Should You Trust Psychiatric Diagnoses?

Should you simply accept and trust psychiatric diagnoses and live with them? Are such diagnoses from medical professionals testable, valid, scientific, objective, consistent and sufficient? What if they are not, as claimed by some prominent medical professionals and researchers? What does it really mean to be diagnosed with schizophrenia, bipolar spectrum disorder, dissociative disorder, hypoactive sexual desire disorder, avoidant personality disorder, mathematics disorder, or attention deficit disorder, to name just a very few? Considering the power of such diagnoses over a person’s life, to the extent that some people even see their identity defined by those diagnoses or “labels” “(I am bipolar”, for example), these are important questions.

Jody (not her real name) came to my healing prayer team. I clearly remember her starting the session with “I have been diagnosed with depression for over twenty years.  I have failed my husband, my children, and my church. I have also failed God as a Christian, with this depression most of my adult life.” She was in tears as she shared this, her makeup ending end up on her Kleenex, which embarrassed her. I reassured her that is not a problem and none of us thought any less of her. Besides, the Lord is especially close to those whom he loves and weep in His Presence. I said that her identity is not in her psychiatric diagnosis or her “failures” in life. The core fact is  that she is a child of the Living God, redeemed and loved by Jesus (John 1:12-13; Eph. 1:5), and no amount of performance, success or failure changes that. Upon hearing this, her face began to lighten.

Then I said “You know what is really depressing?” What?”, she asked. I said “You are not a failure — what is most depressing is that no one as yet has brought you into Christ’s Presence to receive His healing in the deepest places of your heart and soul. That is what is truly depressing. You are a precious child of Jesus, actually waiting for years to experience His healing where most needed.” Upon saying this she said “No one ever put it like that” and then she burst into tears. After several minutes, we started our prayer session. I don’t remember the specifics, but I do remember that in an hour the issues of the past were revealed and there was deep healing. It seems that she lived with a lot of shame and failure. Maybe she came from a legalistic background or a church that treated mentally ill people like modern-day lepers. But in any case, for years she saw her identity in her mental illness and the psychiatric label, instead of in Christ alone.

Another lady came for prayer, but was hesitant to share her needs. It took a while to develop a comfort level with the healing prayer team. She first shared about many years of sadness and deep inner pain and of not being understood in her church or by many of her friends. She eventually sought counsel from her pastor, who concluded that she was probably mentally ill, and thus he referred her to a psychiatrist. The psychiatrist, she told me, diagnosed her as bipolar disorder I. She said she never liked that label and found it hard to live with that diagnosis, as if it was her new identity. The psychiatrist stated that this would be her lifelong diagnosis and therefore she would need psychiatric medication for the rest of her life. I asked her how she felt about that. She replied that it felt like a “life sentence.”

Psychiatric Diagnoses are Descriptive Only

“In twenty years working as a doctor, I have never heard of any person having a diagnosis of depression, schizophrenia, manic depression or any other psychiatric condition confirmed by a blood test, or any other test .. Why no tests? Because no such tests exist. Because no biochemical abnormality has been demonstrated in any psychiatric illness.” Page 42.  

“I believe that the process by which doctors diagnose “mental illness” is fundamentally flawed.” Dr Terry Lynch, MD, 2001, “Beyond Prozac: Healing Mental Distress“, page 175.

Except for the truly organic indirect causes, there are no biological causes for emotional and behavioural problems. There are therefore no reliable diagnostic tests to identify them either – as Jacqueline among many others have discovered. It should be no surprise that psychiatric diagnoses are for description only. How could it be otherwise? Psychiatric diagnoses do not attempt to understand the causes. Psychiatry only “describes” a person’s mental disorder, offering no explanation. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is the authoritative standard text of psychiatry. In the front pages, the manual states that the purpose is to provide diagnostic criteria that are descriptive but “neutral to any theory of cause” and makes no assumptions about any causes. There are no pretension about “etiology”, or causation, at all. Not too enlightening!

Notice carefully that psychiatrists diagnose “disorders”, and not diseases. There is a big difference! Imagine waking up one day with strange spots over your body. How helpful would it be if you were diagnosed with “General Spots Disorder” without any test? Or if you felt pain in your neck and your doctor diagnosed you with “Neck Disorder”? In contrast, being diagnosed with diabetes or measles where the cause and development of the disease are known is indeed helpful. Psychiatry attempts to appear scientific like other medical specialties by using diagnoses, which are not much more than sophisticated descriptions of what patients already feel and experience. Unlike other medical diagnoses, those of psychiatry are only syndromes with related symptoms – not actually diseases—without any proof of origin or development. So the term “mental illness” is actually misleading, a modern invention lacking scientific basis.

Diagnosis without causation means that many people with quite different causes will simply be lumped together in the same classification. For example, people diagnosed with clinical depression might be suffering from rape, abortion,  irrational guilt, an empty spiritual life, or maybe even the effects of racism. Such diagnoses then become meaningless and obscure reality. Yet, all those people would be given the same or similar treatment regardless of the real cause(s). That’s just the beginning of the logical problems.

