The New Psychiatric Disorder That Menaces You:

Psychiatric Disorders Are Bad for You, Part Three

The New Psychiatric Disorder That Menaces You: Psychiatric

Diagnoses Are Bad for You, Part Three

by Steven Goldsmith MD

Have you heard of the latest psychiatric diagnosis? If not, no worries. I just invented it. PDID. The acronym for Psychiatric Diagnostic Identity Disorder. A core malady of countless Americans, more prevalent even than depression or anxiety disorder. PDID has two subtypes—PDID, Fragmented Identity Type and PDID, Lack of Identity Type.

First the Fragmented Identity Type. Here people subscribe to psychiatry’s attempts to parse them into multiple entities, each seemingly with its own independent reality. For instance, many patients have seen me for an initial evaluation saying something like, “I’ve been diagnosed with Bipolar Disorder and Generalized Anxiety Disorder, and I’m taking Zoloft for my OCD and Ritalin for my ADD. And I think I may be borderline. . . . “

This is a wine connoisseur’s model of diagnosis that psychiatry underwrites, one that analyzes patients like glasses of Cabernet. One can imagine a learned diagnostician nibbling canapes while describing a patient who is redolent of Dysthymic Disorder with undertones of Major Depressive Disorder, a soupcon of PTSD, and a distinct aftertaste of Narcissistic Personality Disorder.

What is the problem? After all, these are terms that encapsulate clusters of symptoms and signs that recur throughout the population and inform treatment. True. Unfortunately, as my prior posts noted, only a whole, integrated individual can become well and remain well. A living, breathing patchwork of multiple disorders cannot. In this manner, psychiatry foregoes the possibility of cure by fragmenting the identity of the previously intact individuals it treats.

In PDID, Lack Of Identity Type, individuals camouflage their deficient sense of identities as unique human beings with diagnostic labels. Such a patient may announce to me or others, “I’m an anorexic,” or “I’m a schizophrenic.” We previously saw the problem with such a belief: if your identity equates solely with sickness, you can never get well.

The availability of such labels tempts vulnerable patients to seek refuge in diagnostic pseudo-identities. It encourages lost souls to further lose touch with reality as they identify themselves with abstractions that refer only to certain of their attributes. Dmitri, for example, laments that he is an obsessive-compulsive, a statement that makes no more sense than if he complained that he is a hemorrhoid or acne.

Imagine if the American Psychiatric Association were to include in the next edition of its Diagnostic and Statistical Manual of Mental Disorders, DSM VI, a set of diagnostic criteria and corresponding codes not only for disorders but for healthy characteristics as well. Imagine such terms in its nomenclature as courage, intelligence, creativity, street-smarts, wisdom, generosity, devotion, capacity to love, diligence, honesty, and altruism.

At least then an individual, could replace “I am an obsessive-compulsive,” with “I have obsessive-compulsive symptoms, am devoted to my loved ones, have a strong sense of responsibility at my job, and I can freaking wail on the tenor sax.”

Why not also include in a given diagnosis whatever makes that person different from others, unique, special? That may be the information we need to cure them. But perhaps you’re thinking, there is nothing special about me. I just drift through each day like a waterless cloud, possess no special attributes with no exceptional events in my past. My encounter with so many patients who voice such self-erasure has saddened me. Especially because they are usually wrong.

Years ago a Dr. Faith Fitzgerald recounted this anecdote during a Medical Grand Rounds at Providence Portland Medical Center at which she spoke. (This is not a verbatim account but one as faithful to detail and to the central point as my memory can manage.) As a young attending physician on a medical ward at San Francisco General Hospital, she conducted daily morning rounds. At these rounds the house staff presented to her patients admitted overnight whom they considered to represent the most interesting cases. Put off by this implication that there were uninteresting patients, she insisted that they present to her the most boring patient on the ward.

They selected a woman who had been hospitalized only because of her advanced age and homelessness. Having no current medical problems, she was bedding down on the ward only until social service found her a suitable home. A former hotel maid, she answered questions about her obviously dull, humdrum life in monosyllables. Nothing, it seemed, had ever happened to her. With a growing sense of desperation over her inability to prove her point, Dr. Fitzgerald asked the woman how long she had lived in San Francisco.

“Years.”

“Were you here for the earthquake?”

“No, I came after.”

“Where did you come from?”

“Ireland.”

“When did you come?”

“1912.”

“Have you ever been to a hospital before?”

“Once.”

“How did that happen?”

“I broke my arm.”

“How did you break your arm?”

“A trunk fell on it.”

“A trunk?”

“Yes.”

“What kind of trunk?”

“A steamer trunk.”

“How did that happen?”

“The boat rocked.”

“The boat?”

“Yes, the boat that was carrying me to America.”

“Why did the boat rock?”

“It hit the iceberg.”

She had been a steerage passenger on the Titanic. Despite her injury she made it to the lifeboats. After landing, she was taken to a clinic to have her fractured arm set. Now she was no longer boring, no longer merely a warm body in a bed, but a unique person.

Psychiatry, like the rest of medicine, claims it follows the dictum of Dr. William Osler, the reputed father of modern medicine, and treats the patient and not merely the disease. However, its practice belies its claims, for it always treats diagnoses, regardless of individual variation. There is minimal individualization of treatment. Ten individuals diagnosed with paranoid schizophrenia who file in one after the other to see a particular psychiatrist will probably receive the same basic treatment, most likely one or another antipsychotic drug.

Psychiatric diagnoses are common denominators of pathology. Their diagnostic criteria list what individuals so diagnosed have in common with others who share that diagnosis. The tacit assumption is that having the same diagnosis makes two patients similar enough in their manifestations of illness that they are likely to benefit from the same kind of treatment. However, as prior posts discussed, we find self-healing resources not in diagnostic labels but in people. And in focusing on labels, psychiatrists miss opportunities to know what is most important about their patients. They miss the distinguishing features, the strengths of their patients that must make the difference between endless treatment and cure.

But who knows? If psychiatry recognizes the two PDIDs as bonafide problems, it may yet heal itself.

Do not equate any psychiatric diagnostic label with reality. And certainly do not equate any such label with you as a whole person. For you cannot be defined by any noun, especially one that is as subject to change as a DSM diagnosis. Remember, these labels change every few years. They are merely words voted in or out of the official canon by committees of psychiatrists who have no access to Ultimate Truth and who do not, at this stage of their profession’s evolution, comprehend the need for more useful alternatives. I also recommend that you consider treatments that can actually cure you by utilizing your inner healing resources and treating you as a whole, unique individual. More about such treatments in subsequent posts.

Be well.

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