Deconstructing Psychiatric Diagnoses: An Attempt At Humor

Daniel Mackler
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Based on my experience both as a therapist and client in the mental health field, I have learned that when therapists or psychiatrists give you the following diagnoses all too often here is what they really mean:

Obsessive-Compulsive Disorder:  Your obsessive nature is thwarting my compulsion to reorganize your life.

Paranoid Personality Disorder:  The way I perceive you staring at me when I ask you extremely personal questions about the most painful experiences in your life really makes me uncomfortable.

ADHD:  Your teachers don’t understand you, your parents suck, and I am on their side.

Bipolar Disorder:  You’re going through a rough time, and now that I’ve found a biologically inherent justification for it, your insurance company will allow me to bill all year for your sessions.

Narcissistic Personality Disorder:  I didn’t spend nine years getting this damn license just to listen to you blather on about YOU YOU YOU.  How about ME for a change?

Antisocial Personality Disorder:  You sicko — you actually DO the things my husband masturbates about on the internet.

PTSD:  Since I can’t bill your insurance company for just writing “PTS,” I’ll compromise with psychiatry and add that little “D” to the end…

Generalized Anxiety Disorder:  There doesn’t seem to be anything noticeably wrong with you, but you are here so you must be fucked up somehow.

Histrionic Personality Disorder:  If you keep pushing it, sweetie, I’m going to diagnose you Borderline.  So lower your voice, okay?

Cocaine Dependence:  Fool!  Adderall is legal, cheaper, covered by your health insurance, and works on the same neural pathways!

Anorexia:  They’re models on television.  You’re not.

Dependent Personality Disorder:  We both need to accept that psychotherapy was never intended to last indefinitely.  Well….unless of course you can pay full-fee, in which case I can cook up a more serious diagnosis for you…

Avoidant Personality Disorder:  Thank God you pay out of pocket, because your insurance company doesn’t allow me to bill for all your missed sessions.

Alcohol Dependence:  I probably drink just as much as you do, but since you’re paying and I have a degree I might as well pin an extra label on you.

Dissociative Identity Disorder:  I know, everyone else has diagnosed you with schizophrenia, but I want a really juicy case to present at next year’s conference…

Münchausen Syndrome by Proxy:  Finally I get a chance as a therapist to treat someone who’s just like my mother!!

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42 COMMENTS

  1. And what about the last “disorder” I received, the ubiquitous “Adjustment Disorder”?

    The “everyone can have a disorder,” “disorder”?

    The “I don’t want to adjust to morons defaming me with fictitious disorders,” “disorder.” It was at least the most truthful.

          • Well, if everyone with “any feelings at all” is disordered. I guess it’s just the unfeeling psychiatric “professionals” who have reached the perfect “order”?

            But personally, I’m not impressed with hypocritical, psychopathic, deflamatory, psychiatric torturers and murderers.

            Perhaps intelligent people should learn to agree to disagree when it comes to personal journeys of enlightenment. But psychiatrists are apparently not intelligent enough to respect the opinions of intelligent people.

            They believe any disagreement with their scientifically “lacking in validity” disorders, is proof of their disorders. Too insane for me to bother with, personally. How childish.

      • In all seriousness, though, what do you propose well-meaning professionals do in order to provide heartfelt, recovery-based treatment for any and all who seek it in order to receive compensation from insurance companies? After all, the majority of individuals, whether they simply want someone to talk to or if they have been labeled with a diagnosis, rely on insurance companies. Thanks in advance for your guidance!

        • well, some insurance companies are better than other, though some are simply a joke. more and more what i’ve seen is that insurance companies pay less–less–less and make therapists do a lot more bureaucratic work to get that decreasing money, and also, worst of all, reveal a lot more about their clients. also, it’s almost all diagnosis-based….which to me is farcical. but i guess i expressed all that already and am not answering your question!!!! (sorry.) if i were to go back to being a therapist i think i would not take insurance. the big advantage, of course, is that it can save clients some money. and it’s sad that people would have insurance and yet have to pay out of pocket, though of course co-pays for their insurance were sometimes more than what they paid me if we just worked on my sliding scale!! so….i’ll tell you how i worked with the insurance companies: i always worked to give milder diagnoses, because we had to diagnose. i also gave clients an option about not using their insurance and just paying a low-fee out of pocket instead. also, sometimes for people who had been diagnosed with serious things up the wazoo for years, the insurance could have a great advantage: i could use billing with a diagnosis as an opportunity to give them milder diagnoses than they’d ever had before, and thus, in effect, document their recovery from things like “schizophrenia” — into diagnoses like “PTSD” or “generalized anxiety disorder.” personally, though, what i’ve come to believe is that if you’re going to play ball with insurance companies then one will always have to compromise and work within their diagnostic system. ugh. i don’t want to do that anymore. it’s been a relief to be out of the system…. sorry if that’s a convoluted answer!!! –daniel

