There’s an interesting article by Sonja Grover, PhD, CPsych, of Lakehead University, Ontario, Canada. It’s titled: Reification of psychiatric diagnoses as defamatory: Implications for ethical clinical practice. Thanks to Becky on Twitter for the link.
It’s an old article (2005), but definitely deserves another look. It was published in the journal Ethical Human Psychology and Psychiatry.
Here’s the abstract:
“While the mental health professional generally has beneficent motives and an honest belief in the DSM diagnoses assigned to clients, such diagnoses may yet be defamatory when communicated to third parties. Mental health diagnoses invariably lower the individual’s reputation in the eyes of the community. At the same time, DSM diagnoses are but one out of a myriad of possible interpretive frameworks. DSM descriptors for the client’s distress thus cannot be said to capture the essence of the client’s personhood. When a diagnosis is published as if it captured a definitive truth about an individual psychiatric client, it is, in that important regard, inaccurate. That is, such a communication meets the criterion for a reckless disregard for the truth or an honest belief but without reasonable basis insofar as it is considered to be anything more than a working hypothesis. Hence, in certain cases, DSM labeling may constitute defamation.”
In my view, the fact that the “diagnoses” are spurious lends additional force to the defamation argument.
Here are some quotes from the article:
“Birchwood, Mason, and colleagues (1993) found that perceived stigmatization was a significant predictor of depression in persons diagnosed at some point with mental illness.”
“For instance, should an individual be regarded as untrustworthy and manipulative as a function of their ‘borderline personality’ diagnosis, this may affect employment prospects.”
“The label of ‘schizophrenic’ (even if qualified by the phrase ‘in remission’) may lead to inferences about a potential for future cognitive disintegration and associated lack of mental competence for those who come to know the diagnostic information.”
“It should be understood that the issue in this paper is not one of breach of confidentiality. Rather, the concern is with the potential defamatory nature of DSM diagnoses even when there is consent for communication of the diagnosis to particular others. However, note that the consent may not be truly informed in that the full implications of having the diagnosis and of having it communicated to others may not be adequately understood by the client at the time he or she proffers their consent.”
“The client may even have provided consent for the sharing of diagnostic information prior to knowing what diagnosis if any, would ultimately be communicated.”
“As a consequence of the DSM diagnosis…the client, in effect, loses the freedom to redefine him or herself in future. For instance, once a schizophrenic, in practice, always regarded as a schizophrenic (even if ‘in remission’); once an alcoholic, always considered an alcoholic, but now perhaps a ‘recovering’ alcoholic, and so on. The psychiatric diagnosis thus comes to allegedly reflect something core and always latent in the individual.”
“Thus the self which is imposed via the DSM story may in fact be fictional and in important ways non-reflective of the lived experience of the subject so named…”
“The individual loses not only the freedom to redefine their essence apart from the diagnosis but also the freedom to assign their own meanings to their personal distress and experiences. Rather, these experiences are translated into symptoms devoid of personal meaning and these symptoms into diagnostic categories emanating at the root from some biologic cause over which the client has no control. The choice is to internalize the language of the therapist in assigning any meaning to the experience of ‘mental illness’ or to resist and be left with no one with whom to share any sort of social reality at all…”
Dr. Grover concludes by describing the DSM diagnosis as a defamatory label “…which negates the individual’s autonomous self apart from that self as conceptualized through the lens of the DSM.” Justice, she reminds us, is a basic human need to which every person is entitled, and:
“Justice demands that communication of DSM categorical diagnoses as reified mental disease entities that accurately describe or explain the self of the individual so labeled should result in legal liability for the mental health professional publishing the diagnosis.”
This is an insightful and well-written article, which I highly recommend. It identifies and describes in a comprehensive and coherent fashion the stigmatizing aspects of the APA’s labels.
Dr. Grover’s description of the DSM categories as legally defamatory is, for me at least, a new idea, and one with profound implications.
Please pass this article on.