I had never before heard of the Rosenhan research study demonstrating the existence of a false negative (a diagnostic label inappropriately given to a client) until reading about it in our text recently. It was disturbing as I have a brother in law and a daughter that have been through clinical psychiatry and psychology processes in hospitals and medical offices and have suffered by being stigmatized to different degrees because of being in the system. The so-called clinician labeling effect is clearly a real and disturbing fact because of the possibly life damaging course it can take in a person’s life. The labeling effect is defined as “…a tendency to perceive clients in ways that are erroneous owning to the reactive effects of an existing psychiatric label.” (Schneider, Gruman, & Coutts, 2012). It’s disturbing but its not surprising from where I sit. By this I mean this effect is due to the very structure and methodology of the western approach to medicine and psychology that births its very existence. Compared to eastern medicine and psychology it can be said that this western defined term does not exist, but as every one is human eastern practices can suffer from their own unique biases. However keeping to topic I’d like to contrast the western clinical approach to diagnosis and assessment versus the eastern method in light of the labeling effect to hopefully broaden your minds about the possibilities of healing by looking outside the box.
The “science” of psychology and psychotherapy in general is one based on the scientific method, which the Merriam-Webster dictionary defines as “principles and procedures for the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.” http://www.merriam-webster.com/dictionary/scientific%20method This scientific method includes by necessity the isolating of variables and complete objectivity to the subject in order to tests its hypotheses’. This climate has given rise to a focus mainly on pathology when treating a person, which the existance of the DSM-V attests to. The methodology of diagnosing and assessing seems to focus on a negatively skewed view or “what’s wrong” with the individual and then attempts to “fix you”. Younger and newer forms of psychology are moving away from this approach like Positive Psychology for instance where the definition of Positive Psychology is stated as “… the scientific study of what goes right in life, from birth to death and at all stops in between. It is a newly christened approach within psychology that takes seriously as a subject matter those things that make life most worth living.” (Peterson, 2006, p. 4) The very unfortunate net effect of having a category based tool like the DSM-V and a focus on pathology instead of wider universal view is that you attempt to pigeon hole the various phenomena and data you are exposed to. It has been said in various places regarding fixing problems or in our case diagnosing patients, “If you only have a hammer in your tool box you will always be looking for nails. “ I submit to you that by using fairly inflexible tools like the DSM-V, focusing on pathologies, and interacting with patients objectively and not subjectively, the labeling effect will remain as a very real problem in western psychology. The eastern approach to clinical psychology via Chinese medicine takes a different more subjective and inclusive approach that greatly reduces bias and all but eliminates diagnostic stigma.
Most don’t realize it but the definition of the scientific method given above happens to fit the field of Chinese Medicine perfectly as well. The Chinese take a different approach to empirical evidence and observation that is based on a foundational understanding of the harmony of all things and not an approach that focuses on taking apart, mastering and controlling. Control being the last item in what the purpose and function of what science is supposed to be about. Much can written about this but unfortunately time and space do not permit. An excellent resource on the methodology of eastern clinical psychology via Chinese Medicine can be found in Dragon Rises, Red Bird Flies by Dr. Leon Hammer, a psychiatrist and practitioner of Chinese medicine. What makes this eastern approach unique in offsetting the problem of the labeling effect are three items that I will explain very briefly. The first is that in the eastern system clinical diagnoses are not given names like bi-polar or borderline, but are spoken of according to their energetic quality and its presentation. For example a person could be suffering from “Wood Yin Excess” which speaks of a qualitative state of disharmony in the mind/body affecting the liver organ system which when corrected or balanced will bring relief to the patient. There actually is no label to put on the patient. Second, eastern clinicians use a methodology called “The Four Examinations” to assess their patients. Broadly these four methods are called Mon Shin (Question and Answering), Bo Shin (Looking and Observing), Setsu Shin (Touch and Palpation) and Bun Shin (Listening and Smelling). The first two methods seem to line up with traditional western psychology assessments but they are really much deeper and more subjective. These techniques require a great deal of subjectivity and personal awareness that help to mitigate and preclude most biases. They also serve as checks and balances in that various patterns are sought where these four examinations come into line to make sense of an overall picture of the patient. And third is the subjectivity of the approach itself. It is key to the formulation of diagnosis and assessments that the practitioner be highly aware of his internal and external state as he works with a client. In Chinese medicine health is described as a healthy free flowing of Chi (life force) energy, and to work with this qualitative substance one must be present, open and sensitive. The practitioner is an actual part of the healing process in Chinese medicine, so labels that would stigmatize the patient and would separate him from the practitioner would be clearly counter-productive.
The labeling effect in a western setting seems to feed on the fact that diagnosis often use names of conditions that can carry a stigma with them, that are measured using often times a single measure like a questionnaire or interview, and are highly objective separating the “sick” person from the “well” person. Eastern clinical diagnostic methodology, by referring to energetic states of disharmony, using multiple types of measurements, and being a subjective part of the healing greatly reduce the presence of the labeling effect. Newer disciplines like positive psychology are looking more towards eastern approaches of focusing on positive attributes of a patients rather than needing to confirm that a patient is indeed sick which could bias a clinician towards false negative diagnosis’. As time goes on, more freethinking and open-minded academics should consider what other types of medicine, therapy, and healing exist on the planet. Especially from cultures that are far older than European culture like those of China, India and Africa. There are some very surprisingly well-documented, clinically tested psychotherapeutic wisdom to be had if one only dares to look.
References
Hammer, L. (2010) Dragon Rises, Red Bird Flies. Barrytown, NY: Station Hill Press
Peterson, C. (2006) A Primer in Positive Psychology. New York, NY: Oxford University Press.
Schneider, F., Gruman, J., Coutts, L. (2012) Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Sage Publications, Los Angeles.