Mental health patients are given labels—otherwise known as diagnoses—supposedly telling a person what is wrong with her and indicating a potential cure. These diagnoses sound impressive and are listed in The Diagnostic and Statistical Manual of Mental Disorders (DSM); people think of them as scientifically sound. Despite the impressive packaging, the diagnoses, for the most part, are value judgments made by mental health professionals about behaviors that they consider “sick.” This process first came to public attention in 1973 when the diagnosis of Homosexuality was dropped from the DSM by a vote. This change was brought about through the efforts of gay mental health professionals bringing public attention to the stigmatization of homosexuality and lack of credible evidence supporting its diagnoses as a mental disorder.
One psychologist at the fore of this fight was Charles Silverstein Ph.D., who later went on to found the institute for human identity, a non-profit psychotherapy center where people with non-traditional sexual orientations could receive mental health services without the attempt being made to “cure” them of their homosexuality. The institute for human identity (ihi) is still concerned about the continuing efforts of the mental health establishment to stigmatize people based on the value judgments of its practitioners.
Let’s see how labeling and stigmatization work. The DSM, which used to contain about 50 diagnostic labels in the space of 130 pages, has now grown to over 300 labels and covers 943 pages. There is little research to back up this proliferation of labels; rather, more and more behaviors are deemed “sick” based on the value judgments of hand-picked committees. Instead of picking on homosexuals, the DSM now targets women. Historically, there is a persistent gender bias in diagnostic categories and women are viewed in terms of their reproductive functions and hormones. PMS, by whose definition 90% of the women in the U.S. are suffering from a psychiatric disorder, is the most well-known of these hypothetical mental disorders lacking credible substantiation. Some disturbing, questionably researched labels have been kept out of the DSM by the vigilance of women’s groups. For example, the Committee on Personality Disorders’ proposal to include the diagnosis of “Self-Defeating Personality Disorder” would have labeled as sick any woman in a relationship with an alcoholic or violent partner, putting the blame on her for inciting angry or resentful responses.
Diagnosis, or labeling, has a purpose only if it can pinpoint a problem and suggest a cure. But clinicians are not agreed on what the cause is or how to deal with it most effectively. Depression, for example, is seen by many as a problem with the balance of neurotransmitters to be treated with medications. Others see depression as an unproductive way of viewing one’s life situation and work toward changing the patient’s thinking patterns. Research indicates the latter approach has lasting effects as opposed to medications, which need to be constantly administered and bring about harmful side effects. Phobias stemming from repressed sexual feelings can be treated with years on the couch, or with anti-anxiety medications, or more simply with behavioral desensitization techniques.
Diagnoses are necessary for insurance claims, but psychotherapy consumers need to be wary of clinicians who focus on labeling clients rather than on understanding what their problems are. And clients need to understand that diagnoses do not have scientific validity, rather they are value judgments made about them by people who may not be sympathetic to their life struggles.