In my previous post, we examined some drawbacks to my profession’s
reliance upon psychiatric diagnostic labels. To illustrate further drawbacks, I
have invented a diagnostic label. This I term PDID, or Psychiatric Diagnostic
Identity Disorder. It is, I contend, a core malady of countless Americans. PDID has
two subtypes–PDID, Fragmented Identity Type and PDID, Lack of Identity Type.
First the Fragmented Identity Type. Here patients subscribe to psychiatry’s
attempts to parse them into multiple entities, each seemingly with its own
ontological standing. 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. Accordingly, 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 Axis II pathology.
Well, what is the problem? some may ask. After all, these are terms that
encapsulate clusters of symptoms and signs that recur throughout the population
and inform treatment. True. Unfortunately, as noted in my previous post, only a
whole, integrated individual can become well and remain well. A living, breathing
patchwork of multiple disorders cannot. Thus does psychiatry forego the
possibility of cure by fragmenting the identity of the previously intact individuals it
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 have
already seen 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 pseudoidentities. It encourages lost souls to further lose touch with
reality as they identify themselves with abstractions that refer only to certain of
their parts. 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 its manual
a set of diagnostic criteria and 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, instead of saying merely, “I am an
obsessive-compulsive,” could add, “with loyalty to my loved ones, a strong sense
of responsibility, and I can freaking wail on the tenor saxophone.”
Why not include in a given diagnosis whatever makes that person different from
others, unique, special? That may be the information we need to cure them, or the
realization they may need to cure themselves.
Who knows? If psychiatry recognizes the two PDIDs as bonafide problems, it
may yet heal itself.
But if in the meantime you have been diagnosed with a psychiatric label, I have
two recommendations. First, that you continue whatever treatment helps you or
helps those with similar problems without equating the label itself with reality, and
certainly without equating the 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 my profession’s
evolution, comprehend the need for more useful alternatives. And I also
recommend that you consider other treatments that can actually cure you by
utilizing your inner healing resources and treating you as a whole, unique