The Many Problems of Psychiatric Diagnoses

When I was in graduate school I developed an intense interest in the many varieties of psychiatric diagnoses. I immersed myself in textbooks, research articles and case studies to learn about all the many types of mental illnesses. I gained a deep appreciation for the value of a proper diagnostic understanding in order to determine what kind of treatment a person needs to regain 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:

Psychiatric Diagnoses are Inherently 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 determining whether a certain set of symptoms should be grouped together to form a diagnostic set. Factions for and against different diagnostic conceptualizations have fought each other for control, often resulting in diagnostic compromises to obtain a consensus of what it means to have a certain illness. It's a process that's disturbingly similar to how the govenmental budgets or laws are cobbled together: one faction will support another in exchange for similar favors in return.

The ability to determine what is normal and what is deviant contains the potential for exerting tremendous social control upon the average citizen .  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, it was barely a generation ago that homosexuality was officially labeled as a psychiatric disorder.  Whoever controls the definition of words such as "normal" or "healthy" has the ability to exert control over the rest of society.

Many Psychiatric 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.

Psychiatric Diagnoses Are Stigmatizing

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 once their diagnosis is filed with their insurance company, it enters the data base of the Medical Information Bureau and will be accessed by any prospective insurer with whom you may apply for benefits in the future. People are often denied life or health insurance coverage simply for having mental health-related diagnoses in their claims histories.

Psychiatric 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.

Psychiatric 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 people. 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 in no way proposing that biochemical issues don't exist but they are often not the only or most effective way to address what's wrong in a person's life.

Psychiatric Diagnoses Inherently 'Pathologize' People

By their very definition diagnoses examine what is wrong with a person rather than what is right.  They guide the focus of treatment on examining problems rather than building on strengths and resources.  This approach is less a "mental health" than a "mental illness" model.  This is an inherently imbalanced and narrow approach to examining the complexities and rich nuances of a person's life.

In conclusion, treatment providers 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,etc.  And people seeking help for personal problems need to be careful about allowing therapists or insurance companies to use psychiatric diagnoses in the absence of a highly compelling reason.

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Bill Herring LCSW, CSAT provides private professional counseling, psychotherapy and consultation services in Atlanta.  He specializes in situations involving problematic sexual behaviors that violate a person's promises, values and/or self-control. Examples include chronic infidelity, excessive porn use and cases involving sex or porn addiction. Appointments can be scheduled by calling or using this form.