Comments on Qld Mental Health cont...
Diagnosis
In the past two years, I have seen five psychiatrists - two as an inpatient, three as an outpatient. The array of “labels” which these doctors have assigned me is dazzling: Major Depression, Depersonalisation, Borderline Personality Disorder, Dissociative Identity Disorder, Schizotypal Personality Disorder, and Posttraumatic Stress Disorder.
Is it any wonder that I feel like I’m out of my mind? I can only see two explanations for this:
1) I am a completely dysfunctional human being; or
2) The majority of these diagnoses are wrong.
The diagnoses come from four different “groups” of disorder: Mood, Dissociative, Anxiety, and Personality disorders. How acceptable would it be if physical disorders were “diagnosed” in such a random way?
The common justification offered by psychiatric staff is that many disorders have overlapping symptoms, and doctors diagnose on their interpretation of the symptoms. There are a number of flaws with this justification.
The DSM 4, the “bible” of mental illness, dedicates its full 900+ pages to clearly defining various disorders - their symptoms, causes, and common treatments.
The distinctions between illnesses are defined in the section “Diagnostic Criteria”, which follows a discussion of each disorder. Most diagnoses appear to be made on one or two prominent characteristics or symptoms, rather than an assessment of whether the full criteria are met.
An example is Borderline Personality Disorder, a diagnosis which is traditionally associated with “difficult” patients. Many patients who self-harm regularly (without intention to cause death) are given this diagnosis. However, this is only one of eight diagnostic criteria, of which at least five should be present for the diagnosis to be made.
An opposite scenario often occurs in the case of Dissociative Identity Disorder (formerly known as Multiple Personality Disorder). This diagnosis is rarely made except by a psychiatrist who has specialised in the study of dissociation. A significant number of doctors do not acknowledge the existence of the disorder, despite its inclusion and clear definition in DSM 4.
Doctors who “misinterpret” symptoms to misdiagnose patients, therefore, are not correctly or effectively applying clear diagnostic criteria which they should be familiar with. However, the real problem with their defense is that it does not acknowledge, or even consider, the suffering of the patient as a result of their mistakes.
A patient with a mental illness has as much right to a correct diagnosis and treatment as a patient with any other chronic illness. This is denied when doctors are not held accountable for their mistakes, nor asked to clearly explain to their patients the basis for any diagnosis.
It is the patient, not the doctor, who must live with the label applied. It is the patient who must face the potential stigma and isolation from family, friends, and workmates. It is the patient who often goes through months or years of treatment, at physical and mental expense, for an illness that they do not have.
A book that I recently read about Dissociative Identity Disorder, advised therapists against discussing the diagnosis with patients who raised questions. It stated clearly the concerns that the patient might win the debate, and thus undermine the therapist’s position as expert.
I have seen this attitude at work when I have raised questions about my own diagnosis or treatment. Consistently my doubts about these issues have been diverted into a discussion of my feelings of anger etc, and the “real” (usually past history) causes. I have been left feeling that my doubts and questions are invalid, and that my therapist is essentially infalliable.
No patient can feel in control of their treatment when their therapist is beyond question or rebuke. No patient can feel in control of their life when they are labelled with minimal consultation, and no explanations. Diagnosis is an inaccurate science, and one which automatically disempowers many patients who are seeking greater control over their thoughts and feelings.
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