A poetic update

What a month!

Jun 30, 2023

I’ve been fully immersed back in therapy-land this month; not only with an increasing amount of clients, but also going to various workshops and events.

I may have mentioned before that I am a supporter of the group A Disorder for Everyone which is a group that challenges the culture of psychiatric diagnosis (my poem ‘Labels’ is in their book ‘We are the Changemakers’). I have no problem with diagnosis - if it helps. I like what my friend Adrianna says about a diagnosis - that it should be used like a coat hanger; something that you don’t wear, but that helps to make sense of your wardrobe, as it were! Diagnoses seem to have become increasingly like tattoos; indelible markings that become the first thing that gets noticed and talked about.

I think it is also important that people are informed about the roots of diagnosis.

The DSM that is used for psychiatric diagnosis is full of disorders that have not been categorised or classified thanks to scientific research. They are there because these conditions were voted in by psychiatrists. They were voted in based upon the decisions of a group of 9 psychiatrists who sat decided what should be in there. In his book ‘Cracked’ James Davies recalls an interview he did with one the of the psychologists who was part of the advisory committee, Renee Garfunkel. She recounts how there was a discussion about whether a particular behaviour should be classed as a symptom of a particular disorder. As Davies reports, one Taskforce member declared, ‘Oh no, no, we can’t include that behaviour as a symptom because I do that!’ (p.30)

Spitzer, the lead psychiatrist in creating this book stated, ‘There are very few disorders whose definition was a result of specific research data’. Epilepsy, Alzheimers and Huntingdon’s disease do, but things like general anxiety disorder, depression, oppositional defiance disorder don’t. Yet this is the book that is used to label people and open up the authentication of medication.

So many of our behaviours are trauma responses; are fight, flight or freeze responses in another guise. It doesn’t mean that they are any less serious or difficult or painful, it just means that they are understandable responses as a result of what has happened to us. THIS is why it is important to ask what has happened to people, to understand context.

I wrote the poem Labels after I had seen various clients come in with their labels of ‘disorders’. My ‘compulsive liar’ had been beaten by their mother and raped at school by another child. Why would they trust anyone? My ‘ADHD’ had a father who had left the family abruptly and gone on to have many girlfriends, they never knew who was going to be with him when he dropped in and out of their life. Why would they not find it difficult to focus and be hyper vigilant? My ‘oppositional disorder’ had a father who had beaten them repeatedly for mild transgressions and then left them and their mother for another woman.

There is always context.

"The relevant question in psychiatry shouldn't be what's wrong with you but what happened to you?" Dr. Vincent Fellitti

There is an alternative. The Power, Threat, Meaning Framework has been developed to provide a different narrative to the one used in traditional psychiatric medicine. I talk about it on this podcast episode with clinical psychologist Anne Darcy.

I am not pro or against labels or medication, but, like I said, I think that we have lost sight of a very important factor for both: context.

Labels work if they help you understand a cluster of behaviours in order for you to access help in appropriate places. My concern is that a diagnosis by experts can lead to a power differential in which your voice as ‘the patient’ gets drowned out by ‘the expert’. Not through intention, but through pressure of numbers and quotas.