What is in a Name: One Psychiatrist’s View of Psychiatric Diagnosis

Sandra Steingard, M.D.

March 25, 2012

There has been a lively discussion on this site revolving around the question of whether one believes in mental illness. As I understand the conversation, it is not so much about the question of the existence of altered mood or cognitive states but more about whether these states constitute an illness or a disease state. In these discussions, the concept of psychiatric diagnosis is often disparaged.  I read these blogs and discussions with great interest and have tried to formulate my own response.  As a physician, I live in the world of diagnosis. I am no fan, however, of the Diagnostic and Statistical Manual (DSM) and yet, for many reasons, I can not escape it.  With apologies if this seems overly defensive, I decided that I would start with my conclusion in order to be clear about where this essay is heading.

What do I tell my patients about diagnosis?  I try to explain what a diagnosis is and is not. It is a label that reflects that the person has reported certain symptoms. It is a label for the symptoms not for the person. It might indicate what treatments could be helpful since treatment recommendations are informed by studies that included people who had similar symptoms.  It does not explain to me why the person has those symptoms.  It does tell not me if the person can or can not get well.  It does not tell me that there is some permanent defect in that person’s brain.  It does not tell me about the person’s family or life experiences. It does not need to dehumanize the person unless we give it that power.

The modern version of the DSM is considered to be volume III which was published in 1981. By most accounts, this was as much a political document as a scientific one. I was just starting out as a psychiatrist when the DSM III was introduced. I knew then and I know today that this classification system was in many ways a construct that was somewhat arbitrary.  Giving someone a diagnosis did not signify that I had obtained a deep understanding of what was wrong with the person.  It offered the advantage of improved consistency in communication.  When I used the label schizophrenia to characterize a patient’s symptoms, I had a better chance of matching the label a colleague would use with the same patient than I might have had with earlier versions of the manual. This is helpful when studying and comparing treatments be it vitamins, psychotherapy, or drugs.  Anatomy of an Epidemic would have been a less powerful book if earlier researchers had not made good attempts at clarifying the diagnoses of the people they were treating.

Even diagnoses that appear to be connected to a clear etiology are limited.  For instance, Post Traumatic Stress Disorder is a diagnosis based in part on a history of trauma.  However, in my experience, I have met people who have experienced trauma who do not have the particular symptoms included in the category of PTSD.  I know some people, for example, who hear voices after traumatic experiences. The label I might use is schizophrenia but I still believe the trauma has played a role in the development of those voices.

Another limitation to the DSM is that it considers diagnosis in a categorical manner; one has a condition or one does not.  This does not fit my own experience nor does it fit the research.  Peoples’ problems often  do not fall into the diagnostic boxes of the DSM. On this website, there were recent postings about the presence of psychotic symptoms in the general population as well as in those diagnosed with depression or anxiety.  In one study, for example,  27% of people diagnosed with anxiety or depression had one or more psychotic symptoms even though these are not considered to be symptoms of most depressive or anxiety disorders (1).

So what do I tell my patients?  I try to explain what a diagnosis is and is not. It is a label that reflects that the person has reported certain symptoms. It is a label for the symptoms not for the person. It might indicate what treatments could be helpful since treatment recommendations are informed by studies that included people who had similar symptoms.  It does not explain to me why the person has those symptoms.  It does not tell me if the person can or can not get well.  It does not tell me that there is some permanent defect in that person’s brain.  It does not tell me about the person’s family or life experiences. It does not need to dehumanize the person unless we give it that power.

1. Wigman,JT, et al., “Evidence that Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depresion, Impacting on Illness Onset, Risk, and Severity – Implications ofr Diagnosos and Ultra-High Risk Research.” Schizophrenia Bull (012) 38 (2): 247-257.

Sandra Steingard, M.D.

Anatomy of a Psychiatrist: Dr. Steingard chronicles how she is integrating information from Anatomy of an Epidemic into her community mental health practice. She also discusses changes in Vermont’s mental health system and the influence of pharmaceutical advertising on clinical practice.


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58 thoughts on “What is in a Name: One Psychiatrist’s View of Psychiatric Diagnosis

  1. Hi Sandra,

    I’m glad you wrote on this topic and appreciate your candid words. Since I don’t believe in mental illness, as a viable or accurate definition of human emotional suffering and madness, I don’t see people’s subjetive experiences or their behaviors as symtopms of a disease or illness process either.

    When you wrote above about obtaining ‘a deep understanding of what was wrong with the person.’- I remembered how important that was when I was a medical corpsman for 8 years in the military.

    But my own experience of madness and serving folks in emotional pain and madness for over 30 years, has led me to believe that the physical, medical practice of treating illness doesn’t translate accurately or effectively into responding to other’s emotional pain and madness- that can better be viewed and described in common terms like broken hearts, broken spirits, devastating self loathing, abject terror,the feeling of soul violation and devaluation that comes from of every form of abuse, and the devastating experience of uncontrolable rage- or a grief so intense that it feels unendurable.

    Responding to people that way, through sharing our common humaniity by viewing and naming their experience as not symptomatic or wrong or ill, makes them feel not alien and isolated in their pain. Then we can give open hearted love and compassion that really is the best medicine.

    • Thank you for your comments. Since reading what you and others write, I have tried to be more sensitive and careful about my language. I thank you for helping me to understand how certain words are epxerienced in a way that I might not have intended.

      • You’re welcome Sandy, we are comrades here in trying to find better ways to understand the vocations we serve. It’s a daily challenge for me. I have gotten allot from reading your very thoughtful and heart filled blogs. Thank you.

    • I can only second what you say above, Michael. When people talk about emotional difficulties, is it a symptom of an illness or a disorder, or is it a “symptom”, metaphorically understood, of going through the human experience? Usually, which lands people in a psychiatrist’s office, is not being able to make sense of this their human experience. They don’t know who or what they are, and they don’t understand themselves. Is that a disorder, or is it maybe the very essence of the human condition? Emotional suffering is a “symptom” of being an unconscious, imperfect human being on a quest for consciousness and perfection. So, basically, we’re all psychiatrically disordered in as far as we’re not “God” = pure consciousness in perfection. We all suffer from PTS (no D, as it, in fact, is no disorder to react to life, but indeed a strength: life that doesn’t react is not fit for survival), and struggle to overcome it.

      IMO, in order to be of any value, psych labels should either only be one: “human being”, or they should be just as individual as the person, i.e. one individual label for each and every individual on this earth. However, the question is whether it actually is helpful for the individual (as well as for humanity on the whole) to have their quest for themselves labelled a disorder, a flaw, something that is wrong with them, and needs “treatment” (and isn’t it just logic that the “treatments” this thinking has resulted in usually prevent the individual from searching any further and becoming more conscious, and often even reverse any growth process, rendering the individual an on all levels, cognitively, emotionally, spiritually, etc. as well as physically disabled empty shell?), or whether it maybe would be of greater help to focus on what is right about this quest. I know that to me it was definitely the latter which was helpful, while it was the former that regularly had me feel utterly disempowered and helpless. The same I see to be true for the people I work with.

