Psychiatric diagnoses and the DSM are a sham
Psychiatric diagnoses and the DSM are a sham
Part I-- Mainstream mental health & neurodiversity discourse is whitewashed + How psychiatric diagnoses are unreliable & lack scientific validity
The idea that our emotional and mental distress is caused by biological defects/ deficits/ disease processes is deeply rooted in Western society- and by extension, the dominant model enforced around the world. Questioning this paradigm is often seen as a denial of people’s suffering. On the contrary, the political abolitionist lens aims to identify root causes of the very real pain and emotional anguish we face so we can conjure sustainable long-term solutions to truly alleviate our collective suffering. This series, spanning multiple newsletters, will 1) reveal how colonial capitalist medicine harms us (with an emphasis on psychiatry as a tool of population control) and 2) explore alternative models of healing and care rooted in Indigenous, Black and Brown cultures from the Global South. This is a critical effort to de-center the American and Euro-centric narratives that dominate mental health discourse that ultimately uphold and embolden global capitalism and neocolonialism while liberating no one.
TABLE OF CONTENTS
Definitions- What is the “diagnose and treat” medical model of psychiatry?
Foundations of modern Psychiatry- What was this system built to do?
Demystifying medical diagnoses- How does a diagnosis work in medicine?
Psychiatry is an arbitrary, subjective, reductive field that lacks validity- How psychiatry is distinct from other fields of medicine & the “shadiest”
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1. What is the “medical model”? Some basic definitions
Medicalization: The medical model considers emotional or mental distress (“abnormal” thoughts, feelings or behaviors) the same as a broken arm, diabetes or cancer- i.e. caused by individual neurological deficits, diseases and faulty brain chemicals with no social context. The medical model frames our mental distress in response to societal trauma using medical jargon (symptoms, disorders) to diagnose people (categorize them as abnormal, mentally ill) so they can be treated with psychiatric drugs or institutionalized (including incarcerated against their will in solitary confinement and forcefully restrained/ medicated).
There is now more awareness about how social determinants of health like chronic poverty due to colonialism, capitalism, state-violence, gender or sexual violence, exposure to environmental toxins cause negative health outcomes. Yet, modern healthcare systems are capitalist and if profit is the priority, there is no incentive to truly heal and care for our communities. The more people fall sick, the more profit the medical industrial complex makes. Thus, medicine largely blames individuals for their adverse health outcomes & makes them carry the burden with little to no focus on prevention. Psychiatry, however, is EVEN MORE insidious because till this day, unlike other medical specialties, no genetic or biological cause has been identified for a psychiatric diagnosis and thus, it remains a subjective field lacking validity which I will explain in detail in this newsletter.
Diagnosis: Psychiatry largely uses the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as a rule book to categorize a person’s feelings, thoughts and behaviors that are subjectively deemed “abnormal” as a mental disorder without any quantitative assessment (i.e. no physiological tests run) or tangible evidence of a biological abnormality. This is distinct from how other medical specialties diagnose cancer, infectious diseases or any other disease process which depend on “symptoms” being matched to a physiological “sign” like cancerous cells identified in an organ biopsy, chemical tests measuring organ function or bacteria isolated from an infected organ. Diagnosis is not benevolent under capitalism because it is the pre-requisite to treatment with pharmaceutical drugs which is a global profitable industry despite the lack of evidence showing efficacy of the drugs.
In fact, the bioessentialist myth that mental illnesses are rooted in chemical imbalances or biological defects is pushed in order to promote widespread use of psychiatric drugs. The medical model blames individuals for their suffering which justifies treating individuals (rather than fixing systemic inequities) and exploiting them as consumers in a billion dollar pharmaceutical industry.
2. Psychiatry is a 19th century based colonial system
The foundations of the modern medical system were largely shaped by Anglo European colonizers in the late 18th and 19th century when race was being framed as a biological difference within humans in order to build a hierarchy that justifies the genocide of Indigenous peoples and enslavement of Black people. Psychiatric mental asylums were created to lock up people who rebelled against white male authority to coerce them into slave labor for the state and psychiatric diagnoses were developed in this context. “Draeptomania” was one of the earliest mental disorders fabricated as a disease of “insanity” solely afflicting Black slaves who escaped while Hysteria was a disease afflicting “unhappy miserable women” who did not serve “good husbands” well (i.e. an outcome of their forced domesticity).
The context of what has been considered “madness” is critical because this is the basis of the medical model that frames individual responses to systemic oppression- either distress or rebellion, as “diseases” or insanity to prevent us from turning on the state and wealthy in authority who are to blame. Psychiatry has been a tool of population control used to incarcerate marginalized communities and pin social problems on “broken or defective” individuals. Today- it is a victim-blaming exploitative profitable system that coerces people to “fall back in line” and assimilate to capitalist colonial standards.
Mainstream neoliberal mental health and neurodiversity discourse mimics the global colonial world order where the Global North (ex-colonial empires) dominates over everyone- i.e. whitewashed af.
The European/ American Psychiatric system was enforced onto the world during 20th century colonialism using genocide of Black and Brown communities and violent erasure of our traditions, cultures and systems of healing. This is why Psychiatry is widely accepted- not because it is “correct”, evidence-based or the most effective system to care for our wellbeing, but because it was part of the colonial conquest.
