"One such traumatizing context is characterized by relentless invalidation of emotional experience, coupled with an objectification of the child as being intrinsically defective. No wonder receiving a DSM diagnosis can so often be retraumatizing!"

Robert D Stolorow Ph.D.
Psychiatry
Deconstructing Psychiatry's Ever-Expanding Bible
Receiving a psychiatric diagnosis can be retraumatizing.
Posted Apr 03, 2012
THE BASICS
Recent studies have called into question the fifth and latest version of psychiatry’s Diagnostic and Statistical Manual’s creation of new diagnostic entities and categories that are scientifically unsubstantiated and that over-pathologize vulnerable populations such as young children and the elderly. In an earlier blog post (http://www.psychologytoday.com/blog/feeling-relating existing/201202/pathologizing-grief), I criticized the DSM-5 for pathologizing grief by classifying grieving that extends beyond a very short period as a major depressive illness. In this post, I seek to expose and challenge the philosophical presuppositions that underwrite the entire DSM enterprise. These presuppositions descend directly from the metaphysical dualism of Rene Descartes.
Descartes’s metaphysics divided the finite world into two distinct basic substances: res cogitans and res extensa, thinking substances (minds) with no extension in space and extended substances (bodies and other material things) that do not think. This dualism concretized the idea of a complete separation between mind and world, between subject and object. Descartes’s vision can be characterized as a decontextualization of both mind and world. Mind is isolated from the world in which it dwells, just as the world is purged of all human meaning. In this vision, the mind is pictured as an objective entity that takes its place among other objects, a “thinking thing” that, precisely because it is a thing, is ontologically decontextualized, fundamentally separated from its world.
The DSM is a pseudo-scientific manual for diagnosing sick Cartesian isolated minds. As such, it completely overlooks the exquisite context sensitivity and radical context dependence of human emotional life and of all forms of emotional disturbance. Against Descartes and his legacy, the DSM, I am contending that all emotional disturbances are constituted in a context of human interrelatedness. One such traumatizing context is characterized by relentless invalidation of emotional experience, coupled with an objectification of the child as being intrinsically defective. No wonder receiving a DSM diagnosis can so often be retraumatizing!
Copyright Robert Stolorow
Agree, Absolute Wisdom!
For a child raised in this manner and, later, as an adult having a doctor that associated a mental disorder to them while a real medical illness was the actual cause for pain, it is not only insulting but also assaulting. It is yet another attack on the psyche of someone who has already endured so much mental warfare from person(s) that because they are older or more educated are supposed to be wiser and respected. It is this difference between our own instincts and the wrong diagnosis that causes anxiety.
So as an adult, what are the best means to effectively and efficiently go about desensitizing and healing? How do you learn to trust your instincts? Build or re-build your self esteem/self confidence? Use your voice when you're being misdiagnosed? And while it becomes apparent through the course of treatment, or lack thereof, that it might be time to seek out a different healthcare provider, is it ALSO necessary to remove the parental person completely from your life who treated you as defective and continues to do so in order to completely heal and trust yourself?
wisdom
Assaulting indeed! Over the decades I've heard countless variations on this lamentable theme. We need to find therapists who can understand us from within the perspective of our own emotional worlds and help us to find a sense of validity therein.
DSM isn't the 'bible' after all
Human life is phenomenologically rich and varied, unique like the iris of the eye, or thumb marks--we cannot simply pathologize without digging deeper to the human soul. and seeing the whole picture where the person lies vulnerable.
Whan my boy recieved the
Whan my boy recieved the diagnostic of Asperger syndrome I coped as I always do: threwing my self into books and papers trying to understand the syndrome as a way of understanding my boy.
My husband, ever the practical say to me: Is not a matter of what he have, is about how are we going to educated him.
And the it hits me: I was alowing a doctor to describe my boy, to write it and build him as Asperger.
I was allowing his power to define a person.
At least in spanish we have a diference in the verb to be. TO be can be an esenssial way of nature or an accidental one. I resist Asperger to be an essence to describe/write my boy. Of ccourse, that bring a whole theoretical framework to be inflict to myself as a mother. Isn´t it?
But the point is that we continue futher. We homeschool the boy for two years and then he decided to go back to school. He is a little "to" honest. A little more inocent than is safe. A little obsessed with the topics he likes. He have more a non linear thinking pattern. He likes paradoxes. He is now a leader among his peers. A very popular one. Top grades. Top at sports. Very caring. Very expressive.