      • Hi Sandy,

        Thank you for expressing your views as a psychiatrist. I would like to echo what Marian and Michael have expressed so well as one who got many labels. Whether we like it or not the labels have come to express the person. They are not diagnoses people take on gladly. They help to destroy the very selfhood we all aspire to possess. They increase hopelessness and helplessness. They assume that ‘mental illness’ does indeed exist. They seperate those who are supposed to have ‘ mental health’ from those who have not! They dehumanize, even if you don’t want them to, because like criminals, we are not innocent until we are proven guilty. While ‘mental illness’ exists, all humanity is at risk!

  2. Thanks for this well-written and convincing text. Your balanced and pragmatic approach to the DSM seems to be very close to what Allen Frances (chair of DSM-IV) said in “DSM in Philosophyland: Curiouser and Curiouser” available at
    http://alien.dowling.edu/~cperring/aapp/bulletin_v_17_2/Vol17N2.pdf

    It looks to me an interesting read when the chair of the currently used DSM-IV says: “Biological psychiatry has failed to produce quick, convincing explanations for any of the mental disorders.” and “mental disorders don’t really live out there waiting to be explained. They are constructs we have made up – and often not very compelling ones at that.”

    • Thank you for your comment. I also appreciate your sharing this link. I am familiar with this issue. There are a number of excellent essays and it demonstrates that I am not alone among my colleauges in my critical view of the DSM.

  3. Once a psychiatrist labels you— even if that psychiatrist only saw you twice (to give you a prescription, then to label you according to your response to that condition)— most subsequent mental health professionals don’t really need to know anything else about you.

  4. Re: psychiatric labels, you wrote:

    “It does not need to dehumanize the person unless we give it that power.”

    IMO, we have unfortunately already given some of these labels the power to dehumanize, by the “treatment” that accompanies the label, often by force with some of the more “severe mental illnesses”… In other words, the term “schizophrenia” comes with a very ugly past, and has political and legal implications… It has been given power already in our culture… We need not give it any more power by continuing to use the term.

    I’m for tossing the labels. They seem to cause more harm than good for the vast majority… much like the long-term use of psychotropics.

    Duane

  5. I’m all in favor of tossing the labels, but that would mean tossing out psychiatry as it is currently practiced (in the mainstream). What would Dr. Stein, if I can use her as an example, write as a prescription? Would the insurance companies cover “human being, trauma NOS”? Perhaps, but then Dr. Stein would have to completely revamp her practice. It would be like a surgeon having to retrain as a dermatologist after losing the use of her fine motor skills. Psychiatric labels are like surgical tools to a surgeon. So, while I applaud Dr. Stein because she is trying to come to grips with what’s going on with the movement to de-label human mental suffering, the labels are useful to her- and other psychiatrists – as it now stands. I appreciate that she explains to her patients what the diagnosis is and is not, but once the “S” word has been uttered, as in “schizophrenia,” life on earth as that person hopes it may one day be is over. The “S” word is the Bates Motel and Anthony Perkins and every young man who makes headlines for mass murder. You can’t put the diagnosis back in the bottle once it’s been said. You’ll never get rid of it, even if your doctor says it really doesn’t determine much about you. Your relatives will hear it loud and clear and they will react not very well. They will think their lives are over, too. Try asking a psychiatrist to “un-diagnose” you after you have recovered. What am I supposed to tell my son about filling out a medical form when he eventually has a chance at a job? That the label doesn’t really mean anything?

  6. Well said Rossa! Like you we are struggling with the S diagnosis. My son was diagnosed even though his psychosis was due to olanzapine withdrawal he should have never been on. I explained the circumstances carefully. The psychiatrist didn’t believe me. We didn’t ask for a diagnosis, we asked for something to help him sleep and get off the olanzapine alltogether. He got diagnosed instead and although he managed to get off the antipsychotics without medical help and he is well, his diagnosis stands and the mental health services are pursuing him: “Big brother is watching you” because it states on his medical notes that he is suffering “from severe mental illness”.Psychiatrists refuse to undiagnose him. They dont like to be in the wrong

    • Psychiatrist are lying when they say they don’t hear voices. Everyone hears voices but we are supposed to say we don’t. Angel on one shoulder, the devil on the other and we decide which one to listen to. If we didn’t hear voices of imagination , we would be very stupid and be unable to solve problems.

  7. Thanks to everyone for this discussion. My approach: our way of describing what is commonly called “psychiatric disorders” should be based on what we actually know, with as few assumptions as we can make. And from that perspective, DSM and all current “diagnostic criteria” are failures.

    What DO we know?

    1) Just about everyone struggles with some form of emotional, cognitive or behavioral problem (something either the person her/himself or someone else sees it as a problem/wants to change). Such problems can generally fall on continuums of various dimensions – global/specific, time limited/intermittent, distressing to the person involved/not so much, etc.

    2) There are lots of possible explanations/factors contributing to the genesis and continuation of the problems, as well as ways to change them: my overwhelming vote is for looking at them in terms of psychosocial factors in many different forms (personal experience and relationships, group psychology, culture, sociology, economics, politics). Many people opt for religious/ spiritual or philosophical explanations – I can go there myself, but lean more toward the psychosocial. Bio-psychiatry opts for the extreme reductionism of medical model physical disease states.

    3) I have read that there are more potential states among our 100 billion neurons (with thousands of different potential connections for each cell) than atoms in the known universe – not to mention the 100 billion glial cells and over 100 different chemicals in the brain (and the body) that influence all these. This makes humans the most complex entities in the known universe. It also means nobody really knows how and why we feel, think and act.

    So there’s plenty of room for all of us to explore these questions, from all the perspectives mentioned above. The problem comes when any perspective makes assumptions that extend beyond actual knowledge, claiming their conjecture and assumptions are fact.

    3) This is where bio-psychiatry and DSM and “diagnosis” goes wildly off the rails: they ASSUME our “problems” are disease states, but claim that as fact; they refer to brain “wiring” when that is patently untrue, and the mere use of the word prejudices the discussion in the direction of a mechanistic explanation; they refer to “disorders,” conveying the impression of a scrambled machine and ruling out explanations in terms of human problems being rational, understandable responses to problems of living; they tout explanations based on the “brain,” when in fact to date NONE DSM-defined “mental illnesses” can be “diagnosed” by any physical lesion or condition, and our understanding of the brain, based on color enhanced scans etc. is less than rudimentary compared to what there really is to know; they (and most of us) refer to emotional/cognitive/behavioral problems as “mental illness,” which in itself unjustifiably steers us in the medical model direction.

