From the time I first studied psychology as an undergraduate, I recall four things vividly. Likely the last to actually happen is the one that stands out most. I was ready to declare my psychology major at the end of my sophomore year when a professor told me in class that I could not be a psychologist because of my personality disorder. In 1968 I was out as a gay man at the University. Though it took an additional two decades, I proved him wrong when I earned my PhD and license to practice.
There was also the psychological study in which I participated earlier in my sophomore year. I later found that it was supposed to measure frustration in a rigged card-sort activity. I vaguely recall having said the word shit a few times in that experiment. Again, it was at least two decades later before I understood shit to be considered swearing.
Then there was the time that I was sure that I had every single disorder described in our text, until a classmate told me that my belief was diagnostic of two things: anxiety and narcissism.
But perhaps the recollection that I have been having most recently is from the class in which we discussed diagnosis. I recall the room in which the class was held, the gender of the teaching assistant, and the approximate location of the desk at which I was seated. I learned that diagnosis was meant to name a disorder so that we could describe etiology, usual symptoms, course of the disorder if untreated, promising treatments, and best outcomes.
I have noticed that the meaning of diagnosis, in mental health at least, seems to have shifted since that class more than 45 years ago. It appears to me that more often than not it is used to explain our medications, functional limits, and lowered expectations. Even though the Substance Abuse and Mental Health Services Administration has repeatedly in the past five years called for us to expect cures for mental disorders – and then aim for them – we seem to be slipping further and further away from that notion of restored health and functioning.
I have also noticed the common use of the expressions OCD, panic attack, depression, bipolar disorder, and ADHD by people who have not seen a licensed clinician to make a qualified diagnosis.
Who profits from this?