The Survival of Psychiatric Diagnosis - Prof. David Pilgrim
Personally, I've always been kind of puzzled by psychiatric and clinical psychological committment to categorisation. Perhaps this was revealed by the audience questions which seemed to struggle with Pilgrim's suggestion that we might try approaching clinical psychological work without such heavy reliance on the social constructs of psychiatric diagnosis.
With our recent talk in the social psychology unit about schemas, I could more readily see how schemas apply to, and explain both the convenience and potential consequences of psychiatric categorisation. Diagnosis seems to offer the illusion of cognitive control over the behaviour of others. Kingsley Tonkin (one of the new clinical psych. staff at UC) made the point, for example, that diagnosis was being used as a way of acting on fear and uncertainty about indigenous people's potential future actions in Queensland.
It is easy to talk about this from a philosophical view, but I thought it was great that in the audience were individuals with so-called psychiatric issues who responded to Pilgrim's provocative views. This gave the session an extra, challenging, realism.
As an undergraduate psychology student, I remember writing an article for the university newspaper about the rapid expansion in the diagnostic categories for mental illness which have occurred in the last 100 or so years. In comparison, our vocabulary and understanding about psychological well-being had progressed little. I suggested that it might be time invest more energy in exploring and mapping out the realms of psychological well-being such as, for example, the work Ken Wilber has been doing.
Interestingly, we don't tend to diagnose and categorise well-being, but do tend to with distress. We tend to allow for diverse forms of psychological well-being without imposing artificial labels but when threatened by bouts of so-called madness, Western psychological and psychiatric culture seems to default to labeling in order to achieve a sense of control and protection.
This is not to say Western psychology hasn't achieved much and many parts of it have clearly helped many people towards improved psychological well-being and effectiveness. But many seem to forget that psychology is a young science, with much of its psychological practice heavily embedded in political and cultural agendas. So, I found it refreshing to hear David Pilgrim's warning about the potentially blinkering, limiting, and even inhumane effects of our psychiatric and clinical psychological industries and professions currently being dominated in their weltanschauung by a culturally constructed set of debatable symptom categories.
Professor of Mental Health Policy, University of Central Lancashire UK and Consultant Clinical Psychologist Lancashire Care NHS Trust.