Informed Choice

There are many ways of understanding what we mean by “mental health.”

In Western countries, mental health is an idea that comes from psychiatry (Rose & Abi-Rached, 2013). This field understands behaviours, emotions, perceptions, and relationships as a field of medicine. However, psychiatry is not universal (Fernando, 2014; Mills, 2014). Many communities around the world have other valid ways of understanding and responding to human distress (Linklater, 2014; Chioneso et al., 2020; Jones et al., 2019).

If you are experiencing difficulties in these areas of life, please know you are not alone. Accessing mental health care is an important option that exists for you.

The field of mental health is not in agreement over some of its claims and treatments. Knowing about criticisms and controversies within the field is important. It allows you to make informed choices about the kind of support you need (DeFehr, 2017, 2020, 2022).

A common myth is that chemical imbalances in the brain or body cause mental health problems. But the chemical imbalance hypothesis has never been proven (Moncrieff et al., 2022).

Apart from a few mis-filed conditions such as sleep apnea, there are no scientifically valid biomarkers for any mental disorder (Boyle & Johnstone, 2020; Davies, 2019; Kupfer, 2013).  This means the field of mental health has no lab tests to find signs of illness (pathology) in the body (Cosgrove & Vaswani, 2019; Johnstone, 2019). No lab tests are required for diagnosis of mental disorder (APA, 2013).  Psychiatry has been hoping to develop its first lab test for many decades without success (Boyle & Johnstone, 2020).

At the same time, there is quite a lot known about the social causes of these problems. People facing difficult and unfair social realities often struggle in life. These struggles can be seen in behaviour, emotions, perceptions, and relationships. Poverty, violence, childhood neglect and abuse, sexism, homophobia, transphobia, ableism, white supremacy and racism, impacts of colonialism, lack of support for parents and families, social isolation, and many other aspects of modern life are all known causes (Rimke, 2016).

Understanding difficult feelings and behaviours as disorder or disease is one way of looking at them. It is a choice available to you if that is helpful for you. But it is also possible to see these as responses we have to the difficult world we live in. We all develop coping patterns to the realities of our world, for better or worse. Our brains adapt and learn these strategies to meet our survival needs.

At the end of the day, these problems are real problems whatever their cause. They have impacts on individuals, families, and communities. They can cause difficulties in daily functioning. Sometimes, they can even be deadly or dangerous. WHC takes these problems seriously. We want to make sure you know the facts and what your choices are.

Mental disorder diagnoses are terms such as depression, OCD, bipolar, ADHD, or schizophrenia. These terms allow psychiatrists to have a common language. These are terms used to categorize people’s behaviour, emotions, and perceptions.

It is important to note that mental health diagnostic terms are descriptive. This is different than in other areas of medicine, where doctors describe and discover illness through scientific process that focuses on physical aspects of the body.

Psychiatrists hope that one day biological causes for their categories of mental disorders (also called “mental illness”) will become clear (Kupfer, 2013) but they have been searching for many decades (Rose & Abi-Rached, 2013). At this time, psychiatric diagnosis remains descriptive only.

Mental disorder diagnoses have many functions, which can be positive or negative. People have a wide range of experiences once receiving their diagnosis from “validating and positive,” to “a mix of good and bad,” to “negative or harmful.”

As always, your unique experience is valid.

On the positive side, diagnosis can convey a sense of understanding. A sense of an answer and validation that can be a relief to receive. It can open the door to resources, financial help, prescription drugs, and a community of support.

Mental health diagnosis is also used within the medical administrative process to communicate with other healthcare providers and for billing purposes.

On negative side, mental health diagnosis may cause unintended problems down the road.

Note: Doctors, psychologists, nurse practitioners and physicians’ assistants are the only professionals in Canada that make mental disorder diagnoses. In Canada, Social workers, family therapists, counsellors, teachers, midwives, and nurses do not.

Mental disorder diagnoses describe what is thought to be wrong with you. The idea that people are defective or that their minds are “not normal” can affect a person’s sense of identity. It can lead to difficulties trusting yourself or your mind, which can also increase dependence on your health care provider. People can find that their emotions or mental experiences become frightening to them.

Mental disorder diagnoses can be a deciding factor in child custody, adoption, and criminal cases (Deutsch & Clyman, 2016). They can affect other areas of life as well. They can prevent you from pursuing some professional licenses (DeFehr, 2020; Transport Canada, 2018) or being approved for some types of insurance — or when approved, put you in a higher insurance premium category (Sarmah-Hightower, 2020).