Combustion Disorder

Imagine that one morning your car is suddenly running “ragged” and occasionally backfiring. Your neighbour and a few other folk notice the abnormal, obviously dysfunctional, behaviour of your car. So, like any normal person with proper expectations, you go to your automotive dealer or local garage to get it fixed.

After you explain the problem to the mechanic, he asks you still more questions about your car’s dysfunctional behaviour. He pulls out a clipboard, and from a twenty-one-point checklist for the Tork-Weiler Rating Scale he asks you questions about your car’s behaviour. Your anxiety begins to subside as you realize that your problem is being understood and that help is around the corner for your disordered car.

He then takes you to his office, and you take a seat. In fact, there’s even a leather couch if you want to really relax. You notice the wall behind his desk, lined with shelves of books on automotive theory, diagnostics, and so forth. You also notice several certificates and diplomas on the wall, all attesting to your mechanic’s proven competence. You remain confident in your mechanic’s licensing organization, including the car manufacturer. You then rest, sublimely confident that you are in the hands of a true professional.

A few moments later, without even checking under the hood or running a diagnostic test on the car at all, but after consulting his detailed, 900-page desk reference manual on car diagnostics, he declares that your car is suffering from “Combustion Disorder.” He then gives you an invoice for the half-hour consultation plus a prescription for ten liters of a fuel additive and instructs you to add a quarter liter in the morning and the same amount no later than eight each evening. He warns you that a side effect might be yellow exhaust and fluctuation in oil pressure but encourages you not to be overly concerned. He then directs you to the receptionist, who will book a return appointment for you to see about adjusting the amount of the additive or using a different additive or maybe even another fuel additive in case there are “side effects.”

What would you think? Is that helpful? Most people would be appalled at such a mechanic. Why should anyone expect less for their own soul than for their car?

Psychiatric Diagnoses Can be Quite Subjective 

“Many biological psychiatrists are poor diagnosticians either because of (a) poor application of DSM-IV rules or (b) proper application of the diagnostic rules, which themselves are full of contradictions and cognitive errors.” Colin A. Ross and Alvin Pam, 1995. Pseudoscience in Biological Psychiatry: Blaming The Body. Page 122.

What happens in practice when psychiatrists apply the labels and classify people? How consistently and correctly do people fit into the slots or “pigeonholes” created by psychiatry? Does the “system” work? Not very well, as one would expect given the foundational logic problems already noted.

Diagnoses may well be determined simplistically and / or subjectively. Perhaps the most alarming example of simplistic and biased diagnosing of people is the Rosenhan study. In the mid 1970s, Rosenhan, a professor at Stanford University, and seven other pseudo-patients, who were professionals and quite normal people with no history of hospitalization, went to twelve different psychiatric hospitals to observe what happens there. To get admitted, they called up for an appointment, and when interviewed by psychiatrists at the psychiatric hospitals, they complained about hearing voices saying “empty,” or “hollow,” or “thud.” On purpose, they pretended to have existential symptoms, since there was not a single report of existential psychosis in the literature. There should then be no basis for admission. Nevertheless, on the basis of only that “symptom,” they were diagnosed as schizophrenic. Except for falsifying their names and occupations, they told the truth about their lives and, upon admittance, behaved totally normal.

 They were hospitalized from seven to fifty-two days before release. While they took many notes on what happened in the hospitals, the other patients perceived them as being normal or even “plants.” But none of the hospital staff did. They ascribed the note taking directly to the patients’ mental illness and even fit past facts of the patients to support their diagnosis of schizophrenia. Worse still, the patients were all discharged as “schizophrenics in remission” and thus judged still mentally ill with a possibility of recurrence of schizophrenia.

But the story doesn’t end there. Rosehan later approached a prestigious American teaching hospital and informed the staff that within ninety days a pseudo-patient would attempt to gain admittance to the psychiatric unit. About 193 patients were admitted, and in forty-one of those admissions at least one staff involved alleged that the patient was in fact an imposter.

There was only one tiny problem: Rosenhan never sent any pseudo-patients at all! The obvious point was proven again—-psychiatric diagnoses can often reflect what mental health professionals want to see, thus further undermining the credibility of such diagnoses. When the hospital did not expect imposters, many imposters were allowed in. When the hospital did expect imposters, many people were judged as imposters when in fact they were not. Rosenhan’s second study is an example of extremely low-budget and innovative research. Many other studies and books have been published to show that psychiatric diagnoses have little to do with science. For a thorough review and references, see Chapter 8, “Psychiatric Labels: Science or Invention?”, in my book, “Pills for the Soul?”.

