The Damage of Labels: DSM-IV

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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:
300.0 Anxiety Disorder
309.0 Adjustment Disorder With Depressed Mood
300.19 Factitious Disorder
300.21 Panic Disorder With Agoraphobia
301.6 Dependent Personality Disorder
311.0 Depressive Disorder
314.01 Attention-Deficit/Hyperactivity Disorder
315.1 Mathematics Disorder
780.9 Age-Related Cognitive Decline


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.

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Quotations:

"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,
Psychologist
Author of They're Making Us Crazy, commenting on the American Psychiatric Association's 1987 hearings into DSM.

* * * *

"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.,
Professor of Psychology
Boston University

* * * *

'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

* * * *

"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

* * * *

"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.
Professor of Psychiatry Emeritus
State University of New York,
Author of 25 books
http://www.szasz.com

* * * *

". . . 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."

David Kaisler
Psychiatrist

* * * *

"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?"

Ron Leifer
New York Psychiatrist

* * * *

"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
University of Michigan Neuroscientist
Professor Emeritus of Psychology
Author of Blaming the Brain: The Truth about Drugs and Mental Health

* * * *

Many of the above quotes courtesy of: http://www.ritalindeath.com


http://www.primalworks.com/thoughts/thought020408.html

Life is a disease. Everybody is disordered.

Don't you wish you could rate posts and comments? I'd give you a 5 out of 5 for speaking the truth. *****

You could look at it that way, or you could be more optimistic about labels. My son being diagnosed autistic doesn't make any money for drug companies, he doesn't go to the doctor any more than usual. Actually, he has an outstanding immune system, so he might go less often. Without his label, we'd be wondering why he didn't understand us or do what we tell him. Treating him like an NT would get us nowhere. Understanding labels helps us understand ourselves and each others.

The problem is expecting cures. The problem is interpreting "disorder" as something that needs to be "fixed".

A diagnosis for my son doesn't get us fancy therapies, it gets him accomodations at school, so he can attend with his NT peers.

The DSM doesn't mandate treatment or fixing disorders, it is a tool to understand them. Can it be abused? of course

I have sought treatment for depression, during this time I have never been offered medication for it. Some people do need medication to address real chemical problems in their brains. Labels can help prevent the wrong drugs going to people that can be harmed. For instance, autistics were often diagnosed with schizophrenia and then medicated for that. A better label would prevent that. Some people even report that OTC meds like cold/cough meds work differently in autistics.

One of the 'experts' at the place I was diagnosed was making pretty damning assertions about the DSM and how it came about. Says it's largely driven by pharmaceutical companies, and the hope of funding for scientists pursuing "new and interesting" ailments. If they eek out a place in the DSM, they've got themselves a permanent ticket on the gravy train.

He didn't phrase it quite so cynically; that's me paraphrasing.

Actually by defining him as *autistic* you're limiting him, you and your experience of him. He's not a set of diagnostic criteria - it's not going to make things easier for him to know he's autistic. Where on earth did you ever hear that? On the contrary, kids feel horrible being labeled. And if they don't put up a fight about it, it just means their fire has been extinguished and they have no more energy to fight the stigma/society/parental force. Every child is unique - every child has their own set of characteristics unlike any one else before or after. It is that knowledge that needs to be embraced, and through that understanding to nurture and educate. A label will not give you insight into the mind of your child, simply because no scientist can ever know the mind of your child and no DSM diagnosis will ever come even close in understanding the heart of your child and what he truly needs. Only YOU and HE can know this and it's only through ~connecting~ that you can do it. And that label? It's just another barrier that separates you from understanding without prejudice.

KimJ, I argued some of the same points you have made to some hippie who gave me a video titled "Psychiatry: An Industry of Death"(It's a propaganda film, but many of its claims are true and can be proven. Like anything, be sure to critiscize its contents if you watch it, as it is clearly coming from a biased perspective).

I don't think pyschiatry is an inherently evil or malicious industry. I just think the prevalence of abuse is extremely high today and much of it is the fault of gullible parents who will take anything a 'specialist' says at face value, putting their children on dangerous drugs for real or imagined disorders.

However, courts have also ordered people to undergo treatment and drugging, even when there were other problems to address that the drugging wouldn't fix.


I recall reading somewhere that today, 1 in 5 Americans are consideered 'mentally ill'? I could be wrong on this statistic, but I do believe that it is way abnormally high to the point that many Americans are being treated for minor personality quirks(sometimes forcibly, as is often the case in children) as opposed to serious illnesses. Many of these drugs are addictive and cause problems when one tries to cease use of them.

Some people have the opinion that ADHD, a commonly treated 'disorder', is completely made up as a category to throw less manageable children and individuals onto medication.


It is documented fact that the authors of the 1994 issue of the DSM-IV all had financial ties of some form to the pharmaceutical industry, which by itself is frightening.

While psychiatry itself has many good uses for society, it is also causing untold damage and is a relatively corrupt industry. It is unscientific as well(but it would be nearly impossible to make such a study scientific. After all, many measurements we try to form on people are not quantifiable in numbers today, and may never be, so I can't really fault psychiatrists for this).



I think labels do have some use and validity, but should be used for cases where the life of the person is in danger. It is true that labels won't accurately quantify the person and can't come close to describing them, but they do indeed have a use for treating people and some people have actually seen benefits from treatment.

The problem is that these things can't yet be quantified. What humans don't understand, they make myths and tales about, and I think psychiatry has largely succumbed to this.

And if you watch the film, some of those interviewed interject religious values into the points they bring up. Specialists caqn be chrry picked to exemplify certain points over others to, and just as there are psychiatrists and doctors who are inherently biased in favor of big pharma for their own benefit, there are also those who are inherently biased against the industry of psychiatry due to an emotional need to be right.

The truth? It's something each person has to decide for themselves. I think the facts peak for themselves and that perhaps 90% of the video is correct and factual. The opinions of it count less to me than the raw statistics, but I also realizer I'm making a fallacy in trusting the statistics because they can have their own inherent biases in their recording("There are lies, damned lies, and statistics." ~Mark Twain).

The CCHR is one of the Church of Scientology's front groups, and much of their publications have had an agenda matching that of their creator. This is not to say the CCHR is bad or evil or should be ignored(in fact, I personally think they have been more trustworthy on this topic than the pharmaceutical and psychiatric industries by far), but is to say like anything, critique it, critiscize it, try to find its faults.


I realize my own views may in fact be incorrect(even if I don't think they are), but that's just a part of being human.

No where in the Hippocratic Oath will you find "do no harm". That's a common misconception.
But that's beside the point.
I agree that labeling people is dangerous in general. It can lead to things like self pity and excuses.