Is he "normal"? I couldnt care less about the answer.
Was he bad diagnostivated? Probably.
Philosphy, the theory of complexity, helped me more to unerstand my boy that DSM IV.
The point is: we didnt allow the diagnostic to describe/write my boy. We didn't allow the power of a diagnosis to determined my boy life, even if I was at risk to do that.
I like the way you put it
You said the doctor would "build him as Asperger."
A fine way to describe the distorting effect of an insensitive psychiatric diagnosis.
Love it!
Thank you so much for writing this!
"One such traumatizing
"One such traumatizing context is characterized by relentless invalidation of emotional experience, coupled with an objectification of the child as being intrinsically defective. No wonder receiving a DSM diagnosis can so often be retraumatizing!"
This is a really important point that seems to be ignored by psychiatry but embraced by psychologists. I received a diagnosis when I had just turned 14, so still in my formulative years. In this case the diagnosis was correct (anorexia) but not helpful. What was more unhelpful yet was the stream of diagnoses I have received since, from generalised anxiety disorder, to depression, to dysthymia, to cyclothymia, to social anxiety disorder, to agoraphobia, to depersonalisation disorder...and so and so forth.
The one thing, after well over a decade of suffering to various degrees from symptoms caused by emotional instability, that has helped has been to see a person-centred counsellor. She uses no models, no names, no labels. She refers to me as a client, not a patient. She never refers to illnesses or diagnoses. She just asks me about me. As an individual. She validates my emotions, then asks me to try and validate them myself, instead of seeing every emotion I come across as the ugly head of some monolithic disorder ready to crush my life.
When one's life has been turned upside down by a disorder like anorexia, and you understand that the disorder is an "illness" - a complex one at that - it takes it somewhat out of your control. Next time you suffer an upset, or some emotional turbulence, you are ready to have this complex thing come and crush your life once more, and fully expect it. Not necessarily in the same shape as before - it might not be anorexia, it might be agoraphobia, or somatic symptoms that leave you unfunctional - it'll be something. But one thing's for sure. It will not allow you to lead a normal life. You're ill. You can't have a normal life, not like others.
Of course this is all self-fulfilling and with those thoughts going around in your head all day they inevitably come true, proving you correct once again that you are "ill" that you are in some way defective and can never just be "well" like everyone else. You can never have the life that everyone else leads.
It's important to think of how the use of language and classifications affects people - especially in their formulative years. We may find these disorders are less prolonged if they are treated more as individual differences, troubles that many individuals go through that are normal/natural, rather than as a catastrophic disease.
diagnosing
Thanks for this vivid, and painful, example of the damage that can be done by excessive psychiatric diagnosing.
DSM trauma
It has come to mind recently that the one DSM diagnosis I can not find is trauma from being labeled by the DSM by Mental or Medical professionals. I have experienced medical trauma brought on by lack of blood flow to my brain due to cerebral vasospasms. Many physical and intellectual impairments have been the result of this. However, the most traumatic event in my life, is being labeled as somatic and treated as if I was "fine" when in fact my body was shutting down. Even after a proper diagnosis I put my life on the line for fear of being mislabeled again.
I can see by the insightful comments above, Label Trauma would most likely be a common diagnostic diagnosis. Unlike, the couple of others I have been given this would likely be the most helpful.
Label Trauma
Yes, I've encountered instances of such mislabeling with its traumatic, often tragic consequences. Thanks for your pertinent comment.
You might like a couple of
You might like a couple of "diagnoses" that I am living with:
"iatrogenic neurolepsis",
"iatrogenic pharmacological disorder"....
"iatrogenic" = caused by doctors, or medicine
"neurolepsis" = damage, especially to the CNS/central nervous system....
And, the ONLY truly intellectually honest statement is
"DSM" = a catalog of billing codes for billing, payment & insurance reimbusement
What do you think? Nice, huh!?
Non Localised Consciousness
Your remarks regarding the cartesian premise for diagnosis was well taken. It brought immediately to mind a lot of work I have been reading that theorises a non-local consciousness, a field of inter-relatedness.
