Together at the Poles

Diagnosis and Stigma: How the DSM Is Not our Enemy


I just finished up a degree in psychotherapy, and I heard a lot of different opinions about the DSM, or “Diagnostic and Statistical Manual of Mental Disorders”, the standard guide for diagnoses in psychiatry today. However, there was one, general, kind of vague criticism that I found someone concerning and even upsetting as someone living with a mental illness.

The criticism went something like this: “We shouldn’t be diagnosing people as having mental illnesses, because that ‘pathologizes’ people with mental health conditions and increases the stigma associated with mental illness.” Quite often, the DSM was often treated as though it was some sort of stigma-generation machine, and we should be careful when referring to it, because we don’t want to “reduce” people to their diagnoses.

Now, I think this criticism is actually quite well-meaning. Basically, people look at the way that people with mental illnesses are treated by many people in the mental health field, especially under the so-called “medical model”, and see that there are problems with the way they are treated. In turn, criticism is cast on the very act of diagnosing itself, and then people are taught to treat the DSM with a great deal of skepticism and occasionally dismissiveness.

However, there are several problems with this criticism that I will detail here that I believe those in mental health need to take seriously before being so dismissive of the DSM.

1) It assumes that having a mental illness is shameful.

When we avoid diagnosing people with mental illnesses to avoid the stigma of mental illness, we are buying into the assumption that having a mental illness is shameful.

Part of the motivation here is that, if we can treat mental health difficulties as though they weren’t illnesses, then the stigma of mental illness would no longer apply. This is in some ways quite sensible. If there were serious stigma around cancer, then people would be more hesitant to diagnose people with cancer. However, this is the wrong approach. When we avoid diagnosing people with mental illnesses to avoid the stigma of mental illness, we are buying into the assumption that having a mental illness is shameful. However, this fails to deal with the reality of mental illness. Mental illness is a) disabling and b) hurts. If we get trapped into thinking that we can’t call mental illness “illness” because of stigma, we risk losing sight of the serious problems that mental illness causes people because it is an illness.

2) Why suppose that people will be “reduced to” their illnesses?

A common criticism of diagnosis was that it “reduces” people to their diagnoses. However, there’s simply no reason why that should be. Of course, is we don’t diagnose people, they won’t be reduced to their diagnosis, but then we lose the benefits that come from identifying a treatable problem. However, there’s no more reason that a health care professional should reduce a client to his or her mental health diagnosis than to his or her broken arm. Some health professionals do this, absolutely, but that is because they are behaving unprofessionally. However, we don’t prevent people being reduced to problems by pretending they don’t have problems. We do it by seeing them as human beings with problems.

3) It takes away targetable, specific problems in place of a fuzzy sense of being “messed up”?

Having a diagnosis took this vague sense of being “messed up”, and gave me a small, finite set of symptoms that I could understand and manage.

One of the most important parts of receiving a diagnosis is that it provides us with a finite set of symptoms that make up the disorder. Like most people, before getting my diagnosis, I had the vague sense that there was something wrong, and that I was somehow “messed up”. I was having trouble socially, in school, and with my moods. I was generally unhappy. Having a diagnosis took this vague sense of being “messed up”, and gave me a small, finite set of symptoms that I could understand and manage. This current reaction to diagnosis ignores just how empowering a diagnosis can be, and how having a finite set of symptoms provides us with something that sounds more manageable than our lives previously felt.

4) It’s being sloppy about its targets

There’s no question that there are problems with how people with mental illnesses are often treated under the medical model. It can be dehumanizing, people can ignore our experiences in place of medication, and we can be pushed around with words like “compliance”. And, of course, diagnosis is often a part of this medical model. However, to attack every component of the medical model is not actually a response to the problems of psychiatry. It is a reaction. Rather, we should look at what works in the medical model, what doesn’t, when it works, when it doesn’t, and why. This is a complex process of advocating for ourselves within the medical community. We shouldn’t assume that diagnosis is always bad, just because it “smells” of medicine. At that point, we’re no longer analyzing the problems.

Keeping the Conversation Going

I felt like I was having to raise this subject quite a bit in my program. Because I was openly living with bipolar disorder, I did find that I was heard. However, it’s quite hard to dislodge people from their sense that they are fighting a war against stigma and have already identified their enemies, including the DSM. Nonetheless, it’s an important conversation for us to have, in part because it helps to have a conversation about the true sources of stigma, our experience of stigma and medicine, and how we would like to be described within the community.

