Depsychiatrization: Dispelling Harmful, Diagnostical Self-Concepts in Therapy and Community Health Work

In this article I will be proposing an early framework for a mental health intervention called depsychiatrization. Depsychiatrization describes the processes by which a diagnosed individual learns to expel psychiatrically induced self-concepts and substitute them for more empowering and nurturing understandings. These processes are not, in themselves, entirely novel, as they have been a part of many alternative movements throughout time. It is the ambition behind this proposal to formalize a way of helping and supporting people who would benefit from depsychiatrization, as well as supplying a legitimizing platform to stand on for those who wish to encourage growth without pathology.

Much has been written on the many ways in which psychiatry does harm to individuals seeking help for mental health issues: The medical treatments are far too often more harmful than beneficial, especially in the long run. The symptom-focused therapeutic treatments rarely produce sustainable outcomes leading to better lives. For instance, electroshock therapy is a disputed method at best, a harmful, medieval practice at worst.

Yet we too rarely discuss the harm that psychiatric treatment does to a person’s self-concept and self-narrative. One of the purported positive effects of psychiatric diagnoses is the relief a person may feel when an expert tells them how and why they suffer. And this is sometimes true, at least in the short run. But what happens later, when the psychiatric diagnosis is ingrained in a person’s understanding of themself? What does it mean for an individual to perceive of themself as pathologically disordered in the mind?

It is my contention that self-concepts stemming from psychiatric diagnoses do far more harm than good. The detrimental effects of learning to think of yourself in terms of mind-pathology affect all areas of life, including employment, relationships, parenthood, finances, self-worth, and the list goes on endlessly. The purpose of depsychiatrization is to remedy this harm.

Depsychiatrization was not a method I developed intentionally. Rather, it originated as a byproduct of helping clients in therapy who had been dehumanized and gaslighted into thinking of themselves as disordered or sick. Being a public critical voice, I do tend to see many clients who’ve suffered at the hands of psychiatry, and in helping them I found the process of shedding psychiatrically induced ideas to be intertwined with the process of healing.

Maybe the best way to explain the relevance of this novel concept is with illustrative cases. And none better to start with than the diagnoses labeled personality disorders. They comprise a group of diagnoses that do catastrophic damage to the person who is taught to identify with them.

I was employed for two years in the Danish psychiatric system in an outpatient clinic treating people diagnosed with so-called personality disorders. In my two years of regrettable service I did not find anyone whose personality seemed to be disordered (whatever that means). The longer I spoke to my patients, the less sense their diagnoses made, and the more I came to understand their feelings and reactions as sensical and normal. I did not find any person whose personality seemed pathological. What I did find, however, was an abundance of traumatized, marginalized, discriminated, isolated, and oppressed people.

Names and details have been anonymized in the following case-presentations.

Lea’s story

One of them, Lea, was diagnosed with borderline personality disorder. I was assigned as Lea’s therapist, and my official goal was to alleviate her of as many of her borderline symptoms as possible, and to educate her on mentalization and the ramification of her disordered personality. I opted instead to try to understand Lea. She did feel the diagnosis was a fit at first: She definitely wound up in many conflicts, she felt an emptiness inside, she did tend to feel abandoned and therefore preemptively reject others, but at the same time she felt a strong need for closeness, she did engage in frequent casual sex with men, she did engage in self-harmful practices. The diagnostic criteria seemed to fit the behavior.

During the course of our year-and-a-half of therapy, we explored the many impacts that had shaped Lea’s so-called ‘symptoms’. Her mother had always told her that she’d inherited her troubled mind. Her father abandoned her when she was little. She’d been bullied a lot growing up and had learnt to compensate by making herself hard and confrontational. This side of her existed in conflict with a strongly empathetic side of her. The more we learned about Lea’s past and how she’d coped with instability and abuse, the more her present behavioral patterns made sense. And the more her patterns made sense, the better equipped we were to engage those parts of her that were in conflict within her.

Lea did not want to be a badass border-bitch (her words, not mine) anymore. She wanted to feel feminine without feeling weak, and masculine without acting violently aggressively. She wanted to have friendships that were bidirectional, and not just about constantly putting out fires. And she wanted to experience love, actual love, where she’d dare let someone see those parts of her that she hid from other people. Those were the parts that we spent the most time engaging with in therapy.

