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.

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.