They may also be used to determine immigration and deportation status (El-lahib, 2015; Joseph, 2015; Mi-Kyung, Varghese, Jindal, & Efird, 2017) and can work against people seeking organ transplant eligibility (Cahn-Fuller & Parent, 2017). 

Mental disorder diagnosis often occurs within the first few minutes of an appointment (Frances, 2013). The diagnosis is then documented in your medical record. There is no method of removing a diagnosis from your medical record, even if you are no longer having these problems, you received your diagnosis as a child, or if your healthcare provider thinks it is incorrect; the original diagnosis must still be legible (Canadian Medical Protective Association, 2009, 2021; DeFehr, 2020).

There is also no way to legally be cleared or officially considered recovered or cured from a mental disorder (DeFehr, 2020). The only options available after diagnosis are in remission (full or partial) or relapse (APA, 2013). Just as there is no lab test verifying the presence of mental illness there is no lab test to prove the absence of mental illness (Cosgrove & Vaswani, 2019). There is no limit on how many diagnoses a person can receive.

Mental disorder diagnosis also unfortunately come with stigma. Stigma means “an attribute that is deeply discrediting” (Goffman, 1963, p.3).

One of the questions in the field is where stigma comes from. Is it from the public’s judgmental attitude of these problems, or from a model that uses labels of abnormal? It could be both. Stigma is highly unfair, but unfortunately can change the way you or others feel about you.

People have always used substances to help enhance life and dull pain, and likely always will. WHC supports the use of prescription drugs that helps you function or thrive in your life.

There may be times when psychiatric drugs could be helpful to you. They can be valuable tools and remain options for you. Often, psychiatric drugs are not helpful for long due to the phenomena of tolerance (Moncrieff, 2013). People then may need to stay on the drugs to avoid withdrawal (Hengartner et al., 2019; Horowitz & Taylor, 2022; Davies & Read, 2019; Read, 2020). Research on psychiatric drug withdrawal shows effects can be mild to severe. Some people are not able to stop taking the drugs due to the severity of their withdrawal symptoms.

Psychiatric drugs do not correct chemical imbalances or affect known areas of pathology (Moncrieff, 2020; Moncrieff et al., 2022). Rather, psychiatric drugs are psychoactive substances that create an altered state of consciousness (Moncrieff, Cohen, & Porter, 2013; Moncrieff, 2013, 2019, 2020). Hopefully, it is one you prefer and that helps you in your life. This altered state may or may not be noticeable to you, and usually does not involve euphoria. Classification of psychiatric drugs are either sedatives or stimulants.

It is important to understand how psychiatric drugs work. There is a large range of experiences people have with them. Consider your needs, the potential risks and benefits, and know your options before starting them.

Since there is potential for harm in mental health services (Timimi, 2017), we want to inform and empower you in your care. Informed choice is unfortunately rare in the field of mental health. Clients, patients, and the public rarely hear about these issues (Johnstone et al., 2018). We do not want anybody to not benefit from or be harmed by their diagnosis or treatment.

The ethical responsibility for informed consent rests with your healthcare provider (Canadian Medical Association, 2018; Canadian Psychological Association, 2017). It is common for healthcare providers to use an “implied consent” standard of care for mental disorder assessment and diagnosis (DeFehr, 2020). This means the provider assumes a client asking for their professional opinion is the same thing as consent. Implied consent has not been sufficient to prevent people from feeling misled.

A power balance exists between a healthcare provider and the client/patient. This can make it challenging to talk to them about your concerns. It becomes more challenging for marginalized groups who find they are not understood or listened to.

Healthcare providers intend to help the people they serve. Unfortunately, many are not aware of the potentials for harm or may not consider the impact of the power imbalance.

It is also rarely considered that a mental disorder diagnosis has potential for harm all on its own. Our hope is to raise awareness of these issues and advocate for a higher standard of care.

If the areas we have highlighted are concerns for you, the best course of action is to educate yourself. It is important to know about these issues before you talk to your healthcare provider.

You can ask your doctor to delay a diagnosis until you have had a chance to look at your choices, however, not every provider will agree to this. If you want to decline a diagnosis entirely, you can talk to your healthcare provider about your concerns and see if they are able to assist you without one — this may or may not be possible.

Accessing help is also possible outside of the field of medicine.

There are many ways of approaching the problems we call mental health. There are choices available to work with these problems with or without prescription drugs, such as:

• Finding social support
• Connecting to loved ones
• Connecting to community, culture, or spirituality
• Accessing counselling, therapy, or groups
• Talking to trusted people in your life or community
• Learning more about your own wellbeing and the problems you’re experiencing
• Learning to respond helpfully to your needs
• Making decisions and acting on areas that are problems in your life
• Committing to taking care of yourself in multiple ways

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