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Subjective Diagnosis and Limitations to Psychiatric Diagnosis

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25.  Psychological and psychiatric diagnosis are unlike any true medical diagnosis found in the lab or with real tissue and medical evidence.  Psychiatric diagnosis are really phenomenological concepts and metaphors, in that when a patient is given a diagnostic label, it is for simply doing or not doing a particular behavior or for having a particular feeling or thought.  There are no biological tests, scans or lab done.  Real disease like cancer and diabetsis were and are found by a doctor through patho-physiological examination and with real tissue matter.  Psychiatric diagnosis were and are created by mental health group of people in a room, without any actual patient present, and are only given to a person after a person does or does not do a particular behavior or report a particular thought or feeling.  The Diagnostic and Statistical Manual of Mental Disorders (DSM), the book published by the American Psychiatric Association and used for diagnosing people, has developed and grown to over 700 diagnosis and sub-catergories because the diagnosis are created by committee members who in some years all had conflicts of interest with financial ties to pharmaceutical companies profiting from the creation of new diagnostic labels. The lead Director for nearly 20 years of the DSM, Dr. Allen Frances, who has been called the most important psychiatrist in the world, indicated to me on November 14, 2014, at the International Society for Ethical Psychology and Psychiatry:

“Mental disorders are no more and no less than constructs— necessary and useful, but also fallible and subjective. Experience teaches that anything that can be misused in the DSM will be misused—particularly under the pressure of well-financed drug company propaganda that mental disorders are under-diagnosed, are easy to diagnose even by untrained primary care doctors, are caused by a chemical imbalance, and require a pill solution. The combination of an overly inclusive DSM and misleading Pharma marketing has resulted in a massive mislabeling as mental disorders what are instead the expectable everyday aches and pains of everyday life and of childhood development. … The sad result is that we are massively over treating people who don’t need it.[1]

 In all other branches of medicine, diseases are not created, but discovered.  When a behavior or a thought is voted as unacceptable, the board committee may make it into a metaphorical disease, as was in the case when they included homosexuality years ago as a mental disease. 

Thus, being labeled and diagnosed Schizophrenic, Bipolar or ADHD is not like having a diabetes’s.  Being diagnosed Schizophrenic is like having a sick fiscal policy, and like being labeled Atheist.  If one does not say prayers, does not go to a place of worship, and says there is no God, then they may be labeled Atheist.  They can not have Atheist though.  This is important distinction, as it defines how one might try to understand the thoughts, feelings and behaviors of a person labeled Schizophrenic.

Given this subjective nature of the label, people are often mislabeled with invalid metaphorical diagnosis.  Researcher Nancy Andreasen, one of the longest standing and well respected researchers in the world on schizophrenia indicated “although creating standardized diagnoses that would facilitate research was a major goal, DSM diagnoses are not useful for research because of their lack of validity.”[2] The DSM -4th Edition (DSM-IV), produced by the American Psychiatric Association, states the causes of such symptoms are unknown, and they make no recommendation as to treatment. 

[1] International Society for Ethical Psychology and Psychiatry 2014 conference schedule, plenary speakers. Available from URL: plenary_speakers.php Accessed 10 Nov 2014.

[2] Andreasen, N. (2007). DSM and the Death of Phenomenology in America: An Example of Unintended Consequences, In Schizophrenia Bulletin vol. 33 no. 1 p. 107. [2]