People who use mental health services are given labels-otherwise known as diagnoses-which are supposed to tell what is wrong with you and thereby indicate the cure for the problem. Because these diagnoses have impressive sounding names with corresponding numbers, and are listed in a thick volume called the Diagnostic and Statistical Manual of Mental Disorders (DSM), people think of them as scientific symptom clusters with specific causes and treatments.
Unfortunately, despite the impressive packaging, the diagnoses are not based on research but rather on opinion polls of the psychiatrists who sit on the panels that create the diagnostic labels. The diagnoses, for the most part, are value judgments made by mental health professionals about behaviors that they consider "sick."
This first came to public attention when the diagnosis of Homosexuality was dropped from the DSM in 1973 by a vote! This came about through the efforts of gay mental health professionals to bring public attention to the stigmatization of homosexuality without any credible evidence that homosexuality was, indeed, a mental disorder.
A psychologist leading this fight was Charles Silverstein, PhD., who then went on to found the Institute for Human Identity, a not-for-profit psychotherapy center where gays, lesbians and others with non-traditional sexual orientations can receive appropriate mental health services without the attempt being made to "convert" and "cure" them of their homosexuality.
The Institute for Human Identity (IHI) is now approaching its 30th birthday, and 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 works. 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! And a small group of psychiatrists still endows itself with the power to decide what behaviors constitute a mental disorder that needs to be treated.
The gay community acquired the power to speak up for itself, but the DSM now targets women and other groups. There is a gender bias in diagnostic categories with women being viewed in terms of their reproductive functions and hormones. According to the definition of PMS, 90% of the women in the U.S. are suffering from this hypothetical psychiatric disorder. Other labels have been proposed, again with no research backup, but kept out of the DSM only by the vigilance of women's groups.
For example, the committee on personality disorders wanted to include the diagnosis of "Self Defeating Personality Disorder," which would have labeled as sick any woman in a relationship with an alcoholic or violent partner, and put the blame on her for provoking the abuse.
Do you remember Anita Hill? Some psychiatrists thought she had a delusional disorder, or erotomania, while Robert Spitzer, the editor of the DSM at the time wanted to introduce a new disorder: Victimization Disorder. Nobody suggested that Clarence Thomas had a psychiatric problem.
The DSM police still have problems with sexual behaviors engaged in by consenting adults: practicing S&M can lead to a diagnosis of sexual disorder. How about "deficient sexual fantasies and desire for sexual activity" as judged by the clinician-that can give you the diagnosis of Hypoactive Sexual Desire Disorder. There is no problem with wanting to have a lot of sex, but such behavior is slated to become an Impulse-control disorder when the next DSM comes around. And some psychiatrists are campaigning to have homosexuality re-included in the DSM as a mental disorder.
Diagnosis, or labeling, has a purpose if it can pinpoint a problem and its cure. But clinicians are not agreed on what the cause is or how to deal with it most effectively. Depression, for example, is viewed by many as a problem with the balance of neurotransmitters to be treated with medications. Others see depression as a distorted way of viewing one's life situation and work with people to change their thinking patterns. Research shows that the latter approach has lasting effects as opposed to medication. Phobias can be viewed as stemming from repressed sexual feelings (if you are of a psychoanalytic bent) and treated with years on the couch, or with anti-anxiety medications, or more simply with behavioral desensitization techniques.
Mental health clients may need to be diagnosed in order to obtain insurance coverage, but they also need to be wary of clinicians who focus on labeling clients rather than on understanding what their problems are.