The facts of the matter are that we have known for a long time that diagnoses are often not useful or reliable, but we have nevertheless continued to use them. Even though the first date is intimidating, they do not represent the end of the world. If it makes no sense to label ourselves permanently depressed on the basis of an occasional depression, then it takes better evidence than is presently available to label all patients insane or schizophrenic on the basis of bizarre behaviors or cognitions.
Clearly, patients do not spend much time in interpersonal contact with doctoral staff. Those with the most power have the least to do with patients, and those with the least power are the most involved with them. The rest were either pocketed or deposited in the toilet. Perhaps for the pleasure of it all? The consequences to patients hospitalized in such an environment — the powerlessness, depersonalization, segregation, mortification, and self-labeling — seem undoubtedly counter-therapeutic. All of them employed pseudonyms, lest their alleged diagnoses embarrass them later. If sanity and insanity exist, how shall we know them? And the fact that you want to impress your date only puts more pressure on you. No secret was made of these activities. Similarly, the insane are not always insane. The reasons for this are not hard to find: it is clearly more dangerous to misdiagnose illness than health. Staff and patients are strictly segregated. If patients were powerful rather than powerless, if they were viewed as interesting individuals rather than diagnostic entities, if they were socially significant rather than social lepers, if their anguish truly and wholly compelled our sympathies and concerns, would we not seek contact with them, despite the availability of medications? Freudenberg and J. Heavy reliance upon psychotropic medication tacitly contributes to depersonalization by convincing staff that treatment is indeed being conducted and that further patient contact may not be necessary. Obviously, since my concerns are general ones that cut across individual hospitals and staffs, I have respected their anonymity and have eliminated clues that might lead to their identification. There is by now a host of evidence that attitudes toward the mentally ill are characterized by fear, hostility, aloofness, suspicion, and dread. Psychiatric diagnoses, in this view, are in the minds of observers and are not valid summaries of characteristics displayed by the observed. How many have been needlessly stripped of their privileges of citizenship, from the right to vote and drive to that of handling their own accounts? At the end of the date, you want her to remember things like the great way you smelled — among other things. For others, directly experiencing the impact of psychiatric hospitalization will be of enormous use. Such labels, conferred by mental health professionals, are as influential on the patient as they are on his relatives and friends, and it should not surprise anyone that the diagnosis acts on all of them as a self-fulfilling prophecy. And while there have been occasional reports of researchers who submitted themselves to psychiatric hospitalization, these researchers have commonly remained in the hospitals for short periods of time, often with the knowledge of the hospital staff. How many people, one wonders, are sane but not recognized as such in our psychiatric institutions? The patient is deprived of many of his legal rights by dint of his psychiatric commitment.
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