Debunking the Psychiatric Diagnosis Myth Workshop/Exercise

One of the greatest advances modern society has is medicine. Over the last hundred or so years we have refined the process of discovering and treating medical disorders, illnesses and disease to improve quality and longevity of life.

Something large to write on, such as a white board, chalk board, large pad of paper or computer with overhead projector. Writing implement.

Ladies and Gentlemen, are there anyone here currently today who has ever been treated for asthma, diabetes, bone fractures or a heart condition? [If not, continue for a few more common ailments]

That is excellent. Would anyone like to talk to us about what prompted them to get aid? That is, what led you to seek medical treatment?

[Listen to a few stories if possible, but try not to get lost in the nitty gritty of specific stories. Write on the board “Symptoms”. If someone is getting to bogged down in details, point to the word “Symptoms” and say ‘can we stick to this for now?’]

Thank you. Now I would like to ask you if the treating doctor suggested one or more ideas about what might be happening that caused your symptoms?

[Listen to the responses. Write on the board, under “Symptoms” the word “Formulation”]

Thank you. Did the doctor narrow down their theories to a specific cause? How did they determine this cause?

[Listen to the responses. Ask questions about diagnoses and tests if they are not volunteered. If there was no test, ask how the doctor knew that this is what caused the symptoms. Write on the board “Medical Tests” and under that “Diagnosis”]

Thank you. What treatment did you receive from this tested diagnosis?

[Listen to the responses. Write on the board “Treatment”]
Thank you. Is or did the treatment work? Is it ongoing and having a positive effect? If the treatment didn’t work, did the doctors go back and review your diagnosis?

[Listen to the responses, if any]

Thank you. Now, has anyone here received treatment for a psychiatric diagnosis? Would anyone like to talk about their experiences? [Hopefully someone will volunteer to talk about their experience. If not, relate yours]

Thank you. First, what led you to seek medical assistance?

[Point to the word “Symptoms” on the board. Listen to their stories.]

Thank you. Did the doctor offer a range of possible explanations?

[Point to the board where it says “Formulation”. If the individual was only given one option, ask why the doctor didn’t explore further options. After all, there are different types of diabetes, different types of fractures, different types of heart condition etc. Why is there only the one formulation for this person in this situation?]

Thank you. What medical tests were performed to determine a diagnosis?

[Point to the words “Medical Tests” and “Diagnosis” when appropriate on the board. Listen to the response.
– If there were none, ask how you know if the diagnosis is right if there was no test?
– If it is a subjective mental state test (rate yourself on this scale out of X), ask if you were having a good day or a bad day when you were tested since this is known to bias results. Was a secondary subjective mental state test done?
– If it is a DSM-IV TR style “you have x out of y symptoms” show the scope of permutations this style of ‘diagnosis’ has. Also discuss umbrella terms. For example: Dyslexia describes a range of learning disorders which can include mixed laterality, hearing difficulties, cognition difficulties, colour blindness etc. Each have similar symptoms – the learning disorder, but each have different treatments and tests.
– If it was physical tests of exclusion (blood test shows that it is not thyroid, not mineral deficiency, not etc) then ask how they know what it is when they have only shown what it isn’t.]

Thank you. What treatment was offered for the diagnosis?

[Point to the word “Treatment” on the board. Listen to the response]
Thank you. Is or did the treatment work? Is it ongoing and having a positive effect? If the treatment didn’t work, did the doctors go back and review your diagnosis?

[Listen to the discussion, if any]

Thank you for your part. Now we will open up the discussion to the group. What were the key differences between the physical diagnosis and the psychiatric diagnosis? How did the medical system break down?

I am not suggesting that you dispense with a treatment plan just because no objective test was performed to prove what you were diagnosed with. The idea of this discussion is to recognise the difference between an unproven formulation and a proven diagnosis. Doctors treat formulations all the time, but they are receptive to their hypothesis being wrong. If you find your treatment isn’t working, or feel you should get a review of your “diagnosis”, then perhaps you should have a conversation with your doctor/psychiatrist.

