What is your Opinion of Psychiatric Diagnosis?

This is an important paper written by Steven Coles and colleagues about psychiatric diagnosis. What do you think? Have your say!

What is your Opinion of Psychiatric Diagnosis?

What is your view on psychiatric diagnosis? Should the diagnosis of schizophrenia be abolished as the Campaign for the Abolition of the Schizophrenia Label wish? For both those working in mental health services and those on the receiving end, how important is diagnosis to your life? There are many different views on psychiatric diagnosis from fierce advocates to those who decry the practice. A number of survivors, academics, professionals, and service users have criticised diagnosis. However, within mental health services psychiatric diagnosis remains dominant. Psychiatrists (and other professionals) claim they use diagnosis to understand people’s experiences, behaviour and distress.  Diagnosis shapes how services are organised, who will be helped and how services will support or “treat” people. Psychiatric diagnosis also has a major impact on whether people are detained against there will in hospital – the civil liberties of people with a psychiatric diagnosis are at a greater risk than anyone else in society (other than suspected terrorists). Diagnosis influences whether people are forced to take major tranquilizers (“antipsychotics”), and whether they receive financial benefits.

Despite the immense controversy surrounding diagnosis, my experience is that the debates around diagnosis are not openly discussed between staff or with people using (or forcibly brought into) mental health services. Psychiatric diagnosis has become an everyday and often unquestioned part of mental health practice. Is this simply because critics of diagnosis have weak arguments? Is it because the scientific basis of psychiatric diagnosis is so strong? Is there no alternative? A group of Clinical Psychologists working in East Midlands Adult Mental Health Services have looked at the issue of psychiatric diagnosis and written a position paper (Coles & SPIG, 2010). They conclude that “psychiatric diagnosis does not meet its scientific and expert claims” and does not deserve to be so dominant in mental health services.

The East Midlands group highlighted a number of negative effects of psychiatric diagnosis. They note that diagnosis places the cause of difficulties on the individual; the group feel more attention should be paid to people’s life experiences, such as abuse, poverty, discrimination and disempowerment. The position paper also observes that the language of diagnosis is barrier to communication between staff and people using services. Furthermore, diagnosis is not aware that it is based upon dominant western (often male) ideas of what is normal, and ignores that other cultures and subcultures might have different or a broader idea of what is normal. The paper also notes some modest alternatives to moving beyond diagnosis (for access to the document see www.bps.org.uk/dcp-sigpr/publications-%26-documents/publications_home.cfm).

The East Midlands Paper is accessible at the above link, as well as on the Hearing Voices Network website. The group is hoping to open up a debate around diagnosis and would welcome people’s thoughts on the paper and on diagnosis. The East Midlands paper suggests that the current dominance and use of diagnosis is part of the problem and not part of the solution as psychiatry claims. What do you think? What is your experience of diagnosis?


Coles, S. & SPIG (2010).  Position on Psychiatric Diagnosis. East Midlands: Psychosis and Complex Mental Health Special Interest Group

Steven Coles

Clinical Psychologist


13 replies
  1. Marian
    Marian says:

    “Is it because the scientific basis of psychiatric diagnosis is so strong?” Ha! That’s really a good one!

    Well, let’s see, which one does truly make people, professionals or others, understand other people’s experiences, behavior, and distress, a psych label, “schizophrenia” for instance, or the person’s actual experiences, behavior, and distress seen in context with their life story? Any experience, behavior, and kind of distress becomes meaningless, i.e. a “symptom”, the moment it is separated from the existential context it is a reaction to. To the extent, which for most psych labels is total, that diagnosis views people’s experiences, behavior, and distress isolated from their life story, diagnosis indeed blocks understanding. Understanding is the result of identification with the other. In case the other experiences emotional distress, an identification inevitably includes the risk that I get confronted with my own emotional distress. Psych diagnosis here acts as a shield behind which I can hide: “Anything ‘bad’, unpleasant, painful, you experience is the illness’/the disorder’s ‘badness’, and since I don’t have the illness/disorder, it’s not mine!” A brilliantly thought-up defence mechanism for everybody who fears nothing like their very own humanity.

