Making Meaning of the Absolute Truth in Psychiatric Diagnosis


man with magnifying glass

The last few months I’ve been reading books on subjects such as couple’s therapy, introversion, sex drive, infidelity, and mindfulness. As I’ve been reading, a growing sense of unease has lead me to re-consider labels.

When I say labels I’m thinking about definitions or ways we categorize people and concepts that can be problematic and can even lead to grave consequences.

Awhile ago I wrote about how what’s considered normal seems to be shrinking with each new publication of the Diagnostic and Statistical Manual of Psychiatric Disorders. Ideas about what’s ‘normal’ changes with time and it seems like our society is becoming ‘sicker’ as the number of psychiatric disgnoses grows and the pharmaceutical treatments for these illnesses explodes.

So why is it so tempting to label, define, and categorize?

Defining things enables us to understand them–or at least to think we do–and helps us to feel like we have some control over ideas or things. If you see a high energy child playing and hear someone say he’s A.D.D., a lightbulb may come on and you feel like you ‘get’ this kid. If someone says she’s depressed, you probably have some ideas about what that means. In both situations, knowing these people have these diagnoses might influence how you treat these people–for better or worse.

What’s the problem?

There can be some problems with psychiatric labels. For one thing, diagnoses can become a self-fulfilling prophecy. The label can influence how we act, think, and feel. It can also influence our perceptions of ourselves, others, and the world around us.

Here’s an example. I worked with a creative and dynamic man once who was grappling with his life direction, including whether or not he should stay in his marriage. His well intentioned physician was certain he was bipolar and after a suicide attempt and hospitalization for it, he and his family grabbed hold of this diagnosis and ran with it. He was placed on a cocktail of drugs to stabilize his moods. His personality changed from dynamic, creative, and sparkling, to concrete, flat, and self-doubting. His questions about his marriage became understood as symptoms of his bi-polar thinking according to his physician, and medication became the way to manage his symptoms. Very quickly he was unable to continue working, dropped out of competitive running, and quit meditating. He became increasingly convinced that his judgment and thinking were not to be trusted, but with the right medication, could be managed. He no longer paddled in the direction he chose for his life–his bipolar diagnosis did.

Labels can funnel the way we see things, can provide a sense of meaning, and can tempt us to believe in their absolute truth. But is there actually any absolute truth? Can our behaviours, actions, or motivations really be understood by only one definition? Can diagnoses always precisely pinpoint the troubles a person is experiencing?

Labels can run the risk of becoming the person. Did anyone wince when I wrote that the boy was A.D.D. or the woman was depressed? Are they nothing more than those labels?  How much hope is there really for change if you are A.D.D. depressed, or bi-polar? Do those labels accurately describe everything about each person, or are they something that influences their lives to a greater or lesser degree?

Life is dynamic and ever-changing. And that’s the absolute truth! What do you think? I’d love to hear your comments!