One Response to Diagnosis and Stigma: How the DSM Is Not our Enemy

  • The diagnosis was the turning point for me,It was quite an easy diagnosis for the psychiatrists to make,as it came after a proper full on manic episode.Getting sectioned is a horribly intense way to learn that you have a mental health problem,I found it particularly difficult at 1st,since it was one of my greatest fears.I had studied Karate to Brown belt(1st Kyu) the man who taught me worked in the local Psychiatric hospital & our dojo was in their main hall,so I had seen the long stay patients looking out at us from the wards,tardive dyskinesea making them twitch & drool as they stared out the windows.I can remember thinking when I saw this,that I never wanted to end up in a place like that.So the 1st person in whom I had to address the stigma aspect with was myself.This was further compounded by the fact that I had spent the summer performing Psychedelic Psychotherapy upon myself.I had some vengeful plans for some policemen who had really wronged me,harassed me & caused to to have to leave my degree course,this was a personal matter related to an ex partner who had joined the police & then cynically used her colleagues to get rid of me to avoid paying me a significant amount of money she owed me.I was very very unhappy about how they had wronged me & had been planning to murder them. I am not however someone who can comfortably accommodate such aberrant ideas,but had been through a period of very severe depression as a result of all this.I was rescued from this period by a mate who came & found me & encouraged me to come squatting in Hackney,East London,a hotbed of the squatting movement & very colourful place/scene at that time.I had met someone who was as interested in psychedelic science as I was,who had shown me his precious copy of Stanislav Grof’s book”LSD Psychotherapy”,not long enough to read it,but enough to give me the ideas,I had already read a large amount of the available literature available at that time(very rare & hard to come by books)I enthusiastically(manically)started to try to sort my head out or destroy my psyche .I was disgusted at myself for failing to have the courage to commit suicide during the severe & prolonged depression that had been the response to what had happened to me & could tell I needed to change.So when the psychiatrists told me that I was a classic case of Manic Depression I was sceptical,knowing that I’d just munched a large amount of LSD over a 5-6 month period.I had however managed to lose the hatred for the cops & regained some sense of who I was,what I cared about,regained my enthusiasm for life,classic responses to psychedelic therapy,as I now know.I was unlucky in that Lithium carbonate didn’t help much,it was useful in so far as it meant that I saw my excellent GP fairly often,he was an ex fulltime psychiatrist, now working part-time as a psychiatrist & had moved into General Practise ,he was a real help & facilitated a good relationship with the excellent consultant psychiatrist who’s care I came to be under.Dr T Turner was an exceptional man,he had been the vice president/chair of The Royal college of Psychiatrists.We tried it the conventional allopathic medicine route,but it didn’t really work very well,7 out of 7 antidepressants caused mania a or severe dysphoria. I suffer from mixed moods.Lithium didn’t help at all with the depression,but did lead to the very worst mania I have ever endured,it led to the 1st 360 hour awake & bouncing hard mania,It was at this point that I started to take control of my own care,It was a long process that took 8-10 years,with my being sectioned 4-5 times many of the sectionings being as a result of the antidepressants I’d been given.I had started to unicycle & play unicycle hockey at this point,the increase in fitness & stamina(I regained the fitness I’d had when studying Karate)I now know a great deal about Psychedelic science & the neuroscience of exercise.I read a paper by Dr Rick Strassman,now famous for his DMT study at New Mexico.This paper published in Tom Lyttles “Psychedelic Essays & Monographs vol 5” was about the possible production of endogenous DMT in the pineal gland.I actually think now that Rick is quite wrong about the pineal,I believe that he & his colleague Dr S Barker at the Cottonwood research institute are correct about endogenous DMT to some extent.But it’s not pineal activity,the pineal does however produce melatonin the circadian rhythm regulating chemical.I believe that it is disruption of the production of melatonin that causes the Bufoentine(inactive) to be converted to the very active 5MeODMT rather than N-N DMT.this is a matter of controversy within the psychedelic science field at this time,with Dr D Nichols of Purdue & the Heffter & Dr D NUtt Prof Emeritus of Psychopharmacology at Imperial college London amongst others