Most professions or trades use language specific to that line of work. In the workplace of psychiatrists, psychologists, and therapists, there is a specific language used in assessing, diagnosing, and treating clients and patients. I have come to be familiar with this as my mother is a therapist and we have talked about her work and diagnosing people with a variety of mental health disorders. The problem with such language and expressing that language in a book like the DSM (Diagnostic and Statistical Manual) is that it can be used against people in a way that is not healing but harmful and something that very often too few people consider.
This language is sometimes used to take very human and real and normal life situations, like bereavement and trauma and sadness and anxiety, and somehow attach a medical diagnosis to them. And, of course, if there is a medical diagnosis, than there must be an accompanying treatment or cure for a cost. According to Philip Hickey in his article entitled, “Behaviorism and Mental Health” (2011) in 1952, homosexuality was listed in the DSM as a sociopathic personality disturbance and according to the American Psychiatric Association homosexuality was a mental illness up until 1974.
Neil Postman states in his essay The Word Weavers/The World Makers, “By naming an event and categorizing it as a “thing”, we create a vivid and more or less permanent map of what the world is like. ” (853) That is what happened in the world of psychology and psychiatry regarding homosexual behavior. The American Psychiatric Association agreed that this “thing”, homosexuality, is an illness and we are Page 1 attaching a name to it: sociopathic personality disorder. It suddenly becomes something very different by the use of those three words, something more frightening and more dangerous sounding according to Hickey (2011).
The language of psychiatry, defining a person’s behaviors and feelings and thoughts, and attributing to certain collections of these behaviors, feelings, and thoughts, a mental illness can be dangerous when not used with extreme care. How many people underwent intensive and costly therapy to “cure” their homosexuality and how many felt intense guilt and self-loathing? How much pain was caused and harm done in a profession whose first oath is to do no harm? Homosexuality is just one example of that.
Not to mention the fact that suddenly after 1974, homosexuality was not a mental disorder anymore. Were homosexuals suddenly “cured”? Of course not. A group of people who believed that their feelings, thoughts, and behaviors were not indicative of illness, gay rights groups, protested and brought enough pressure to bear that language was changed and, slowly, so were attitudes and beliefs. This year an up-dated edition of the DSM-5 was published. This manual lists the symptoms and names of the mental health disorders diagnosed and treated in this country.
Prior to this year the DSM-IV included the term Mental Retardation to describe people whose intellectual functioning fell below a certain pre-determined set standard. That term is now excluded and no longer used as it is considered hurtful and offensive. Why? Because a term that originally was used clinically as a short cut and more descriptive term for professional purposes became something used to insult people and put people down. As stated by John Grohol in “The Dangers of Diagnosis” (1996) the language and the term became harmful, not healing.
These professionals use terms like bi-polar, schizophrenia, depression, and others to quickly communicate to others who are familiar with the language. But often those short cut terms are used in hurtful ways or are simply misunderstood and used incorrectly. Page 2 Proponents of the DSM argue that one of the many reasons to use such specialized language is to have a short cut in discussing topics related to the work and as a tool to allow professionals to have a common understanding and clarity in the work.
Grohol (1996) states in “The Dangers of Diagnosis” it is needed in speaking to other professionals and it is needed to access the system of insurance and managed care. The language helps to communicate efficiently and effectively and the professionals who speak that language can move through the work more quickly and, at the same time, often get paid because it has become what not only the psychiatric and psychological businesses use, but also what insurance companies have come to use in way of what they will or will not pay.
The power to define is great and it should be used carefully, cautiously. Postman states, “For the point is that in every situation, including this one, someone (or some group) has a decisive power of definition. In fact, to have power means to be able to define and to make it stick” (837). The other power is that these labels and this language is used to access insurance and money that, without the labels, is otherwise withheld from people. Insurance companies will pay for certain conditions and not others.
They take the language and the list of symptoms and decide what is worth paying for and what is not. There is danger in that because someone could be labeled or diagnosed simply because it is the thing that the insurance company will pay for. Just because a small group of people have this ability to label behaviors and feelings and thoughts as certain “things”, does not mean the people in the field must use these terms or get so use to using these short cut terms that humanity in the field of psychiatry and psychology is lost or forgotten.
As Judith Butler states in Undoing Gender, “…relations of power that circumscribe in advance what will and will not count as truth, which order the world in certain regular and regulatable ways, and which we come Page 3 to accept as the given field of knowledge” (743). We are complicated, complex human beings experiencing a variety of wonderful and terrible things throughout our lives. Sometimes forgetting the labels and the short cuts and taking the time to focus on the person and what their unique experience is could be a way to improve the process.
As the reading states, our control of language aids in our perception of the world. We use language to bring what we see under control and make the complexities of the experience manageable. This is what diagnostic language is used to do. According to Grohol in “The Dangers of Diagnosis” (1996) some diagnosis are needed so that two professionals do not sit across from one another and recount fifteen types of behavior and thoughts when two words, for instance, paranoid schizophrenic, would do.
However, maybe what is needed is more conversations about those symptoms and what they mean. In a world where there is less time and more demands than ever, the answer to some of this might be to slow down and have conversations with colleagues about what patients are experiencing and perhaps bringing some of that power to bear over insurance companies. These days and in conjunction with the new Obamacare legislation that power could somehow be used so that mental health issues are covered in their entirety.
Because of the way language is used clinically some people do not seek treatment because of the fear that somewhere a diagnosis will be put on them that will follow them the rest of their lives. Clinical language is meant for helping professionals in their work not to stick someone with a label that will follow them wherever they go and maybe, unnecessarily restrict them in the future from doing things or holding certain jobs. The point of clinical language is to help the clinicians and doctors, not burden the patient with a label when they are already suffering with a mental health challenge. Page 4