Does using psychiatric labels stigmatize the patient?
Throughout the last decades many criticisms have appeared against the practices that psychiatry was accustomed to perform at certain moments in its history. For example, the movement of antipsychiatry, driven by referents such as R. D. Laing, denounced an overmedication and humiliating treatment of many vulnerable people interned in mental health centers, as well as an approach that was too focused on the biological.
Today psychiatry has improved a lot and criticism against it has lost much strength, but there are still battle fronts. One of them is the idea that the psychiatric labels used to diagnose mental disorders are, in fact, stigmatizing , which makes the problem worse. But ... to what extent is that true? Let's see it
- Related article: "Antipsychiatry: history and concepts of this movement"
Criticisms of psychiatric labels
This type of attacks directed towards the use of diagnostic labels usually start from two fundamental ideas.
The first is that mental disorders, in fact, are not anomalies that have an origin in the biological configuration of the person, that is, they are not a fixed characteristic of this, in the same way in which you have a nose of a certain shape or a hair of a certain color. In any case, these mental problems would be the result of a system of interaction with the environment originated by one or several experiences that marked us in the past. Thus, using labels is unjustified, because it indicates that the problem lies in the patient as being isolated from the environment.
The second is that, in the current social context, using these denominations serves to place people in a disadvantaged and vulnerable position, which not only damages personal relationships but also influences the search for work, etc. In a way, it is criticized that these labels dehumanize whoever wears them , making that person go through an individual more than those diagnosed with a certain disorder, as if everything he does, feels and thinks was the result of the disease and its existence was completely interchangeable by that of any person with an equal label.
These two ideas sound reasonable, and it is clear that people with mental disorders suffer a clear stigmatization even today. However, everything seems to indicate that it is not the use of these labels that produces that bad image. Let's see what is known about the subject.
The influence of the diagnostic categories
To begin, it is necessary to point out that diagnostic labels are not adjectives, they do not serve to comprehend in broad strokes what a person is like. In any case, they are theoretical constructs developed by experts that help to understand what kind of problems are those that the person is more prone to suffer; It is not the same to have depression as an autistic disorder and, although these categories do not tell us about someone's personality, they help to know how to intervene to improve the quality of life.
On the other hand, the stigmatization of mental disorders goes back many centuries before the appearance of medicine as we know it, let alone psychiatry. When appearing, these applied sciences They acted according to this marginalization of minorities with disorders , but that discrimination already existed and is documented in very old texts. In fact, during certain stages of history it was believed that the symptoms were manifestations of Satan and that, therefore, the closeness of a person with mental disorders was dangerous.
Beyond this fact, there is no evidence that the quality of life of the people diagnosed has worsened after passing through the psychiatrist or clinical psychologist.
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Going to the tests
Is there evidence behind the claim that diagnostic labels are harmful? If there are, they are very weak. For example, David Rosenhan, one of the great critics of this practice in the field of health refused to provide empirically obtained data to demonstrate this when another researcher named Robert Spitzer asked them.
Years later, a writer named Lauren Slater claimed to have conducted an experiment for which she faked a mental illness and managed to obtain a psychiatric diagnosis. However, he ended up recognizing that this investigation did not exist.
On the other hand, much of the criticism indicates that it is very easy to be diagnosed in some psychiatric category, or which is uncertain. There are cases of people who They fake the symptoms and they deceive the medical staff , but when faking, instead of leaving the medical history as it is, it is added the observation that the disorder is on the way to disappear, something that is left in writing very rarely in cases of real disorder. This fact indicates that physicians are capable, despite the will to deceive, of distinguishing between severe cases and others in which they evolve towards recovery.
Therefore, it is better to take advantage of the good side of the tools that good psychiatry offers us, and at the same time we should not confuse ourselves believing that these labels summarize who we are.
- Spitzer, R. L. (1976). More on the pseudoscience in science and the case for psychiatric diagnosis. Archives of General Psychiatry, 33, pp. 459-470.