believing that DMT never reaches meaningful levels in the brain.I believe they are wrong,one of the members of The Heffter Dr Jace Calloway of The Kiupo school of Neuroscience was kind enough to send me a paper by Karkaainen & Raisenen which showed that the breakdown metabolites of DMT(which have been found in more that 60 studies)were shown to be raised in psychotic patients ,I was informed by Dr Nichols that this paper is being reexamined.I am sure that I am correct about the role played by endogenous DMT as an experienced psychonaut I recognised the territory,indeed the skill sets I learned as a result of extensive reading around the psychedelic science meme(in fact around almost every aspect of psychedelic culture)have been the saving of me,the skills one needs to come through the heroic doseage range of experiences serve you very well when you are dealing with a 360 hour mania.It has been edifying to see the current evidense about the positive effects of psychedelics & mental health,we have managed to come to a point where the hysteria generated by the 1960’s is finally passing & we are once again realising that these substances show great healing potential.I was aware of this potential as a result of my nerdily compulsive obsession with things I find fascinating. It was what enabled me to find another path to being able to cope with this disorder.I had read about Humphrey Osmond & Abram Hoffer & their work with B6 & schizophrenia & their & Linus Pauling’s ideas of Othomolecular medicine,One of their protégé’s Patrick Holfords book”Optimum Nutrition for the mind “proved very useful.As did Valerie Ann Worwoods “The fragrant mind” & also Leslie & Susanah Kentons “The. New Raw Energy” I would also recommend Dr Liz Millers”Mood mapping”although I must say that by the time I read it,I found it to be a bit self evident & I had already incorporated/ formulated my own versions of everything that she suggested prior to reading it.But K have found this to be true of many things I have read,examples being Scott M Peck’s “The road less traveled” Dr D Burns “The Feeling good Handbook”, I must point out I am not dissing these books,they are very useful,it was just that I had already incorporated their ideas from other sources,they merely confirmed what I already thought,I have had 2 courses of CBT,but in each case the psychologist told me that they had nothing to add to what I had already learned,The 1st one was useful in that he made me realise that for every idea he presented I had an analog from psychedelic science or culture(ie Shamanic healing etc)I had read about many cognitive programming modalities such as NLP CBT etc.I tend to assimilate the bits that resonate & work for me,rather than slavishly following any of them. The 2nd course was useful but from a massively different perspective,the guy was a fool,subsequently dismissed,he didn’t follow his own protocol or methodology & even told me that he’d found treating me intimidating due to my level of knowledge,both were useful in that they made me realise I had the toolkit I needed to sort it out myself.Dr Turner & I agreed that I would not go down the antidepressants route as I am treatment resistant & have had problems with medication,I must stress I have limited appreciation of the viewpoint of Dr Breggins,R D Laing & the antipsychiatry movement,I have suffered some degree of iatrogenic injury ,but have a robust physical system & recovered,it did force me towards a healthy lifestyle, which was a positive outcome.Dr Turner referred me to a German consultant psychiatrist Dr Ursula Wernicke who’s interests are complementary therapies ,I had had some useful treatment from a friend who was studying Shiatsu,Ursula was a qualified if not particularly skilful acupuncturist,this led to my finding a very skilled acupuncturist/osteopathic practitioner namely Jean Barnard Hadleigh.I would tell all of you whjo suffer from this disorder that the combination/fusion of these 2 therapies has proved to be one of the most useful things I have found in dealing with this condition.I am going to wind this up now,as I hadn’t intended to write quite so much.If any of you wish to contact me regarding anything I have written,I am on Facebook,my name is Martin Izat & I’m easy to spot,my profile picture is of me in a Dangermouse costume,holding one of my unicycles.When contacting me please refer to this post so I will know why you are contacting me

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Psychotherapy from Daniel

Daniel Bader, Ph.D., RP (Qualifying), CCC

Daniel Bader, Ph.D., is a Registered Psychotherapist (Qualifying) and Canadian Certified Counsellor specializing in bipolar disorder, offering in-person psychotherapy in Kitchener, Ontario, and online and telephone psychotherapy within Canada.

To book an appointment with Daniel, please visit his Psychology Today profile.