How Using the Dsm Causes Damage: A Client’s Report
Diagnoses can convey the following meta-communications: (a) The client has a “disease,” (b) the self and the disorder are identifiable entities, (c) the client is a victim of the disease, and (d) the self is fundamentally untrustworthy because it is disordered or “ill.”
The application of DSM diagnoses and the attendant stigma have the potential to convey the message to clients that their perceptions are untrustworthy. These messages may undermine therapeutic growth. When clients’ experiences are labeled as pathological, they may learn that their interpretations of reality cannot be used as an acceptable guide.
In Steve’s case, the diagnosis of paranoid personality disorder diminished his capacity to determine when he was in situations of real threat. Steve tended to assume that most of his fears were irrational and therefore lost his ability to trust his own evaluations of situations.
In the case of Steve, it could be argued that his paranoia was an appropriate protective device. Steve had been emotionally and physically abused by his grandfather and his mother. In this context, Steve’s “excessive” fears reflect the degree to which his environment was threatening while he was growing up, not his degree of “craziness.” Steve’s paranoia may be seen as his way of making meaning out of an otherwise incomprehensibly threatening environment.