Deconstructing Psychiatric Diagnoses

Based on my past experience both as a therapist and client in the mental health field, I have learned that when therapists or psychiatrists give you the following diagnoses all too often here is what they really mean: 

Obsessive-Compulsive Disorder:  Your obsessive nature is thwarting my compulsion to reorganize your life.

Paranoid Personality Disorder:  The way I perceive you staring at me when I ask you extremely personal questions about the most painful experiences in your life really makes me uncomfortable.

ADHD:  Your teachers don’t understand you, your parents suck, and I am on their side.

Bipolar Disorder:  You’re going through a rough time, and now that I’ve found a biologically inherent justification for it, your insurance company will allow me to bill all year for your sessions.

Narcissistic Personality Disorder:  I didn’t spend nine years getting this damn license just to listen to you blather on about YOU YOU YOU.  How about ME for a change?

Antisocial Personality Disorder:  You sicko — you actually DO the things my husband masturbates about on the internet.

PTSD:  Since I can’t bill your insurance company for just writing “PTS,” I’ll compromise with psychiatry and add that little “D” to the end…

Generalized Anxiety Disorder:  There doesn’t seem to be anything noticeably wrong with you, but you are here so you must be fucked up somehow.

Histrionic Personality Disorder:  If you keep pushing it, sweetie, I’m going to diagnose you Borderline.  So lower your voice, okay?

Cocaine Dependence:  Fool!  Adderall is legal, cheaper, covered by your health insurance, and works on the same neural pathways!

Anorexia:  They’re models on television.  You’re not.

Dependent Personality Disorder:  We both need to accept that psychotherapy was never intended to last indefinitely.  Well….unless of course you can pay full-fee, in which case I can cook up a more serious diagnosis for you…

Avoidant Personality Disorder:  Thank God you pay out of pocket, because your insurance company doesn’t allow me to bill for all your missed sessions.

Alcohol Dependence:  I probably drink just as much as you do, but since you’re paying and I have a degree I might as well pin an extra label on you.

Dissociative Identity Disorder:  I know, everyone else has diagnosed you with schizophrenia, but I want a really juicy case to present at next year’s conference…

Münchausen Syndrome by Proxy:  Finally I get a chance as a therapist to treat someone who’s just like my mother!!

19 thoughts on “Deconstructing Psychiatric Diagnoses

  1. This is hilarious. Thanks for the good laugh!
    Several years ago the Trauma Center in Boston was trying to get the Developmental Trauma Disorder in the DSM. I understand that the efforts were not successful. It seems like such a diagnosis might be helpful. Wondering about your thoughts on this.

    • Developmental Trauma Disorder is a really good diagnosis for everyone as the implication is that the things that happened to us in the past are causing the symptoms that we see now, whether those symptoms are obsessive, depression, anxiety, hallucinations, or anything else that interferes with our smooth functioning. Right now, I use Post Traumatic Stress Disorder for all of my patients because it comes closest to being accurate for all of my patients.

      I do not think Developmental Trauma Disorder has a chance in hell to be adapted by the DSM people because it implies environmental causality and therefore, should not involve psychiatric drugs, which is what standard psychiatry is all about. (Making more money for the pharmaceutical industry.)

  2. My son. 42 years old, on clopixol depot for 5 months, he was getting 300 mg shot every 2 weeks, been of now for 5 weeks, but as gone into him self , will not talk , and seems so sad, lays sleeping all the time, very hard for me to get him out of bed.
    Is it “anhedonia” what can I do to help him. I am giving him . B3 niecine and fish oil capsoles, he is eating, but is like a vegetable ,very frightened nothing there? Very sad.
    Is this normal withdrawal systems.
    He was sectioned after smoking pot, hallucations, and falsed injections, and Depicote. Clean now, but I am worried for him.
    Please advise. Thank you x

  3. OMG! This was much needed
    I have become a big fan of your work. You are doing amazing work by putting another light on psychotherapy.
    You are literally an inspiration to me. 4 months of being a trainee psychologist, and I thought I was gona loose my mind over how psychotherapy is practiced and taught.
    I asked myself daily, am I the only one who see’s what mess psychotherapist are creating.
    Awesome job! keep up the good work. Your words bring sanity to my thoughts.

  4. Daniel~Eternal thanks for all that you’re doing! Invaluable. Outstanding.

    I’m wondering about an essay you mentioned about becoming a therapist in other than the traditional way, or something along those lines. I have another related question also however i feel uneasy posting it in public.

    Continued courage!

  5. Hello Daniel,
    How are you doing! This is sort of personal question but if you know something about it please respond!
    I live in Finland I have been in talk therapy for about 10 sessions but that did not work so i have been to psychiatrist now. I just visited psychiatrist yesterday who prescribed me a drug named “VENLAFAXIN”. He said this drug works best if you combine it with with discussion therapy, exercises, etc. and he said don’t be afraid by internet horror stories and trust me and use exactly how i tell you (very low doses to high steadily) this is be very helpful for your depression (which i got 24 in Beck’s depression inventory questions).
    What do you think about this? Can you suggest me something, i would be very grateful.

    Regards

  6. This is truly frightening. I have been given 5 or 6 of these diagnoses over the last 4 years and I won’t accept any, other than I’ve experienced psychoses which directly relate to a traumatic experience at work, then a retrauma within the psychiatric system. I’m now in a position that I cannot drive unless I ‘comply with medication’. I am not complying but pretending to…although I haven’t reapplied to drive yet. I frightens me how the ‘state’ can trap people like this, although I am trying to face the fear and not collapse in it. my first psychoses was aged 45 – is this unusual?

    • hi jaycee. hmm, it could be unusual or maybe not. although a lot of people who have a so-called psychotic episode first have it in their late-adolescence or early adulthood, i’ve known people and heard stories of lots of people who had some experiences labeled as psychosis later in life. no reason it couldn’t happen to someone anytime, given the right circumstances externally and psychologically. wishing you the best on your journey! daniel

      • I threw myself around a room and at furniture with full force, and it took 6 people to restrain me and inject me. I have no recollection of this happening whatsoever, but was covered with bruises the next day, so I accept it did. My memory was that god told me the only way I could live was to go down the sewers – I assume this throwing myself around was me getting flushed down the sewers. Is that a psychosis? I have lost my career because I whistle blew and then wasn’t able to take care of myself through the repercussions, and I believe my fear of how I could survive is what led to this episode. Your films have given me faith I can face the future and recover – both my mental health and my financial health. Thank you

  7. Thank you Daniel.. the weight of diagnoses, their prevalence, their meaning, the value attributed to them.. can be heavy, engulf your identity, make you doubt your path.. and this essay it helps, it helps.. humour can help to make things lighter, to see things clearly, give perspective.. thank you

  8. Normally, this would be extremely funny, but it is so factual that the humor is overshadowed.
    Lloyd Ross, Ph.D.

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