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The Torch is the newspaper for Lane Community College in Eugene, Oregon, USA. After student columnist Haydenn Harper was widely criticized for his language in an article he wrote for the Torch about allegedly "crazy" people he saw on the bus, he investigated the topic of psychiatric labeling with several interviews, including with David Oaks, Director, MindFreedom International. Harper looks into the origins of labeling via the psychiatry's Diagnostic and Statistical Manual, also known as the DSM.

Mental disorders - diagnoses or discriminating?

Date Published:

Jun 03, 2010 12:00 AM

Author: Haydenn Harper

Source: Torch, LCC, Eugene, Oregon


For original article click here.



[See above link for photo: Caption - Judi Chamberlin (left), a well-known psychiatric survivor activist, and David Oaks (right) are performing a "normality screening" of mental health consumer advocate Sally Zinman.]



Some people labeled with mental problems may need a loving community instead of a diagnosis


What is a mental disorder?


After I wrote "FML - I really need a car," an article that offended some of members from the disabled community, I set out to find the answer to this question. After many interviews and guidance from people who specialize in studies of the mind, I found an answer.

From this perspective, there is no such thing as a mental disorder.

I'm sure I just offended another group of people by saying that, but I stand firm by my statement. I'm not saying that people don't have mental or physical differences that can disable them in certain ways. I'm just saying there's nothing wrong with that. I'm also saying that disorder and disability mean two different things.

A disorder refers to an abnormal mental or physical condition. There is no such thing as a normal mental condition because we all think differently. There is also no such thing as a normal physical condition since we are shaped differently.

A disability is another word for disadvantage. This word is more accurate in reference to people who can't accomplish certain tasks based on their mental or physical conditions.

I've found that people try to fit themselves into a lot of social boxes or categories. The boxes collectively encompass how people should think and act. Anyone who doesn't fit inside these boxes runs the risk of getting labeled with a mental disorder.

The labels and what comes with them can be active forms of open discrimination and oppression, just like racism, but it involves people's minds and actions. It's telling people they don't function like the rest of society and they need to. These labels are saying, "You need to be like us."

I realized the issue with my article ran deeper than its contents when I gave an apology on public television and people still wouldn't let it go. The real centerpiece of the debate has to do with diagnosing the mind with disorders. It doesn't just have to do with the way society reacts to people with these mental disorders. It also has to do with deciding what they are.

I'd like to walk you through the journey that led me to knowing what I know now. What you find may shock you, as it did me.



Who decides what a "disorder" is?


The mental health system is set up as a hierarchy. The general public, who knows nothing about mental disorders, is at the bottom. The people who have been diagnosed with them come next. Those who have the license to diagnose people with mental disorders are on top of them and the people who decide what the disorders are make the pinnacle.

The lower you are on the totem pole, the less of a right you have to even speak of a disorder, let alone accuse a person of having one. It's the people at the top of the pole who decide what the disabilities are and the specialists right below them who have the right to diagnose these disabilities.

The American Psychiatric Association is the publisher of the "Diagnostic and Statistical Manual of Mental Disorders," a book that defines what disorders are. The people who make up this group are the pinnacle of the mental health system - they decide what a disability even is. Everyone in the medical field uses this book, the DSM, to diagnose individuals with a mental or emotional disorder.

Sounds like the people who wrote the DSM better know their stuff, right? Well, the thing is - they don't all the time. I've found doctors, counselors and professors who question their logic.

How can some of the ways people think, act and function be labeled as a disorder that needs to be fixed while others aren't? It sounds like that decision could be largely based on opinion. It sounds like the DSM is implying that people need to think, act and go about their lives in a certain way to be considered "normal" or else they will be at risk of showing up somewhere in the book. It sounds like everyone in the world needs to copycat each other or else they'll risk being labeled as "crazy."

After reading parts of the DSM, I went to the Lane Counseling Center with some questions.



Controversy over the DSM


Here is a book that describes how people should and should not think, act and feel. Needless to say, the DSM has been edited countless times.

The first issue was released in 1952. The DSM is now on its fourth revised edition. A fifth one is set for release in May, 2013, according to the APA website.

Lisa Griffin is a part-time personal counselor at Lane. She was required to take a course on diagnosing using the DSM for her masters degree program in counseling at Oregon State University.

