Tuesday, 12 November 2013

Who Are The Stigma Villains?

This one is mostly for my colleagues – and yes, I’ll be pointing some fingers.

There is an international movement afoot to reduce the stigma surrounding mental health issues with the endgame being that people who are facing mental health problems can seek help without fear of being judged, marginalized, or vilified.  One such movement in Canada is Partners For Mental Health of which I am a member.

A recent exchange on a forum for mental health practitioners illustrated for me that one of the largest and most powerful populations perpetuating the stigma around mental health issues are counsellors and therapists themselves.  That’s right, I’m looking at you Counsellor.

Here’s the breakdown of the problem;

Far too many mental health professionals oppose the use (even the existence) of the Diagnostic and Statistical Manual of Mental Disorders which is now in it’s fifth edition (DSM-V).  They rail against it, claiming it labels people, transforms psychiatrists into shills for the large pharmaceutical companies, etc.

A few years ago I was diagnosed with Type II Diabetes after my physician compared the list of my symptoms and the results of blood tests with the diagnostic criteria for Type II Diabetes.  I was then gradually prescribed various medications and dosages plus a change in diet until my Diabetes became manageable.

Was I “labeled”?  Some people try to when they say; “Oh, you’re a diabetic.”  And when they do, I am quick to correct them; “No, I have Type II Diabetes.”  Just like a person with a mental health disorder such as schizophrenia isn’t a “schizophrenic”, they are a person who has schizophrenia.

Mental Health practitioners who vilify the DSM-V and the diagnosing of mental disorders are responsible for intensifying the stigma of mental health problems.  By protesting against the DSM-V and against diagnoses, they are saying that a mental health diagnosis is a bad thing – that it labels a person and makes them a social pariah; someone to be shunned.  That a diagnosis is something to be avoided at all cost.

I have a very dear friend who spent most of her early teen years deeply depressed, barely surviving three serious suicide attempts, and withdrawing completely from society.  She believed that she was flawed, that she couldn’t ever be like other people, that there was no hope for her.  She was finally (and properly) diagnosed with Complex Post-Traumatic Stress Disorder, and when she learned what it was and how it happened to her, AND that it was treatable, she was profoundly relieved.   These symptoms that had driven her to want to die weren’t her – they were the result of something that had been done to her.  By being diagnosed and beginning treatment, she could separate who she was from what the CPTSD was trying to turn her into.

The DSM-V is a tool, nothing more.  Like any tool, its value lies in how it is used.  I can use a wrench to fix your car or to damage it.  If someone misuses a tool and causes damage, it isn’t the tool’s fault.

The DSM-V is used to diagnose mental health disorders for a number of reasons;
  • To create a starting point for effective treatment by educating practitioners on the nature of any particular disorder
  • To allow individual practitioners to determine if they have the skills to treat this person or refer them on to someone with specific expertise in that area
  • To allow extended health plan administrators to justify authorizing the adequate number of sessions to treat the disorder

So, to my colleagues who continue to vilify the DSM-V and diagnoses in general; apply some critical thinking to what the end result of your ranting will be.  It just might convince someone like my cherished friend that getting diagnosed is a bad thing and could result in them ending their life.

And that would be a tragedy.

Aaron D. McClelland, RPC – www.interiorcounselling.com/aaron


  1. I like the wrench analogy because I think it's apropos. I agree that having a diagnosis is helpful for the reasons you've outlined, however I am convinced by observation, experience, and research, that diagnoses are all-to-often applied when they are not warranted. If those using the DSM V or the ICD 10 remembered that the criteria are exclusionary and did not apply a label where ALL criteria have not been met, your post would be completely accurate.
    In reality, I'm not sure it is ...completely accurate, that is.
    The same wrench that bashed in my friend's car window is the one her husband uses to change the fan belt. The same DSM that was used to help your friend is also used to diagnose 3 year olds with mood disorders. There is something inherently wrong when understandable and manageable human experience is pathologized, medicalized, and subsequently medicated.
    Critical thinking skills rarely allow one to completely espouse one side or the other of any debate, and this one is no different.

  2. I think you made my point of the DSM being a tool that can be used or misused depending on the motivation of the user.

    And I too have seen far to many misdiagnoses in my time. So many at-risk and high-risk children and youth came to me with an alphabet soup on their diagnosis line; ADHD, RAD, ODD, CD, etc, and once our team began working with them we discovered that under it all lay trauma. Once we treated the trauma and helped each one empower themselves in their healing, the symptoms that led to those misdiagnoses faded or disappeared altogether.

  3. "...we discovered that under it all lay trauma..." *clapshands*

    That has to be the most profound sentence in all the mental health universe. This is my experience as well, but trying to convince a psychiatrist who has diagnoses my client BPD that, in fact, she no longer qualifies for this diagnosis because she's processed the causative trauma was futile. "Once BPD, always BPD," was his response. "If she qualified for the diagnosis 10 years ago, she still has it now, it's just in remission or latent."

    It's not really the DSM/ICD that is the problem - it's the premise that applying the medical model to mental health is a legitimate and beneficial foundation for considering an individual's behaviour.

    No. No. No.

    I do use the DSM/ICD, but carefully, judiciously, and only when the benefit of a label outweighs the disadvantage of being labeled.

  4. I find it interesting that this phenomena exists in the medical model for metal health issues when one of the cautionary metaphors that medical students are told about diagnosing physical ailments is "If you hear hoofbeats, don't think 'zebra'."