Anthony,
It appears relatIvely obvious that your opinion is fairly fixed on this subject, and it is certainly yours to have. So again, I am not out to change your opinion, but to offer up some instances where my professional opinion differs from your, so that others can make an informed decision for themselves.
Therefore, like before, I would like to pose a few more food for thought items. Starting with what I strongly believe is the overuse or misuse of the words "facts/proof", as there are none! Inherent in the field of psychology is the inability to do "true experiments" based on ethical and logistical dilemmas. Ethically we can not withhold tx from clients in search of "facts", and likewise we can not account for all contributing factors to get down to "one" variable to hypothesize about and confirm or deny through experiment. The best we can do is to have two tx groups or longitudinal studies, and then draw our best impressions from those findings. But remember even statistics, which most believe to be fact, are based on self reporting or clinical observations, which have/do slant the numbers, since both are unreliable (much like "eye-witness" testimony").
The next point is about "theoretical labeling without having a proper assessment". Now, as a licensed professional capable of assessing and diagnosing clients, I DO NOT take that process lightly, for I know an incorrect dx can lead a client down a harmful and non-healing path!!! But with that said, I do believe that at times there is therapeutic value in "cautiously speculating" about an abuser's, etc bio-pyscho-social-cultural-spiritual contextual background.
For example, I think it can be very helpful for a therapist and a client to "responsibly speculate" about what might have contributed to an abuser's behavior, like that of my own mother's towards me. And the "speculation" might very well resemble or closely adhere to a DSM label, or DSM label criteria, features, or tendencies. Although I will admit, that a professional should only do this if there is therapeutic value to the client and with a phrase like "if I were to hazard a guess about what your abuser's assessment
might be, then I would likely be lookin at "this" or "that" or some combination.
Just think about the educational value alone, though I must admit that when it was first done with me (before my mother made an appt with my therapist under a false identity and "accidentally" received an assessment/dx instead of stalking information on me) I felt as if my therapist was giving my mother an "excuse" for why she abused/neglected me based on her own life story. But if "speculation/hypothesizing" is done responsibly and say narcissistic, histronic, despression, etc are looked at and reviewed in a respectful and merited light, then when collaborating a professional alliance, a client might get a better understanding about themselves, their experience, their diffulties, their strengths, their obstacles to healing, and their specific treatment objectives.
Also such exploration with a client, in systems theory, etc, and through pattern tracing (genograms) has demonstrated tremendous value in helping to break the intergenerational transmission of such disorders and disfunction. As in it provides the client with more choices, opportunities, and conscious decisions to help stop the harmful cycles of abuse, addcition, trauma, fear, obsessive compulsions, etc - And I wholeheartdly believe that the next generation would reap the benefits of our new found awareness, exploration, and more mindful actions from all of us. We are survivors, but none of us, I think, want our children to be sufferers too.
However, if by chance no one sees the value in that example, let me draw a "labeling without being properly evaluated" parallel to the medical community. And I will make it personal as it is my opinion, but not mine alone. And please trust in 5 days I will and been in one of two hospitals for 7 full months. Have a valid lawsuit waiting in the wings, and so I typically do not use this forum to speak about medical insanity. Therefore please bear with me.
I have a group of rare autoimmune disorders and few more typical ones, that much like an DSM label or disorder are just a bunch of symptoms with a socially connstructed. And in my case, the first one has a label that does not coincide or reflect the lists of known symptoms. After that, the medical community "decided" to leave the "inaccurate dx label" in place since they "believed" that it affected more people (largest study ever done in the US was with 17 people in Philadelphia) and yet name change would only lead to "confusion", "less people getting diagnosed with it" (since the old name had a larger body of journal articles), and "fewer treatments being discovered".
Now with that misunderstood and inaccurate dx label, I have not only received near lethal ER treamnet, but have been denied Prednisone because the "label" alone does not suggest that it is indicated, have also had the same doctors who discount this rare disorder use it to attribute other symptoms to it without an exhaustive search for other causes yet still deny Prednisone, and have had others complete dismiss me, it, and my pain because it may not be "visible to them" at that time so it "must be psychosomatic"...just to name a few.