    The DSM is nothing more than a self-serving promotional manual written by a particular discipline. Psychologists, social psychologists, social workers, sociologists – all the disciplines named above could have (and maybe should have) written their own manuals promoting their own assumptions (only I hope not as dishonestly as the drug money influenced bio-psychiatry did). That way it would be clear that these problems can’t be automatically called “psychiatric” any more than they should be exclusively called “sociological,” “spiritual,” “economic,” or “psychological.” All we really know is that someone thinks they are problems and there are many ways of looking at them

    Back to the honest psychiatrist, psychologist, social worker, counsellor, religious advisor in her/his office, referring to a “DSM diagnosis.” The best thing to say is, “This is one way of looking at the reason you came to see me. It is by no means the only way. My own preference is for X point of view, and if you are comfortable exploring that point of view, along with your own, let’s get started. I don’t assume that the DSM characterizes you or your problem at all – the only thing we can be sure of is that insurance won’t cover what we do here unless I give them a DSM label for you – but my belief is that label has no clear use besides insurance reimbursement.

    • Thank you for this post. It is one of the best things I’ve read about all of this in the past year. If I could figure out how to make my computer print out your particular post I would for it is worth saving and sharing with others. However, my computer keeps many secrets to itself and will not allow me to do as I wish!

      Thanks again!

    • This supposed innocent explanation that without the life destroying bogus but deadly stigma, insurance won’t pay, the victim should be urged out the door before his/her life is destroyed by this permanent stigma on their record for life that will likely negatively impact their career, ability to get various types of health and life insurance, put their civil, democratic and basic human rights at permanent risk with the threat of being falsely accused, involuntarily committed and forcibly poisoned and shocked with the pretense of treatment when the goal is intimidation, punishment and torture to discredit, silence and disempower the victim in relationship to the more powerful and probably abusive people in his/her life. Thus, the victim should be given informed consent about the science behind bogus DSM stigmas or lack thereof per Dr. Paula Caplan cited here and the damage they and their treatments do to the victim’s life. The victim caught in this web of deceit should be allowed to pay out of pocket for education about toxic psychiatry and be allowed to leave unharmed and unlabelled. Of course, this won’t happen, which is why books like Dr. Peter Breggin’s TOXIC PSYCHIATRY are so critical to one’s survival, freedom and human rights in our increasingly Orwellian society.

  8. I’ve been trying to make a similar case for a long time. the DSM describes clusters of symptoms insofar that that those clusters of symptoms can be addressed by treatment in possibly more helpful ways than others. They do not describe a person, should not be used as a lifelong label, and should disappear when someone no longer experiences such symptoms.

    Now to only get other mental health services providers, the legal system, insurance companies, and school systems to agree.

  9. Thank you for all of the comments. I certainly agree that we should try to stick with what we actually know. I also would favor a more dimensional approach that just focuses on symptoms and/or domains of function. Perhaps it is time for the “s” diagnosis to be retired. Words do count and this diagnosis is so misunderstood and maligned (does it bug anyone else when this word is used to describe the weather?).

    • Dear Sandy,

      I really do like the fact that you are willing to rethink the labels. You also said, “Words do count and this diagnosis is so misunderstood and maligned (does it bug anyone else when this word is used to describe the weather?).”

      My answer to your question is that I have evolved. I used to want to “protect” my son from hearing the “S” word mentioned, and then I realized that I hadn’t gotten over the label. If I feel insulted by the word, then maybe I am buying into the diagnosis. “Schizophrenia” is an interesting word, and as such it really doesn’t convey ill will, it carries a meaning of “radically changing positions/thoughts at the drop of a hat.” I have developed a thicker skin and can even find humor where humor can be found in the labelling. I laugh, hoping that my son will also pick up on the absurdity of it all. Actually, the word has been banished from our house, but I can’t tune out the media. The “S” word has a different meaning when it is screamed across the front pages of newspapers in connection with, e.g. mass murder. “Schizophrenic off his meds kills 15 people!” I certainly don’t want my son to think that if he isn’t on meds, he is a danger to society. I don’t want him to think that he is truly sick. “Schizophrenic weather” I can deal with (slight cringe), but I really resent the term when it is applied to people.
      Thanks for an always interesting and honest post.
      …Rossa

      • There are a couple of things I find interesting in the DSM discussion.
        One is that psychiatrists try to give up labeling people, but it happens anyway. I can see how psychiatrists are just as caught in the system as “patients.”

        The tail is wagging the dog, because the psychiatrist has to go by the book in order to make a living.

        My diagnosis has morphed over the years through many of the labels in the book. This happened in part because I changed doctors, providers, etc., but they do follow me.

        The strangest change was when it went from Schizophrenia to Schizotypal Personality, to a nice compounded Schizoaffective Disorder. That recent one made me realize “they” didn’t know what to call “me”.

        The Us vs. Them is the biggest problem in labeling. The psychiatrist is safely on his/her side of the Line of Sanity. How is a “patient” supposed to trust a psychiatrist who automatically elevates him/herself above us just by the fact that s/he has the power to label someone.

        If there were a super-glue remover out there that could remove these sticky things, I would invest in it, but give it away to free to anyone who asked.

        No psychiatrist ever sees him/herself as having a derogatory label, and that is exactly what diagnostic labels are. The label is more devastating than the “illness”.

        The other thing I have noticed in recent years, probably because of direct to consumer advertising for psychiatric meds, is people labeling themselves!

        It comes in quite handy to explain your behavior as bipolar.
        Everyone I know labels themselves or others with a psychiatric diagnosis. Sometimes it’s phrased as, “Do you think she’s bipolar?” or “Maybe I’m OCD,” or “His meltdown must be caused by going off his meds.”

        In some ways I have discovered a label-remover which works for me, and that is don’t go to a psychiatrist or psychologist. My Internist still has the labels in my chart, and they have definitely colored the way she sees me and treats me.

        I am hoping that the passage of time will allow them to drop out of the medical records and out of my life.

        I also hope that Dr Sandy will someday have the courage to cross that line and perhaps find that “we” aren’t so scary after all.

    • Absolutely – retire the S word. Mary Boyle, in her Schizophrenia – A Scientific Delusion?, deconstructs the concept of schizophrenia, arguing for simply describing what is known about a “patient” (another word that casts the subject in medical model terms). If someone hears voices, just say, “Mr. A reports being upset at hearing voices that accuse him of being evil,” or “reports seeing things others tell him are not there.” She and Richard Bentall make a good case that the source of this kind of specific complaint can often be identified – e.g., the content of the voices may correspond to specific traumatic experiences in the person’s history – and this can be a basis for working to relieve the problem.

      I think the other common psychiatric labels should also go. Depression is amorphous, covering a multitude of sins, and thanks to PhARMA’s $60 billion/year marketing budget, and to psychiatry’s collusion, stands for “chemical imbalance” and perpetual medication in the minds of hundreds of millions. If someone reports being sad and sleeping three hours per night – SAY SO. Psychiatry is so afraid of not sounding medical and scientific that they’d rather use a “diagnostic” term instead of something that actually describes a human being.

      Ditto “social anxiety disorder” – ridiculous. I’d rather hear “… reports being painfully shy in social situations, especially when he doesn’t know many of the people present.”

