Tag: psychiatry

Dr. Thomas Szasz and Psychiatric Name Calling

Post author By Dr. Jeffrey Rubin
Post date November 17, 2014
1 Comment on Dr. Thomas Szasz and Psychiatric Name Calling

On this blog, one of the main topics of discussion is name calling. And, from time to time, some people have asked me what I think of the types of names psychiatrists use to talk about their patients.

In response, I wrote a post titled Name Calling by Psychiatrists: Is it Time to Put a Stop to it? It stirred up a great deal of interest, and the various comments led me to write several follow-up posts. While all of this was going on, several people asked what I thought of the psychiatrist, Thomas Szasz. And so, today’s post at least begins my reply.

It was 45 years ago when I first heard of Dr. Szasz. I was about 19 years old, it was the late 1960s, and I was taking an Abnormal Psychology course as an undergraduate student at Brooklyn College. Professor Meyers presented a whole class on Dr. Szasz’s recent book, The Myth of Mental Illness. It was a time when many of us were raging against the Vietnam War. Questioning all authority went right along with that, and so Szasz’s position, for me, fell right into that general mindset.

Labeling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment.--Dr. Thomas Szasz. — Labeling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment.–Dr. Thomas Szasz.

After the course had ended, I really didn’t think much about Szasz’s ideas again until about 15 years later. I was working with youth in the Corning, New York area, when I began to notice a dramatic increase in the number of young children and teenagers being prescribed psychiatric drugs. At one point, five straight foster children that were brought to me for counseling not only were taking a psychiatric drug, but were taking several of them. Those students typically were unhappy about this, complained about serious side effects, and when I went to the library to check out the various risks associated with their use, I became very concerned.

To address my concern, I began to organize a debate on the use of these drugs, and the first person I thought to call was Dr. Szasz. He was very helpful, agreed to debate the topic, and the debate created so much interest that other people began to ask me to help organize similar debates in their communities. In the end, that single debate turned into a series of seven debates.

I learned a great deal from all of the participants, but it was Dr. Szasz who most challenged my thinking. Although I disagree with some of his ideas, I admire his guts for standing up for what he believed, his humor, and his extraordinary intelligence.

Thomas Szasz passed away a couple of years ago at the age of 92.

A great deal of Szasz’s writings and ideas are readily available on line (see for example the article on Wikipedia). Nevertheless, to give my readers a little sense of his ideas, I am providing below a little snippet of his opening remarks from one of the debates that I helped to organize. It is slightly edited because he was not the first speaker during the debate and some of his comments alluded to remarks that someone else had said earlier during the proceedings. Without having heard these other remarks, Szasz’s comments would be hard to follow, so I edited them out. This gives his comments a slight disconnected feel at times, so I ask that you not blame him for that.

And so, without any further ado, I give you, Dr. Thomas Szasz:

Portrait of Dr. Szasz that hangs in the medical library at the SUNY Upstate Medical University

Ladies and gentlemen…. I would like to take this time to present my views of psychiatry ….

I believe…ideas have consequences. Words only mean what we do about them. They do not have abstract meaning. So the question is what do we mean when we say something is a disease?

Now to me, psychiatry doesn’t have to do with diseases at all. Just like, to me, communism doesn’t have to do with ideas.

Communism was symbolized by a bunch of stones called the Berlin Wall. But what it actually meant is that if you lived in a communist country, you can come in, everything was fine and you were told everything was wonderful for you, but if you tried to leave you found that they shot you, that you couldn’t get out. This is what happens in a mental hospital. You can get in, but you can’t get out….

Psychiatry is a branch of the law, it has alway been, and always will be… To me, psychiatry is coercion. I have always said, I support psychiatry between consenting adults… I am only interested in involuntary aspects of psychiatry.

For the sake of the argument, I don’t believe this, but for the sake of the argument, to make my argument clear, let’s say schizophrenia is a brain disease, just like cirrhosis is a disease of the liver. If we accept this and treat it like other diseases, then psychiatry disappears. It would then be treated by a brain doctor. The insanity defense disappears. Involuntary psychiatry disappears. If somebody kills somebody they are tried like everyone else. There are no psychiatrists lining up to testify to say Prozac causes murder, or mental illness causes murder, or everything causes murder except free will.

