The Misuse of Psychiatric Terminology

Source: Comedy_and_tragedy_masks_without_background by Booyabazooka, CC

In the June 2018 issue of one of the newspapers for psychiatrists, Clinical Psychiatry News, a psychiatrist by the name of Carl T. Bell wrote about something I have been harping about for years: the sloppy use of psychiatric terminology by both the public and by many psychiatrists themselves.

It’s good to know I’m not the only one who has noticed this.

He brings up three examples: the use of the words (two of which also have a common meaning separate from the corresponding terms in psychiatry): traumatized, depressed, and bipolar.

Colleagues of his had used the word traumatized as something that happened to a person who was the subject of a statement by another person that has come to be described as a microaggression. A microaggression is defined as “a statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority.”

Worrying about that sort of thing has recently become endemic on college campuses. Especially if any offense was unintentional, the result of this big ado is a subtle message to individuals that they are so fragile and vulnerable that they can’t handle anything. Some have also argued that it has led to the suppression of free speech, something supposedly valued by the same people who fret over microaggressions.

As far as I know, there has never been an example of a microaggression, or even a direct verbal insult, that in and by itself has to lead anyone to develop post-traumatic stress disorder (PTSD). According to Dr. Bell, being stressed by something like that, or by your boss chewing you out, is a far cry from being traumatized. Being distressed by something like the death of a parent is a little worse. It can come up from time to time, like on the anniversary of the death. However, in both of these cases, unlike in PTSD, “The mind is able to make peace with reality… and life goes on."

“Traumatic stress, on the other hand,” he adds, “is an event so painful and disruptive that it runs the risk of breaking the mind’s ability to make peace with the event…[and it] disrupts or destroys normal psychic life.”

I would add that if everyone around you treats you like you are so fragile that the slightest stress will do that, you start to believe it even though you probably aren’t really that fragile at all. And if you feel like that, you are probably not going to take measures to actively oppose and undermine things like racism, sexism, and homophobia. In fact, if enough people think like that, it is paradoxically a great boon to racists, sexists, and homophobes everywhere.

I’ve already covered the misuse of the term depression in my post of December 15, 2017, "Depression: A Symptom, Not a Disorder." Major depression is a clinical condition that has many physical symptoms and is something that can be quite disabling. Being unhappy, sad, grieving, or even demoralized is not the same thing at all. The latter conditions do not respond to antidepressants in the least, while major depression does. Unfortunately, researchers doing recent studies on antidepressant efficacy have become very sloppy and often do not exclude merely unhappy people from clinical trials as they should.

Bell then addresses how the term bipolar is creeping into common usage to cover things such as being moody and having difficulty regulating one's moods or having a bad temper (especially in kids, I might add). For maybe 30 minutes or an hour. And many psychiatrists just take patients at their word when they misuse the term and prescribe unnecessary and ineffective mood stabilizers.

In that vein, another article in the April issue of the same newspaper quoting a Gabrielle Carson who discussed the issue of tantrums in children. It advocates investigating the child's symptomatology to rule out bipolar and other mental disorders, as well as clearly behavioral problems like so-called disruptive mood dysregulation disorder, ADHD, and oppositional defiant disorder.

The only mention of environmental factors that might lead to the tantrums is a quick and superficial reference to child abuse and school bullying. But the article says absolutely nothing about the far most common cause of frequent tantrums by children (as discussed by child psychologist and columnist John Rosemond as well as other people who actually look at what goes on in the child’s home): problematic parenting practices such as acting like a friend to your kids instead an authority figure, letting them make decisions that should be made by the adults, micromanaging them and engaging in helicopter parenting, compulsive yelling or lecturing, and inconsistency in administering discipline.