      ADHD: just say, “Johnny got out of his seat in math class an average of 5 times per day, and efforts to redirect him have been unsuccessful. He reportedly acts similarly in Sunday school, but not in soccer practice, at home or during non-school socializing.” The terms of art allegedly clarify, but actually these blanket buzz words confuse and obscure. You hear “ADHD” and your mind jumps to stereotype a child – whereas a description as above actually conveys what the child does, and may contain the seeds of clues to what may be going on.

  10. “It offered the advantage of improved consistency in communication. When I used the label schizophrenia to characterize a patient’s symptoms, I had a better chance of matching the label a colleague would use with the same patient than I might have had with earlier versions of the manual.”

    But what about the quality of communication with your patients? A democratic, transparent, patient centered approach to communication that usually avoids diagnosis, such as Open Dialogue, may be more effective and do less harm.

  11. Recent research undertaken by the Mental Health Foundation in New Zealand found that the practice of diagnostic labelling is association with first onset suicidal thinking and behaviour. Research subjects explained that before being given a label, they saw themselves as people struggling to function as a result of a variety of circumstances. Once given a label however they felt sub-human, isolated and defective. This led to thoughts of suicide.

    However you dress it up, labelling people is harmful and as a doctor, doing harm should be something that is avoided at all costs. Perhaps those of you who use the DSM should conduct an experiment and advise your child’s school, friends and sports coaches that they are schizophrenic, bi-polar or psychotic…then watch the impact on your child. Perhaps that would give you some insight into the real consequences of what you conceptualise as an academic debate.

  12. Apologies for the lengthy post (this topic really gets me thinking):

    My concern is about the “we” who may or may not give mental health diagnoses the power to dehumanize you mentioned, seemingly suggesting it is up to us — you were subtly intending to mean everyone, correct? — to play our part in making sure this doesn’t happen. How can this “we” be accounted for, on a large scale, and in a way to ensure a diagnosis or set of diagnoses making the proper impression, though? Generally speaking, the individual who is receiving a diagnosis or set of diagnoses does not have his or her diagnosis or diagnoses explained to he or she in the manner you explain them to your patients — which is terribly unfortunate, and I commend you for incorporating an explanation of the kind you indicated when you diagnose. Most professionals who make diagnoses are not as responsible as yourself, which is not always their faults (many, perhaps even the majority don’t know better), but the ramifications are what they are, nonetheless. Moreover, in the vast majority of cases, the individual who is being diagnosed has little idea about what a mental health diagnosis truthfully entails. So, if it isn’t explained to he or she how you explain it to your patients, as is most likely the case, and if he or she has little idea of what diagnosis truthfully entails, as is most likely the case, well, you can surely understand how problems may result as a matter of consequence: an external locus of control, a self-fulfilling prophecy, etc. Another concern of mine is the feedback a person who has received a mental health diagnosis or set of diagnoses receives from their diagnosing professional, supposing again, the situation plays out how it most typically seems to do so, with both parties, as a whole, starting out and ending up less than adequately informed about what mental health diagnosis does and does not encompass. In this case, the diagnosing professional may very well unintentionally do harm by encouraging/exacerbating an uninformed individual’s potential external locus of control and/or self-fulfilling prophecy, etc., regarding his or her own mental health. (You know, if the idea of chronic illness should come into play.) Then, what happens to this individual if he or she is ultimately placed on a psycho-pharmaceutical or psycho-pharmaceuticals as a consequence of his or her diagnosis or set of diagnoses, either upon receiving the diagnosis or diagnoses, or some time later, after a potential external locus of control and/or self-fulfilling prophecy, etc., has detrimentally influenced his or her outcome to that point? We both know a psycho-pharmaceutical or psycho-pharmaceuticals would not help the situation over the long-term, more often than not, but would actually serve to worsen this individual’s long-term outcome — more often than not. Concerning.

    Consequently, and in my opinion only, there is no defense or justification for the process of mental health diagnosis as it currently stands, whether it be posed directly or indirectly — none, not even when done in a selective and lukewarm manner, not even when including the fact of when you diagnose, it’s done as humanely as possible as a means of augmenting the palpability of the message — as it seems to me this is what you’ve done.

    A simple epigram, such as yours: “It does not need to dehumanize the person unless we give it that power,” proves idealistic and impractical when taking into consideration how a mental health diagnosis or set of diagnoses is most frequently presented to the individuals receiving them, the frequency with which a diagnosing professional is mistaken about what diagnoses accurately encompass, the knowledge individuals receiving a diagnosis or set of diagnoses most frequently have about them on their own, and the potential implications of all this. And while what you wrote may seem simple enough to some, as it was likely written simply enough by yourself, and is surely simply enough said to your patients, its widespread, effective application is no simple matter and unlikely — given the nature of mental health diagnoses’ rather inherent impersonation of real medical problems, the level of misinformation viral amongst the American public, and in that it seems a diagnosis or set of diagnoses stick with an individual for his or her entire life’s course. (Perhaps, I’m mistaken on this last point. Apologies in that case.)

    The real problem is the nature of mental health diagnoses, not what we give to them. I understand you tell your patients, “It does not need to dehumanize the person unless we give it that power,” but the language you wrote in is not seemingly directed at an individual or set of individuals, being your patient or patients, as one would think would be the case, whereas you wrote this is what you tell your patients about diagnosis. It seems more likely in your writing, you were contriving to establish the point being, “It ‘– the mental health diagnosis/diagnoses –’ does not need to dehumanize the person unless we give it that power,” generally, as if this statement were realistically, effectively applicable, on a large scale, and therefore, partial justification for mental health diagnoses as are. This is where I take offense. I apologize if I have misinterpreted your intentions; I’m very sensitive about this matter, due to what is at stake, and the scale on which this plays out, as I’m certain you can sympathize with.

    I understand your post, if you were intending to defend yourself and how you practice, whereas I think you would be justified in doing so — relative to what some who read your post likely think of psychiatrists and their profession. However, in that you take the time to explain a mental health diagnosis or set of diagnoses in the way you do to your patients, and seem to put a particular emphasis on doing so, this implicitly acknowledges the potential for harm if you, or another diagnosing professional, were to act alternatively, does it not? And whereas you must surely understand the majority of professionals who make mental health diagnoses are not nearly as informed or circumspect as yourself, how are your post’s readers to understand, for themselves, why you would be writing in a somewhat explanatory manner about the reasons for mental health diagnoses, implying defense of them — while you acknowledged some of the shortcomings, yes — even when done in the selective, lukewarm manner that you have?

    The matter in question boils down to this, if nothing else: have mental health diagnoses done more harm, or more good? The answer, unequivocally, and as you must surely understand, is they have done more harm — and that they are doing more harm. Please, do away with them.

    Sincerely concerned,
    Nigel

    • Thank you all again for the thought provoking comments.

