On one fine spring day, I was sitting on a Central Park bench and two women were sitting one bench just to my right reading their newspapers. Suddenly, one of them cried out, “Sophie, can you believe this! The story I’m reading here, oh my God! This young boy, seventeen years old mind you, the same age as my Jonathan, he’s struggling with ideas about suicide. Seventeen years old, his whole life before him and he wants to kill himself. What would lead a boy to this?”
“Such a young boy, Bessie?”
“Yes. My God.”
“He must have some type of mental illness.”
“Oh, you’re right, Sophie. I just glanced at the next paragraph, and a psychiatrist explains that the boy has a mental illness called major depressive disorder.”
With that explanation, the two women nodded to one another, and continued on to another story, seemingly satisfied that they now knew why the boy was dealing with this issue.
This notion that when a psychiatrist says someone has a mental illness, or some type of mental illness, that this offers a valid explanation for why the person is struggling with personal difficulties is, as far as I’m concerned, a bunch of nonsense. Just before the incident in the park, I had seen a performance of Shakespeare’s Hamlet, which tells the story of a boy about the same age as the one in the story Bessie was reading and is also struggling with feelings of committing suicide. As Shakespeare’s story unfolds, the audience is presented with a character that has motivations, conflicts, frustrations, disturbing situations and emotions. In the end, I left with some insights into why a character such as Hamlet might struggle with feelings of suicide.
In my opinion, even a play, which lasts but two or three hours, can only provide in its narrative a simplified account of what real life stories are all about. And yet, in today’s world, for many people a very different type of play is sufficient for providing the reason why someone is dealing with a challenging concern. This new type of play begins with the curtain rising. A character says to the audience he is struggling with feelings of suicide. A psychiatrist then proclaims the character has the mental disorder known as major depressive disorder, and then the curtain comes down. That’s the whole play. And people walk away fully satisfied that an adequate explanation has been provided.
When psychiatrists start calling people names, they get them from a book called The Diagnostic and Statistical Manual of Mental Disorders (DSM). They claim that they are not just calling people names, but, instead, they are making a diagnosis. Diagnosis, as it is defined in Wikipedia, “is the identification of the nature and cause of anything” (http://en.wikipedia.org/wiki/Diagnosis).
It would be reasonable to assume, therefore, that the DSM would assist in identifying the nature and causes of the types of personal concerns that come to be called mental disorder. But the DSM uses a descriptive approach that attempts to be neutral with respect to theories of the nature and cause of the various “disorders” that it describes. Therefore, referring to the DSM as a “diagnostic” manual is contrary to reason.
My Personal Understanding of the Nature of Diagnosis
When I was fifteen years old, I was tackled hard in a football game. After the pile of tacklers got off of me, I found that when I tried to put any weight on my left leg I felt excruciating pain. Shortly after this unwelcome discovery, I arrived at the Coney Island Hospital. A doctor asked a few questions and decided to take an x-ray of my left leg. Minutes later, he showed me the x-ray, and pointed to where a bone in my leg was broken. His “diagnosis” was that my left leg had a fractured fibula.
Now, what if the doctor did not take an x-ray, but instead just said to me after he asked me a few questions, “Your problem is that you have ‘Major Inability to Stand Disorder.’” Making such a statement, as far as I am concerned, is quite different from what the doctor did when he took an x-ray, looked it over, and declared that my left leg had a fractured fibula. To refer to both types of statements as examples of the same thing—that is, a diagnosis—makes it more difficult to see this difference.
Consider, if you will, another situation. A few years ago I had trouble starting my Ford Pinto. I brought the car in and the mechanic provided me a theory that perhaps I needed a new starter. This, it seemed to me, was his initial theoretical diagnosis. He then inspected the starter and found that it was in fine shape. Thus, his original theory of what was wrong proved incorrect. He then theorized that my spark plugs were dirty. He took a look and found that they were indeed dirty. He cleaned them up, put them back in their proper place, and the car started right up. In the end, as far as I was concerned, he “diagnosed” what was wrong with my car as having dirty spark plugs. If the mechanic had instead just asked me a few questions, and then told me that the problem with my car was that it had “Major Non-starting Disorder,” then this to me is something very different than “diagnosing” my car’s problem.