However, in so doing they missed catching my brain tumor, allowed pneumonia to develop into a blood born infection with abscesses and C-Diff, intubated and excubated me using improper proper medical protocol (when I handed the protocol to them, for I am never without it), enabled an aggressive giant cell tumor grow on my spine since they wrote off my stated pain to my original AI while having to change my clothes for me each day, and have just now diagnosed me with Nephrotic Syndrome which is ironically another missed AI disorder whose only management (keep symtoms at bay for as long as possie) is, what else but, Prednisone (and such a delay in dx and tx has left them with significant and irreversible damage).
Please do forgive my previous paragraph formatting. I should have found a way to make them into list to make it easier to read and follow, but I AM doing the best I can with the resources I have. And by the way, the two AIs I am referring to are both Lupus or MS type diseases with only early detection to intialize management tx for there is not cure for either. So before I depart from what Anthony and I agree on (and others), I wanted to clearly indicate, that just like with any Mental Health Dx label, medical evaluations and DX labels must also be approach with great respect for if they are wrong or inaccurate, at best healing is delayed. And at worst much harm will occur or lives may lost.
Now for the helping aspect of "labeling without being properly evaluated". I personally have been diagnosed with "COPD" and my grandmother while in my care was diagnosed with Alzheimer's. Well one might say that is wrong to do if we can only use medical Dx labels that can evaluated in some way as "true" or "proven" with a lab result or scan or something evidence based. And then others may say why is it wrong. In support of Anthony's position, it would be grossly wrong since both diseases can ONLY be accurately evaluated and labeled after an autopsy is performed. Ouch!
But I do not believe that this is wrong (and maybe Anthony does not either in this medical sense) for in my case my breathing issues extend beyond all the symptoms of chronic and severely resistent Asthma. And they are further complicated (or exacerbated) by my rare autoimmune disorders to the point where no Dx applies. As for my grandmother's Albeimer's Dx, it too at some point left the realm of dementia to, where again, there is no true Dx code. However, the labels DO serve a purpose, even if not able to be accurately "proven". They serve to inform other medical healthcare providers that all less severe dx are no longer applicable, so pleade DO treat this patient as if they have COPD/Alheimer's so that we may attempt to improve/extend their quality of life for long as is it is possible with current treatment regimens for both.
And well, I would loosely liken these medical examples and processes to the more healthy aspects of "cautiously hypothesizing" in a professionial alliance about how/why someone has experienced and been damaged and harmed by another in the mental health arena. I would also add that just like the preemptive medical treatment here to help facilitate/extend well-being and delay grief, that looking and exploring and abuser's "possible" disorders can better enable the client-therapist dyad to educate and to assess the potential risks of "what if the abuser is really narcissistic, histrionic, severely depressed, OCD, pedophile, etc?" Because only then can a client make an informed decision as to how best to proceed to themselve and their children safe from further harm and truly on the path of healthy healing. And so in assuming the worst, when within reason to do just that, we likely will be better equipped to prepared to protect, stay safe, have less harm inflicted upon our children, and yes, even be alive and in a proactive place/state where healing can occur.
And my last "food for pondering thought" centers around the "revenge" factor, as well as, the "helpfulness" of such therapeutic speculative hypothesizing. Although I have had my fair share of revenge fantasies, about a mother's sadistic abuse/neglect/death threats/suicidal road trip towards her replacement daughter, my father's role as a look the other way bystander (not protector) and verbal/physical abuser, my one brother's many different assault tactics along with pimping me out to his friends, the two local brothers who stabbed me with a knife because I stood up and declined to sign their KKK petition and who two (?) years later went on to shoot, kill, and dismember their parents in their own home, my high school math teacher who started baiting and grooming me for her emotional/sexual exploits when I was still in middle school and also taking high school math/science courses, my very first and mandated male psychiatrist's repeated weekly rapes with amnesiacs and/or paralytics following my suicidal/fatigued/emaciated/trauma related 302 psychiatric hospitalization...(all before I reached the ripe old age of 25 and most before I could verbally speak but a few simple words and phrases)...I have never once speculated or hypothesized about my various to exact some form of revenge or vindication or hate for anyone but myself, for I blamed no one but me for all that had happened to me.