That you say that many supposed 'illnesses' are less to do with an isolated body and more to do with human interaction is sensible and logical and indeed, humane. The fact that it is such a humane concept implies the inhumanity of the APA's definitions. Labelling grief as a disorder is one of the stupidest ideas I have ever heard of. 2 weeks as a limit to it is insanely reckless.
I think the board of the DSM may be suffering from 'empathic deficit disorder' and 'predictive cognisant dysfunction' wherein the sufferer cannot understand the future consequences of their actions.
empathic deficit disorder
Thanks for your great comment, Daniel!
TRUTH
Rene Decartes was so enmeshed in "dualism", and "duality", that he had completely lost perspective. It was only after I'd read various Mahayana/Tibetan Buddhist texts and writings - you know, that Dalai Lama guy - that I came to see the illusions, delusions, and REALITY of the limitations of such an antiquated and obsolete world view. Duality CAN BE "re-capitulated" into a wholistic world view. (No, it's spelled correctly! The "w" is intentional.) But, what that really means, is that nobody has *A* mind, - no, we ALL SHARE a mind. While it's true that your body is physically distinct from other people's bodies, your "mind" is solely the result of the interactions with other minds which were here before you were born, and which in turn were created by interaction with still other, earlier "minds". But in reality, it's ALL ONE big, old human mind. ALL so-called "mental illnesses" are in fact imaginary, subjective models, at best. They are no more "real" than a present from Santa Claus!
I'd love a reply....
Attachment to diagnosis
http://sycofx.wordpress.com/2011/08/30/attachment-to-diagnosis/
An incisive article
Thanks for this article, which distils very helpfully the problems with over-diagnosis.
The protests around DSM5 remind me of similar movements going back as far as the 60s. I'm glad to say that these ways of thinking have had a deep influence on my training, and hence on my work with clients.
I do hope that the increasing volume of dissent results in some tectonic shifts in the psychiatric-pharma-therapy complex.
http://therapy-thinking.blogspot.co.uk/2013/06/the-other-side-of-wafer-thin-barrier.html
Regards,
Ian
Pathologizing Life
Thank you! I agree with every word you write and feel that it is so important to put viewpoints such as yours (and mine) out there on the web, where people in need and their counselors can find healing options. As a healing story practitioner, I find that ancestral wisdom tales and myths -- which guided and uplifted human beings for thousands of years -- can offer a greater context for living and a more intelligent way of understanding and rebuilding life in times of grief, depression, post-traumatic response, and other non-ordinary mental states.
pathologizing life
Thanks for the great comment, Juliet. Keep an eye out for my post, "When Grief Finds a Home," coming in a few days.
Dumping the DSM5 can let the psychiatry grow
Help the growth of psychiatric knowledge: dump the DSM5! I am a psychiatrist who has been a faculty member at the Sapienza University of Roma (Italy). In Italy the services use the ICD classification, so there is no need to adopt DSM; I never considered buying the latest DSM, and I will not do it now; we teach the ICD10 classification, albeit no psychiatric classification can be as good as an assessment of trans-diagnostic cognitive-behavioral dysfunctions.
dumping DSM5
Thank you for your comment!
DSM and ICD
In Romania the law put DSM instead of ICD overnight. All psychiatists are trained on ICD. How can it be possible for such a doctor to put a "correct" diagnostic? If you go in USA, you have to be reexamined in order to practice medicine. But not if ICD is replaced with DSM. Can I trust such psychiatrists. Peoples are shoked with the new "ilnesses" in DSM-5 but they have to be shoked with the old ones to.
shocking
This clearly shows that such diagnoses don't correspond to anything real; they are established by convention.
Trauma and possibilities for retraumatization via DSM
There are two additions I would like to make to this article so brilliantly written by Dr. Stolorow. Both pertain to young people.
The diagnosis that is received by a young person can facilitate being accompanied by a personal sense of aliveness. Being gets facilitated when no one has spoken much to this young person "about themselves." Their deep deep suffering comes from not being spoken to about themselves or nonbeing. Beingness can ignite when a psychiatrist is talking to his patient in the so-called being-starved-experience creating the feelings: "someone finally is speaking to me about me and I know this because this doctor is so certain about me." The tragic problem with this is very complex but the desire to be spoken to trumps the words that are said. It is better for the young person to be called something rather than nothing at all. The very identity of the young person (I am Anorexic or I am Bipolar)becomes deeply personalized as some truth about their very being. This is a side to the tragedy of the use of the DSM. These types of events may mirror earier experiences of traumatic harm by using hurtful words by the adult responsible for this child, words that in reality, have nothing to do with that child's being.