Clearly, psychiatric labeling is not an exact science. You can readily see this in the DSM-IV that lists “atypical” behaviours, “subtypes,” and the loose, nebulous category of “other behaviours or effects not elsewhere specified.” This reveals the difficulty of boundaries for mental disorders that won’t cover all situations; not all people fit into boundaries the same way; and the correct classification of people is a probability. A number of authors and researchers expose psychiatric labeling as a pseudo-science.

Diagnostic challenges abound. Not everyone can clearly distinguish between say anxiety, phobias, obsessions, compulsions, which can be required to make a diagnosis. The expression of the same behavior might be different for different people, and might change over time. The diagnoses look at a pre-determined list of symptoms, and will ignore others, as well as the full context of a person’s life. Worse still, the diagnoses of many patients change over time, and of course the past diagnoses are then called “incorrect.” Sometimes the diagnoses are actually changed to justify the prescription of another drug. Does the change in diagnoses over time mean that the supposed disorder changes over time as well? It is like being diagnosed with cancer, then arthritis, then hypertension, while the cancer disappeared, and then diabetes, which will disappear in a few years.

Different causes in a person’s life could lead to similar symptoms. Or similar causes could lead to different symptoms. Or symptoms could change quite substantially from the same cause(s) over a person’s lifetime. This is simply because each person’s story is unique and people have different ways of expressing their inner pain and woundedness. You can’t fit a round peg into a square hole. This is certainly true when psychiatry attempts to fit people into its artificial slots or pigeonholes. Remember that medical doctors as well as psychiatrists make such diagnoses, and sometimes in minutes.

Years ago, I watched “Girl, Interrupted“, a movie based on a true story of a girl who was put into a mental institution all too quickly and subjectively. Watch the short trailer, and see the movie or read the book if you are so inclined.

Prescription Tunnel Vision

A major purpose of psychiatric labels is diagnosis for the prescription of a psychiatric drug. This becomes description leading to prescription, with little attempt to truly understand people and their lives. The diagnoses are inherently biased towards drugs and pharmaceutical companies. At times one can actually deduce which psychiatrist is treating a patient by looking at the prescribed drugs, irregardless of the patient’s mental problems.

This reminds me of a cartoon where a man is sitting in front of a computer and there is something on the computer monitor that he either does not like or is incorrect. So what does he do? He reaches for some whiteout and applies it to the screen! Why do we laugh? Because the man has no idea of how the text or image appeared on the screen.  So when you seek help from a psychiatrist and you leave the office not understanding any more than when you came in, except for a “label” and a prescription, don’t be surprised. We can all agree that it is indeed great to “see the light” at the end of the tunnel. But what if someone put you in the wrong tunnel?

But let’s not forget that there are mental health professionals and psychiatrists that really do care for their patients, and some do wonder about the pressures and ethical dilemmas of the mental health system and pharmaceutical industry as a whole. Their professional certifications require standard diagnoses for standard, observed symptoms. Some people have a sense of relief upon being diagnosed – “someone finally understands, I am not imaging all this stuff in my life”.

So should you trust psychaitric diagnoses? Given the reasons above, not really, and certainly not at face value and uncritically. Pragmatism suggests that if you want  medical coverage through an insurance plan, you have no choice but to accept the labels. To receive services through the mental health “system”, you must have a psychiatric diagnosis.

The Psalms: Superior to Psychiatric Diagnoses and Labels 

Psychiatric labels are hard to assess biblically since they are so foreign to anything found in the Scriptures. The Psalms talk of one’s soul being downcast (Ps. 42:5-6;43:5), in anguish (Ps. 31:7), weary with sorrow (Ps. 119:28), sorrow in one’s heart (Ps. 13:2), one’s soul and body in grief (Ps. 31:9), one’s heart grieved and one’s spirit embittered (Ps. 73:21), having a wounded heart (Ps. 109:22), a broken heart (Ps. 147:3), a crushed spirit (Ps. 34:18), fear (Ps. 55:4-5) and so forth. Indeed, the full range of human emotions appear in the Psalms. But that’s so different from modern psychiatry with its technical world and terminology—or “shrink rap.”

Are Christians at a disadvantage because the Bible only uses “common terms” like fear, anxiety, sorrow, madness, confusion of mind, or sadness? Not for one second. Psychiatric labels are largely built upon different combinations, durations and intensities of emotions and behaviors. A complex, supposedly “scientific and professional” edifice is constructed upon what you ultimately find in the Psalms and the rest of Scripture. That very edifice is problematic with many logic issues. The Psalms ask the deeper “truly diagnostic” questions – “why are you downcast, O my soul?” (Ps. 42:5, 11) and call for healing and transformation (Ps. 23:3) – far beyond the symptom management of  psychiatry. The Bible is the most potent source of psychology and understanding of the human condition. Healing and transforming prayer in the Presence of Christ is by far the most effective and lasting way to peace (Gal. 5:22-25; John 10:10; 14:27), life and wholeness, which our hearts and souls long for.