Ok,… let me give you two English sentences. The statement Jones is bleeding, is a statement about his body. The statement that Jones is boasting is a statement about Jones. They sound like the same type of statement, but they are not. The question, what do we mean by schizophrenia. Do we mean that they are a type of lesion, or do we mean, behavior. How does someone first diagnose someone with schizophrenia—from his body, or his behavior?

Let’s assume the person has a disease. The person is still behaving, the person is still a moral agent. Patients, from a moral, legal point of view, are exactly like non-patients. If I have asthma, Parkinson, etc., I can still behave. When people have Parkinson and they shoot somebody, they are responsible, if they are nice to their wives, they get along, if they are not so nice they get a divorce and so on.

Now we come to some more issues. Supposing someone claims that someone has a disease. On whose authority do we take this? In my lifetime, great authorities have maintained homosexuality was a disease. When I was in the US Navy 30 years ago, that was one of the major ideas of the service was to single out homosexuals, who were then given diagnoses by psychiatrists. This was viewed as a serious disease. Now, on the cover of Time we find that they are entitled to civil rights. What happened to their disease?

Not only was homosexuality a disease, so was being black according to an early psychiatrist, Benjamin Rush. According to him, blacks were blacks because they had a form of leprosy. On whose authority did he claim this? On the authority that he is a doctor?

Now we are shown pictures of brains and told that they prove that schizophrenia is a disease. On whose authority? The fact is that no pathologists diagnose anyone as schizophrenic based on any pictures of someone’s brain, or any other medical test. Even on postmortem, when the patient said to be schizophrenic dies the pathologist says no disease was found. The same thing with depression…

The discussion of who has a mental illness is based on judgements of a person’s behavior. So this idea that you can have a brain disease, like schizophrenia, is a little strange. Let me just give you a few questions to stimulate you. What would asymptomatic depression look like. Now we know what asymptomatic hypertension is, or asymptomatic leukemia,… but what is asyptomatic depression? Better yet, what is asyptomatic schizophrenia? What would that be. Or asymptomatic Judaism, or Christianity. These are behaviors. If the behavior is not there it is not here….

My time is nearly up, so let me leave you with a couple of questions. Please listen carefully because this is a question and a joke. If somebody has a delusion of having cancer, then he has a mental illness, right, because he doesn’t have cancer? What would it mean if he has a delusion of being mentally ill?

Okay, now to the issue of saying someone has a mental illness which is due to some biological basis. This is nonsense because everything we do has a biological basis… The most ordinary things are biological bases, namely eating and sex, called hunger and lust. These are not diseases. And just because they have a biological basis that doesn’t mean that you have to act. Urination and defecation have a biological basis. These are powerful impulses that have a biological basis but that doesn’t mean we have to do it in the middle of the living room…. Life begins with responsibility and ends with responsibility…. Psychiatry is a discipline that undermines responsibility. Thank you.

———————

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 intelligence. To begin at the very first post you can click HERE.

Tags free social intelligence and emotional intelligence curriculum, insults, mental disorders, mental illness, name calling, negative criticism, psychiatry, Thomas Szasz

conflict resolution DSM Name calling psychiatrists psychiatry respect The Diagnostic and Statistical Manual of Mental Disorders William James wisdom

Psychiatric Name Calling: Is Science to Blame?

Post author By Dr. Jeffrey Rubin
Post date September 22, 2014
14 Comments on Psychiatric Name Calling: Is Science to Blame?

A couple of weeks ago I raised the question, “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” In response, some blamed the insurance companies and other third party payers for the name calling. Because it is true that these payers do require the pathologizing of people seeking mental health services, in last week’s article, I took a close look at that issue.

Others responding to my question argued that diagnosing mental illness is based on the principles of science. So, let’s look at this line of thought.

The Nature of Science

Science enquires what is the nature of something? what is its constitution, origin, and history? Human beings also make enquires of a different sort, What is the object’s importance, meaning, significance, or value now that it is once here? Neither judgment can be deduced immediately from the other. They proceed from diverse intellectual preoccupations, and the mind combines them only by making them first separately and then adding them together.