      Although I can not be responsible for what all psychiatrists or clinicians do, I do have some influence in my own community and I try to convey these ideas not only to my patients but to my colleagues and students. This essay is meant to be shared with my patients. I am fortunate to work with some wonderful people, including psychiatrists, and I do not believe the ideas I express here are antithetical to their views. As I noted in the blog, I have no choice but to work with the diagnostic nomenclature as it currently exists. I get paid by my employer who gets paid by insurers and they all require a diagnosis. I am fully aware of my ethical obligation to the best thing for my patients and I struggle with this daily but for now, as long as I continue to practice in this setting, I have to use these labels. So my approach is to be careful to explain what they do and, more importantly, do not mean. I understand that for many visitors to this site, there is no way to practice as I do in an ethical manner and, as I have written elsewhere, I understand that I may have some irreconcilable differences with some who read this.

      • “I get paid by my employer who gets paid by insurers and they all require a diagnosis. I am fully aware of my ethical obligation to the best thing for my patients and I struggle with this daily but for now, as long as I continue to practice in this setting, I have to use these labels. So my approach is to be careful to explain what they do and, more importantly, do not mean. I understand that for many visitors to this site, there is no way to practice as I do in an ethical manner and, as I have written elsewhere, I understand that I may have some irreconcilable differences with some who read this.”

        I’m sorry. So, whereas we are to understand you “struggle with” your ethical obligation to do the best thing for your patients, daily, how are we to then understand you successfully upholding your ethical obligation to your patients, daily? I am sincerely confused. If one could practice your profession, as you understand it, regularly conforming to the ethical guidelines clearly defined by The Hippocratic Oath, why would you struggle — and struggle daily? Either your profession conforms to The Hippocratic Oath or it does not. This matter is unambiguous. Other types of physicians surely do not “struggle with” their ethical obligations to do the best thing for their patients — and surely not on a daily basis and in a manner similar to yourself, even if so.

        It would appear the time has come for you to explore other employment options. Otherwise, you have lead us to believe whereas you “struggle with” your ethical obligation, and daily so, you are, at least on frequent occasion, knowingly practicing in a manner incompatible with The Hippocratic Oath — which you swore to uphold. I am assuming The Hippocratic Oath does not have a portion I am unfamiliar with, which would excuse its necessity of being upheld in cases where individuals get paid by their employer, who gets paid by insurers and they all require a diagnosis — in which case, and in which case only, my argument would be null. If I am mistaken, please correct me. And excluding any considerations for the irreconcilable differences you may or may not have with some who read what you have written here, it seems likely, and more importantly, that the field of psychiatry has some irreconcilable differences with The Hippocratic Oath.

        • Dr. Steingart,

          Many psychiatrists should heed Nigel’s stark application of the Hippocratic oath, but you are not one of them. And others like you do honestly struggle with issues like this. Doctors of all kinds struggle to apply the Oath daily, because medicine deals with profound issues in the complicated lives of real humans.

          But your position on diagnosis seems unnecessarily complicated. Decades ago, a therapist said to me, “The insurance industry requires me to assign a diagnostic code so you don’t have to pay out of pocket; so with that understanding, I am going to assign you the diagnostic code for depression – is that ok with you?”

          That is straight forward, non-stigmatizing – and honest. As this discussion shows, DSM-style diagnosis has problems on many levels – most, if not all, could be avoided with Mary Boyle’s approach. If even DSM IV’s head honcho acknowledges DSM “diagnosis” as inherently problematic, you are on solid ground to simply say the one thing we really know – the client will have to pay for the session unless you assign a diagnostic code.

          Some clients/patients are so steeped in the culture’s romance with bio-psychiatry that they welcome a diagnosis: “At last I know what’s wrong with me.” They might distrust a doctor who DOESN’T “diagnose” them, but I think in the long run even they are best served by gently holding out that they are not damaged goods, but humans with understandable problems. If other clients/patients need to talk more about the diagnosis issue, that can be a valuable part of building a mutual understanding that contributes to your therapeutic alliance with them.

          • Peter,

            Thank you for your considerate, initial appraisal of my comments. However, I’m forced to disagree with you on how you followed it up.

            I phoned my sister today, a practicing physician — and not a psychiatrist — caught her at what would have been her lunch break, rather luckily I might add, and posed to her this very question: “Would you say you struggle with your ethical obligation to do the best thing for your patients, and if so, on a daily basis?” Her answer provided me with the following insight:

            First, she answered no, that she does not struggle with her ethical obligation to do the best thing for her patients — and certainly not on a daily basis, as I had guessed. She said she gives great thought to each decision she makes on a patient’s behalf, especially when the context in which the decision must be made does not afford a specific, clearly established method of proceeding. And she said when there is a decision to be made of this nature, she proceeds in the most prudent manner possible, touching all of the bases, so as to make sure nothing is missed and no harm is caused to her patients as a matter of consequence, as may well be the case if she conducted herself alternatively. But, she reiterated that she does not struggle with her ethical obligation to do the best thing for her patients, and not on a daily basis.

            She said has been taught to proceed how she does in obscure instances, and therefore, is confident she does everything in her power to make sure no harm comes to her patients as a result of them being entrusted into her care — in the aggregate, only a benefit, given all practical considerations. Of course, she acknowledged, there are instances where physicians end up having been mistaken with their decisions, and consequences, sometimes severe, are the very unfortunate result; but then she added, rather frequently physicians are sued in such instances, and we proceeded to have a laugh together.

            Then, I asked if she thought her fellow physicians, those she knows best, “struggle with” their ethical obligation to do the best thing for their patients, and on a daily basis. She told me while she could not speak for them directly, she would imagine they feel similarly to her.

            (Just saying.)

            This appeal has left me leaning in the direction I’ve indicated. Also, I can imagine you might be inclined to respond to this post making the argument of how my sister having been taught to proceed how she does in obscure instances — which allows her confidence and freedom from struggling with her ethical obligation to do the best thing for her patients, mind you — is similar to psychiatrists having been taught how to practice in the manner in which they do. So, as a precaution, I would like to establish this point: I am sure that if my sister came to believe there was the possibility of her inflicting harm on her patients, in the aggregate, and through any means of her practice, she would avoid those means altogether, and at all costs — whether those costs be simply pecuniary, ultimately career threatening, or otherwise. Surely, there was a time when psychiatrists did not realize the potential harm of their continued practice, but from what I’ve come to understand here, and from the words of a psychiatrist, mind you, it would seem this time has come, and passed.

