Psychiatry has been criticized for using diagnostic categories that harm. Does this really happen?
Over the last decades, many criticisms have appeared against the practices that psychiatry was used to carrying out at certain moments in its history. For example, the antipsychiatry movement, promoted by referents like RD Laing, denounced an over-medication and humiliating treatment of many vulnerable people admitted to mental health centers, as well as an approach that was too focused on the biological.
Nowadays psychiatry has improved a lot and the criticisms against it have lost much force, but there are still fighting fronts. One of them is the idea that the psychiatric labels used to diagnose mental disorders are, in fact, stigmatizing, thereby making the problem worse. But … to what extent is that true? Let’s see.
Criticisms of psychiatric labels
These types of attacks directed towards the use of diagnostic labels usually start from two fundamental ideas.
The first is that mental disorders, in reality, are not anomalies that have an origin in the biological configuration of the person, that is, they are not a fixed characteristic of this, in the same way in which you have a nose of a certain shape or hair of a certain color. In any case, these mental problems would be the result of a system of interaction with the environment originated by one or more experiences that marked us in the past. Thus, using labels is unjustified, because it indicates that the problem lies with the patient as being isolated from the environment.
The second is that, in the current social context, using these names serves to place people in a position of disadvantage and vulnerability, which not only damages personal relationships but also influences the search for work, etc. In a way, it is criticized that these labels dehumanize whoever wears them, making that person pass for one more individual than those diagnosed with a certain disorder, as if everything he does, feels and thinks was the result of the disease and his existence was Fully interchangeable for anyone with the same label.
These two ideas sound reasonable, and it is clear that people with mental disorders are clearly stigmatized even today. However, everything seems to indicate that it is not the use of these labels that produces this bad image. Let’s see what is known about the subject.
The influence of diagnostic categories
To begin with, it is necessary to point out that diagnostic labels are not adjectives, they do not serve to broadly understand what a person is like. In any case, they are theoretical constructs developed by experts that help to understand what type of problems are those that the person is more prone to suffer; Having depression is not the same as having an autistic disorder and, although these categories do not tell us about someone’s personality, they help us to know how to intervene to improve the quality of life.
On the other hand, the stigmatization of mental disorders dates back many centuries before the appearance of medicine as we know it, let alone psychiatry. When these applied sciences appeared, they acted in accordance with this marginalization of minorities with disorders, but this discrimination already existed and is documented in very old texts. In fact, during certain stages of history it was believed that symptoms were manifestations of Satan and that, therefore, the proximity of a person with mental disorders was dangerous.
Beyond this fact, there is no evidence that the quality of life of the people diagnosed has worsened after passing through the psychiatrist or clinical psychologist.
Going to the tests
Is there evidence behind the claim that diagnostic labels are harmful? If there are, they are very weak. For example, David Rosenhan, one of the great critics of this practice in the field of health, refused to provide empirically obtained data to demonstrate this when asked by another researcher named Robert Spitzer.
Years later, a writer named Lauren Slater claimed to have conducted an experiment in which she feigned mental illness and managed to obtain a psychiatric diagnosis. However, she ended up acknowledging that such research did not exist.
On the other hand, much of the criticism points out that it is very easy to be diagnosed in some psychiatric category, or which is uncertain. There are cases of people who fake the symptoms and manage to deceive the medical staff, but when they stop pretending, instead of leaving the medical history as is, the observation is added that the disorder is on the way to disappear, something that it is rarely left in writing in cases of actual disorder. This fact indicates that doctors are capable, despite the will to deceive, to distinguish between severe cases and others in which recovery is progressing.
Thus, it is better to take advantage of the good side of the tools that good psychiatry offers us, while we should not be confused by believing that these labels summarize who we are.
- Spitzer, RL (1976). More on the pseudoscience in science and the case for psychiatric diagnosis. Archives of General Psychiatry, 33, pp. 459-470.