Lane counselors don't diagnose mental disorders, but they know of them from the DSM. The book defines the disorder and lists possible reasons it could have occurred. Once a patient is diagnosed from the DSM, mental health professionals decide what course of action to take to cure the disorder.

The big debate over the DSM lies in one simple question, "What is a mental disorder?"

Homosexuality used to be marked in the DSM as a disorder. It wasn't removed until the release of its third edition in 1986. It is now referred to as "persistent and marked distress about sexual orientation," under the "Sexual Disorder Not Otherwise Specified" category.

Funny thing is, the DSM doesn't include a diagnosis for homophobia. I thought that was pretty strange. The DSM has a diagnosis for people who feel bad about their sexual orientation, but no diagnosis for those who make them feel that way.

Something else that caught my attention is that there's no reference to victims who suffer from the effects of racism. There also isn't any diagnosis for racism. Its absence in the DSM means that it isn't considered a mental disorder by the mental health system. This leads me to believe that it's considered to be okay for people to think like that since the DSM doesn't say otherwise.

"I've gotten death threats by skinheads," Mark Harris, Lane drug counselor, said. "Are they mentally ill? According to western psychology [DSM] - they're not."

"And that's the piece," Griffin said. "You've got a group of people who are deciding what is and what isn't a disorder."

So, the APA decides what's normal and what isn't. Well, what happens if you don't fit "normal?"

"I think that if it isn't the norm, you could potentially be in the DSM as some horrible mental condition," Griffin said. "We can find, actually, little pieces of ourselves in a lot of these labels." She also noted that people might not be able to fit all the criteria and get the official diagnosis, but they can still find some parts of themselves that fit into certain labels.

I found her to be completely accurate in that statement. According to the DSM, young boys who avoid rough types of play and girls who don't want to menstruate or don't wear feminine clothing suffer from "Gender Identity Disorder." The book refers to this disorder as a "disturbance" of some sort.

The DSM seems to have a lot of diagnoses for the victims of society, but nothing on the persecutors. Where are the gay bashers, the sexists, the Nazis, the skinheads? They don't have a mental disability, but someone who hears voices in their head can be diagnosed schizophrenic? People hear God when they pray, what about them?

"I don't know that people pull out the DSM for racism," Griffin said. "That's more of a behavior that hasn't been classified as a diagnosis. It's classified as a behavior rather than a mental disorder."

In short, the DSM gives diagnosable labels to schizophrenics and children who refuse to conform to gender norms, but racism and other forms of discrimination get close to nothing.

So, how can a professional be fully valid in diagnosing someone with a mental disorder? The answer is, they can't.

"You can't tell that somebody is mentally ill by a blood test," Harris said. "All you can tell is by what they say or what they do in terms of behavior. They're assumptions that are not backed up by physical evidence."

He's right. Think about it, people are diagnosed with mental disorders based on pure judgment. Perfect, that means anyone can lookup the symptoms for ADHD online, visit their doctor and get a prescription for aderol if they play the role well enough.

I say this because I've known people who have taken advantage of prescribed drugs in this way and I've known students who buy aderol during dead weak from friends or through other connections.

I guess who ever they bought the drug from didn't really need it all that bad.

I guess their diagnosed "mental disorder" was a load of baloney.

Diagnosing people with mental disorders from the DSM has the potential to give everyone access to a legalized drug dealer. Who needs speed when you can get the legal stuff from your doctor?


The dark side of the mental health system


I was very excited to interview David Oaks. He was capable of telling me a story many may not have heard before, especially me.

Oaks was born into a working class family in Chicago, Ill. He attended Harvard University on a number of scholarships, one from his father's Teamster's Union. He graduated from Harvard with honors and now lives in Oregon with his wife. He enjoys fishing and camping.

He sounds better than normal, right? He sounds like he's achieved a lot. He has, but it didn't come easy. Oaks has also been diagnosed schizophrenic and bipolar, force-fed medication and locked in solitary confinement in a medical institution, during his college years.

Oaks didn't know what he was getting himself into. "I had extreme, overwhelming, mental and emotional problems as a college student," he said. McLean Hospital, Harvard Medical School's largest psychiatric facility, was voted one of the best hospitals, from Oaks' understanding. He expected to get counseling, support and a chance to de-stress and recover.

