There seems to be a never ending stream of popular books whose titles use the word "syndrome" preceded by some fictional character's name or some scientific language,  Psychology today should require that diagnostic categories be empirically validated.

Besides  those we mentioned, other dubious  diagnostic categories that have been proposed are  "Compulsive Shopping"  proposed by a pharmaceutical giant, and "Relational Disorder"  initiated by a psychiatrist leading the DSM project. These proposals reflect many of the same problems and raise many of the same types of concerns  of what should be called social problems and what should be called medical ailments. But even if these two new categories are never included in the psychiatric manual, like other invented labels such as "Road Rage" and "Codependency," they may come into wide use.

A next problem certainly is ‘bias’, lets just take a brief look at ‘bias’ in for example ‘old age’, False Memory Syndrome, Sexual Abuse of Children, Schizophrenia and Post-traumatic Stress Disorder.

The tendency to pathologize everything about old people leads directly to diagnosing many as mentally ill when they are not. The psychiatrist who interprets the misery of the elderly as an illness helps to perpetuate a vicious form of oppression" (Seymour Halleck, The Politics of Therapy,1971, p. 113). Factors that have an emotional impact on the well-being of old people are further exacerbated by living in a society in which the old are regularly ignored, demeaned, scapegoated, and treated as distasteful and ridiculous. Such ageist treatment hurts targeted people, making them feel depressed, outcast, angry, and ashamed.

Age bias includes a troubling combination of invisibility and hypervisibility in the mental health field and in society generally. This combination  also manifests itself in the intense phobia affecting people of all ages about calling old people "old." The word is commonly avoided, replaced by " elderly," "senior citizens," or people in "late life," their "retirement years," or "golden years."

Invisibility may lead to underdiagnosing the symptoms that bring old people into mental health offices, and this can result in the withholding of necessary services, while hypervisibility can lead to overdiagnosing, overmedicating, and even institutionalizing people who may not need it, resulting in further deterioration . The aged poor are subject to class prejudice as well as age bias and are even more likely to be ignored or overdiagnosed.

When institutionalized due to overdiagnosis, they are often subjected to the worst possible treatment in poorly funded, understaffed institutions. Even experienced and well-meaning clinicians may find themselves caught between the two mistakes of either ignoring or overdiagnosing old people, especially if the clinicians do not consistently examine their own ageist assumptions (See J.E. Myers, Aging: An overview for mental health counselors. Journal of Mental Health Counseling 12, p. 245-59,1990).

This is not to say that medication and diagnostic labels are to be completely avoided in treating old people but rather that special care is required to make sure that the old person's complaints are neither dismissed as simply part of aging nor overdiagnosed and overmedicated. When physicians prescribe medication, they may medication, they may neglect to adjust the dosage for age or to evaluate all of the patient's other medications and medical conditions. Since many medications used by old people affect mood and mental functioning, these need to be considered in diagnostic decisions.

Like people of any age, old people can benefit from and are entitled to supportive services, counseling, understanding, and problem solving when they are grieving, isolated, and afraid. Failing strength, illness, isolation, and the fear of death, all of which are associated with aging, though formidable, do not in­evitably cause depression. Many an old person can live with grace and dignity. The fact is that a number of old people withdraw to some extent for a variety of reasons, such as that they may have less energy than when they were younger, they are ignored in social situations, their friends and agemates have died or moved away, and/or younger people have not responded to their overtures of friendship. When some of these hurdles are removed, when op­portunities for engagement and activity are provided, as in some retirement communities, senior centers, and health clubs, old people can be fully en­gaged in activities and relationships.

The problem for those who have not yet achieved or acknowledged old age is that they are so uncomfortable when an old person's sorrow, fear, anger, or longing comes to their attention that they attempt to distance themselves from the messenger of such feelings by pathologizing the person and the feelings.