As Steven Jay Gould, professor of zoology and geology at Harvard University, explains it:

“The net of science covers the empirical realm: what is the universe made of (fact) and why does it work this way (theory). The net of religion extends over questions of moral meaning and value. These two magisteria do not overlap, nor do they encompass all inquiry (consider, for starters, the magisterium of art and the meaning of beauty). To cite the usual clichés, we get the age of rocks, and religion retains the rock of ages; we study how the heavens go, and they determine how to go to heaven.”

In the natural sciences there is a branch called pathology that classifies tumors, lesions, bone fractures, tissue tears, toxic reaction to a chemical, blockage of blood flow within the circulation system, blockage within or to an organ, and microbe infections. Pathologists have reliable ways of identifying and categorizing these naturally occurring entities. When we take a science view of each of these entities of interest to pathologists, it is not a value judgment if they exist or not. If ten pathologists look at a tumor, they can all see it, describe its color, density, weight and what each of the tumor’s cells look like under a microscope.

Pathologists, as scientists, have been studying these entities and sometimes they found that some of them are associated with certain physical complaints. For example, some people complain about headaches and vision problems. When they died, autopsies were carried out and often a tumor was present that was pressing against the optic nerve.

This finding led to a theory that for people who expressed this type of physical complaint, if an operation was carried out while the patients were still alive and this type of tumor was indeed pressing on the optic nerve, perhaps removing it would alleviate the complaint. Studies were carried out and it led eventually to a valued treatment.

The connections between the research findings of pathologists gave doctors some understanding of what was causing some of the physical complaints of their patients. But often doctors could not find evidence that any of the entities of interest to pathologists were the cause of the complaint. When this occurred, most doctors merely changed the expressed complaint into some medical jargon that sounded somewhat like those concerns that had been shown to be due to a pathological condition. In such cases, they offered some treatment that was often based more on the commercial art of medicine rather than science.

These doctors usually called both types of physical complaints (those with pathological findings and those without) “illnesses” or “disorders.” By doing so, the science of medicine and the art of medicine became blurred. And then, business interests became wrapped up in the various treatment options and principles of science began to become more and more murky when applied to the medical world.

Disorders and Psychiatry

In a book titled Psychiatric Persuasion by Elizabeth Lunbeck, there is considerable documentation that back at the turn of the 20th century when the main job of psychiatrists was running insane asylums their professional organization decided to expand their market by doing two things. 1. Persuade the public that more and more normal behaviors are pathologies that require psychiatric treatment, and 2. Develop a category system that converts all psychological concerns that a person might want to get help for into a language that sounds like a pathological condition. This would legitimize the treatment of anyone who came to their office, thus the argument that the current psychiatric “diagnosis” system has become a business tool while being promoted as science.

Now, it is certainly possible to create a categorical system consistent with science for the problems that come to the attention of psychiatrists and other mental health service providers that don’t confuse conditions that are associated with pathological findings and those that are not. Such a system would classify “mental health concerns,” rather than calling people names. A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of the following topics: behavior, emotion, mood, meaning of life, managing chronic pain, work, relationships, education, eating, cognition and sleep. Two classes of mental health concerns are concerns expressed about oneself and concerns expressed about someone else.

One benefit of classifying “mental health concerns” rather than “mental disorders” has to do with inter-rater reliability. Consider being in a room with 100 psychologists, or even 100 average Joes and Jills, and a person in front of the room says she has been feeling depressed. A questioner asks the client, “Are you concerned about feeling depressed?” and the person says, “Yes.” If you asked for a survey of how many people in the room thinks the person has expressed a concern about being depressed, you would get, I believe, 100 percent agreement. Expressing a mental health concern is a specific action that people do, and therefore it is clearly observable.

Research on the inter-rater reliability of the mental disorders classification system has demonstrated that its inter-rater reliability is very problematic.

Science is Not to Blame

It is not science that is to blame for psychiatric name calling; it is the psychiatric business tool that is cleverly designed to capitalize on the public’s respect for science.

