For context, I have read the entire other thread, although I haven’t commented there.
In response to the DSM issue, the prevailing view among psychologists is that it’s flawed, but currently necessary in order to be able to bill insurance and provide care to a broad range of people. However, it doesn’t need to be an all or nothing. The DSM can have come from a substantial (though also flawed) research literature and therefore be scientific and get some things right while also not having perfect validity. I generally support adopting a dimensional system in the future but we’re far from having consensus of what that would specifically look like or enough evidence to support the move, let alone handling continued partnership with the medical system. It’s not ideal. We’re currently stuck with it. I’m excited for us to continue moving forward as a field. But it’s also not entirely horrible.
I’m also wondering if your contention with mental illness is simply one of nomenclature? I agree with other points you’ve made about systemic change likely improving mental health across the population; however, I think it’s important to treat people who self-identify as experiencing distress regardless of whether that distress was primarily caused by individual or societal factors. Someone who experiences physical trauma outside of their control and needs medical attention to improve their functioning by, say, setting a leg can reasonably describe themselves as being hurt. Similarly, someone who experiences societal trauma and has trouble achieving goals and meeting their own expectations for daily functioning should be able to be described as hurt, even if this is a normal response. Bodily injury is also a normal response that not necessarily everyone develops. Psychologists then treat the situation at hand and try to help that person function the best they can in their given situation. I would prefer that the negative stigma around “mental illness” continues to decrease, but regardless of the term, it seems reasonable to me that people who are on a far end of a spectrum of human experience can receive professional support to move more towards a normative state (assuming that’s their goal).
I’ve stated that these people still need help, and should have access to affordable and effective treatment. If it was just being used for billing and to get people treatment, I wouldn’t have a problem with it. However, as I’m sure you’ve read in that thread, that’s not it. People are acting like these DSM diagnoses are real diseases as if it’s a scientific fact, when it’s not. It’s a checklist of a bunch of symptoms having to do with undesirable feelings, thoughts, and/or behaviors that were voted in by psychiatrists and others, many with ties to the pharmaceutical industry.
My big problem with it is that it can and often does have real negative consequences for the person being diagnosed and given a stigmatizing label, and it very often pathologizes normal human experiences and reactions. I think it’s absolutely ridiculous to diagnose people with something and not even take into consideration the context in which those symptoms appeared. Yet, that’s what typically happens with psychiatric illnesses, according to the DSM.
On the medical side, context and etiology matters a lot in most, if not all, cases. For example, a cough due to asthma or smoke inhalation will be treated very differently than if someone got exposed to Covid and is presenting with cough.
With psych, especially now that they’re doing universal screenings in primary care and other areas, they’re literally clicking through a checklist, and diagnosing people in less than 10 minutes with a stigmatizing mental illness that will never be removed from their record, and is not even a true illness in a lot of cases. Someone may have just been going through a rough time.
They get put on psych medications that have side effects and can be difficult to taper off. People think there’s something wrong with them for reacting a certain way to their circumstances, even though a lot of times, it’s a perfectly normal response. (I’m not talking about the catatonic or psychotic patient, or the extreme cases here.)
What’s worse is that I have personally seen how horribly a lot of these “psych patients” are treated when they come in contact with the healthcare system. The stigma, discrimination, and harm is real. I’ve heard it’s bad in the legal world, and it also affects people’s employment opportunities.
Furthermore, once these patients are labeled with a mental illness, their rights can more easily be taken away, or their credibility can and does come under question. If they dare to disagree with the psychiatrist or doctor about their diagnosis, the doctor can just say they don’t have good insight into their illness, or anything is blamed on their mental illness.
I’ve heard of patients with a history of anxiety coming to the ED with chest pain, and they weren’t worked up right away because it was just assumed that it was due to anxiety or panic attack when they were actually having cardiac issues and ended up coding.
I’ve seen a nurse try to give someone an SSRI, and when the patient asked about the potential side effects, the nurse refused to answer his questions, and, instead, said it’s his anxiety that is making him ask questions about possible side effects. Ugh!!!
Many other times, nurses try to forcefully make a patient do something they don’t want to do, so of course, the patient gets agitated. Then the nurse asks the doctor for an antipsychotic to give the patient, even though the nurse’s actions caused the agitation, and it wasn’t a life-threatening emergency to try to get labs by force. Doctor tried to explain the antipsychotic is not indicated, but nurse insisted, so doctor finally caved.
I’ve heard of many instances of doctors blaming patient’s symptoms on anxiety and depression even though they actually had something physically wrong with them. I have so many more examples that I could give.
I read a story where a woman witnessed a murder by her boyfriend and she was just a witness in the murder trial. The defendant’s lawyers tried to get court order or subpoena for all her mental health records including therapy notes, and tried to say she was not a credible witness because of her mental illness. There were other witnesses who provided the same testimony, and yet, she was the one being harassed and having her privacy invaded. Luckily, the judge didn’t allow the records to be released, but her mental illness still became public and a part of the court record. People have run into the same issue of their private psych notes being released to the courts or other side’s lawyers in divorce and custody battles, even though the child was not in danger. There are endless abuses against people with so-called mental illnesses. They can be hospitalized against their will, even though that’s been shown to be harmful…
I want people to get treatment that they need, but I hope the system changes so that they don’t need a label to get it. It’s not ok that vulnerable people get harmed like this. Diagnosing people with mental illness is not benign. If there was solid scientific evidence and pathophysiology to support most of these diagnoses, I would say we should just work more on protecting them from the stigma and discrimination. As it stands, we don’t use the same scientific rigor with mental illness that we do with physical illness. A lot of it is subjective.
I don’t think psychologists are necessarily the ones handing out diagnoses recklessly or as easily as other healthcare professionals. They’re actually probably the ones doing it more responsibly. However, insurance requires a diagnosis during the first visit in order to pay for treatment. I initially thought universal screenings in primary care and non-psych areas would be a good thing. It’s probably led to so much over- and misdiagnosis, and unnecessary utilization of psychotropic meds.
I didn’t even touch on the abusive employers creating toxic environments and excessive, chronic stress that leads to physical and mental problems, and then telling people to call EAP or work on their resilience and self-care. This one makes me irrationally angry. Lol. As much as I hate the overuse of the word “gaslighting”, it’s gaslighting to act like employees who are stressed and anxious from working short staffed in toxic environments are mentally ill instead of the organization being toxic and exploitative.
