Diagnoses, Some Thoughts to Consider

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Most practitioners in the field of mental health would agree that it is important to have diagnostic categories and criteria, as presented in the Diagnostic and Statistical Manual 1V. Diagnosis is necessary for psychiatrists to decide the best use of medications for such acute and chronic illnesses as Schizophrenia, Bipolar Disorder, Major Depression and other Axis I disorders.

However, when it comes to the Personality Disorders, and they are Axis II, how helpful to a patient or therapist is it to diagnose someone with a Borderline, Dependent, Avoidant, Paranoid, Obsessional, or any Personality Disorder? Medications do not relieve or cure symptoms in the diagnostic category of Personality Disorders. Too frequently, the diagnosis becomes part of the self identity of the patient.


Very recently someone E. Mailed me with a question about psychotherapy and wrote that they are “a Borderline Personality.” I always find this to be a very curious way for people to define themselves and therein, in my opinion, lies the problem.

When you have the flu, do you describe yourself as “I’m Flu?” No, you state that you have the flu or that you are fighting a virus. Can you imagine that, if you had a bout with the recent swine flu, that you would call yourself a swine? I certainly hope not, and we all realize that it would be downright silly for anyone to refer to himself that way. Yet, when it comes to the mental illnesses I often hear or read about someone “being schizophrenic, bipolar, borderline,” or any variety of mental illness with which they have been diagnosed. The worst possible statement is when I hear someone say, “I am crazy!”

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We often speak about the stigma attached to having a mental illness. There are  well founded fears of rejection if someone else learns that we are depressed, schizphrenic, bipolar, etc. Even today, society does not look kindly upon mental illness and continues to cling to stereotypes of those who suffer from these.

I want to emphasize some points about diagnosis in psychiatry:

1. By continuing to use such language as, I am: a depressive, bipolar, avoidant personality, and so on, we are unwittingly contributing to the problem of stigma.

2. In this area of human behavior, there is no such thing as “we and them.” “We” refers to those of us who have mental problems, and “They,” refers to those who do not have mental problems.

What I want to urge upon the reader is that there is no such thing as “we and them” in this area. We are them and they are us. What do I mean?

Some examples of what I mean by “we are them and they are us,”

1. Psychiatrists, Psychologists, Clinical Social Workers, Medical Doctors, all struggle with the difficult issues of life, depression, family problems, ADHD, Anxiety and all the other emotional ailments. They are not immune simply because they are the experts. That is why it is so important for mental health professionals, from Psychiatrists to Family Therapists, to attend psychotherapy for themselves.

2. All the mental illnesses fall on a spectrum and that spectrum includes everyone. In other words, it is entirely possible for any human being, under certain types of pressure and trauma, to experience an hallucination, delusion or any other type symptom. Here, too, no one is immune. It might be that the symptoms are transitory or they clear up once the crisis passes, but, the experience is that of a real symptom, nevertheless.

Therefore, what I would like the reader to think about is this: that you no longer allow some diagnosis to define who you are. You may feel depressed but you are not a depressive.

Your opinions, questions and experiences are welcome and encouraged.

Allan N. Schwartz, PhD

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