The Armchair Psychiatrist/Misguided Mental Health Diagnosing by Terri Marini, RNBC, CARN
We all have met the “armchair quarterback,” but have you met the “armchair psychiatrist?” I think you have, I think we all have. You may be one yourself. You know who I mean. It’s Uncle Gunnar who tells everyone his wife is “bipolar” when she screams like a “maniac” because she doesn’t appreciate having to un-ball his smelly socks before throwing them in the washer. It’s your best friend Belinda who says her boyfriend must have “split personality” because today he ignored her while she was cooking his breakfast wearing an old stained tee shirt and sweatpants, when last night in bed he told her she was the most beautiful woman he had ever seen. It’s your daughter Venus who calls you “psycho” because you won’t let her take your new car during a blizzard to go to her best friend’s house to take selfies in the snow. You get the picture.
So why do we feel so free in throwing clinical terminology of mental health disorders around so easily and carelessly. Why are psychiatric or mental disorders thought of so differently than other medical disorders? No one “diagnoses” you with “colon cancer” when you have a stomach ache. It’s unlikely your red eyes from no sleep will bring forth a diagnosis of “glaucoma.” And there is only an outside chance that someone would conclude you have “lumbar radiculopathy” when your back hurts .
The prevalence of treating mental disorders differently than other medical disorders has been a long standing issue. Discriminatory practices and disregarding the need for mental health treatment had such a negative impact on the health of millions of Americans that it led to the enactment of The Mental Health Parity Act of 1996 (MHPA), which provided that large group health plans cannot impose annual or lifetime dollar limits on mentalhealth benefits that are less favorable than any such limits imposed on medical/surgical benefits. (https://www.nami.org/Blogs/NAMI-Blog/April-2015/What-Is-Mental-Health-Parity)
Most of the time our casual “diagnosing” of our loved ones is harmless, and done without malice; but our words do have power. Sometimes we spew words thoughtlessly that not only are hurtful to others, but also expose our prejudices, judgements, and beliefs. We risk painting a picture of ourselves that is not how we want to be seen, nor is it accurately representative of who we are. Granted our family and friends will likely respond to our “diagnosing” them with disregard, or will defend themselves by dishing out their own “diagnosis” of us, however at other times the use of clinical diagnostic terms is quite unacceptable. Using these words in the workplace or in reference to our child’s teacher is not a good idea. Sadly, the practice of labeling others has become all too common. We hear news people and talk shows hosts describing political figures as, “personality disordered,” based on a behavior or statement that emerged in response to a situational stressor. When in fact, the diagnosis of Personality Disorder requires an evaluation of an individual’s long-term pattern of functioning, in addition to other criterion. We see tweets written by public figures making incredibly personal judgments with comments like “it must be close to that time of month,” referring to Premenstrual Dysphoric Disorder, based on irritability or weight gain. So it’s no wonder why we too jump on the bandwagon and feel justified in throwing in our two cents.
Unfortunately, most of the time the diagnoses thrown around are no more accurate than what you would get for 5 cents from Lucy Van Pelt’s Psychiatry Booth in Charlie Brown.
Not only should lay people refrain from making psychiatric diagnoses, but mental health professionals, including psychiatrists, have recently reignited this debate over the appropriateness of offering an opinion or diagnosis on public figures. In fact, the American Psychiatric Association has a Principle of Medical Ethics known as the Goldwater Rule. Part of the rule states “it is unethical for a psychiatrist to offer a professional opinion about an individual based on publicly available information without conducting an examination.” The Goldwater Rule evolved out of an incident involving Barry Goldwater who was a presidential candidate in 1964. A magazine had polled 12,356 psychiatrists in regards to his mental fitness to be president. It was published that 1189 of the 2417 who responded deemed Goldwater psychologically unfit to be president. Goldwater ultimately lost the election, but he did win a libel suit against the magazine. (https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/08/the-goldwater-rule)
Psychiatric diagnosis occurs in the context of an evaluation. A diagnosis is given only after thorough examination, history taking, and the gathering of collateral information when available. Psychiatrists who render a diagnosis not in accordance with these standards of best practice compromise the integrity of the profession of psychiatry. Obviously, our off-handed, ill-informed “diagnoses” do not rise to any appreciable level of damage to psychiatry, but it is possible that we subtly chip away at the legitimacy of mental disorders. Every time we use the terms “bipolar, psycho, borderline” we water down the true meaning of the words. We become desensitized, we show our ignorance, and we display a lack of empathy towards what it really means to have bipolar disorder or borderline personality disorder, or what it feels like to be psychotic.
Even though the use of mental disorder terms has become so acceptable, so common place, if you stop to really think about it, how is it any different than freely throwing around racial or gender slurs. One by one, let’s start to censor ourselves and each other. The next time you hear someone say “don’t listen to her, she’s schizoid,” have the courage to speak up and bring attention to what is being said, evaluate and decide if the use of those words actually convey the intention or spirit of the message, and have a discussion about other ways to express ourselves.