Is it ethical for a therapist (not a medical doctor) to diagnose a family member of having bi-polar disorder?

[junkets1961]

Can a family member (psychologist, not psychiatrist) ethically diagnose a family member for a mental illness?
My psychologist sister-in-law (not a medical professional, just a licensed therapist) constantly tells -- and "confides" in -- others (including me) that my wife is either bi-polar or chemically "imbalanced". This has caused deep division within their family (their late father, as well as their mother, have time and again punctuated their conflicts and differences with my wife with a "well, you're just bi-polar" conclusion). My wife deeply resents her sister, not just for posing herself as an "expert" in this arena, but also for having this constant need to "diagnose" her. That she then presents herself as a "professional" and shares her "expert" diagnoses confidentially with my wife's close friends, family members, and acquaintances just infuriates my wife. I myself get incensed whenever my wife tries to talk with her about this, as she inevitably puts my wife off because of her "condition". I am at my wit's end trying to help my wife to get her sister to stop this behavior. Not from having her "opinion", but from representing it as a "diagnosis" to our friends, family, and acquaintances. Any thought or suggestions would be welcomed. Is it possible, as a last resort, to report the sister's behavior to a licensing board?

[lindahand]

I come from a past that is less than stellar. One book that really helped me was called "Healing the Shame that Binds" by John Bradshaw. Considering the toxic nature of your wife's family she may find it helpful. It is an old book so you may have to go on Amazon to find it. I am pretty sure it is still in print as it is considered a classic.

As for the sister in law. Sit her down, tell her it has to stop. If it doesn't cut her out of your life, or do so to the extent that you can. Sounds harsh but may be the only way to stop the abuse. Because your sister in law is abusing your sister and stopping abusive behavior is difficult. SIL probably truly believes she is helping her sister, and delusions of that nature are hard to overcome. It is a bit like the sentence "Have you stopped hitting your wife?" If you say no then it implies you are hitting your wife. If you reply yes it means you used to hit your wife. There is no winning answering the question. The only thing you can do is walk away. I think you have to lay down the law. Stop it or you are no longer part of my life.

[junkets1961]

Hey, CrazyCali.

I appreciate your input. However, when you wrote, "yes your wife may have bipolar disorder", it makes me think you are missing the boat. The point of my missive was not my wife's "condition", but rather my sister-in-law's inappropriate "diagnosing" behavior, her blurring of professional and personal boundaries, her meddling where she was not invited, and her inexcusable and unethical sharing of information she may have, for all intents and purposes, created in her imagination, with others.

Your other comment, "If you and your wife think that she may have bipolar disorder or some other mental illness then i suggest finding a therapist/psychiatrist that your wife can fully trust" also suggests that you were not altogether getting the point I was making.

PS I think I accidentally nominated "Best Answer" to your comment which was certainly not my intention. No offense.

[junkets1961]

Thank you for your insight, rogelio63.

That may have to inform the approach my wife and I will have to take with regards to the sister. It is an almost Sisyphean dynamic that had been put into motion so many years ago (when the sister first put the "diagnosis" out there), to the point where the family relating defaults into "well, you have chemical imbalance, that's why get so mad all the time", which, of course, can only elicit a ragedul response, thereby "proving" the sister and family's position. (It's like the syllogism "you are either an alcoholic or in denial - denial is a symptom", or the more grown up version "I know you are so what am I?")

As an outsider (this dynamic was put in place many years before I married into this particular family, a combination of the the Hatfields, McCoys, and Corleones), it appears that the bi-polar disorder "diagnosis" provides a convenient crutch for family members to latch onto when difficult, painful subjects come up (including the childhood abuse and neglect), and spares the perpetrators the duty and responsibility of listening.O

Still, they are family, and we have to figure out some way to anaestethize that toxic relating mode, or keep it at army's length.

Once, again, thank you for the insight.

[rogelio63]

I'm a retired physician and it's never a good idea to diagnose members of your own family.  Especially if the diagnosis relates to mental health. You can't be objective.  You just can't.  I'm not the only physician I know of that has said the exact same thing.  In fact, working in the hospital, I've known of doctors with family members on their floors that had their family see another doctor, one they trusted.  You can't help but watch the treatment and as a learned colleague evaluate it, but you have to put your trust in another doctor because they see things that you don't.

[junkets1961]

As a special educator since 1982, I've worked with numerous children and adults diagnosed with a wide variety of physical, learning, emotional, mental, and social challenges and differences (including autism, schizophrenia, bi-polar disorder, Down's Syndrome, quadriplegia, etc.). While I have worked intimately and intensively with individuals struggling to "fit in" with their challenges to what is a sometimes abrasive and intolerant society, I have left the diagnosing to trained, experienced, and medical experts, and contented myself with teaching, coaching and encouraging (to the best of my ability) those whom I was fortunate to have at my charge.

Again, I leave the diagnosing to others. Still, my close to 30 years experience  in the field tells me my wife is not bi-polar. The "troubling" behavior my wife exhibits (rage) and which my sister-in-law sees fit to "diagnose" as symptomatic of a bi-polar disorder to me seems an appropriate response to her family relating dynamic. My wife's childhood, and, to a lesser extent, her sister's) has been marked by abuse and neglect at the hands of an incompetent mother and an alcoholic father. The rage that erupts in her in response to them (and the therapist sister who refuses to discuss their shared past) I believe to be, in addition to bottled up and accumulated rage, a learned response: that is the way members of that family handled their anger. To take that behavior out of context of the family dynamic and then give it a label I think is patently wrong. I think it is also immoral for someone involved in that family dynamic to do the diagnosing. Ethically, since the sister does not have any formal training in that arena, I think it is unethical and possibly illegal.

I have no doubt my wife could benefit from counseling. She is open to it, and we have already made some inroads in that direction.

It is my sister-in-law's heinous behavior that is extremely troubling and disturbing, and which I want to manage in order to keep it from harming our lives.

Thank you.