The second point I want to make is the considerable distance diagnosing can have in psychotherapeutic treatment. My experience calls up images of the therapist behaving superiorly to a borderline patient for example, an antitherapeutic stance that becomes iatrogenic.
additional points about retraumatization
Thank you for these excellent additional points, Peggy. They are VERY insightful!
Misdiagnosis
Two of my children were misdiagnosed by the same Psychiatrist. While my younger child was engaged with her Team (essentially one person a Health Care Worker - incompetent) my daughter was brought in for a chat (she had been become a bit withdrawn; I feared bullying but I couldn't get an answer and didn't want to probe). After 20 / 30 mins chat I was called in (my daughter sent out) and I was told that she had Asperger's and to contact Aspire. Totally shocked I insisted on checks - which took 6 months and revealed that my daughter was highly empathic, highly resilient way more advanced than her peer age group who wouldn't catch up with her until they were 16 / 17. My sons engagement took four years - no assessment and no help - he was opting out of learning. My husband and I had stated at the outset that he was way more advanced than his peers, with whom he tired of at times and he was bored in school - this is recorded on the agency's file - but ignored. Years later he had educational testing which revealed "excetional intelligence, exceptional academic abilty and seriously underachieving" Three years later later during testing for learning blocks (not engaging in learning - he had no educational blocks - I sought firt agency's records and was shocked to find that he had been diagnosed with O.D.D. Queries to the Psychiatrist proved fruitless - she couldn't even give symptoms - she had carried out no checks and she had made the diagnosis 8 months after we had terminated engagement. She retired mid query and resigned registration from the Medical. A Council. A "Review" carried out recently (no findings, etc. all positive information such as school reports,Connors Questionnaire at age 8 -9 indicating very good behaviour ignored yielded nothing but the response Your response by the Reviewing Psychiatrist - the initial Psychiatrist's Director “ it was not possible for me to definitively confirm or refute the diagnosis … however it is my view that it was reasonable for Dr.xxxxxxx and the team to consider a diagnosis of ODD “ My son knows nothing about the diagnosis which was made public and had severe repercussions for him (Principal advised parents to discourage their children from associating with him - child has no idea why friends ostracised him
misdiagnosis
Appalling and heartbreaking.
Misdiagnosis
Thank you very much Dr. Stolorow. You comment is a huge relief; it gives me strength to go on.
It appears to me that the education system allows for highly intelligent linear thinkers and those in the ASD range, i.e. those lower in empathy and understanding, to get into professions where the utmost empathy and understanding is required. It appears to me that knowledge is confused with understanding, that behaviour is confused with empathy and that usual is confused with normal.
Reading through articles, I, a lay person with no medical training, am shocked at the level of lack of common sense. No offence, to the Psychiatric, Psychology profession, there are numerous highly empathic people, for instance, Dr. Dorothy Rowe, the eminent Austrian Psychologist, whose books I read avidly, but a certain element seem to lack the basic understanding of fellow man that ordinary every day people have
Child & Adolescent Mental Health Services
Below is the advertisement for the CAMHS agencies.
Aside from the title which is immensely tactless - imagine being a child, who was brought by naive parents to this agency for help in dealing with a challenging environment (being gifted, being bullied, etc.)- and stumbling onto the website which advertises as per below. I wonder if this advertisement was the last thing some young suicides read before dying:-
---------------------------------
"Child and adolescent mental health services
Child and Adolescent Mental Health Services (CAMHS) is a free specialist service for children and adolescents with serious emotional, behavioural or mental health difficulties"
Makes sense...
Next step in the logic that is being unfolded by you Robert is that because illnesses become "things" (in res extensa), the therapists become engineers who administer "treatments" as one would do in a world of res extensa. Both disorders and therapy thus become externalized "things" and the role of "mind" banished from this whole construct of the world. Welcome to managed care!
For more on my own critical theories of psychopathology and what I call technical/rational therapy, visit my psychotherapy blog.
technologizing therapy
Well put, Rune!
Good conscious
How can one evaluate and diagnose a child during a one hour meeting? This is what is expected but I think unreasonable and not pure common sense. Nevertheless, this is the only way insurance benefits will be paid.