What I was looking for when hypothesizing with my therapist was "language and words" to better describe to her what I had experienced and to validate that the shame that I carried around was not my shame but theirs. And even against the advice of most everyone in my life, I never fully cut myself off from my bio family. One of those reasons, was to protect my four nieces and nephews from such abuse/neglect - I figured my life was over, but I was not going to standby and allow another generation in my bio family to be abused/neglected/destroyed. The cycle was to stop with me, period!
The other reason I chose not to cutoff was primarily to "purposefully" and "therapeutically" go back from time to time into that "sticky wicked web of torturous destruction" to "see thru my adult eyes" what my "young eyes bore witness to". In essence to see it thru another lens and then to test if any of our "therapeutic hypotheses" seemed to ring true in my "adult eyes with adult observational skills and knowledge. I did not have much of an emotional vocabulary to help out with overlaying the emotional impact I felt on top of the actual experienced events - I could only write them down like some kind of cruelty "to do", or in my case, "not to do" list. And the little emotional vocabulary that I did have was twisted up from years of actual isolated captivity (except mandated school) where I was silenced, told what I wanted to eat, what I wanted to wear, what I wanted to do, what I wanted to want,/need .... and ultimately what I was to feel (true or not).
So based on needing to find my own voice and a very detailed and methodical approach to looking at the DSM, my gifted therapist and I generated a "what it might feel like to the adult me and the child me if so and so had certain DSM pathological symptoms." And proactively armed with that and my detailed database of emotions, complete with continuums for intensity, I re-entered that web from time to time, when hitting each new wall, in order to purposefully learn from and test our reasonable theories thru a series of comparisons and list emotions to see which ones ring true in present day interactions.
Then after doing that, actually I have never stopped doing it, a portal from the present to the past slowly started to open. And although it still took me well over five years to move from speaking only through the use of novel passages, song lyrics, flow charts, encrypted numerical sequences, photographs, electrical schematics, blue prints, chord progressions...to tenatively speaking, what I call, my "Whispers From Within" (my life story) in a very whispered voice. And unfortunately I HAD to do all these things before I could even begin to tackle my worthless, defects, self-hate, deficiencies, or intolerateble shame.
So, for me, I do see the value of exploring your our lives and lived experience through different diagnostics labels to see which ones shed some light on your own internal reactions and can assist in our own healing. But ironically I still refer to my own mother as "sadistic bio bitch Barbie doll" or "my personal ventriloquist with her hand literally up my ass" or "the ultimate puppet master with me as her spider down below, not able to make a single move without her permission", rather than the "sociopath" (antisocial PD) that she was diagnosed twice as. I just tend to call her "not human" and yet still tend to see humanness in her.
I do not know if she has any resemblance to a conscience and no, I do not see any remosre, but she also can not sit with herself and appears to always be running from her own shadow. So in the end, I do not believe things just because she was assessed, I only believe them when I can see/feel it for myself. And really, who wants to see their own mother as a sociopath? When we are so very young love is needs/wants and needs/wants are love as we do not yet possesses the knowledge to differentiate. All I can say is that we need more childhood interventions before those critical times and developmental stages close forever.
And though I differ in my opinion, I do strongly believe that my right to speculate/hypothesize about my abusers ends with my own personal journey of healing! Thus anonymously on here with ever stating full names of any abuser should be ok, if you feel you need more justice than that, most assuredly the courts, attorneys, etc will need much more.
I suppose I will end with that. I do, for whatever internal reasons find myself being pulled to this thread and so I do so appreciate it. I also must humbly thank those who decided to wade their way through this post and end up here at this paragraph. I know it must not have been easy.
Respectfully posted,
Alex
(who most likely needs the psych ward more than the ICU at this time)