That didn't happen.

"Once you sign in, the door is locked," Oaks said. "I found out that a lot of people there have been drugged, electroshocked. They immediately pushed drugs on me. I didn't want drugs. They dragged me to solitary confinement, held me down and forcibly injected me."

Oaks says the experience was traumatizing. "A lot of people with mental and emotional problems have experienced trauma. When they go into the mental health system, they can get retraumatized with this extremely aggressive care that is very chemically oriented."

That wasn't any exaggeration - Oaks was put into solitary confinement for refusing to take drugs. He was even locked into solitary confinement for complaining, refusing to eat a cookie that was offered by staff and crumbling it over a garbage can.

"It can all work for the general public until one of your love ones has a mental and emotional crisis," Oaks said. "Now you're looking for real help and you go down for real help and all they have is a bag of pills."

Locked in solitary confinement in a Harvard University hospital, Oaks decided he would work to improve the mental health system once freed. He is now the director of MindFreedom International, a nonprofit organization that works toward equal rights and alternatives for the community that has been labeled with disorders.

In Oaks' experience, the mental health system had a stronger focus on drugging individuals labeled with mental disorders and a weaker focus on therapy. "I've been in a psychiatric facility and it tends to be drug, drug, drug … with a little bit of talk therapy," he said. "I was held down and injected. A lot of people are forcibly drugged." He credited family and peer support, exercise, nutrition, counseling, wilderness trips and employment as his source of mental and emotional healing.

The interesting thing about the drugs that are prescribed to reduce symptoms of the disorder is that the symptoms will get worse if the medication is stopped. The individual will become dependant on the drug. It sounds like one solid, secure profit for drug companies and they already know it.

Dr. Joseph Biederman, a Harvard psychologist who is considered one of the most influential researchers of child psychology, was reported to have received approximately $1.6 million in consulting fees from drug companies from 2000-2007, according to the New York Times. That same article stated that approximately $200,000 of this money was not reported to university officials.

He assured Johnson & Johnson drug company that his research would benefit the company. Biederman's work led to a large increase in diagnoses of bipolar disorder.

"He was getting lots of drug company money without recording it, while at the same time drastically increasing the number of young people with this label," Oaks said. "The drug companies practically run the mental health system."


The effects of labeling


Let's face it, we all have a label. We all label each other too, but why?

"It is, quote-on-quote, 'normal' to label people," Harris said. "We have to put people into categories. Known [and] unknown."

Labeling can be harmful to people, especially when it comes to labeling the way their mind works. Schizophrenia and bipolar disorder, both of which Oaks has been diagnosed with, are under the umbrella of psychosis. Needless to say, there is extremely bad stigma attached to this word.

"If you let the new neighbor know that you're a lesbian or that you're Arab-American, you may get some prejudice," Oaks said. "But let the new neighbor know you're diagnosed psychotic and you will have prejudice."

The word didn't get a bad reputation all on its own. Oaks blames part of it on the media. He believes the coverage of mental disorders the media portrays has been unfair.

"One of the worst cases is when people think of our folks as dangerous," he told me. "One of the few times your colleagues in mainstream journalism cover our people is when there's violence, is when somebody with a mental health label shoots somebody. And then we get the headlines."

Having a mental disorder alone doesn't make a person violent, Harris said. It's the individual that has chosen to act in such a way, not so much the disorder. He also has an interesting perception of who the real dangerous people are.

"It's not so much people with mental disabilities that are the danger," Harris said. "It's normal people - so called 'normal' people - that are even more dangerous than the mentally disabled."

He says this for a number of reasons. For one, there really isn't such a thing as "normal" when it comes to matters of the mind. We all think differently, act differently, speak differently and function differently.

Another reason he believes this has to do with the way "normality" functions. It gives people a free pass to do what ever they want, even if it's wrong, as long as enough people are doing it with them. He used slavery as an example. It's outlawed now, but in the 1800s it was "normal" to have slaves. It was okay.

"The general norm of society is deadly," Oaks said. "It's wrecking the planet." It's normal to pollute the Earth and destroy natural habitats to build new towns and roads. So, is normal really a good thing?