    When it comes to labelled people themselves, having to truly understand one’s experiences, behaviors, and distress, and not being able to explain them away with a label, also means that one would have to take responsibility for these experiences, behaviors, and the distress, i.e. for oneself. Ouch. Another aspect of this is that taking responsibility means that one no longer can be the victim. And, as Sharon J. LeFevre has it, for traumatized, victimized people being the victim equals to being loved. In the victim’s eyes abuse, pain and suffering, is love. The roots of self-harm. All the negative consequences of psych labels taken into account, as well as the fact that one, because of the lack of scientific evidence for the labels’ validity, has a choice, identifying oneself with a psych label is a kind of self-harm.

  2. Taania
    Taania says:

    Certainly bends your mind to consider something u have grown to believe and live with could be disgarded. Some name is needed to accept a sequence of experiences. are you suggesting we break the labels down to indicate the specific disordered symptoms? (low mood, mood swings, depressed thinking etc) But throw away the umbrella terms?
    I can accept voice hearing and visual aberitions are not symptoms of an illness in themselves. But i recognise when my mood swings and my thinking is disorderd.. i feel unwell. I am unwell. it effects my functioning, i am out of sorts.
    There is such a thing as mental illness, for me its the “Treatment” as u aluded to, that needs eradicating. The clinical services methods of over medicating, not listenning and calling pepole liers when they speak the truth, this needs to b replaced with a human approach.

    • Marian
      Marian says:

      Taania, I wasn’t sure whether your questions were directed towards me, but since nobody else picks up on them, here in short what I’d answer to them:

      No, I for one don’t suggest to throw away the umbrella terms, while still addressing the different aspects of the human experience in a pseudo-medical fashion. I suggest throwing away this entire pseudo-medical lingo, and calling things by their true names.

      Suffering, feeling “unwell”, is part of being human. Indeed a necessary part. Without suffering there’s no incentive to bring about transformation, without transformation there’s no growth. And without growth there’s no life. Unfortunately for the corporate western world, periods of more extreme personal suffering, transformation and growth also often are periods of less productivity in other areas, like at work for instance. Does that mean we have to succumb to the dictatorship of capitalism, and accept its definition of us as diseased or disordered, as not quite right? Or does it maybe mean that something isn’t quite right with modern western civilization?

      If you believe in “mental illness”, you’ll a) have to live with the “treatment” offered by psychiatry today. All you can do is hope for new, better drugs to be developed. Medical conditions need medical treatments. And b) you can’t expect anyone to listen to you and take you seriously. “Mental illness” means that your mind, i.e. your thoughts and emotions, is diseased/disordered. And who is to say exactly which of your thoughts and emotions are healthy, and which are sick? Least of all you yourself. That’s in the definition. So, you will have to leave it to others, preferably the “experts”, to decide which of whatever you say is true, and which is a lie, the figment of a diseased/disordered mind. You can’t have your cake and eat it.

  3. John Sawkins
    John Sawkins says:

    Psychiatric thinking appears to be – at least sometimes – devoid of any emotional or spiritual dimensions: i.e. “You must suppress this hypersensitivity on your part; slow down these racing thoughts; be mindful; what do you mean by “belief” and “faith”?,…” I would contend that the patient’s reality is a much more enhanced experience than theirs. They would seem to be actually trying to make psychopaths out of their patients by encouraging them to avoid gut-reactions – replacing these with very unreliable “rational” solutions. Rational means making things fit: accommodating as opposed to assimilating new ideas and experiences. Though the left brain may be dominant and therefore always win the upper hand in any argument with the right brain, this does not mean the left brain is right. Psychiatric hegemony mirrors this behaviour: those with power are right; those without power, ergo, must be wrong.