When we begin to use a classification system that does not clearly separate principles of science from values involved in business interests, other values start to slip into the classification process as well. Early on when the pathologizing of human experience was just getting underway, William James made a number of relevant comments about this.

James argued that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character” and give life “a truer sense of values.” To support his contention, James first provided three examples of famous individuals who expressed concerns about melancholy. Such experiences today, if expressed to a psychiatrist, would probably be converted into a so-called “diagnosis” of “major depressive disorder.” St. Paul, the religious figure of the New Testament, Cesare Lombrosa, a late 19th-century Italian criminologist, and Immanual Kant, the 18th-century German philosopher, became, according to their biographies, better as a result of their troubling experiences.

Although hallucinations can mean madness to some, James presented the case of Socrates who “once stood motionless for many hours in the cold and spoke of having a guiding demon.” Attempting to counter the association between pathologies and hallucinations, James stated, “Even if this demon [of Socrates] were really meant hallucinations of hearing, we know now that one in eight or ten of the population has had such an experience and that for insanity we must resort to other tests than these.”

James stated that there is no end to the possible types of obsessions that we see all around us. What benefit can such experiences have? James wrote about Henry Borg, founder of the American Society for the Prevention of Cruelty to Animals in 1866; Charles Henry Parkhurst, a Presbyterian clergyman and reformer who held a New York City pastorate from 1880 to 1918 and who launched a furious attack on organized crime in state government that led to an official investigation; Dorothea Dix, a mid-19th-century humanitarian who visited the insane asylums and successfully advocated for legislation to improve the care for those labeled mentally ill.

Later, James stated, “Individuals are types of themselves and enslavement to conventional names and their associations is only too apt to blind the student to the facts before him.”

James concluded that,

“Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another. Moreover we are all instruments for social use, and if sensibilities, obsessions and other… peculiarities can so combine with the rest of our constitution as to make us the more useful to our kind, why, then, we should not call them in that context points of unhealthiness, but rather the reverse . . . The trouble is that such writers [pathologizers]. . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity… Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?”

To illustrate what James means here, consider an article in the American Journal of Psychiatry (May, 2004), titled “Virginia Woolf (1882-1941).” Although she is described by psychiatrists as having bipolar disorder, her diaries and letters, document movingly, her emotional extremes and her capacity to savor the “ordinary rhythms of life.” At times Woolf railed against her distressing emotional experiences, felt frustrated and impeded by them, and at other times she felt it was essential to her. In diaries and letters, she returned to the question repeatedly without reaching a resolution: were her emotional experiences a terrible obstacle to her art, or were they the necessary condition for it?

For those trying to sell psychiatric drugs, a simplistic answer to this question is eagerly promoted. Science has not provided a definitive answer to this question as far as I am concerned, and throwing around phrases such as “the brain is malfunctioning in depression,” or “the brain has a chemical imbalance in depression” goes way beyond the available evidence.

Psychiatric labels are like masks held on by rubberband straps. They hide some of the characteristics of an individual. Wearing such masks may serve some purposes, but after a while they start to get uncomfortable for many, particularly around the ears. Let those who want to wear these masks be free to do so. But let those who want to meet us face to face, also be free to do so.

——————————-

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.

Tags disrespectful, DSM, free social intelligence and emotional intelligence curriculum, insults, mental disorders, mental health, mental health concerns, mental health services, mental illness, name calling, psychiatry, science, Steven Jay Gould, William James

conflict resolution DSM psychiatrists psychiatry The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: Are the Insurance Companies to Blame?

Post author By Dr. Jeffrey Rubin
Post date September 16, 2014
5 Comments on Psychiatric Name Calling: Are the Insurance Companies to Blame?

Last week, I posted an article titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” It created quite a stir and it’s currently challenging my two previous most popular posts—“Teaching Children How to to Deal with Criticism” and “Is it Wise to be Assertive?”—for the number one spot.

