On the Question of Psychiatric Diagnosis

It is a label used by society to determine eligibility for service recipient and service provider, and responsibility for reimbursement of service exchange that takes place within the broad framework of health industry. The criteria for a diagnosis is not static, but a fluid process, based on advancement of knowledge and science, and a common understanding of a social framework to address  behavioral anomalies in the context reducing or eliminating personal and associated social distress.

While the” illness model” (somebody has an anomaly that needs to be fixed by outside intervention) using a biological determinism and interventions involving biological and supportive psycho-social interventions, is palatable and acceptable to all and to many, but “mental illness” as many of us understand with psychogenic origin and or major involvement  of psycho-social factors, is often viewed  as of an “personal existential crisis,” with associated personal and social distress (associated with at risk behaviors” or potential for such behaviors), and this view  may rightfully cause dilemmas and concerns to many.

This “illness” model of” treatment” may violate a sense of personal freedom, ownership for one’s thinking and behavior, originating from within one’s self system, and may work counter to a sense of “personal independence,” personal unique ways of adapting to one’s existential reality, which is also valued as important component to one’s wellbeing and sense of autonomy.

Many believe that social experiences and conditions promote people to develop what one considers “mental illness,” as such the focus should be fixing the “social community and environment,” rather stigmatizing people with a mental illness criterion. Compounding the issue, many people diagnosed to have “long-term mental illnesses” do not have the social support and therapeutic milieu so to speak that many without a dx of mental illness have (e.g., family, work, social group, religious or community affiliation, etc.,), which do provide support as well monitoring of one’ behaviors for any personal and or social distress that may be associated with “at risk behavior tendencies.”

In an ideal society, if a “therapeutic milieu” is structured for all, and people can access participation in various supportive group activities, and where “at risk status” can be monitored within the context specialized support and milieu along with social rule of law for managing any “at risk deviation,” then there will be no need for any “destigmatizing illness label. Persons may choose to enter or exit based on perceived ‘benefits,” and responsibility and onus on providing such satisfaction in entirely on the providers, just like in any consumer oriented buying and selling “exchange of goods and services.”

Additional issue is that “destigmatization” for a specific “mental illness,” such as “schizophrenia” is more of a perception of meaningful lack of progress with the “existing treatment modalities,” for most who are diagnosed with this “malady,” as the so-called “symptoms” continue to persist with “impaired level of functioning” for many in spite of years of involvement in “treatment.” In order to have this egalitarian ideal into practice, societies must be able to routinely build in provisions for all such “entitlements.”  In some ways, Pope Francis’ sermons highlight this view in some way.

But this may again violate many people’s political and social values that one hold, giving too much power to “society” over individual freedom and choice, and valuation of personal freedom and free market thinking.



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