Fundamental to the process of diagnosing people is the question, "Who is the patient?" Whom is supposed to be treated or diagnose when a relative or caregiver brings an old person to a therapist? Is it the old person, the relative, or the family? There is no simple answer, but the old person's needs must be primary, even when one addresses the relationships of family members. Relatives and caregivers often need help in coming to understand their own feelings, their ambivalence and fears, as well as those of the person they brought for treatment. Whose needs are being met when the old person is given a psychiatric label or is medicated or institutionalized? The practitioner must be careful to recommend what is best for the old person, without colluding with family members in prescribing a solution that is detrimental or distasteful to the old person; the solution that gives relief to relatives who want the old person classified as "the problem" may or may not be what's best for the old person. The available alternatives for old people who need special care are never perfect or easy to choose, but skillful, caring mental health experts can help the family sort it out.

Also, exactly how much loss of function or damage is "normal" for an old person and at what stage of "old"? The label "old" is associated with a deficit model of advanced age, a model that is grounded in a deep fear of death, an overemphasis on youth and physical perfection, and a multitude of ageist biases and misinformation.

Although aging is a natural process experienced by every living organism, ageism is a social phenomenon that is culture-specific, composed of usually negative societal attitudes, assumptions, and behavior regarding aging, old age, and the aged population . The deficiency model of aging and the power and pervasiveness of ageism, as well as its invisibility as a form of bias and oppression, increase the frequency with which people are pathologized simply because they are old.

Instead, a model of late life, in which old age is considered an important developmental stage in the life cycle, with a focus on the strengths, courage, and creativity that old people exhibit in coping with the numerous and never-ending challenges of old age, should also validate the contributions to society that people make in old age as they continue to touch many lives.

False Memory Syndrome and Sexual Abuse of Children

The coining of the term False Memory Syndrome and the dissemination of information by the False Memory Syndrome Foundation had a significant impact on  popular press reports. M. Stanton in  U-Turn on memory lane. Columbia Journalism Review, July/ August, 44-49 (1997),  revealed a  shift in how four major popular press magazines (Time, Newsweek, U. S. News & World Report, and People) treated the topic of sexual abuse. In 1991 more than 80 percent of the coverage was weighted toward stories of survivors of sexual abuse, but by 1994 more than 80 percent of the coverage fo­cused on false accusations, often involving supposedly false memory.

Until the past twenty years, instances of child sexual abuse were believed to be infrequent. For example, the authors of one of the most widely read professional texts Comprehensive Textbook of Psychiatry-(1975) reported that the incidence rate for incest was about 1.1 to 1.9 per million people. However, data collected since the late 1970s show this not to be the case. Although the rate of abuse varies due to differing methodologies, populations, and definitions of abuse, instances of sexual abuse are  considered much higher according to later research.

One of the claims frequently made by the false memory proponents is that amnesia for memories of childhood sexual abuse  rarely occurs. Interestingly, however, a review of empirically based studies supports a very different conclusion. According to Courtois (1999), more than thirty-five scientific studies have been published, and corroborated case reports (descriptions and citations of documented cases can be found at www.brown .edu/Departments/Taubman Center/Recovmem/Archive.html) have been compiled that document various degrees of amnesia/forgetting for experiences of child sexual abuse.

So when considering the validity of a False Memory Syndrome construct it is important to keep in mind that if Psychiatry is to become instead of an art,  a science, then each scientific claim should prevail or fall on its research validation and logic

Schizophrenia Bias

Those in the grip of the received view of schizophrenia see the significance of this fact in terms of the immaturity of current science and the complexity of the disease: with more time and resources, they believe research will produce an understanding of the brain disease called "schizophrenia." However, the alternative hypotheses, that there is no such thing as schizophrenia and that the concept is scientifically meaningless, seem better confirmed by the research record to date than are the received view and this optimistic outlook for the associated research program.

This is not to say that there are no brain diseases at all; it is to say that a commitment to the idea that the concept of schizophrenia picks out a brain disease is currently groundless. Certainly it is possible that some individuals who happen to fall into a category defined by DSM-IV criteria for schizophrenia have, as part of their condition, some brain disease or other. But this in no way vindicates the category as a brain disease, and, in any event, it should be kept in mind that not just any condi­tion that leads to problems is a disease.