It took about a year’s time to lay the foundation for fundamental change towards these goals. One day as we sat quietly and gazed out my window, Lea told me after some thought: I’m not disordered… I’m traumatized. We’d discussed this several times before, but on this day the realization seemed to hit her as fully true.

That day changed Lea’s life. Her journey towards healing was not done at this point, but something fundamental had shifted. She’d finally shed the psychiatric explanation for her reactions and embraced a contextualized, meaningful approach. We began to explore what else she was: Creative, caring, analytical, and also less flattering but equally important aspects. By and by she developed a nuanced and integrated understanding of herself that was defined neither by diagnoses nor trauma, but rather by just being Lea with all which that entailed, with a self-compassionate outlook on her previous (and sometimes present) modes of being in this world.

The progress that Lea and I achieved would not have been possible if we’d worked within the established framework of psychiatric therapeutic treatment protocols. No protocol teaches you to like your patients, to care and root for them, and to embrace all their many ways of being themselves without judgment (and, indeed, without pathologizing).

David’s story

David had been depressed for a long time when I met him. The psychiatric treatment for his diagnosis—bipolar disorder—had little effect other than to quell some of his anxiety, which, admittedly, did serve to help him cope in the short run. After a few sessions I asked David: “Are you aware that you’re constantly monitoring your own mood?” He said: “Yes, of course, I’m deathly scared of becoming manic again! Or becoming depressed again, like I used to be. But I’ll probably kill myself if I become manic. I could never put my family and friends through that again!”

His first manic episode occurred a few years after he’d started treatment for depression with SSRIs. This is not uncommon, as the number of manic episodes in the population has exploded since the introduction of so-called antidepressants (which, evidence-wise, can’t actually be said to be antidepressive). David was also under severe stress during the time when he experienced a manic episode: He tried to balance a fast-paced career, several hobbies, independent projects and many relationships all at once. The more we explored the circumstances of his mania, that more it made sense that his mind would launch into overdrive in an attempt to cope, even to a degree where he lost his grasp of reality.

David and I did therapy in the sense that we collaborated on understanding his thoughts and feelings, both past and present. But we also did something else that was very helpful on its own: I provided true psychoeducation. Now, psychoeducation is usually taken to mean an expert explaining this or that about mental suffering, usually in the form of diagnoses and treatments. And few diagnoses are as adamantly claimed to be biological in nature (counter to all evidence) as much as bipolar disorder.

David had been psychoeducated to accept his mood swings, mania and depressive episodes as his neurological hard wiring. I told him that that was just plain wrong. That no one has ever established any such thing to be true for people diagnosed with bipolar disorder. Although David trusted in me, it took a while (and some reading on his own) before he accepted that I was right. That bipolar is indeed only a name psychiatry has for a certain type of behavior. This also led to a gradual discontinuation of the medical treatment with assistance from a Danish nonprofit that offers guidance on stepping down from psychopharmaceutical drugs. If bipolar is neither a chemical imbalance nor a brain dysfunction, then there is little reason in trying to ‘correct’ a non-existent problem.

For David, depsychiatrization meant re-education on some of the fallacies and flat-out lies that patients are told during psychiatric treatment. This allowed him to oppose the instructions that he’d been given, including the hypermonitoring of his own mood. With his own words: “I’m no longer afraid to wake up in the morning. I don’t fear waking a little bit sad, and I don’t fear waking up a little bit glad. Those moods are natural, and it is unlikely that I will become psychotic or manic again, since my life has changed so much since I first collapsed”.

Laura’s story

“Do you have anything I can stir my coffee with?” she asked at the beginning of our very first session. I’d offered—as I usually do—instant coffee but had failed to provide anything to stir with. I answered “Yeah, sure, just grab that knife on the shelf right there and stir with the handle.” She froze. She froze long enough for me to notice. I sat down and waited. She did take the knife and stir her coffee, and as she sat, I asked her “It seemed something just happened. What was that?” She hesitated before saying: “I’m just so used to the idea that I’m dangerous that I couldn’t believe that you just offered me a knife”.

Laura had been diagnosed with paranoid schizophrenia earlier in life. She’d been out of the system as well as out of medication for some years, but she’d never found peace with herself. She sought me out through recommendation from another therapist who thought I’d be a good match for the task at hand. This turned out to be true. As is true in almost all cases, that which psychiatry had labeled ‘paranoid schizophrenia’ was mostly trauma responses. Laura had had a rough childhood. She hadn’t ever really thought of herself as psychotic, but she did hear voices at a point in time.

