Diagnosis as a Naming Ceremony

Our modern society likes to draw a sharp dividing line between “religion” and “science.”  Religion is the stuff of ritual and superstition, while science is a beautiful man-made structure built entirely of FACTS.  Objective.  Proven.

I don’t think it works like that.  Faith is an integral part of life – even in the presence of facts, faith can make all the difference in the world.  Likewise, ritual, or patterned behavior with special significance, is something that we as humans can’t help but create in our interactions with others and the world around us.  Easy to recognize in other cultures, but harder to see in your own — until you start looking.

Now what would happen if we subjected the culture of psychiatry to the anthropological gaze, started looking for the mystical, ritualistic elements there…?

“We’re a science, too!”  – Psychiatry

Psychiatry is kind of an easy target.  When it comes to “scientific disciplines,” psychiatrists/psychologists have always had a sort of inferiority complex as they compare themselves to doctors treating biological pathology, and with good reason (this, in part, is what has driven the bio-chemical argument of mental illness; if biology causes it, than psychiatrists are real doctors treating real pathology, too!  Of course, money played the biggest role of all – biochemcial imbalances are treated with pharmaceuticals).  Psychiatric illnesses are amorphous, ill-defined categories that seem to run together into one blob.  A quick glance through the DSM-IV, psychiatry’s diagnostic Bible, confirms this; nearly every category of diseases includes a catch-all – if a patient doesn’t fit any of the criteria for the above, stick ‘em in here.  Additionally, co-occurring diagnoses are the norm, not the exception.

This can easily lead to over-pathologizing, where every symptom is associated with a different disorder and a different drug to treat it.  That’s how kids end up with every major diagnosis in the book attached to them, 6-8 pharmaceuticals taken daily, and a heart-breaking, bewildered look in their eyes.  I’ve seen it.  A lot.

Is this kid really ADHD, bi-polar, autistic, schizophrenic, Aspbergers?  (and that is how kids will identify themselves sometimes) How can it be?  It is only so because doctors have said so… not because science has shown it to be “true.”

Diagnosis as a Naming Ceremony

Keeping the mystical, amorphous elements of the DSM-IV discussed above in mind, let’s take a look at diagnosis not as a scientific process of placing pathology into pre-defined categories, but as a ritual – the naming ceremony.

DIAGNOSIS

A patient must come at an appointed time to an appointed place.  This place (the doctor’s office) is kept ritually clean – I say “ritually” because there is little fear of contagion from someone suffering mental distress.  In this room, there are all kinds of ritual “equipments,” their purposes relatively unknown; an examining table with tissue paper spread over it perhaps, many implements and gadgets, and of course the ubiquitous pharmaceutical ads and products, speaking a foreign language of miracle cures.

 

In mental health (as opposed to physical health and general practice), a DIAGNOSIS, once given, will likely stay with the patient for life.  Doctor after doctor (no matter his discipline) will repeat and reinforce the new name.  It can easily come to define the person upon whom it was bestowed.

These names have a power which most pdocs readily invoke.  “You are bipolar, and you will need to take meds for the rest of your life.”  A DIAGNOSIS represents a strong, mischievous, psychiatric spirit that will wreak havoc in the patient’s life if not placated regularly with offerings (pharmaceuticals), or so your doctor will likely tell you.

All of this implies a loss of control, of agency for the person so named.  The spirit of DIAGNOSIS now rules that person’s life.

Eduardo Duran describes diagnosis

Eduardo Duran is a Native psychologist trained both in “Western” methods and the traditional healing practices of his people.

In Healing the Soul Wound: Counseling with American Indians and other native peoples, Duran expands on the ritualistic nature of diagnosis:

Naming ceremonies are part of Native traditions and are used to assign spiritual identities to those receiving a name.  Therefore, the naming ceremony performed by a healer or therapist has deep implications to the individual and community…

The patient goes through a diagnostic process that she perceives as a naming ceremony that literally gives her an identity of pathology… The patient then takes on the identity of being sick and in so doing carries the illness being projected by the therapist into her psychological makeup…

Over the years, I have had many patients who identify themselves as a diagnosis and not by their given name.  Many of these patients are quick to tell their new therapist that they are depressed, anxious, alcoholic, and so on.  Their identity has been crystallized through the unconscious naming ceremony of the diagnostic process.  Within some of the belief systems of Aboriginal People, there is the notion that once a name is given, it remains until a more powerful ceremony occurs…

–          Eduardo Duran

Duran goes on to discuss a way of using diagnosis positively.  In part, this involves recognizing the power that such a name may have for the patient and the healer:

The fact that diagnosis is such a pathologizing and colonizing activity does not mean that diagnosis is a totally useless activity.  If the healer/therapist is able to make the diagnosis within a proper cultural context, then this is part of the therapeutic/healing encounter.  As part of their healing work, Traditional Healers take part in diagnosing patients as part of the treatment encounter.  The mind-set and psychology that the Traditional Healer utilizes as part of the naming of the illness in order to extract or balance the energy creating the problem for the patient is very different from the Western medical model approach…

Traditional Healing in most Aboriginal cultures is based on the belief that illness itself has a consciousness that relates to the psyche and the body of the individual.  Belief that illness is conscious leads to the idea that all illness has a distinct purpose that eventually will teach and bring wholeness to the individual…

The key purpose in naming a sickness in Traditional Healing is to restore a relationship with the energy of the sickness.  Instead of the fearful antagonistic purpose of diagnosis in Western healing, the illness energy is not perceived as inherently evil nor is it something to be extinguished.  Once the patient and the healer discover the identity of the illness, the illness can be asked about its purpose and about what it is trying to teach the patient and the healer…

–          Eduardo Duran

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