            - Nigel

            P.S. The dubious credentials of psycho-pharmaceuticals only paint a graver picture. Why potentially harm the individual with diagnosis, if you are then only going to potentially harm he or she with a psycho-pharmaceutical or psycho-pharmaceuticals — in consideration of how it has very apparently come to light that these drugs tend to worsen individuals’ long-term outcomes? Perhaps, an argument could be made for their short-term use, but as Robert Whitaker so eloquently reported in Anatomy of an Epidemic, these drugs are extraordinarily difficult to successfully withdraw from. And in consideration of this point, why would any ethical physician in the know prescribe them? Doing so would only seem to ensure the individual receiving a prescription for them, and following through with taking one or more of these drugs, ultimately being led into a set of circumstances in which he or she would be delaying the inevitability of having to deal with a difficult period in his or her life — and this, of course, is in the absolute best case scenario, supposing the prescribed drug or drugs provide short-term relief, which isn’t sufficiently likely to justify the potential complications, in my opinion. And when the individual begins to come off the drug or drugs — 4 – 6 weeks after beginning on them would be ideal, I conjecture, to start weaning off — he or she would then likely be only little more equipped to confront he or she’s life’s stressors effectively, but would have a difficult chemical withdrawal experience to combat as well. It would appear that there is no logic, whatsoever, relating to any of this psychiatric nonsense.

            That’s it. No more posts for me.

          • I believe the so called patient should be given informed consent about bogus, unscientific life destroying junk science DSM labels and how they will define the victim as a mental case for the rest of their life even if it is “only” depression, which will most likely turn into bipolar due to the invalidation of the person’s real problems like abuse related trauma and the iatrogenic harm by the useless but deadly drugs. The victim should be told the whole truth and nothing but the truth and allowed to walk away unharmed. Sadly, psychiatry now does the opposite to deceive patient, family and the public while doing nothing but harm to all and totally betraying the Hiprocratic oath in every way.

            I realize that Dr. Steingard is trying hard, but the truth is that biological psychiatry is totally fraudulent, the DSM is totally bogus with invented, voted in stigmas to push lethal drugs without a shred of medical or other evidence and no medical tests to prove anyone has them while leading the world to believe the opposite, the whole field is based on lies and pseudoscience with the pretense that they are dealing with genetic or brain chemical/wiring imbalances based on neverending billions wasted on fraudulent studies and research and they have done all in their power to brainwash the public to believe these lies. The bipolar fraud fad is one of the worst crimes ever perpetuated against humanity to push the most lethal poisons ever on NORMAL children and adults with normal life problems, crises and traumas.

            So, it is totally unrealistic to claim that any DSM stigmas are anything but life destroying as are all their corresponding toxic treatments while deliberately invalidating the social injustices and emotional distress for problems of living that caused the person to naively seek help after seeing psychiatrists in movies only giving talk therapy only to be horribly betrayed by the horrific bogus medical model from the current biological psychiatrist who must use much bullying and deception to attempt to deny the so called patient’s reality, a massive betrayal and retraumatization!!

            I believe very strongly that biological pychiatry is based on such fraud and lack of any science or evidence and can only do much harm to those they pretend to treat, that the only solution is to abolish it and start over. Psychiatry is only a means of social control but as Attorney Jim Gottstein has shown, it should not be allowed since our Constitution and the U.N. reject the cruel and unusual punishments of inflicting brain damage and a ton of other lethal effects causing much earlier death while torturing the so called patient at the same time. Most prisoners prefer serving jail time rather than time being tortured in a psych ward, but now therese tortures of brain damaging lethal drugs and stigmas are inflicted in jails too. So, the only solution is to remove BIG PHARMA/BIG BUSINESS influence from medicine and even prisons, abolish the junk science biological psychiatry profession and seek new, ethical ways like Open Dialog, Soteria or some form of Quaker moral treatment using some volunteer peers that actually work to help the people recover without destroying their lives and/or killing them and others due to dangerous poison drugs as is the case now. I see no other solution if our country and our children are going to even survive never mind thrive, which would be the ideal goal.

  13. I think there’s something important that’s being missed here.

    “What do I tell my patients about diagnosis? I try to explain what a diagnosis is and is not. It is a label that reflects that the person has reported certain symptoms. It is a label for the symptoms not for the person. It might indicate what treatments could be helpful since treatment recommendations are informed by studies that included people who had similar symptoms. It does not explain to me why the person has those symptoms.”

    As a person who has been diagnosed, I have found consistently that the “symptoms” the doctors say I have are nothing more than aspects of what other people see in me. They are only an outward manifestation of very complex inner issues. The inner issues relate to identity, rejection, trauma, fear, and more. On the outside, I am considered to have a “mood disorder”. But I _don’t_ experience my life as “highs” and “lows”. I’ve actually had problems connecting to myself, of going for what I need and want in life, and of thawing my emotions after having gone numb for years. It only LOOKS to people like psychiatrists that my “crises” are “mood” issues.

    So when you say to me that diagnosis is useful because it reflects “symptoms” that others have as well, I would point out that I have actually gone to so-called “support groups” and talked to others with the same “diagnosis” as me, and there is very little I feel we have in common.

    Further, the drugs that are prescribed to me, rather than giving me the subjective sense of having a “stable mood”, simply make me feel shut down and slowed, somewhat numbed.

    I don’t see how the diagnosis has done me any good – except to teach me what OTHERS see, so that I can, for example, avoid hospitalizations in the future. I certainly find no usefulness in, say, all the articles that talk about how to “manage one’s mood”. CBT was similarly useless. My way of making progress in life has been to completely reject trying to overlay the diagnosis’s pattern into my own experience. By getting away from any sort of medical or so-called “scientific” view of my own behaviour, I am able to look at myself as a human being with a story, who has been through difficult experiences, and lost myself.

    Furthermore, I did not report symptoms. I was told I had them. You have to remember that many of us are TOLD we have a mental illness rather than seeking out a diagnosis.

    -S

    • Many psychiatrists LIE and claim you have symptoms you don’t have to falsely claim you are psychotic and delusional to give you a bogus bipolar or other fraud stigma to push toxic drugs and also invalidate and discredit you for the power elite they are really serving. It is becoming all too frequent in our increasingly Orwellian society that children and adults bullied and abused a home, work, schools and other places are forced to see a psychiatrist to be allowed to return while the psychopthic/narcisstic bullies are allowed to drive the victims to suicide as was the case with the infamous case of Phoebe Prince. Sadly, I read in the paper that she was on the horrific antipsychotic Seroquel–now wonder she wanted to die. The monster who presribed this drug to a bully victim should be jailed since this poison drug contributes to suicide and abject despair!

      Thus, psychiatry now plays the same and more extensive role in the U.S. as it did in Soviet Russia and many have admitted online that when an employer sends an employee for a psych exam it is understood the so called psychiatrist will do all in his/her power to destroy the victim’s reputation, credibility and career by making the person appear to be a mental case unsuitable for the job while completely validating the boss who is most likely bullying and/or mobbing the victim as decribed on such web sites as BULLYONLINE, THE MOBBING ENCYLOPEDIA and Dr. Gary Namie’s web site. Psychiatry should not have this power or the right to abuse their power as so called medical experts to do nothing but harm against every medical ethic by acting in ways that are known to drive their victims to suicide.

