Why We’re Turning Psychiatric Labels Into Identities

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From The New Yorker: “In ‘DSM: A History of Psychiatry’s Bible‘ (2021), the medical sociologist Allan V. Horwitz presents reasons for the DSM-5’s botched revolution, including infighting among members of the working groups and the sidelining of clinicians during the revision process. But there’s a larger difficulty: revamping the DSM requires destroying kinds of people. As the philosopher Ian Hacking observed, labelling people is very different from labelling quarks or microbes. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how ‘individuals experience themselves—and may even lead people to evolve their feelings and behavior in part because they are so classified.’ Hacking’s best-known example is multiple personality disorder. Between 1972 and 1986, the number of cases of patients with multiple personalities exploded from the double digits to an estimated six thousand. Whatever one’s thoughts about the reality of M.P.D., he observed, everyone could agree that, in 1955, ‘this was not a way to be a person.’ No such diagnosis existed. By 1986, though, multiple personality disorder was not only a recognized psychiatric label; it was also sanctioned by academics, popular books, talk shows, and, most important, the experiences of people with multiple personalities. Hacking referred to this process, in which naming creates the thing named—and in which the meaning of names can be affected, in turn, by the name bearers—as ‘dynamic nominalism.’

Three new books—Paige Layle’s ‘But Everyone Feels This Way: How an Autism Diagnosis Saved My Life,’ Patric Gagne’s ‘Sociopath: A Memoir,’ and Alexander Kriss’s ‘Borderline: The Biography of a Personality Disorder‘—illustrate how psychiatric classification shapes the people it describes. It models social identities. It offers scripts for how to behave and explanations for one’s interior life. By promising to tell people who they really are, diagnosis produces personal stakes in the diagnostic system, fortifying it against upheaval.”

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13 COMMENTS

  1. I don’t know if I agree that a diagnosis shapes a person’s identity. It’s their identity that is meant to suggest a psychiatric label. And they are labels. Without a physical basis, it is hard to definitively diagnose. But the label can be useful for suggesting appropriate treatments or therapies or connecting them to the right support groups.

    If people are choosing their identity based on a diagnosis, that may not be helpful. But i doubt its harmful. People choose their identities. Let them instead of patronizing and invalidating them.

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  2. I was intentionally misdiagnosed with “lifelong’ BD in 2004, like thousands of others, post DSM-IV.

    What I discovered regarding the topic of this article, was that many people in stressful and/or
    traumatic episodes are relieved to be told that it’s identifiable…and can be ‘treated’…or ‘fixed’.
    I was, initially. I trusted, believed, acted per instructions.
    Many felt comfort being so defined…. for a variety of reasons, being described as helplessly driven by a “disease”…and accepted it. The psych industry encouraged it AND emotionally rewarded the acquiescence. To someone emotionally vulnerable, it’s a very comforting message.

    But I noticed… questioning their ‘teachings’/authority in any way, was asking for an erosion of the ‘relationship’-‘help’ for your troubled times.
    Surrender/Infantilazation was ‘All or Nothing’.

    I get it. I was part of it. And I recently had a bad medical scare. I know the flood of relief when a doc defines it and has a confident-sounding ‘game plan’.

    My (12-year) experience encompassed east coast to west coast, private, top-shelf insurance support to Medicaid, state assisted community clinics.

    Most notably, I ultimately rejected their ‘lifelong’ sentence, held them accountable for a prescribing ‘error’ (of many) NOT ‘connected to the diagnosis’, and challenged them to choose….
    THEIR commitment to the ‘lifelong’, absolute-ism of THEIR diagnosis…OR…their ‘committment’ to their career$…in the face of a big, messy, easy to understand (for the media and public) malpractice lawsuit…for anaphylaxis (reported as an ADR on 1st dosage), given immediately AGAIN (!), and identified by an ER and treated. (Antipsychotics…again)
    Here was my opportunity.

    They chose their careers….over their fealty to the cult’s “evidence-based” “lifelong” diagnosis, drug-treatment, and a Serious Mental Illness certification (permanent disability). EVERYTHING/LABEL they had committed to ‘selling’ to me, and other clients.

    My terms were doctor-guided withdrawal, however long it took (2.5 terrible years)..AND the vacation of THEIR ‘lifelong’ diagnosis IN WRITING.

    They couldn’t agree fast enough…or more quietly.

    Nothing illustrates their own cynical lack of conviction/belief in the BS dogma of psychiatry-They ALL (2013-2016…CEO, CMO, VP-Arizona BH contractors) chose their paychecks….over their ‘scientific convictions’….just make this go away.

    There’s a label for that, too.
    Fraud.
    And they owned it…but ‘just between us’.

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  3. Scheff called this the role of the mentally ill in 1963.

    See:

    Scheff, T. J. (1963). The role of the mentally ill and the dynamics of mental disorder: A research framework. Sociometry, 436-453.

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  4. “Psychiatric diagnosis, wrapped in scientific authority and tinged with essentialist undertones, offers a potent script.”

    A potent script that breeds cruelty, bigotry and tyranny.

    Plus, the inevitable and tragic loss of one’s identity (sense of self).

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      • I understand more than most how a psychiatric label can be damaging. I was diagnosed with bipolar disorder about a decade ago and it has caused me much more harm than good. It is true there is absolutely no biological test for any of these labels. Psychiatrists and the public would do well to understand that it’s just a label when it comes down to it. It’s not a physical truth.

        The only use for it I can see is to guide therapy approach and treatment. Perhaps it can help connect a person to the right support groups. But using it as a medical justification for involuntary medical incarceration is almost always wrong. And using it to justify an involuntary pharmaceutical treatment is unilaterally wrong too. Not to mention how money plays into it.

        My point though is that the labels CAN have uses. But they shouldn’t be treated like getting diagnosed with diabetes.

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