Definition
Iatrogenic harm (Greek iatros = "healer" + -genic = "produced by") denotes harm caused by the therapeutic intervention itself rather than by the underlying condition. The term originated in medicine to designate complications of treatment — surgical infections, drug side effects, hospital-acquired conditions — and has been extended to psychotherapy and psychological interventions, where it includes:
- Retraumatization — therapeutic exposure that re-injures rather than processes
- False-memory induction — confident belief in events that did not occur, generated by suggestive interview techniques (the recovered-memory controversies of the 1980s–1990s being the canonical case)
- Symptom proliferation — therapy frames that produce the symptoms they purport to discover (ironic example: certain DID treatment protocols can multiply alters)
- Dependency — therapeutic alliance that erodes autonomous coping
- Misdiagnosis cascade — initial diagnostic error producing escalating mismatched interventions
- Stigma and labeling — diagnostic classification producing identity-internalization harms
Empirically, psychotherapy is generally net-beneficial across populations, but iatrogenic harm rates are non-trivial: meta-analytic estimates suggest 5–10% of clients experience deterioration during therapy, with higher rates for specific high-risk modalities and populations. The discipline of evidence-based practice exists in significant part to constrain iatrogenic risk through protocolized intervention.
In the EA recovery context, iatrogenic risks are especially elevated because the underlying damage is precisely to the epistemic apparatus the therapy must rely on. Standard trauma-processing techniques can:
- Reinforce the perpetrator's framing if the therapist accepts the victim's perpetrator-supplied narrative uncritically
- Destabilize an already-fragile self-structure through premature intensive exposure
- Substitute the therapist's interpretive authority for the perpetrator's, perpetuating epistemic dependence rather than restoring autonomy
- Mistake EA-induced fragmentation for trauma dissociation and apply protocols that miss the active external manipulation still in progress
Context
Within the Prismatic Platform Kompendium, iatrogenic harm is treated as a first-class clinical concern in the application chapter /kompendium/06-klinicke-aplikace/. The chapter explicitly warns clinicians against several common errors:
- Premature narrative reconstruction — pushing the client toward a coherent story before the epistemic apparatus is repaired enough to evaluate competing narratives
- Interpretive authority transfer — replacing the perpetrator as "the one who knows what really happened" rather than restoring the client's own evaluative capacity
- Diagnosis-as-identity — anchoring the client's self-understanding to a clinical label in ways that produce new fragility
- Single-modality fixation — applying one therapeutic frame (CBT, EMDR, IFS) without integration
The Mereologická rekonstrukce approach is designed in part to minimize iatrogenic risk by sequencing interventions: first restore source-evaluation capacity, then re-establish narrative coherence, then process specific traumatic content — never the reverse.
- Disociace and EA must be carefully distinguished; treating one as the other produces reliable iatrogenic harm.
- Narrative Identity reconstruction must be client-led rather than therapist-imposed.
- The Decision Engine supports clinicians by surfacing differential-diagnosis indicators rather than committing to single hypotheses prematurely — a design pattern that mirrors good clinical practice.
- Color Teams Blue Team protocols include iatrogenic-risk audits when designing platform interventions: even technical defenses against EA can produce iatrogenic effects (e.g., aggressive content filtering inducing learned helplessness or reality-checking-dependence).
The kompendium's stance is unequivocal: an EA recovery intervention that does not actively monitor for iatrogenic harm is professional malpractice, not therapeutic care.
See Also
- Disociace — Differential-diagnosis counterpart
- Mereologická rekonstrukce — Risk-minimizing approach
- Epistemická anihilace — Underlying condition
- Narrative Identity — Reconstruction target
- Kognitivní anihilace — Adjacent harm category
- Metakognitivní destrukce — Specific damage subtype
- Kompendium — Full Czech-language taxonomy
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Created by Tomáš Korcak (korczis) | Open Source under GHL