Labeling is another form of normality. "It's a mechanism that allows you to make quick judgments without thinking," Harris said. "I think it's actually better to develop the skill of thinking." He said the human brain will stereotype because that's what it does automatically, but people have to actually make the effort to think about what they're seeing.

"Labeling happens, but you have to read the ingredients," he said. "You have to see what's inside people and see how they actually act … be willing to go beyond the stereotypes and the stigma to see the person with real needs."

According to Nancy Hart, dean of Lane Disability Resources, some people need the label. "I respect peoples rights to want to have a diagnosis," she said. It can give people a sense of validity when all their symptoms add up to a specific diagnosis. It also helps people who want medication and treatment for their symptoms. When patients are diagnosed from the DSM, there's a code next to the diagnosis that is sent to their insurance company so it can provide funding.

"Differences become something that people don't readily accept and that can be painful for the people who feel different," Hart said. "It is nice when we come to understandings about each other and some of those understandings are just recognizing our differences and being okay with that."

Part of that process has to do with thinking, Like Harris said, and not letting your brain automatically stereotype an individual.

"Thinking is hard work, but the more you do it, the easier it gets," he said.


Sidebar



Why diagnosing mental disorders is controversial


Note: The DSM is a publication created by the American Psychiatric Association that is used to diagnose mental disorders. The following comments are backed up by professionals in the mental health system.

  • -The mind cannot be physically measured
  • -Mental disorders are diagnosed by judgment and not backed up by clear, physical evidence
  • -The DSM is too selective and opinionated in its selection of disorders
  • -The DSM diagnoses victims and rarely diagnoses persecutors
  • -The DSM constantly undergoes constant revisions based on the norms and opinions of society
  • -No one is "normal," everyone's mind works differently
  • -Everyone can find parts of themselves in the DSM


Emotional disorder - a stronger, more accurate focus


Since the mind can't be measured, focusing on a person's emotions would be more accurate. Although emotions can't be measured either, they can have a clear, negative impact on a person's life. Mental disorders by themselves don't always cause these emotions. Negative emotions can come from anywhere, such as the individual and people in that person's life.
Negative emotions can damage a person's body, such as stress causing stomach ulcers. They can also lead people to hurt themselves or others. Mental disorders have more to do with how someone's mind operates, or why they're not "normal."

Here is a simplistic view of curing emotional disorders:

  • -Target the negative emotion or issue in the person's life
  • -Determine where it comes from
  • -Find ways to fix it

Therapy is a process that works great when it comes to dealing with emotional disorders. Not all problems can be solved with these three steps alone. In those cases, the individual should reach beyond the help of family, friends and peers by seeking out a psychiatrist.

Lane offers free personal counseling. To sign up, visit the Counseling Center on the first floor of Building 1. For more information, call 541-463-3200.

What is "normal" anyway?


The true definition of diversity is "us." Every single individual in this world. No matter how similar two people can look or act, they're still different. No one thinks the exact same way, acts the exact same way, looks the exact same way and so on. No matter where you go, you are in a diverse setting.


The dangers of normality


"Normal" is possibly one of the most dangerous things on this planet. It entitles people to do anything as long as most of the community is doing it with them. It's been used to justify horrible things in the past and it still is. Here are a few.

  • -Slavery
  • -Sexism
  • -Racism
  • -Stereotyping
  • -War
  • -Terrorism
  • -Pollution
  • -Harassment


Alternate approaches


When dealing with issues involving others in the disabled community, remember these alternatives.

  1. Think as if there is no such thing as a mental or physical disorder. Choose not to label someone as having that.
  2. No one is normal. Not even you.
  3. It's only a disability, meaning there's certain things this person can't do. The individual may also function differently. There's nothing wrong with that.
  4. Step out of your everyday frame of mind. Look at the person or situation and force yourself to think. Do not let your mind automatically pass judgment or create stereotypes.
  5. People who have a disability need a loving, understanding and accepting community more than anything. That community comes from you.


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Hugh Massengill

Hugh Massengill, psychiatric survivor and MFI member, addresses opening session of City of Eugene, Oregon, USA conference on Choice in Mental Health Care as a Human Right at the University of Oregon.
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