The Ethics of Armchair Diagnosis
When you resort to name calling, you’ve lost the argument. When you resort to diagnosing, they’ve lost credibility. Is it any wonder why non-mental health professionals are diagnosing people out of anger?
Some people diagnose because of a disagreement. How many times have we heard a friend relay stories about his “bipolar” girlfriend after they have ended the relationship? Or what about a frustrated mother who is fed up with her son’s “ADD” when he refuses to do homework?
When someone does the opposite of what we want them to, it is tempting to label the behavior as a scientific defect. When the problem person has been labeled with a disorder, the blame is completely within their body. We, are off the hook.
Psychiatric disorders, unlike physical conditions, are not easily measured. A heart condition can be detected through an EKG test. A histrionic personality disorder is measured by a series of behavioral patterns. The reasons for behavior, however, are not always taken into consideration.
If a patient is crying, talks about suicide often, and uses physical appearance to draw attention to herself, her behavior could be considered abnormal and labeled histrionic.
If this same patient is being used for sex trafficking purposes, her behavior could be completely reasonable considering the circumstances. If the patient is taken out of this situation, her behavior may very well return to normal.
Depending on the experience of the professional, this patient may or may not be labeled as having a personality disorder.
To diagnose someone with a psychiatric condition, professionals in the field often use what is known as the Diagnostic and Statistical Manual. The DSM is owned, sold and licensed by the American Psychiatric Association.
Gary Greenberg, a contributor to The New Yorker, The New York Times, and Mother Jones, suggests that disorders come into the DSM in the same way that a law becomes part of the book of statutes. The disorder is suggested, discussed, and voted upon. There is little if any scientific evidence involved in diagnosis.
Armchair diagnosis is a term used when professionals or non professionals diagnose someone they have never treated. The latest and most popular example of this phenomenon involves Donald Trump’s mental health.
A guideline (based off presidential candidate Barry Goldwater, who was misrepresented as “unfit”) named The Goldwater Rule, restrains any psychiatrist from giving an opinion about public figures they have not personally examined. Even if the public figure meets many of the diagnostic criteria for the diagnosis, the public figure can not be diagnosed from afar no matter how strongly a professional may feel. Because there is no scientific test for a psychiatric disorder, the risk for error is too great to be considered ethical.
Regardless of libel, hurt ego, and possible mistreatment, the popularity of diagnosing non-patients can normalize sickness.
What kind of normal behavior can “cross the line” into a mental disorder? Many people want their possessions clean or in a certain spot. They may wash dishes right after they eat or become upset upon finding dirty socks on the living room rug. If this is what many people consider obsessive compulsive disorder, does the seriousness of this disorder ever gain recognition? Furthermore, does this mean everyone who has a propensity for precise order should be treated with OCD medication?
Similarly, the diagnosis of Attention Deficit Disorder has been on the rise for years. Children who are considered ‘wild’ or have an exaggerated sense of energy are often times examined for ADD. Sometimes the diagnosis is made as early as three years of age.
If parents are unaware that their child may have ADD, teachers can request the parent have their child examined. ADD, unlike many other types of psychiatric disorders, is primarily treated with stimulant medication. While the medicine can greatly improve school performance and certain types of behavioral problems the child may exhibit, not all hyperactive children need or react well to ADD medication. In some cases, the medicine may become addictive not only to those who don’t need it, but for those who do. If there is a risk in treatment for ADD children, over-diagnosis may be a dangerous method of understanding common symptoms that one may or may not find within the actual disorder.
Gary Greenberg hints that the DSM is made up primarily of words instead of medical science. If words are the common denominator, what do we want those words to mean? Do we hurl them as insults or do we use them to treat people who are in actual need of help?
It’s a conversation worth having.
Lee, R. (2018). The Ethics of Armchair Diagnosis. Psych Central. Retrieved on July 7, 2020, from https://psychcentral.com/blog/the-ethics-of-armchair-diagnosis/