April 8, 2002
The Damage of Labels: DSM-IV
It is useful for everyone to know about the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). This huge bible of a book is published by the American Psychiatric Association. It was supposedly created to assist psychiatrists, medical doctors, and psychologists in diagnosing mental illness. Each diagnostic category (and there are hundreds) has a code number and a list of possible symptoms. With the label and a number, the specialist can easily keep records, fill in medical insurance forms, and find indications for treatment.
A sample of the diagnoses can be found at www.behavenet.com
With the DSM-IV, a diagnosis begins by gathering verbal accounts from the patient and/or family, and searching for a disorder that seems to match the problem. In each section, there is a list of possible symptoms - a "multiple choice" checklist that requires, for instance, "five (or more) of the following symptoms. . . " to achieve a positive diagnosis. If, in this case, five or more items are checked off, the client is categorized with a diagnostic label and a number. Here are some examples:
Or, if the specialist isn't sure:
300.9 Unspecified Mental Disorder
Then, with that label and code, various publications, websites, and pharmaceutical advertisements can be consulted that list the recommended treatments for that code number. Most of the choices are medications. In fact, thanks to the DSM-IV, the drug companies actively get their chemists to design drugs to fit the defined and coded disorders.
It's so fast and easy. In fact, to make it easier, there are computer "patient interview" programs available that not only make the diagnosis for the specialist, but also prescribe the medication! And if the patient doesn't agree with the diagnosis and treatment - that is also conveniently classified as a disorder:
V15.81 Noncompliance With Treatment
All doctors, including psychiatrists, take the Hippocratic Oath, which states "Do no harm." I believe that the DSM-IV diagnosis protocol, itself, violates that oath.
When people are labeled in this way, it does them harm. It is a judgment on their person, their character, and their value. It is a subjective opinion that places them under the control of so-called experts and will haunt their personal record for life.
In the wake of such a judgment, clients often conclude that there is something fundamentally wrong with them. Such a message can injure self-esteem, increase a sense of despair, depress the immune system, and endanger physical health.
We are not numbers. We are not labels. Our problems cannot be reduced to lists and multiple choice. To objectify people and treat them with such a lack of feeling is, in my opinion, a serious disorder of its own.
People already know they have problems - that's why they come for help. They don't need labels, they need understanding. Since emotional issues are a whole-person phenomenon, their causes and healing cannot be reduced to single categories. In fact, labels, by falsely simplifying, obstruct the healing process.
Professionals argue that they need the criteria and a common diagnostic language in order to discuss and act on the many "cases" they have to process. This is itself an indictment of the assembly line mentality of modern health care. If specialists took the time, and treated those in their care as people - not just cases and numbers - greater healing would take place at a lesser cost, without the need for numbers and labels.
"The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. You feel like Italian, I feel like Chinese, so let's go to the cafeteria. Then it's typed into the computer."
Dr. Paula Caplan,
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"Given their farcical empirical procedures for arriving at new disorders with their associated symptoms lists, where does the American Psychiatric Association get off claiming a scientific, research-based foundation for its diagnostic manual? This is nothing more than science by decree. They say it is science, so it is."
Dr. Margaret Hagen, Ph.D.,
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'There are too many diagnoses without any objective basis or biological support,' said Dr. Pearlman, a psychiatrist in Houston."
"There has never been any criterion that psychiatric diagnoses require a demonstrated biological etiology' [cause], said Dr. Harold Pincus, vice chairperson to the DSM-IV task force. 'In fact, virtually no mental disorder, except those that are substance induced or due to a general medical condition, has one."
"The manual is also taken too seriously by the rest of society - including the government, the courts, the hospitals, and insurance companies,' said Dr. Suriff, a clinical psychologist at the Massachusetts Institute of Technology in Boston."
Excerpts from an article printed in Clinical Psychiatry News
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"Research has yet to identify specific biological causes for any of these disorders. Mental disorders are classified on the basis of symptoms because there are as yet no biological markers or laboratory tests for them."
The U.S. Congress Office of Technology
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"Mental illness is a metaphor (metaphorical disease). The word "disease" denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term "mental illness" refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors) like societies with economic diseases (bad fiscal policies) are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment."
Thomas S. Szasz, M.D.
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". . . modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. . . Patients [have] been diagnosed with 'chemical imbalances' despite the fact that no test exists to support such a claim, and. . . there is no real conception of what a correct chemical balance would look like.
Yet conclusions such as 'depression is a chemical imbalance' are created out of nothing more than semantics and the wishful thinking of scientist/psychiatrists and a public who will believe anything now that has the stamp of approval of medical science."
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"There's no biological imbalance. When people come to me and say, 'I have a biochemical imbalance,' I say, 'Show me your lab tests.' There are no lab tests. So what's the biochemical imbalance?"
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"Contrary to what is often claimed, no biochemical, anatomical or functional signs have been found that reliably distinguish the brains of mental patients."
"... many are not aware of the enormous influence that the [pharmaceutical] industry has in shaping our views of mental disorders and the effectiveness of psychotherapeutic drugs..."
"I am convinced that the pharmaceutical industry spends enormous amounts of money to increase its sales and profits by influencing physicians and the pubic in ways that sometimes bend the truth and that are often not in the best interests of science or the public."
Dr. Elliot Valenstein
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Many of the above quotes courtesy of: http://www.ritalindeath.com