  4. Sophie Ashton
    Sophie Ashton says:

    If the DSM had a sound scientific basing then I might (and thats a big might) be able to come to terms with that. But the fact that the mental illnesses that are added to this manual are decided by a voting group of psychiatrists is absolutely crazy. As far as I am concerned, these illnesses are literally being fabricated. Why? So that the drug companies can create a “cure” for them and make even more billions than they already make.

    I am sick of the drug companies claiming that their drugs are the cure for all suffering. All that these drugs achieve is to add to the already existing problems of an individual. How is medication going to erase traumatic events in the past? They cant.

    From a personal perspective, being given a diagnosis made me feel powerless. I was made to believe that my brain was effectively diseased. I lost responsibility for my distress and, as a result, never explored past traumas, which I believe is pivitol to my feeling better.

    Here are some of the mental illnesses that are included in the DSM IV:

    Conduct Disorder
    Non Compliance with Treatment Disorder (How convienient for them)
    Sibling Rivalry Disorder
    Phase of Life Problem
    Unspecified Mental disorder

    With diagnoses like this, it is quite possible for anyone in society to be classed as mentally ill. This is Psychiatry going crazy. Ironic.

  5. Marc Handelman
    Marc Handelman says:

    Experience does not neatly fit into a category. When someone focuses on diagnostic criteria – or ‘symptoms’ – the person become a pathological entity. Nonetheless a patient can find relief in having a diagnosis. Having a name for ones problems means others know what it is, perhaps how to treat it, and it means it’s “real,” in some way. It’s not uncommon for individuals to go from one doctor to another, to another, to another, in an effort to get a diagnosis for troubling symptoms. Still diagnostic categories serve the pharmaceutical industry and the insurance industry but not the people they are supposed to help.

    Psychotherapists must always start off trying to meet their patients on an experiential level and failing to do so can lead to objectification and dehumanization of the person. Whether or not psychological techniques are used, or physiological interventions such as medication are administered, a therapist’s primary task begins in finding access to the patient’s emotional state. The work of a therapist must involve the experience of the patient in all its nuance and complexity. The work cannot start off with a diagnosis.

  6. John Hoggett
    John Hoggett says:

    Here in Reading some people have been referred to some really useful groups on the basis of diagnosis (PTSD and mania are the ones I have heard about) and some on the basis of life experience (surviving childhood sexual assault). So in the case of the PTSD group and the mania group diagnosis proved useful for the people I know who attended them.

    However these are uncommon, “Treatments.” The usual, “Treatment,” for all extreme forms of distress, that get people diagnosis like schizophrenia or borderline personality disorder, is medication and what is usually a patronising chat with a social worker once a fortnight. This often results in people being pensioned off for life and no real lessoning of people’s distress, just some rather unpleasant psychic numbing from the medication.

  7. Marian
    Marian says:

    Just to broaden the horizon a bit: the pharmaceutical industry has a huge influence, yes, and much of the insanity that is going on in the mh system — and after I recently had my debut experiencing a locked ward from the inside, though luckily as a visitor, I can only say the reality of this insanity is much worse than I’d ever expected it to be to judge from others’ accounts only, it is beyond horrid — is caused by this influence. Nevertheless, the insanity didn’t start back in the mid-1950s when Thorazine/Largactil hit the market. It started a long, long time before.

    I had my debut experiencing a locked ward visiting a friend who was committed/sectioned. Her childhood experiences are the same as so many others’ who end up at the locked wards of this world, labelled “insane”: beatings, her mother an alcoholic, and she was raped both by her father, her uncle and her brother. She told her psychologist about the rapes a few years ago. It’s in her record. Which also is in her record is the remark by the professionals that she has no evidence for the rapes to actually have taken place, and that thus her belief that she has been raped has to be seen as evidence (!) of her being “insane”. The mh system wasn’t established to sell drugs, initially. It was established to protect the abusers. Nothing is more efficient when it comes to protecting abusers than to silence their victims, and nothing, not even murder, is more efficient when it comes to silencing a person than to label her “insane”.

