Thoughts on Diagnosis and Disorder:
Stigma and What It Means To Be Normal

Last modified on: 08/08/06

The Stigma of Suffering

Emotional pain and mental distress carry significant stigmas. From crying as a sign of weakness or neurosis to the ridicule of those with schizophrenia or dissociative identity disorder in the media, society imposes shame and guilt on those whose thoughts and feelings are a source of suffering.

Emotional Pain and Disease

Environment plays a huge role in determining how one feels. It's natural to feel anger, sadness, frustration, worry, grief, and fear during the course of life, because life is naturally filled with troubling events and situations. People in unusual circumstances respond with unusual distress, but the external causes are often disregarded and the distress considered the sign of a psychological disorder. Emotional pain is not in itself a disease or a mental disorder but usually a natural response to certain situations and events, perhaps over the long term. The purpose of emotional pain is to motivate behavior intended to improve well being even if that is not the result.

"It's your fault" or "It's a disease"

In mental health care, it seems the only options on how to view mental and emotional difficulties are: 1) blaming people for their problems or 2) attributing them to a biological disease. There's another option. People have difficulties when their circumstances, or some combination of who they are and their experiences, trigger emotional pain or confusion severe enough to surpass their ability to cope. It happens because the world is not ideal, and we, as humans, are not perfectly engineered for our environments. Sometimes people make mistakes, behave stupidly, or act out of malice, and sometimes physical conditions affect thoughts and emotions, but in many cases, people have only a certain level of ability to survive emotionally, and experiences test and break that ability. That's when one needs help; not medicine or confinement, but empathy, compassion, and practical assistance meeting needs and thinking effectively.

Interconnectedness

If you look at how much of who we are depends so deeply on the influences of those around us, it becomes apparent how interconnected we are. You are the clay, and you come into the world with a certain consistency and color and some other basic qualities, but it is the world that sculpts you into the beautiful, intricate shapes you take in life. We are so much a response to those around us, that the human race is like one large organism, constantly renewing itself with life just as cells in our body live and die.

If we perceived the human race as one large organism, the way we would respond to the mental or emotional pain and anguish of one individual would be entirely different. Instead of further isolating that individual, calling them diseased, and drugging them, it would be clear that the emotional pain was like the crest of a wave, a dimple in the the social continuum, and would require a social intervention.

American Diagnosis of Schizophrenia

American doctors are more likely than European doctors to diagnose a moody person as schizophrenic. Experimenters showed video of an awkward unmarried man to American and British psychiatrists. While only 2 percent of the British psychiatrists labeled the man schizophrenic, 69 percent of the American psychiatrists gave this diagnosis.

The Drug-Centric Model of Mental Illness

One thing to consider in forming an understanding of mental illness is that few people are out there looking for ways to treat mental illness that do not involve drugs.

Funding is probably part of the reason for the focus on drugs. Drug companies provide support for the search for treatments, which may steer research towards the discovery of pharmacological solutions. The National Alliance for the Mentally Ill, for example, is supported by money from pharmaceutical companies. The NAMI "Campaign to End Discrimination" against people with mental illnesses was made possible by more than $11 million from Eli Lilly, Janssen, and other drug companies from 1996 to 1999. In addition, an executive from Eli Lilly assisted NAMI with their strategic planning for the campaign.

While pharmaceutical advances are a blessing to many, it would still be nice to explore other avenues, but the funding situation doesn't seem to make this possible. Programs that depend on providing people with a caring social environment, for example, have been shown to be effective and are not necessarily more expensive, but they have difficulty attracting sources of funding.

What is Normal?

The field of psychology has a very rough time defining abnormality. One common way of determining abnormality is by looking at the percentage of people exhibiting the behavior or symptoms; a response is abnormal if it is found in only a certain small percentage of people. For example, every person exposed to a traumatic event will avoid reminders of the event, startle easily, and experience some form of flashbacks. However, only about 15% of these people will continue to feel this way several months after the event. For this reason only, these people are diagnosed with Posttraumatic Stress Disorder and considered somehow different from the others. Although few have been able to identify what makes these people different, they are still considered abnormal. Similarly, the difference between natural emotional distress and many psychological disorders is simply a matter of degree.

The Diagnosis Bible

The major diagnostic manual now used to label people as mentally ill or psychologically disordered has not gone without the criticism of experts. A diagnosis should be received with consideration of the objections others have raised. For example, the previous version of the DSM, (DSM III), included homosexuality as a mental illness. The editing committee removed the offense because of the protests from the gay community. The current version, the DSM IV, considers frequent marijuana smoking a mental illness.

The following is from the book, Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders, by Herb Kutchins and Stuart A. Kirk:

When does worry become "generalized anxiety disorder?"