      Psychiatry also has a horrific influence on marriages, child rearing, divorces, child custody and other areas where they have no expertise whatever and base opinions on prejudice, sexism, racism and other nefarious reasons since it is dominated by a white male old boy network calling the shots while pretending their decisions are evidence based as described in Dr. Paula Caplan’s THEY SAY YOU’RE CRAZY and many other exposes.

      I think Dr. Steingard knows that bogus DSM stigmas are life destroying and to say otherwise would cause any of her patients to be labelled delusional or psychotic with a lethal antipsychotic forced on them.

  14. S.A. I am sorry you have been in this situation, but I admire what you say about dealing with it. Your account is exactly what I referred to at the end of my last post. The psychiatrist/ professional’s first making clear that a “diagnosis” is NOT who the client is, and then really listening to the client’s reaction to the diagnosis, is a great opportunity to know the client as a person, and to forge an honest relationship. How many psychiatrists/other professionals do this to move their relationship with the client forward?

    What you wrote is hugely important information – and how often do professionals NOT get that type of information? What professional could hope to have a genuine therapeutic relationship based on the diagnosis’s WRONG information, that the client pretends to go along with? To think this is ok is to reject trust and safety as important in the therapeutic relationship.

  15. Well said. Early on, I learned from ex-patients, that the way to get on with life is to shed the label and avoid medicalizing the so-called illness. I’ve been trying to extract my son from becoming a permanent patient ever since.

    • Dear Rossa,I know exactly what you are talking about: I have been trying to do the same.I know perfectly well that my son is not suffering from “schizophrenia” as defined by psychiatrists. I have tried to explain to them what happened and I have been told to “leave it to the specialists”. The “specialists” have litterally tried to brainwash him into believing that he suffers from a “serious mental illness”.I tell him not to believe a word of it. He is fine but “They” won’t leave him alone. He wants to be a free man to get on with his life and he can’t.

  16. When I learned of my PD diagnosis, I was ambivalent. I was happy that what I felt has been recognized in others. I always knew I had depressive mood problems (MDD and dysthymia) but felt like those labels didn’t really cover all the symptoms that I had. When I heard borderline I was happy: my feelings have a name; I was also angry: now my PERSONALITY is deemed defective– the essence of who I am is maladaptive (plus, the general stigma of BPD that society AND the mental health workers seem to hold breaks my heart). Now, I have a therapist that says I do not have BPD, which makes me more confused. Diagnoses can be double-edged swords.

  17. I think it’s important to do whatever you can to get out of the box of patient or client or consumer or whatnot. If a person moves on with their life – pursues a career, becomes active in the community, makes contributions to the world – they don’t have to perpetually be in “therapy” or “treatment”. I really see self-definition and the pursuit of one’s own life and dreams – not any sort of “therapeutic” relationship – as being the way out. Of course, friends and supports do help, and are necessary, but I really don’t believe that “help” necessarily helps, and what is often needed is simply a person cultivating resilience and taking back control of their own life.

    Ideally we should get to the point when we don’t need any more “help” than the average person who was never diagnosed, and I don’t think we need to use that “help” to get there, if it doesn’t work for us. I don’t even think we have to pay attention to this “recovery” idea, because it still is imposing someone else’s language and agenda on us. I couldn’t get anywhere until I decided to live my life in my own language. Why does “recovery” have to be my goal when instead I can talk in the same terms others talk, e.g. having particular career aspirations, wanting to find or create opportunities, being drawn towards things of beauty, etc.?

    I say better to have a job than to see a therapist every week, for example. Everyone has struggles – hell, unemployment causes great hardship. Growing up and living well are universal human problems. It is a mistake to think that some of us are doomed to be needy and dependent forever. And we really do have the responsibility, those of us who have been “diagnosed”, to stop using the label as an excuse to avoid taking charge of our own lives. You can have empathy for yourself without the sort of self-pity that poisons and limits you – but that empathy can rest on the hard times you’ve had in life, the experiences which have built your character, and not on some presumed flaws that a doctor tells you are a disorder.

  18. Once again, Sandra, I am impressed with your courage to open dialogues and your thinking around very charged issues that clearly have a great deal of impact on the way we practice psychiatry and medical care and also the way we respond to and live with those decisions, particularly those who have received a label.

    I am a sociologist by training. Labeling theory was a particular area of interest. I am biased in favor of removing labels as they seem to do more harm than good in social interactions and cohesion in any context, not just mental health. Labels are “other-making” machines that categorically reduce the human experience while enhancing the potential for abuses of power.

    That said, I see the mighty challenges you are up against as a provider in an ossified and lumbering mental health care system that continues to grow more complex. The institutional, economic and policy drivers are creating more categories and labels than ever before.

    When medical coding is one of the fastest growing career segments, we’ve got a problem that extends far beyond your office and even psychiatry.

    So the question is, how can we all work together for change? It seems it will take us all, together, to make this change. Thank you for your willingness to reach out to engage in thoughtful dialogue with your patients and all of us here…

    • I believe that the worst thing that could have happened to my son was that he was given a diagnosis. As soon as he got labelled, he got negated (to paraphrase Kierkegaard). The label meant that our family wasted years of precious healing time by thinking and treating my son as a patient. I am obviously naive, but since billing seems to be the reason a diagnosis is given in the first place, why can’t insurance companies accept a diagnosis of “nervous breakdown” or something that implies the same sort of thing? (The prescriptions for the drugs wouldn’t change, since the same drugs cover most diagnoses.) So, because this thought seems so logical to me, there must be something else going on. Are the insurance companies the real problem, or is it psychiatry? I think it’s psychiatry. There is no incentive for psychiatrists to insist on a one-size fits all label for mental distress. If they believe in only one diagnosis (human pain), then they will radically have to change their doctor/patient relationship, which will mean lowering their salaries. The only way change will come is for people to vote with their feet and raise their voices. Change is coming because of the Internet community and the more sharing of information, the better informed people will be about their own needs.

      • Thanks, Jennifer. I have found it helpful to be reminded to pay attention to what the labels mean to individuals and to try to talk about and clarify that with each person. I had a long talk about this with a woman I have knonw for many years. She told me how hurtful the label was but at the same time it was hard for her and me to separate the harm done by the label and the harm done by the social consequences of some of her behaviors when she was not feeling so well. This is hard to talk about but a part of the experience for many people I know.
        Rossa, I have a question and it is genuine, I am ot trying to be snide. How is a label of “nervous breakdown” different or less demeaning than a label of schizophrenia or psychosis, for instance?

        • A nervous brakedown is not a brain disease. It is a one off thing that carries no stigma. You usually bring it on to yourself by overdoing things and stressing unecesserally. You recover from it by resting and examining where you went wrong. You don’t get labelled for life. Sleep deprivation has a lot to do with it. I had one at the age of 18; i went to pieces and started hearing voices in my head. I learned from it and became much wiser after it and never had another break down. Thankfully nobody ever plied me with antipsychotic medication. I got a teaching job without any problem. Had I been labelled “mentally ill” and fed neuroleptics, I am sure I would not have fared so well.