Your doctor/psychiatrist has great knowledge. Understand the medical process so that you can better use them.

Understanding our experience

When an experience occurs that we do not understand and have nothing to compare it to, we humans slip into a state of survival and change. There are a number of reasons why we can not interpret the experience and many stories we can create to explain the experience. Our need to survive often leaves us vulnerable and looking for help from experts, which can de-localise our power and understanding.

An experience, in this case, can be something such as having an extreme mood (happy, sad, grief, etc), an odd perception (all the humans seem to be carrying demons on their backs, have turned into animals, the earth is actually attracted to us, not us to it, I am being of light and I must light up the dark etc), a survival of extreme pain and fear (persecution, rape, torture, bullying etc) or a physical difficulty (heat attack, diagnosis of terminal disease, kidney failure, vitamin/mineral deficiency/over load etc). Of course, there are so many more experiences that are beyond our prior expectation that we can have that it is impossible to list them all, or even to categorise them.

I am going to deviate the conversation just a little to discuss how we humans process ideas. When I receive a new idea (from someone/book/thought experiment etc), I link it to knowledge that I have via either similarity or contradiction. For example, that new thing is like this other thing, except for this and that. Or it fits between this knowledge I have and that knowledge I have. We create bridges in our knowledge with comparisons.

You can think of our knowledge pool as a jigsaw puzzle. We have pieces that fit together and create areas of knowing and areas of not. We bridge slowly into these ares of not knowing by building pieces of comparison to what we do know, piece by piece into the vacant areas. Often we are afraid of these areas because we feel blind and are not sure of what we know in these areas. We may avoid doing things so we don’t have to populate the blank spots in our knowledge with pieces of jigsaw puzzle that we are unsure of. What if we don’t like the picture of the world that is created with these new pieces?

Experiences expand our world by giving us knowledge, memories, ideas and so on to store. They change our world and our perception of it by increasing the understanding and stories we attribute to events. In effect, knowledge is the story pool we can use to explain how events link together.

What happens when an event happens, or knowledge is gained, that we can not link to any other? It isn’t like anything, and it isn’t opposite to anything, or the existence of this knowledge contradicts a large part of the puzzle we thought was sound. At this point we either become lost, or we reject the knew experience or we are forced to reject prior experiences to accept the new one.

Imagine how much of your thought process can be distracted by this amazing recreation of your knowledge pool. While this is going on, who is paying the bills, cleaning the house, cooking meals, looking after the kids, looking after the parents and so on? Also, how is your internal reorganisation being treated by those who care and love you?

There are two factors I have raised here – survival of self and survival in society.

First of all, we will often be forced to choose between reorganising our internal knowledge pool and surviving. If I have to do basic life things to keep surviving and I don’t have the personal resources to spend time in working my knew experience into my knowledge jigsaw puzzle, then I may put the experience off and find some cheap and nasty coping mechanism such that I keep eating, keep my shelter and survive the day, the hour and the minute. Yet sometimes the experience can be so profound that it destabalises your efforts to maintain your life and you must address the experience over and above maintaining that status quo. For example, what if a conclusion you draw from the experience is that those who you thought were protecting and nurturing you have some very sinister and life threatening outcome in store for you? What if you are right? Your survival right now looks more like you have to run away from food, shelter and support. I appreciate to the reader that this may seem fantastic, but there are enough people who realise they are the child in a sexual molestation ring that running away is a very good thing to do. You can’t just assume that your new insight is wrong and bad for you.

The second point I make is the effect your experience has on others. In the year 2000, I decided to change my life path considerably. Many people who socially interacted with me did not like the new me and some actively tried to intervene to bring back the old me. My change was relatively minor – I stopped being a prat and became a nice person. Many of my friends and associates had huge difficulties understanding where I was coming from, why I was acting differently and were quite worried about me. Imagine what they would say if my realisation was more profound than “I have become the person I didn’t want to be”. By profound, I mean life changing.

