“Medical diagnosis, then, is not so much about ‘discovering what disease someone is suffering from’ or ‘what illness they have’ as about trying to match a person’s bodily problems with a more general pattern already described by researchers. This is always in the hope of answering the questions: ‘How have this person’s problems come about?’ and ‘What can be done about them?”
Page 16 of A Straight Talking Introduction to the Power Threat Meaning Framework.
I’m very concerned because research consistently shows that people live to their labels – children treated as smart do great in tests, those treated as truants act out, those treated as caring are kind. We know this and have demonstrated the powerful effects of labels, obedience, authority, and adaptation in research over and over again and yet we pay very little attention to the massive risks of diagnosis, particularly being diagnosed with syndromes.
You can be diagnosed on the basis of a single experience such as hearing voices. On the basis of that ONE experience, people are told they have a condition that includes many other debilitating symptoms. We have just increased the likelihood that the person will experience all the rest of the cluster, and that when they do they will attribute them to the illness. It’s no surprise to me that many people with schizophrenia lack motivation, between the stigma, disruption, loneliness, and low expectations isn’t it the slightest bit reasonable that lack of motivation might occur? Is that really a ‘Mental Illness symptom’ or a reaction to circumstances?
https://sarahkreece.com/2012/06/10/is-did-iatrogenic/
…the transformation of people’s thoughts, feelings and behavior into symptoms and illness categories has to be based on subjective social judgments about what are believed to be normal ways of thinking, feeling and behaving. It’s not surprising, then, that terms like ‘excessive’, ‘inappropriate’ or ‘out of proportion’ are common in psychiatric diagnostic criteria. These are obviously meant to convey abnormality without saying what is normal. However, diagnostic criteria also often include specific numbers: for example, the person must show a specified number from a longer list of ‘symptoms’, or must feel or do something at least once a day or have shown the ‘symptoms’ for a specified length of time. All of this gives a false impression of scientific exactness, when there is no reliable evidence to support any set of numbers over another.
So, in order to count as a symptom, what we feel or do should not be understandable or expected in our social context. But what is a ‘normal’ or ‘expected’ response to having insecure work, being in an abusive relationship, having parents who neglected you, living in a consumerist society, being racially or sexually harassed, or losing a beloved partner, child or pet? And who decides? The answers will depend on who you ask, where they live, and at what historical time. The answers can also tell us more about people’s limited knowledge, imagination and empathy than about the causes of feelings and behaviors. Just as important, the answers can tell us about power structures in a society. Given all this, we should not be surprised that what are said to be symptoms of mental disorders tend to reflect current social concerns.
None of this means that emotional or behavior difficulties are ‘just’ social judgments. Our emotions and behavior may at times be extremely distressing and troubling to us and/or those around us. But there is a big difference between acknowledging the reality of distress and troubling behavior and presenting social judgments about it as if they were illness categories.
Pages 20-22 of A Straight Talking Introduction to the Power Threat Meaning Framework.
As people move through mental health services, it’s not unusual for their diagnosis to change or for them to collect several diagnoses (known as ‘co-morbidity’). This can be confusing and distressing, leaving people feeling that no one understands their problems or, perhaps worse, that they have so many disorders it is difficult to see a way forward. In fact, the problem lies in the diagnostic system. This situation is inevitable if reliability is low and clinicians cannot agree on what illness someone is supposed to have. It also arises from the fact that our responses to very difficult life circumstances don’t fall into artificial ‘disorder’ categories.
For example, many – if not most – people who are given a diagnosis of a mood disorder such as ‘major depressive disorder’ will also meet the criteria for an ‘anxiety disorder’. This is not because they are suffering from two mental disorders but because the kind of circumstances that make us feel very anxious and apprehensive can also make us feel hopeless and despairing, especially if we can’t see any way of dealing with them or if nothing we’ve tried seems to work.
Psychiatric diagnosis cannot explain distress because the argument is always circular: ‘Why does she hear voices?’ ‘Because she suffers from schizophrenia.’ ‘How do you know she suffers from schizophrenia?’ ‘Because she hears voices.’ And using one diagnosis to explain another is just as circular. There is no possibility of finding an exit from the circles through identifying signs, as is possible with physical disorders: ‘Investigations have shown that her headache is caused by a tumor in her brain’ or, ‘His stomach pain is caused by an ulcer.’
Pages 23-24 of A Straight Talking Introduction to the Power Threat Meaning Framework.
What we pay attention to and how we make sense of it, the authors of the study argued, is always subtly influenced by our culture—that is, by how we expect others around us to think the world works.
They explained that implicit “cultural invitations” on how one should behave, how to make sense of and value experience, and on what counts as a mind, person, spirit, and normal experience vs. pathological one can have an immense effect on how we feel. This is something I have called “cognitive ideology” or the power of culturally-specific ideas and biases on what counts as a mind, what counts as real, and what counts as “normal,” desirable, or undesirable experience in shaping our most intuitive modes of affect and action.
Our culture, paradoxically, nominally values individuality, but aggressively imposes a highly standardized framework on behaviour, which can be measured, catalogued, pathologized, and punished with terrible precision.
Contemporary Euro- American culture may be the most aggressive of such frameworks ever implicitly ingrained, because it extends far and deep into other people’s thoughts and sensory experiences. The extent to which other people’s mental lives are considered “transparent” (and hence knowable) or “opaque” (and unknowable) is another important difference found across cultures. In contemporary Euro-America, in addition to thinking of ourselves in increasingly neurochemical terms, we think and worry excessively about what other people feel and think, and we have slowly incorporated a set of simplified medicalized assumptions and worries about how “normal”, healthy, sick and dangerous other people’s thoughts are. (see Suffering)
Add to this a moral panic about a simplified catalog of psychopathology, an obsession with self-authorship, and pervasive marketing from pharmacological industries, and the system of domination is almost total because people will police their own selves before policing others. Any private mental experience that departs from this sanitized norm will tend to be self-interpreted as scary and as the potential marker of mental illness.
https://www.psychologytoday.com/intl/blog/culture-mind-and-brain/201604/daring-hear-voices