The article points out that by using the term “diagnosis” in psychiatric terminology it misleads people in a variety of ways. For example, when psychiatrists provide their patients a so-called diagnosis many people believe there is now a valid explanation for why they are struggling with their personal difficulties. Instead, all that has really happened is that the psychiatrist has converted the expressed concern of the patient into pathologizing language.

The manual that psychiatrists use when deciding which words to use when converting concerns to “diagnoses” is called The Diagnostic and Statistical Manual of Mental Disorders (DSM). Of course as this manual was developed there was a huge financial interest to utilize language that encourages the perception that an expressed concern is a very, very serious life-long condition that requires medical treatment for a lifetime. Consequently, when patients express a concern about being depressed, the psychiatrist informs them that they have “major depressive disorder,” and often couple this with statements such as, “This is a serious lifetime condition that must be managed for a lifetime.” Any language that suggests that there is substantial evidence that most people recover even without treatment runs counter to the psychiatric business plan.

Among the many comments that I received about the name calling article are those that point out that most of the doctors who are using the psychiatric terminology provided in the DSM are not psychiatrists. Pediatricians, general practitioners, internists, psychologists, and neurologists daily call people these names. Other comments present the argument that it is the pharmaceutical companies that promote the pathologizing of human concerns in order to convince people to ingest their drugs.

I’ll be exploring these issues in coming weeks. But today, let’s focus in on the argument that the real group of people at fault for this type of name-calling is the third party payers such as insurance companies, Medicaid, Medicare, and Social Security. After all, by far, the DSM terms are used most by these types of entities.

The DSM and Third Party Payers

Most people in the United States who seek mental health services don’t directly pay for them. Instead, they have insurance policies that cover some, or all, of the fees; or they qualify for Medicaid, Medicare, or Social Security benefits. Insurance companies and these other agencies are called third party payers.

Third party payers currently have a form that must be filled out whenever someone seeks mental health services under their plan. That form has boxes for the name of the person seeking services, his or her contact information, policy number, some information about who is being asked to provide services, and then, imbedded in all of this, is a little box that currently says, “Diagnosis.” In that box, mental health professionals must fill in the DSM code that corresponds to their “diagnosis” of the person seeking services.

Third party payers initially developed their form for people who were seeking medical services for physical complaints. Physicians would fill in the diagnosis box with a code that corresponded to a list of diagnoses in their pathology manuals based on a visual inspection of a tissue tear, the results of x-rays, blood test, or a pathologist examining a tissue sample of a tumor under a microscope. Sometimes it was based on a report from a toxicologist because it was theorized that the patient had been exposed to some toxic substance. In each of these cases, the diagnosis that was provided actually did provide some understanding for why patients were struggling with their expressed physical complaints.

However, I hasten to point out that in many cases physicians were unable to uncover the reason for the physical complaint. At such times they often did pretty much what psychiatrists do today—they converted the physical complaint into medical jargon, typically using Latin derived syllables, and then stuck them into the third party payer’s “diagnosis” box on the third party payer forms, prescribed some treatment, and low and behold, third party payers paid the doctors just like they did when a real diagnosis was provided.

A physician once confided in me that for the majority of his cases he was unable to identify the reason for the physical complaint but he nevertheless provided some diagnosis and a prescription for a pill. “If I didn’t,” he said, “my patients would feel that they wasted their money by coming to see me.” I then asked him how he felt about misleading his patients in this way. “Well,” he replied, “if my patients feel that I have made a real diagnosis and prescribed some pills, they feel a sense of being reassured and the pills can have a placebo effect which may be very curative in its own way.”

“The pills that you prescribe,” I replied, “are not simply substances with no physical effects beside the placebo effect, they have a number of real serious side effects associated with their use. Is that really ethical?”

“Well, the physical side effects often help the placebo effect because the patient feels something is really physically happening. It is part of what reassures them that what was prescribed has a powerful effect. When weighing the risk of serious side effects versus the minor side effects that can be helpful, I make my decisions on what to prescribe.”

And so, that’s a little of my understanding of the reasoning behind this type of misleading name-calling and prescribing practices of physicians dealing with physical complaints. I prefer honesty. However, for those who prefer this fatherly treatment that is mixed with huge financial interests, I’m advocating that they continue to get what they want.