Today, mental health discourse is dominated by people in the Global North (colonial empires like the U.S., Europe, Canada, Australia, NZ etc) who cling to the medical model and try to further “spread” it by advocating for marginalized communities to be funneled into the Psychiatric system and have “more access” to diagnoses. This is not recognized for what it is- a form of neocolonialism or the strengthening and expansion of colonial systems in the 21st century to maintain global power structures and at the expense of continued erasure of alternative models of Indigenous healing.
Psychiatry is not a kind, benevolent, life-saving system because it was not built to be despite the positive personal narratives we read. Psychiatry is a colonial capitalist system that must be abolished to make way for true healthcare.
Systems of oppression are built to seem like they are helpful as they advantage some while disadvantaging others. Your seemingly “positive experience” with an oppressive system is not a justification for its existence. Some people do somewhat flourish under racism, capitalism, heteropatriarchy compared to others- on the surface, but in reality these systems are exploiting and slowly killing us all. However, as I’ll discuss later, a diagnosis is sometimes helpful in the short-term for people to make sense of their mental distress and connect with others, but in the long-term, it is a carceral system that preys on you and forces you to conform to capitalist colonial standards. In fact, research shows that people who turn to the “diagnosis and drugs” approach are more likely to have lifelong dependence on the psychiatric system (Anatomy of an Epidemic, R. Whitaker). We do not need to cling to the crumbs that have been thrown at us and resort to colonial systems when better is absolutely possible- if you’re willing to mobilize with others.
3. How does a medical diagnosis work?
In all other medical fields, the process of diagnosis is roughly like pattern matching where docs match patterns of physiological symptoms identified in research with the complaints of a patient. I specialize in the diagnosis of infectious diseases as a clinician and a researcher so I intimately understand this process. In order for a patient to be diagnosed with a bacterial infection for example, we need to identify patterns of symptoms (fever, fatigue, pain, vomiting, etc) that indicate a specific infection as reported in accurate, precise and reproducible research PLUS isolate the pathogen from an infected body site. In order for a patient to be diagnosed with cancer, oncologists rely on several chemical or blood tests, imaging (MRI, CT) or biopsies to identify cancerous cells in the body. Psychiatry is the one branch of medicine where the entire diagnosis process requires no such testing- there is not a single quantified assessment run to identify a biological marker of “disease”.
A golden rule in all of medicine (except Psychiatry) is to NEVER solely rely on symptoms because pain, nausea, fatigue, etc are subjective, feel different to different people, common and have many causes.
Medicine therefore has emphasized on matching symptoms with other bodily processes that can be objectively measured (like organ damage, isolation of a pathogen from an infection, antibodies, chemical levels in blood or organs, etc). We look for objective evidence that shows that the sign came first and “caused” the symptom- this is the only way we can confirm that symptoms aren’t just co-occuring by chance. Medicine relies on years of strong research evidence to know what signs to look for and which symptoms are associated with a certain disease process. Medical diagnoses, except Psychiatry, are about gaining an objective understanding of the cause behind someone’s symptoms and NOT about finding which disease is afflicting someone. Now diagnostic criteria do evolve as we make more research discoveries and the process of arriving at a diagnosis is sometimes straightforward, and other times very confusing, speculative and uncertain. One thing is for sure- it is never enough to just match up a list of symptoms to a disease construct without any measurement or evidence, except in Psychiatry- that is all you need.
4. Psychiatry admits that their diagnoses and the DSM V lack any scientific validity
The British Psychological Society issued a damning report in 2018 that called for the abolishment of Psychiatry and the DSM as we know it due to the lack of scientific evidence to support the diseases they have constructed, proposed abandonment of the “mental illness” lens entirely and advocated for the non-pathologzing “Power Threat Meaning Framework” (PTMF) that frames our mental anguish as responses to systemic oppression and environmental stressors. The report states:
In the same year, the publication of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5, 2013) was accompanied by explicit admissions of fundamental difficulties in the diagnostic system. For example, Dr David Kupfer, Chair of the DSM-5 task force, noted that: ‘In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting’ (Kupfer, 2013). Former Chair of the US National Institute of Mental Health (NIMH) Dr Steven Hyman, described DSM-5 as ‘totally wrong, an absolute scientific nightmare’ (Hyman, quoted in Belluck & Carey, 2013), while the then NIMH Chair Dr Thomas Insel declared that ‘Patients deserve better…the weakness is [the DSM’s] lack of validity’ and announced that NIMH would be ‘re-orienting its research away from DSM categories’ (Insel, 2013).
While the medical models asks “What’s wrong with you?”, there has been a collective push from within the medical community itself to instead ask “What has happened to you? How did it affect you? What sense did you make of it and what did you have to do to survive?”. This is a solid start but I’d like to push us further to ask “How can we address the systemic roots of our suffering to truly alleviate harm? How can we build life-preserving social systems that meet our basic needs? How can we build non-hierarchical systems that care for our entire ecosystem’s wellbeing (human and nonhuman entities)?”
When we examine how all other medical diagnoses work, we see that psychiatric diagnoses are subjective, arbitrary and unreliable.
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