I am most appreciative of the opportunity to give feedback to the open letter describing this task force’s very important critique. I believe that the letter is impressive and addresses areas of context and relationships that have in the past been neglected. A major step forward is the inclusion of “experts by experience” — those who have seen firsthand the harm that past diagnostic systems have caused. Their input is invaluable. My question would be how to best ensure that their opinions will be valued and given credibility when their input is evaluated in juxtaposition to the opinions of professional experts. Ultimately, what is of primary consideration is whether a diagnosis (name) is more helpful or harmful to the person being named. Does the assignment of a diagnosis provide a means to find the best support and treatment services or is it merely a reflection of current societal norms that have resulted in isolation and shame for those so named? Can any name be free from generating too-biased perceptions that foster stigma and discrimination? I am glad to see that the task force has listed the above as a concern and hope that the narrowing of what is deemed acceptable behavior is described more fully in future work.
A core question that I pose is whether there is truly a need for any diagnostic system. Regardless of nomenclature, a diagnosis forces one to strive to break out of a box that ignores diversity and neglects to see the uniqueness of an individual’s needs. Those fortunate to “recover” and resume their quest of “becoming” and who strive to realize their dormant potential, are hindered by having to confront diagnosis-based obstacles. Too often when carrying a diagnosis, one is required to act more normal than normal, with ultra-sensitive antennas to subdue or hide signs that in others could be swiftly dismissed as benign eccentricity.
A final conundrum that I see is the threat and power to inflict forced treatment/incarceration on those who are eligible to receive a diagnosis. The task force describes in the letter the importance of collaboration. I fully agree that trust provides the foundation for genuine collaboration. So I suggest that the more we can do to equalize the relationship between doctor and patient, removing the threat of involuntary treatment, the better the opportunities to create positive outcomes.
Ronald Bassman, PhD, is executive director of MindFreedom International, board member of Disability Rights International and board member emeritus of the National Association of Rights Protection and Advocacy.