The impact of a psychiatric diagnosis on the self-narrative of the recipient

Abstract

A psychiatric diagnosis can have a range of effects on the person receiving it. Some welcome the diagnosis, seeing it as an explanation for their distress, while others perceive it as an unwelcome medicalised label impinging negatively on their sense of themselves as rational agents. I focus on how the diagnosis affects the latter group, and in particular how it may impact on their self-narratives. I therefore outline some key themes in narrative theory which have been explored in various ways by philosophers, though to a lesser extent by psychologists. These theorists emphasise the importance of self-narratives in human psychology. I argue that those receiving a psychiatric diagnosis may be vulnerable to experiences of epistemic injustice, as described by Miranda Fricker. This includes what Fricker describes as hermeneutical injustice, where individuals lack the ability to understand their experiences or difficulties in ways that make sense to them. The medicalisation implicit in psychiatric diagnoses conveys a particular kind of narrative which may conflict with the recipient’s previous self-narratives. When such effects occur, they may reduce the recipient’s sense of agency and induce feelings of hopelessness about recovery, which may then limit the prospect of a positive outcome for the person concerned. A greater use of formulation could mitigate those effects.