"Determining when relatively common experiences such as anxiety or sadness or memory lapses should be considered evidence of some disorder requires the setting of boundaries that are largely arbitrary, not scientific, unlike setting the boundaries for what constitutes cancer or pneumonia. Because these boundaries are arbitrary, agreements must be hammered out among a few psychiatrists serving on special committees. Where the boundaries are set determines how prevalent a disorder is 'discovered' to be in the population."

Where do you draw the line?

In reference to the definition of a mental disorder stated by the DSM, which requires that a mental condition be rare and cause distress or disability to be considered a disorder: "What about mental conditions that are rare (i.e., statistically unexpected) and undoubtedly cause distress or disability, such as the condition of people who exhibit extreme degrees of selfishness, cowardice, slovenliness, foolhardiness, gullibility, insensitivity, laziness, or lack of talent? These mental conditions appear to meet DSM's definition of mental disorder, yet they are not in the manual and are generally not considered as disorders. On this count, the DSM definition is too broad to be valid."

What is normal is based on what is expected, but what if we don't know what to expect?

Also in reference to the definition of mental disorder, which attempts to eliminate emotional responses to circumstances from earning the diagnosis of mental illness: "The definition excludes from the list of disorders any expectable response to environmental events. But what is unexpectable is often a direct function of our knowledge and ability to accurately predict events, not merely an attribute of a syndrome. The unexpectable clause, if taken seriously, would exclude as disorders some of the conditions that are already included in the manual as disorders. For example, a now expectable response to extreme trauma is Posttraumatic Stress Disorder (PTSD)... Depression is an expectable response to major loss. Anti-social behavior can be an expectable response to socialization into a criminal subculture."

Lowered qualifications for mental disorder

In reference to "shadow syndromes," a new set of "mental disorders" to be used for diagnosing more of the population: "Given the DSM's approach to identifying disorders by providing a Chinese menu of specific behaviors and requiring that some arbitrary number of these behavioral criteria be met before the diagnosis is used, these mental illness entrepreneurs are proposing that people may have a disorder even if they only exhibit a few of the required symptoms."

Diagnosing normal responses to tragedy

In reference to Posttraumatic Stress Disorder: "Although it is important to recognize the suffering of these victims [of the traumatic event], it is a major leap to identify characteristic reactions to assaults, abuse, and harassment as symptoms of a mental disorder; this practice leads to the complaint that psychiatrists and other mental health workers are blaming the victim... PTSD has become the label for identifying the impact of adverse events on ordinary people. This means that normal response to catastrophic events often have been interpreted as mental disorders."

Explaining the Behavior of Others

In Social Psychology, research shows that people generally attribute the actions of others to their personality and not their circumstances. Even actors are subject to this misjudgment, as people often think actors are similar the characters they play. This misjudgment is called the Fundamental Attribution Error. This error comes into play when expressions of emotion are attributed to personality problems and not to circumstances.

Experiment Shows "Pathology" in the "Normal"

In an experiment featured in the video series Discovering Psychology, narrated by Philip Zimbardo of Stanford University, a woman was hooked up to a machine which measured her brain waves while she was awake. The woman's brain waves were normal, until one of the nurses asked her about her boyfriend, with whom the woman had just separated. The brain waves changed and exhibited patterns recognized as pathological depression. However, as soon as the topic changed, the woman's brain waves returned to normal. This suggests that people diagnosed with an emotional pathology may instead be responding normally to events in their lives.

The Calming Effect of Tears

When you cry, your body releases a chemical that acts as a sedative. Crying also, like laughing, relieves muscle tension caused by stress. These are both strong evidence that crying is not only natural, but a healthy adaptation to stressful situations. This doesn't always mean it will improve your outlook on things, but physically you may be better off.

Brain Disorders? But Thoughts Can Change the Brain

Many psychological disorders are associated with biochemical changes in the brain. However, long-term stress can cause semi-permanent changes in brain structure and biochemistry, which means that many psychological disorders may have roots in negative environmental conditions.

Biological Origins or Biological Effects?

A biological sign of a mental or emotional problem does not mean that the problem is biological in origin. If you miss sleep or eat a lot of junk food or sit around motionless all day, your mood will undoubtedly be affected. However, thoughts and experiences also affect your mood, and though they may produce biological changes, these changes are still a part of and possibly amenable to the thoughts and experiences that created them.

Recommended Reading

Mad In America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill

By Robert Whitaker
2002
Reviews and ordering information

Toxic Psychiatry

By Peter Breggin, MD

Copyright © 1998 by Lisa Lindeman. All rights reserved. No part of this website may be reproduced without the permission of the author or appropriate citation.