Psychiatric treatment did lessen the voice hearing to an extent, but along with the voices she lost a lot of herself. She fully internalized the idea that she was mentally ill and concluded that she was therefore a burden on her family, friends and society, leading to several suicide attempts. The medication made her unhealthy and uncaring, and she gave up on her dreams, including that of having a family of her own, a career and a happy relationship. In fact, she was told by several professionals that the outlook wasn’t positive with regards to those dreams. Hearing this part of her story, I reflected out loud: “Well, if anything’s gonna convince you to kill yourself, it’d be that: Being a diagnosed burden with no possibility of a better future”.

Laura laughed at that. It even became a thing: “Here comes the burden!” she’d proclaim on entering my office. But it’s true: The way psychiatry defines e.g. voice hearing steals away hope, context and meaning, and it adds stigmatizing narratives such as the perceived danger of being around people diagnosed with schizophrenia. People who hear voices or have other extra-sensory experiences are not more dangerous than other people. The public just tend to hear that narrative a lot, whenever something tragic happens involving someone who is diagnosed. But voice hearing is neither dangerous nor uncommon. It’s a natural phenomenon that some experience to a higher and more manifest degree than others, especially those that are exposed to childhood trauma.

Trauma-informed therapy was necessary to help Laura. She needed help to deal with the adverse experiences that had landed her in psychiatry in the first place. But first we needed to deal with a lot of the harm that psychiatry itself had done to her and her way of thinking about herself. This involved active participation by both family and friends, some of whom were invited to hear a very different story about Laura from the one where she was a paranoid schizophrenic. People fear what they don’t understand, and this unfortunately often goes for close relations as well as strangers. But hearing a story that you connect with and understand makes the other person’s mental distress familiar and natural, and it engages empathy and connectedness which are fundamental precursors for the kind of healing and comfort that only close relationships can provide.

I could tell countless more cases like Lea’s, David’s and Laura’s. If you add onto those all of the cases that I’ve read and been told outside of therapy, then that strongly indicates a staggering universality in the way in which psychiatric treatment teaches patients to understand themselves in ways that are harmful and invalidating to them. It follows naturally that learning to dispel these (mis)understandings from the mind in a safe, supportive environment paves the way for other, more constructive and compassionate self-concepts. Depsychiatrization is thus not a battle against something as much as it is a battle for something: It is for the right to understand yourself as a normally reacting person who deserves to be understood on your own terms.

Future directions

I’ve mostly worked with depsychiatrization in individual therapy. I do believe, however, that the concept has just as much potential as a group intervention and even as a community intervention.

In group therapy, it’d be possible to systematically undo the most common misconceptions spread by psychiatry in a setting where former (or current) patients would be safe and free to ask questions and be doubtful. It’d also be possible to work together on common themes that tend to arise with psychiatric internalization, for instance the loss of hope of any meaningful future. Depsychiatrization would lend itself perfectly to a group setting, where the group could also help each other mirror nonpathologizing perspectives on those sides of each group member that psychiatry has pathologized.

As a community intervention, it’d be interesting to see what would happen if established institutions and organizations were to adopt a fully nonpathologizing approach. This would not necessarily entail the abrupt discontinuation of all collaboration with psychiatry, especially for practical reasons seeing as how psychiatry is almost universally involved in mental suffering in our day and age. But what would happen if mental health professionals outside of psychiatry rejected the legitimacy of diagnoses to say anything at all meaningful about the person we’re meant to help?

Another form of nonpathologizing community intervention could be peer-run facilities. These do tend to be nonpathologizing in nature already, as they tend to grow out of a strong desire for creating a space to receive help that is not expert-driven, but rather driven by universal needs and rights that the mentally distressed individual has. I can strongly recommend looking up two places that I’ve come across during my time as an activist: Leeds Survivor-Led Crisis Service in England and The Wildflower Alliance in the US. Both places excel at offering something that is fundamentally different from pathologizing, and which allows the distressed person to grow and heal out of a pathologized self-concept.

Depsychiatrization is not new, not in the sense that a lot of peer-run organizations already provide the space to achieve the same. The novelty in the concept lies in the distinct choice to formalize and label the process of dispelling those psychiatrically imposed self-narratives that do the most harm. It is a way of reclaiming the right to be understood through a nonpathologizing, rehumanized lens rather than as a pathologically afflicted, disordered patient. It is my hope that depsychiatrization will inspire and provide a platform for new discussions amongst professionals and those with lived experiences alike.