When we have experienced something extreme, we often find that our social supporters are scared, resist change and often do not understand what is happening to us. Quite frankly, the average Joe is not educated enough or trained in the right areas to know how to help friends who are experiencing a profound life experience. When we do not have the personal resources to process the experience, we outsource – that is, we turn to processionals.

Professionals are trained to minimise risk, categorise behaviour and to treat the categorised behaviour. Behaviour is seen as “abnormal” and put on a spectrum of “no need to act” and “treat”. This is a part of containment, risk management, stabilisation and reputation protection. There are some excellent reasons why this system is in place and some fantastic instances of where it is exactly the right thing to do. It can also quite help people.

When it doesn’t, it is very difficult for the person going through a profound experience to muster up the free personal resources to object to the mis-treatment. By mis-treatment, I do not refer to abuse as such, but a treatment regime that is misapplied. The person often has enough troubles surviving the experience and finding resources to process the change let alone argue against an authoritative professional who is well educated in the diagnosis of difference and oddity.

I would like to see professionals trained more in helping people understand their experience and filling in those blank spots in their knowledge jigsaw such that they can go back to running their lives independently of the professional system. I would like professionals to be trained in ways of retaining maximum personal power rather than de-localised power.I would like to see humanity and dignity returned to the system.

I appreciate that I got a bit ranty towards the end their. My apologies!

The Life Cycle of Psychiatric Diagnosis

After working with many people and speaking with many peers and consumers, I started to see a pattern for those who had been diagnosed.

I appreciate that this is going to be contentious, especially for people who either diagnose others, or have found that a diagnosis has given them a sense of identity.

This is a pathway to recovery and well-being beyond diagnosis. If practitioners used formulation to inform therapeutic styles rather than diagnosing to define someone, I believe that a lot of the following list could be skipped – that is, from steps 2 straight to 10. In effect, I believe that a diagnosis is much like a familiar, comforting scenic tour, which may indeed get to the final destination, but a detour that is not necessary to make.

Please keep in mind that this is a theory that has not been independently verified and no experiments or research have been done to confirm this life cycle. 

1- The Schism (between now self and society)
The feeling of separation creates distress. The distress results in behaviours which attempt to address the distress and are often mistaken for a fault in the person rather than an attempt to  save the self and survive the situation.

2- The Diagnosis of Behaviour
The behaviour is catalogue and compared to many others. The diagnostician is attempting to catalogue the behaviour to find a solution to the behaviour which is seen as disruptive to the person, without realising the behaviour is protective. The diagnostician often misses the underlying cause of behaviour and fails to solve the problem.

3- The rejection of diagnosis
The diagnosed person will often reject the diagnosis for various reasons. Often this is because the diagnosis is damning, stigmatising, degrading and not helpful towards a solution. Sometimes it is because the person perceives that the diagnosis implies fault in the person, either mental weakness or physical failings in the brain or genetics. Underlying this may be the intuition that the diagnosis does not address the root cause of the behaviours.

4- The doubt of self
As the diagnostically appropriate intervention continues, the person begins to doubt themselves — their identity, their sanity, their methods of survival. Often the questions of “what if they are right?”, “what if I am crazy?” and “they are professionals, surely they would know” enter the mind set of the person. Doubts undermine the survival mechanisms created to survive the root cause, often resulting in the person coping less. 

5- Acceptance of diagnosis
The person accepts the diagnosis as an accurate description of not only their behaviour, but their experience as well. Typical of diagnostically appropriate interventions requires “insight” – the acceptance of the diagnosis, and this is seen as diagnostically appropriate step towards minimising damage from the “illness”.

6- Incorporation of diagnosis into self
Often the person changes their behaviour to more closely match the diagnosis, making a better fit, and hopefully make the diagnostically appropriate intervention a better solution. Behaviours that protected the individual from the root cause are discarded for those which protect the self from the perceived dangers of the diagnosis. All actions are interpreted through the filter of the diagnosis. “I do this because I’m sick”, “I can’t change, I have no choice”, “we just have to find the right drugs” – all solutions are external to the person.

