ABSTRACT
It should be understood that the issue in this paper is not one of breach of confidentiali ty. Rather, the concern is with the potential defamatory nature of DSM diagnoses even when there is consent for communication of the diagnosis to particular others.1 However, note that the consent may not be truly informed in that the full implications of having the diagnosis and of having it communicated to others may not be adequately understood by the client at the time he or she proffers their consent. Consider in this regard that there is evidence that internalizing the medicalization of one’s DSM-defined “mental health problem/disorder” is a strong predictor for depression (White, Bebbington, Pear son, Johnson <Sl Ellis, 2000). Further, it has been found that those who accept explana tions of their experience as one of having experienced a “psychotic episode” are also more prone to depression than those who resist integrating the experience in this way (Jackson et al., 1998). One is safe to assume that the client had acceded to the DSM la bel, to the extent they did, in the hopes that the entire process would alleviate psycho logical distress. Thus, significant depression as a function of receiving the DSM diagnosis may suggest, at least for some voluntary clients, a lack of full informed consent in subject ing themselves to the diagnostic process and in agreeing to have the diagnosis communi cated to certain third parties. (This is aside from the issue of whether the consent to treatment and communication of the diagnosis to others was genuinely voluntary. This is difficult to discern given the societal pressure to cooperate in all respects in the hopes of conforming one’s behavior and reports of personal experience to the norm).