  8. Ann Gonzalez
    Ann Gonzalez says:

    Marion is completely correct. This was my experience. I told my mother at 5 years old that my 15 year old brother molested me and she threatened to put me in an institution. 50 years later I confronted my brother and he admitted the abuse I had subsequently buried. 52 years later I threatened suicide in an email and was involuntarily committed. I was dissociating due to the police breaking into my home and I told them I was a child abuse survivor–what was the response? They handcuffed and searched me. I was only kept 20 hours but now I have a psychiatric label I can never shake.

    Wow, they really made my life more worth living. Thanks, DSM, MH system and police. Also, thanks to the broader psychological field and the public for letting this go on.

  9. Rachel
    Rachel says:

    The mental health system can be really destructive to the very people its meant to help – you need and want help, so you open up about your inner world, then you get labelled, then you get prescribed drugs. Antipsychotics have side effects which cause the brain to shrink and can cause diabetes and obesity, but its too late because you’ve become chemically dependent on them and there’s little other help available. You can’t work full-time because you can’t function, so you claim benefits – but the benefits are only given as long as you comply with the mental health system. Finally you wake up to the absurdity of this no win situation, but having been disadvantaged by being out of work for so long, and having been labelled as mentally ill, and having become chemically dependent on the drugs, you realise that you’ve been screwed by a system which everyone says is there to help you.

  10. MindMeister
    MindMeister says:

    The thing biopsych advocates overlook is that the light, sound, smells, touches, and tastes we encounter in our everyday lives physically send signals into our brains which then interacts with already present neuron patterns that determine how the person responds/decides to react to the information.

    So in other words since everything and not just pills effects brain chemistry then it does not follow that because something is a chemical imbalance that automatically we should treat it with pills.

    It’s a false dichotomy. When you pick up feet and take a step you are not just deciding to move your feet you are without realizing it deciding to move around aspects of your neurology. Neither thoughts cause brain chemistry or vice versa, thoughts(and feelings and imagination and everything mental) ARE brain chemistry. It’s harder for us to control because well, we can’t look directly at our brains, but we can look for clues in our environment and in conversations with other people to figure out how to manage it.

    Since we know a lot more about how we can influence people by talking to them and helping them deal with their problems and have done that for thousands of years, why not do that rather than by putting expensive chemicals into their body that only target a few chemical pathways why is it that chemicals are the first choice of treatment?

  11. Steven Coles
    Steven Coles says:

    Lots of interesting comments. To my mind the minimum stance on diagnosis is honesty and transparency. Even if a professional believes in the current diagnostic system(personally I’m not sure why they would on the basis of evidence and theory), then they need to let the people they are applying the label to know that the practice is highly contested and critiqued. This is minimum – any less cannot be ethically justified.

    Sorry for the lateness of response and thanks for all the comments to the original article.

  12. Annmarie - a spirit who cares & understands & believes everything matters
    Annmarie - a spirit who cares & understands & believes everything matters says:

    I’m grateful that m.health is being looked into in a new positive light. I have had my trials/tribulations from 2006-2009 (only 3 months off work). Feared, despaired & faced all my demons negatively & angels positively: mentally,emotionally,soulfully, spiritually & physically. I have so much to share but my family were concerned & worried I would ‘revert’. It’s something I will never forget & my experiences might help others. I did take medication for a while but decided I would try to do without because I value a natural health holistic approach. I have fought so many inner battles & I feel proud of my journey & am now more able to accept everything regardless if good or bad in a more positive way rather than tearing myself apart in anguish & despair. I care for my welfare & development & anyone who has shown support. I hope most profoundly that others will get there on their journey & be more peaceful with their inner selves. The Universe wants us all to succeed, yes I love Reiki too x


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