7- Redefinition of self as diagnosis
The diagnosis no longer describes the behaviour or the illness, but now describes the person. “I am a [disorder]” is a common phrase used by the person, reinforced by others saying “s/he is a [disorder]”. The sense of self identity has become corrupted by the behaviours originally adopted to minimise damage to self from a root cause. The person becomes the “illness”. This can result in isolation from others so as not to hurt them, or an excuse to take advantage of others since “I’m sick and can’t do it myself”.

8 – The rejection of self
Eventually the diagnostically appropriate solution is shown to not work, as the behaviours just recur, get worse, or adapt to the diagnostically appropriate intervention. The person is labelled as resistant, not wanting to get better and chronic. The person looses hope and faith, often retreating into the self, or acting out in violent, dramatic ways. These can be cries for help, acts against the self or an escape from grim and frightening reality. The person enters a crisis of identity.

9 – New definition of self without diagnosis
A solution to the above crisis of identity is to separate out the diagnosis from the self. This is not a return to a previous state, as too much erosion of the original self has occurred. Rather this is an evolution beyond diagnosis, seeking to put into context all of the experiences, good and bad, since the original schism. The person has gained both bad habits from the diagnosis and mal adapted survival traits, as well as a set of coping and survival tools.

10 – Acceptance of self
Evolving past defining the self allows for an acceptance of self as an existing being. There is an acknowledgement of pain, suffering and growth. If the person is able to go from Step 1 to here, then the person can move straight on to Step 11. Otherwise the person may need to pause to heal from erosion and self harm picked up from Steps 2-9.

11 – The healing of schism
The persons tries to work out where they belong in society, in life and what brings joy, contentment and meaning. The persons learns to love themselves for who they are, not what they do, not what others want them to do and not what they expect others think they should do. The behaviours learned to survive the original schism can be let go of if they are causing ongoing difficulties, or embraced if they create ongoing joy.

Grief and loss – Simply put

Grief comes in all shapes and sizes. Actually grief is just grief, how we deal with it is the real question.

Grief is a response to loss. Simply put, it is adjusting emotional ties to someone or something that is no longer a part of your life, or is no longer in your life the same way. In effect, grief is the process of adjusting to change.

Loss is something that creates a change. For example, a change in your job – such as being fired, quitting your job, missing a promotion, getting a promotion and so on. Each affects your life, creating change. Each change opens new possibilities, as well as closing possibilities. Adjusting to the loss of possibilities- that is adjusting the emotions tied to those losses – is grief.

Loss and grief can be very subtle forces in our life. I recall the time I lost a magnet that I liked when I was a child. On average, it does not affect me unduly, but on occasion, I wonder what has become of my magnet and I grieve for it. I have also lost many other magnets in my life, but these haven’t affected me as I did not form an emotional connection with them.

Emotion is the key behind grief and loss. If you don’t form an emotional connection to the thing or person that changes, then the change does not affect you directly, or indirectly. As such, the change does not trigger a loss. The stronger the emotional tie, the greater the effect to your life and the more you may feel loss.

While all change means loss of some kind, this does not require a focus on that loss. If you focus only on the gains and opportunities that the change can give you, then you do not feel grief. If you only focus on the loss of opportunities, the broken emotions and missed opportunities, then you gain no joy from the change and risk being lost in a cycle of grief.

It is rare that a change evokes only one extreme of emotional consideration. Generally change evokes a mix of perspectives, which can lead to an internal contradiction in how you feel about the change. I can be happy that my grandmother is no longer in pain, but sad that she is no longer part of my life. If I am okay with this mixture of emotions, all well and good. However if I feel that I should not feel happy, because I should be “grieving” and this makes me a “bad person”, then I complicate my adjustment to the change in my life.

In my next blog on grief, I will discuss the most commonly recognised text about grief – the Kübler-Ross five phases of expected loss model.