The received view of schizophrenia,  is a stereotype that leads to a number of biases that influence and undermine the diagnostic process.

Schizophrenia as a stereotype tends to promote a simplistic causal understanding of the condition of the person as involving a core disease process and the pathogenic cascades to which it leads: all pathological features of the person will tend to be understood as downstream causal consequences of the core disease process. Within such a framework, the person's perception, thought, feeling, and behavior are considered to be driven by an internally located, pathologi­cal process," and thus, they tend to be viewed as the psychologically meaningless causal fallout of a diseased brain. Alternative causal hypotheses mentioned above (viz., independence of problems, environmental causes, complex interactional feedback loops, normal psychological processes) tend to be ignored or minimized, and a pathology-oriented view of the person as the passive victim of a brain disease tends to predominate.

In this way, the schizophrenia stereotype compromises clinical practice by misleading clinicians about the character and complexity of the circumstances in which individuals are embedded and tends to promote a simplistic understanding.

The biases it promotes are deeply rooted within the culture: the broad socioeconomic infrastructure in which mental health care is embedded; the reimbursement practices, specifically regarding the financing of mental health care; the current zeitgeist within mental health practice, and the training and socioeconomic reward structure of the clinical professions.

But instead of assuming that all features of a clinical picture provide support for choosing a particular diagnosis, one can consider that such features may be relatively independent of each other and have in­dependent causes, including environmental ones. And alternative practice concerns "patient education": rather than attempting to indoctrinate a person into the harmful schizophrenia stereotype in an effort to increase the person's (apparently deficient) insight into their situation or to increase the likelihood that they will comply with treatment recommendations, one can frame one's concerns about either in­sight or compliance more directly, without employing the language of brain disease (e.g., a problem-solving formulation that appeals to the person's capacities and the challenges they face).

Post-traumatic Stress Disorder

In the more than twenty years that have passed since PTSD was first intro­duced into DSM-III (APA 1980), the conceptualization of the diagnosis and its use have altered dramatically. Stressful events that might precipitate the disor­der were described in DSM-III and DSM-III-R as needing to be "outside the range of human experience" (APA 1987, 236; 1980). This definition of stress­ful events excluded many traumatic phenomena that were well within the scope of women's experience, because abuse is so common, thus well within the range of human experience. In DSM-IV-TR (APA 2000), therefore, in acknowledgment of the fact that domestic violence, rape, physical abuse, and child sexual abuse are commonly experienced by girls and women, it is no longer stated that traumata resulting in PTSD must be "outside the range of human experience." However, they must pose "actual or threatened death or serious injury, or other threat to the physical integrity of self or others" and also have "involved intense fear, helplessness, or horror" (APA 2000, 467). Although this definition is helpful for female trauma victims who have been in danger of serious physical injury or death, it is not so useful for those adults for whom emotional events produce posttraumatic symptoms.

There has even been a suggestion that differences in the ways women and men respond to traumata may be hormonal. A growing group of advocates suggests that abused women currently diagnosed with BPD might better be considered as suffering from a "complex" or chronic variant of PTSD. However, problems with the replacement of the diagnosis of Borderline Personality Disorder with PTSD are manifold.

For example  not all women currently diagnosed as having BPD have been sexually or physically traumatized, and the various symptom constellations we call "borderline" are produced by the interaction of multiple facets. There  indications in the treatment literature that, although some women with histories of clear-cut traumatic antecedents and PTSD symptoms are being removed from the "borderline" group, a group of women considered "true" borderlines is being left behind (See D.Becker Becker,  When she was bad: Borderline personality disorder in a posttraumatie age. American Journal of Orthopsychiatry 70 (4), 422-32. 2000). Thus, diagnosing greater and greater numbers of "borderline" women with PTSD will not, in the end, eliminate the pernicious BPD diagnosis.


For updates click homepage here