagnoses, however, only apply to a person, not a relationship, and thus are very limited in their perspective.
Diagnoses "Medicalize" Problems
The concept of “medical necessity” has become the benchmark for determining whether an insurance company will reimburse a therapist for providing services. Therefore, there is a great incentive to label life problems as medical problems. This is another force behind the push to pathologize. It may sometimes be comforting to consider a life crisis as a medical problem subject to "treatment" and "prescriptions" rather than a problem of meaning, spirit, or relationship. I'm not trying to say that biochemical issues don't exist but that they are not the only or even the primary way to address what's wrong in a person's life.
So therapists must be exceptionally ethical, careful, experienced and cautious in the use of psychiatric diagnoses for the way they can influence definitions of what is normal and abnormal, good and bad, masculine and feminine, moral and immoral, functional and dysfunctional, healthy and sick. And people need to be careful about allowing therapists or insurance companies to use psychiatric diagnoses in the absence of a highly compelling reason.