Finding 'Truth' in Psychiatric Diagnoses

By Kelsey Fritts (Staff Writer) 

We've all encountered mental illness in some form or another. Maybe someone in your family suffers from depression, or someone from your school was rumoured to by “crazy”, or perhaps you are convinced that the homeless man on the sidewalk who yells a lot has schizophrenic paranoid delusions (even if you aren’t 100% sure what that means) and you therefore try and steer clear of him. And whether diagnosed or assumed, sometimes we have the tendency to see deviant or abnormal behavior as a symptom of an illness, and vice versa. These assumptions that mental differences are linked with illness come, in part, from the dominance of psychiatry as a discipline in the Western world. My goal here is to highlight that while psychiatry and its diagnoses may seem absolute and accurate, they are not necessarily the only way of explaining or viewing mental illness. Psychiatry is purely the dominant discourse of the age, rather than the end-all, be-all. I hope to show that other methods of conceptualization in regard to mental disorders, emanating from outside psychiatry, do exist as meaningful constructs.

Psychiatry was attacked in the 1960’s and on-wards for being purely constructed by dominant medical discourses of the day in attempts to control deviance (1,2), that there was no reality to mental disorders, and that diagnoses were not inevitable or objective classifications (3). In the Euro-American context, this resulted in a more medicalized psychiatry coming into being, one that searches for the same legitimacy as bio-medicine by attempting to define mental disorders as physical diseases (3,4,5,6). In a sense, this approach is searching for legitimation of the reality of mental disorders, a reality grounded in biological and physiological factors. This medicalized approach has resulted in psychiatric treatment frequently paralleling medical treatment. This shift has also played a dominant role in how the general public understands mental illness. Just as you would take someone to the doctor if they displayed with a persistent cough, if someone displays abnormal activity then you take them to a psychiatrist. The psychiatrist takes their symptoms, boils them down into a diagnosis, and prescribes a corresponding medication or treatment (2,7). Because of the authoritative position assumed by bio-medical practitioners and psychiatrists, these diagnoses are taken as nonnegotiable fact.

But this raises considerable problems, including the fact that psychological disorders have very limited – if any – biological markers, and manifestations are fluid, overlapping, and changing. There is also heavy reliance on changing and contextual narratives of distress as empirical fact. While bio-medical knowledge had been presented as universal, concrete, and indubitable, medical knowledge can also be defined as manifestations of social, cultural, and political norms (1): “at the time that each classification [is] in use, it seem[s] somewhat inevitable, a perfectly natural way to classify… yet when we see the parade of ungainly labels, we quickly realize that these classifications are highly contingent. Each reflects the medical and social attitudes of a particular epoch” (8). In the construction of a presumed “reality” of diagnoses, psychiatrists end up imposing social labels on patients, labels which appear to be based in indifferent, organic, natural evidence but may in fact be assumed abnormalities based on social norms (1,5,9). While I in no way mean to indicate that this a conscious doing on behalf of psychiatry as a discipline, I merely want to point out that in reality, diagnoses can be constructed by contextual assumptions of normality and deviance.


Let’s take schizophrenia and voice-hearing as an example through which to examine the inevitability of some psychiatric diagnoses. In addition to hallucinations and delusions, a characteristic symptom in the biomedical diagnostic category for schizophrenia is auditory verbal hallucinations (AVH) (10). AVH have become a hallmark symptom of madness and deviance, often assumed to be indicators of schizophrenia and psychosis (10,11). While it is well documented that voice-hearing and other symptoms can run in families, suggesting a genetic component, and other factors like viral infections or imbalances in dopamine have been said to influence the development of schizophrenia, there is no tangible proof of biological cause and it cannot be diagnosed through biomedical processes like brain scans or blood tests (8,12,13). A schizophrenia diagnosis is dependent upon and derives validity from a psychiatrist’s categorization of symptoms as abnormal, and the patient’s illness experience becomes fundamentally based on a socially constructed diagnosis that labels that person and their symptoms as being abnormal and sick (15).

The Hearing Voices Movement (HVM) – just one of many such groups – has a completely different explanation to account for the hearing of voices other than a schizophrenia diagnosis. HVM seeks to illuminate and challenge the socially constructed nature of psychiatry and to provide a different way to conceptualize and respond to voice hearing (3). They believe that just as a diagnosis is constructed rather than inevitable, so is the assumption that certain symptoms, like AVH, are indicative of illness (10). Instead, voice-hearing is seen as a meaningful experience, one that can be interpreted in different ways. The voice-hearer is argued to just be experiencing different stimuli with which they construct their reality (10): “the schizophrenic utterances we have focused on would normally be called delusions, that is false beliefs about external reality. But when viewed as simply true expressions of some individuals’ experiences, in the light of the Kantian notion of objective reality as a production, they are reinvested with a new meaning” (16). From this perspective, voice hearing is not a symptom of illness or abnormality, nor does it mean that a person is losing touch with reality. Indeed, 5% of people who are otherwise healthy experience AVHs, and many have no negative reactions and live with their voices without any need for psychiatric intervention (17). If we consider that reality is just a construction based on our own experiences of the world, then voice-hearers are simply creating their understanding based on a slightly different model. The HVM is just another legitimate construction attempting to regard AVH in a way that patients can understand and relate to, and for some patients it may provide a more acceptable explanation than a Western bio-medical diagnosis.

All these different conceptualizations, whether based on psychiatry or the HVM, serve to name and frame experience, perhaps to help access health care, perhaps to aid in defining identity, perhaps to search for a “real” reason for suffering, or perhaps, simply, to be able to understand suffering and make sense of it (4). These symptoms do not necessarily have to be looked at as signs of illness or deviance; instead they can be understood as different experiences of reality (16). While the dominant medical psychiatric discourse may seem inevitable, it is not. This is not to say that diagnoses are not helpful; indeed, psychiatric diagnoses can provide legitimization, normalization, and hope for a cure for many patients. It makes conditions that some naysayers would say are imagined a reality. But in fact, patients can and must choose a method of understanding that provides them with the help they need to cope with their suffering. Whether or not voice-hearing or schizophrenia are mental illnesses or socially constructed assumptions of deviance does not de-legitimize any attempts to reduce suffering. Illness experience is simply a negotiation of reality, and legitimization relies on a patient’s perspective of “truths” as being either useful or harmful. It is simply important to note that there is more than one way to conceptualize the “truth” of a diagnosis.

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(9) Szasz, Thomas (1972) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Suffolk, Great Britain: Granada Publishing Ltd.

(10) Woods, Angela (2013) The Voice-Hearer. Journal of Mental Health 22(3):263-270.

(11) Jones, Malcolm, and Michael Coffey (2012) Voice Hearing: Secondary Analysis of Talk By People who Hear Voices. International Journal of Mental Health Nursing 21:50-59. (12) Smith, Brian (2013) What Causes Schizophrenia? Psych Central. Reviewed 30 January. Web. Available at <>

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(15) Gray, Benjamin (2008) Hidden Demons: A Personal Account of Hearing Voices and the Alternative of the Hearing Voices Movement. Schizophrenia Bulletin 34(6):1006-1007.

(16)  Dawson, Paul J. (1994) Philosophy, Biology and Mental Disorder. Journal of Advanced Nursing 20:587-596.

(17) Pedersen, Traci  (2013) Why Hearing Voices is No Problem for Some. PsychCentral. Reviewed May 25. Web. Available at <>