1. “You have a fractured fibula.”
2. “You have ‘Major Inability to Stand Disorder.’”
Similarly, the DSM, by claiming it is a manual for making diagnoses, masks the difference between making the following two statements:
1. “My theory for why your car is not starting is it has dirty spark plugs.”
2. “Your car is not starting because it has ‘Major Non-starting Disorder.’”
In both of these examples, the number “1” statements offer some theory for understanding the cause for what we believe has gone wrong. The number “2” statements just restate the expressed concern about something we believe has gone wrong in some technical terminology. The DSM actually is just a classification system for expressed mental health concerns, and it would be far more accurate if it honestly said so.
A major reason why scientists classify is to speed up the process of obtaining useful information. The classification, when useful, is a labor-saving contrivance. Let’s look at an example that makes this vividly clear.
Suppose a biologist named Steve comes upon a whale for the first time. He has never seen such a creature before. He wants to learn more about it. He observes that it is a vertebrate, gives live birth to its offspring, and uses mammary glands to feed its offspring. Once this is observed, Steve can see if other biologists have collected any information on this creature by looking in a book that uses a certain classification system. By looking in the book under mammals, which has a pretty clear definition, he can save an enormous amount of time because he will not have to bother looking at all the insects, birds, and reptiles. This saves him from needlessly examining millions of specific listings—a clear time saver.
I hypothesize that there would be no significant difference between the so-called diagnosis system called the DSM and a classification system that simply classifies expressed personal concerns in retrieving valued scientific information. Individuals would not be classified, only their expressed concern. If I want to find out about any scientific studies that looked at different ways that addressed concerns about depression, in Google Scholar I can now simply put in the search engine— “depression, treatments.” Without adding the words “major” and “disorder” in the search engine, I can currently get numerous relevant hits. If the new concern classification system was adopted, soon the term “addressing concerns” would be receiving the same number of relevant hits that I now get by using the search term “treatment.” Thus, this scientific requirement would be amply fulfilled without using the search terms of “major depressive disorder” and “treatment.”
The DSM and the concern classification system would both serve a valuable scientific function—the retrieving of relevant scientific information in a time- saving manner. The accepted term for such a system in science is “classification,” not “diagnosis.” If “diagnosis” was clearly recognized as a perfect synonym for “classification” then it wouldn’t matter which term was used. But “diagnosis” indicates that something more than classification is being provided in the DSM, whereas the concern classification system would make no such claim. The concern system would not seek to present itself as something that it can’t back up as accurate. And it avoids the negative name calling of people that so many find offensive and stigmatizing.
Another Problem with Psychiatric Name Calling
Furthermore, when psychiatrists provide a so-called “diagnosis” of a mental disorder it indicates that there is something wrong with the person. This masks an alternative possibility. It is very possible that the experiences typically being diagnosed as mental disorders are more aptly construed as tools. That is, a hammer can be used to drive in nails in the construction of a life-preserving shelter or to bludgeon an innocent person to death. A car can be used to rush a child to an emergency room so that life-preserving treatment can be administered, or it can be used to tragically end a prom night. Similarly, there are numerous people who have had the experiences that are said to be diagnosed in the DSM as a mental disorder, who report that the experience ended up helping them to achieve enormous benefits; whereas, others became ambivalent, and others agree that they proved to be all bad. It may be very true that it is up to each one of us to find the wisdom to use these tools for good.
The percentage of people who report that the experiences now referred to in the DSM as mental disorders turned out to be good, bad or mixed is a question for science. Mental health practitioners when using the DSM participate in proclaiming that all of these experiences are all bad, thus masking these vitally important variations of experiences.
A scientific classification system is better when it helps us to see things of interest more clearly, rather than to mask them. The classification system of mental health concerns would serve to break us out of the DSM cloister of words and reopen us to the source of our experience.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.