          • Arta,

            Sleep deprivation was the beginning of my problems, too. I often think, “if only I had been able to sleep, if only someone had seen that was the cause, if only someone had understood and not told my parents I would ‘never get well’.”

            Insomnia is still the demon I can’t conquer.
            Thank you for your insightful and courageous comment.

            Marianne

        • Sandy,
          .A nervous breakdown used to be a common enough occurrence, but you never hear the term used anymore. It was something that nobody wanted to admit to having, but the understanding was that it was related to a person’s inability to cope with something happening in their life, and with rest and learning coping skills, one recovered and got on with his or her life. There was stigma associated with a nervous breakdown, for sure, so people generally did not want it to be known that this had happened to them. I wonder how many people now with psychosis or schizophrenia labels think that what they were going through was a nervous breakdown that got hijacked by the need to feed the pharmaceutical industrial complex. The problem is, many people now have never heard of a nervous breakdown. They’ve heard of bipolar disorder, and schizophrenia and schizoaffective disorder, etc. etc. One of my favorite books is Memoirs of My Nervous Breakdown, by Daniel Paul Schreber. He was a high court judge in Germany around 1900 (before the labels schizophrenia, dementia praecox, or manic depression was invented). What he called a nervous breakdown seemed like what today is labelled schizophrenia. He had two breakdowns and died just before his memoir was published.

          • Recently a flight attendant and then a pilot had “meltdowns” which I believe may be the new term for nervous breakdown.

            Both people were restrained by passengers, humiliated by the events being recorded on cell phones, taken off the planes in wheelchairs and into the psychiatric ambulance, where they were deemed to be “off their meds” (not “in withdrawal” which is more likely, if they had in fact gone off their meds).

            Passengers were then given airtime to smirk and make fun of these people on network news.

            This is where Dr Sandy and her ilk can safely point the Finger of Authority and be assured they haven’t contributed to this person’s MISERY.

            I would like to know what these two people’s stories really are. I suspect they were “screened” by the airlines, but the stress of the job sent them to a psychiatrist, who prescribed meds based on a diagnosis, probably depression, and the SSRI’s either caused the meltdowns or missing a dose brought on withdrawal and rebound which “we” know is WORSE than the original problem.

            What kind of future does either of these people have now?
            How is any of this “ethical” from any perspective?

            Dr Sandy has to comply with labeling people in order to get paid for “services”.

            But do the people she labels get to keep their jobs? Even if they do, they will be watched closely for the next “meltdown”.

        • I’m responding again because I should have been more to the point in my answer to your question about how is the label “nervous breakdown” less demeaning than the label “schizophrenia”? They are both labels, but the schizophrenia label invokes fear, not understanding. I think people “get” the idea that with a nervous breakdown, there is recovery, and I suspect, but do not know for sure, that the doctor will help the relatives and the person examine the stressors that led to the breakdown. Schizophrenia panics family and patients, because the medical profession and pharma has done their best to show how hopeless this so-called “disease” really is. We’ve been told it’s a chronic brain disease and that “no one knows what causes it” which is ridiculous, really, since it’s a complex reaction to a stressor (very rarely can it be traced to a medical cause). It’s only later that one finds out that many people fully recover, but your doctor will be the last person to tell you this because the doctor believes in the diagnosis, especially for schizophrenia. If one has to diagnose at all, the vaguer the diagnosis the better. Nervous breakdown fits the bill of stress/trauma related and nicely vague.

          • Thank you for your perspective. What I was trying to do in the blog is to explain what the label does and does not mean. It may be too late to undue whatever stigma is attached to the label of schizophrenia but I do try to explain it carefully to my patients. If we had included the label “nervous breakdown” in the diagnotic nomenclature, then by now that label would also be infused with the beliefs that you cite above.
            I am currently reading a book by a former friend and colleague, David Servan Schreiber, about cancer and the ways the body can protect itself from cancer. I will probably write more about this in a blog. But one thing it brings to mind is that we have an underemphasis on studying people who have recovered from psychosis. I believe that Coriina West has mentioned this. I also belive that Elyn Saks is stydying this at UCLA.

          • Rossa,
            “Psychiatrist” is a label too.

            I know of one psychiatrist who dislodged the label but it didn’t work out.
            In removing the label, she bared some of her human qualities, revealing that she was vulnerable and had a kind heart.

            That frightened her, so she put the label back on and is doing well. She refuses to speak of the brief time when she went naked.

            Sad case.

            Once a psychiatrist has the label, the dig diploma, and the comfortable income, it is difficult to get them to let go. And why should they, since it “works” so well.

  19. It’s sad but enlightening that Dr. Steingard admits the DSM does not take any environmental factors into account with their bogus life destroying stigmas invented with BIG PHARMA to push the latest lethal drugs on patent as Dr. David Healy so superbly describes in his book, MANIA: A SHORT HISTORY OF BIPOLAR DISORDER, which explains this evil holocaust against humanity to help BIG PHARMA become a multibillion dollar global enterprise by this evil ploy to make profit centers out of people suffering from all types of social injustice, poverty, abuse, trauma and other life challenges/crises while destroying them in the process as Robert Whitaker and all too many expose.

    Though the DSM may give lip service to social or other factors, these are routinely ignored in favor of the latest fraud fad diagnoses admitted by DSM IV editor Dr. Allen Francis of ADHD, bipolar and autism. Dr. Carole Warshaw, Psychiatrist and Domestic Violence expert admits psychiatrists are trained to focus on SYMPTOMS ONLY while ignoring environmental factors like child abuse, domestic violence and traumatic stress causing the symptoms. Whereby these used to be stigmatized as the insult “diagnosis” borderline personality disorder per trauma expert, Dr. Judith Herman in her classic work, TRAUMA AND RECOVERY, the new life destroying insult stigma and garbage can diagnosis replacing schizophrenia as psychiatry’s new “sacred symbol” (Dr. Thomas Szasz)for domestic, work and other abuse if the bipolar fraud fad for the most part per Dr. Carole Warshaw.

    Dr. Jay Joseph and many others have exposed the fraud behind all claims of genetic, brain chemical imbalances, faulty brain wiring and other bogus claims of scientific claims behind any of psychiatry’s bogus stigmas in such books as THE GENE ILLUSION and THE MISSING GENE. Psychiatrists admit now that the chemical imbalance of the brain claim was nothing but a BIG PHARMA ad ploy, but they saw no problem lying to patients and public that it was/is true to force them to take poison drugs in the guise of medicine for greed, power and status.

    Dr. Joseph also exposes that this biomedical approach to the “99%” by the “1%” power elite is more to do with a social agenda by the right wing to maintain the status quo and neutralize any threat to their latest robber baron status and crimes against humanity.

    These are just some of the reasons why biological psychiatry must be abolished if we are to take back our democracy hijacked by this medicalization of normal human behavior to allow the power elite to enforce a totalitarian dictatorship with psychiatry acting as the current police for it.

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