          • That was helpful, thank you. In an ideal world, I would prefer not to take insurance for all the reasons you mentioned; However, in trying to work primarily with individuals who need to rely on insurance, this is impossible. I do appreciate your posts as well as your feedback. Thank you.

        • Providing treatment for those who seek it isn’t a problem for me. I don’t know that i was seeking treatment for an illness i didn’t have when the police dragged me out of bed with tazers ready, and then delivered me to a hospital for an examination by a psychiatrist.

          Fortunately the psychiatrist acted in an ethical manner and released me, as he knew i had no
          Illness.

          Welcome to Franz Kafkas Trial.

  2. Daniel:

    This is brilliant and healing and validating at the same time. May I be so bold as to make a suggestion? Please consider copyrighting this (I guess it already is by publishing it in MIA) and continue until the every diagnosis in the DSM IV has been rewritten in this vein. Maybe you could crowdsource it. Then please sell it at a profit and give the money to Mindfreedom or another organization that desperately needs resources to fight the uphill battle that must be waged to win human rights in the mental health system.

    • hey! that’s a cool comment. thanks. well, about copyrighting it…hmm…i also put it on my website, so in a way it is copyrighted. as for crowdsourcing….i don’t really even know what that is, but if you want to try that feel free to go for it. also, i “defined” another 10 or 15 diagnoses but chose the best for this essay……..i was going for brevity!! all the best, daniel

  3. Hi Daniel
    This is so good and even though the issue is anything but fun, you really have a point!!! Yesterday I told a young woman I meet in therapy that I am so grateful I never turned to psychiatry when life was very hard and I had a lot of symptoms. I am sure if I had done that my life would have been very different by now. As you know, I have been against psychiatric diagnosis for a very long time and as it seems as if more and more people start to realize how absoultely crazy it is to categorize human beings like that. Reading your list makes it even more obvious….

  4. A great use of humour and truth Daniel.

    I received a letter from our chief psychiatrist from which i provided “reasonable grounds” for him being a danger to self or other using the same method that was applied to me.

    He had rewritten a section of our mental health act (delusions of grandeur, a danger to the community), attributed powers to doctors where they have none, and claimed that a senior doctor no longer worked at the hospital when he did (hallucinations?).

    It made me laugh to think of him being detained in a locked ward in his pyjamas and how his claim of being the chief psychiatrist would be viewed in this environment.

    Thanks for the giggles

    Regards
    Boans

  5. The thing I liked most about this blog was reading that you are a <i<former therapist. Thank God. Your “attempt at humor” failed completely. I found each of these supposedly humorously re-worked diagnoses to be more offensive than the next. You’ve presented mental health clinicians as callous narcissists who only want to take money from patients and make fun of them in the process. Perhaps that’s the way you ran your practice, but the clinicians I’ve known are compassionate healers who truly dedicate their lives to helping their patients. Some of these “jokes” are not even accurate to the diagnosis. Antisocial Personality Disorder is not about sexual perversion, it’s about lack of empathy. Anorexia is not about vanity, it is a serious disturbance of self that results in eating disordered behaviors; and it’s the deadliest of all mental disorders. As a patient, I am deeply offended. As a future psychiatric nurse, I am horrified that you ever treated actual human beings, and I hope that your former patients have better help now. Do everyone a favor and stay away from all health professions in the future.

    • Well, then I just hope you’ll be a better nurse than most of the “professionals” I’ve met in my life. Healers is not a way to describe them, the words I am looking for are more like morons and sociopaths.
      And the humour was not directed at the unfortunate patients of these individuals but the “professionals” themselves who so very often project their own issues at people they’re supposed to help or mindlessly stick labels on people without even trying to figure out what’s going on.