Now, once third party payers began to provide coverage for mental health services, their administrative forms didn’t have to be changed. There was already a precedent for placing in the “diagnosis” box on the form fake diagnoses, and psychiatrists seeing that this business model was a source of a great deal of money created the DSM.

What would be a Reasonable Alternative to the DSM?

For those who prefer to be treated honestly, can an alternative to the DSM be developed?

The alternative I’ve been working on is called The Classification and Statistical Manual of Mental Health Concerns, or, for short, the CSM. With this approach, no individuals would be classified, only their expressed concerns.

With the CSM proposal, all that we would be asking insurance companies to do differently in order to add value to their customers, is to slightly change that little box that currently requires a diagnosis or a word pretending to be a diagnosis. Instead of just saying “Diagnosis” as it currently says, that box would just add two little words, so it would end up saying “Diagnosis or Concern.” Then, when mental health professionals fill in the box, they would be given the choice to either write in the letters DSM and its code number that corresponds to its so- called diagnosis, or they would write the letters CSM and its code number that corresponds to the expressed concern.

The cost and efforts for insurance companies would be minimal, and we would have numerous testimonials from customers that documents that this change would be viewed as a significant improvement.

Now, some of the insurance company executives might pause and say, “Wait a minute. You’re asking us to permit the use of the CSM as an alternative to the DSM. Just wait a minute. The DSM has been developed by mental health experts and is backed by a major mental health professional organization—the American Psychiatric Association. Does the CSM have that type of authority to back it up?”

If we prepared for this, we will be able to answer that the CSM was also developed by mental health experts and does have several mental health professional organizations backing up its use as an alternative to the DSM. I believe this can be achieved. We have in our alternatives group several people who would qualify as mental health experts, and I think we can get some more involved as well. And when the latest edition of the DSM was released several professional organizations expressed a strong desire that an alternative to the DSM be developed. I think it’s reasonable to assume that at least some of them would agree to back this alternative, especially if we involve them in its development.

In short, the creation of the CSM would permit us to present to insurance company executives and other third party payer administrators a real alternative to the DSM. It would be virtually cost free for them to permit its use, it would have the authority of being developed by experts in the mental health field, the backing of mental health professional organizations, and it adds value for a significant number of their customers.

The CSM Would also Help Mental Health Service Providers

Now, besides the insurance companies and other third party payers, the other big group of people in America that is currently using the DSM is mental health services providers. How would they react to being given the choice to replace the DSM code with the CSM code on third party payer forms when they felt in their professional judgment that it was appropriate? Well, we get a little sense of what their reaction would be from a survey Paula Caplan tells us about in her book, They Say You’re Crazy. According to this survey, over 70 percent of those practitioners who responded to the survey said that the only way they use the DSM is to fill out the insurance form. Other than that, it doesn’t help them at all.

To those who believe that the use of the current DSM terminology helps to enhance the placebo effect of treatment, keep in mind that this is a testable theory. We can arrange for studies that compare the outcomes of service providers that utilize the DSM coding system with service providers that employ the CSM coding system. But that would be an approach that employs basic principles of science, rather than unsupported claims backed by enormous financial interests.

——————————-

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.

Tags disrespectful, DSM, insults, insurance companies, mental disorders, mental health, mental health services, mental illness, name calling, psychiatric disorders, psychiatry

conflict resolution Name calling

Name Calling by Psychiatrists: Is it Time to Put a Stop to it?

Post author By Dr. Jeffrey Rubin
Post date September 8, 2014
55 Comments on Name Calling by Psychiatrists: Is it Time to Put a Stop to it?

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.

The DSM, by claiming it is a manual for making diagnoses, masks the difference between the following two statements:

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.

Classification

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.

Biology Example

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. In an article that I published in The Journal of Humanistic Psychology, I fully explain this concern alternative (see HERE).

Briefly, with the concern approach 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.

Tags criticism, DSM, insults, major depressive disorder, mental disorder, mental health concerns, mental illness, name calling, personal concerns, psychiatry, The Diagnostic and Statistical Manual of Mental Disorders