    • In my experience, with the psychiatrists on my personal case and with the ones that I work shoulder to shoulder to at a state hospital, most psychiatrists are callous narcissists who believe that they have every right to run peoples’ lives because they’re the supposed so-called “experts.” In his attempt at humor Daniel reveals most psychiatrists to be just exactly what they are, people who love running other peoples’ lives. Take it from this psychiatric survivor and ex-patient, Daniel hit the nail directly on its head IMHO! Truth is, he was probably being much too kind to this group of psuedo-doctors.

      • I also agree with his major premiss; diagnostic labels achieve nothing useful or helpful. I will always contend that the diagnosis they tried to pin on me was one large pile of bull feces. It was not helpful to me but just the opposite. It was extremely hurtful. The psuedo-doctor who pinned it on me looked at me one time during the fifteen minutes he took to label me with it, otherwise he couldn’t even be bothered to treat me with one little shred of decency and respect.

  6. Here you go! I was just going to point out that some people like diagnoses and it makes them feel better knowing that their problems have one because then it is not their fault and there is nothing they can do about it but take maybe some magic pill. You have the proof right here. Personally I despise diagnoses and I think that they do more harm than good and they mark a person for life – in a negative way. That does not stop a lot of psychiatrists from being well meaning and kind people. My son’s psychiatrists were all kind people, nevertheless they nearly killed him with their diagnosis.

    • thank alix. yep — basically i wrote this essay not to critique individuals but to critique the whole diagnostic system. i see it as needing to be scrapped, and i chose to express that through humor….which has its risks!! i’ve written so many “straight” essays about this and usually they get a much more tepid response. humor — people either love it or hate it!! well, if it’s halfway decent humor….as i hope this was.

  7. Thanks for your humour, Daniel. I have found humour at various stages has helped me greatly in helping me see how spurious these “diseases” are.
    My diagnoses, which changed with the mood of my then psychiatrist, and were at times used as threats and insults, left me feeling quite fundamentally flawed…devastated, in fact…and between them and the meds, induced such a parlous state that I was very nearly a successful suicide. I am sure he was sorry – I saw tears in his eyes – however, I suspect he really had no true understanding of human vulnerability or how to be present and allow people just to be and to heal.
    My current psychiatrist has never diagnosed me (well…not that he’s told me), and has suggested we hold off on meds until “next week”, on the few occasions I have just felt it was all too much and asked for a “magic pill”. I am very thankful for that.
    I’d be even more thankful were he more like you, Daniel, with a playful and healthily irreverent sense of humor! It’d be affirming to share some humanity with him, and humour is a wonderful way to do that.

    • thanks kim. much appreciated. yes…….i do like humor, and i used it as a therapist a lot, because it is part of my personality. however, i was pretty careful in using it, because it could quickly alienate some people, as has even happened by posting this essay. that’s the risk, i guess. but sometimes i just……need to laugh!!!! 🙂 daniel

  8. What gives me solace in a dark humor kind of way is that the new world order feudal billionaires and their flunkies including psycho-pychiatrists and nurse rachets and numerous other perpetrators of the therapeutic state somewhere deep inside are afraid of their very own Madame Defarge moment catching up to them as there crimes against humanity from cradle to grave grow more obvious to more and more of the population.

  11. I’m surprised you didn’t do something with the old diagnosis of sociopathic behavioural disorder Daniel, you know that one “I’m revolted by homosexuals and wish to chemically castrate and tazer your brain disorder”. Of course they did manage to cure all these ill people overnight lol.

    Bit harsh maybe.

    On a lighter note, i said to my psychiatrist once that everybody hated me, and he replied don’t be silly, they don’t all know you.

  12. As usual- I adore your viewpoint Daniel! I make my living as a therapist and I work primarily with teenagers and young adults. I typically spend the first few sessions helping my beloved kids look at the world of “mental health care” through a different lens. They are all so traumatized and usually present with a variety of diagnoses (and conjunctive medications of course) that they assume they are broken as a human being. We always discuss the history of psychiatric labeling, the conformist culture of labeling, and what it means to be a traumatized human being attempting to navigate through a largely uncaring community of collective people. Some times they are so overlabled, and so attached to these labels, that they get really pissed off when I refuse to give them another (or to confirm the ones they have). It often takes them some time to adjust to the fact that in our sessions we will talk about their suffering and not their diagnosis. It’s too bad that as a culture we’ve medicated the revolt out of our youth…how will we ever progress as a people without youthful passion? Thanks for your work.

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