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Re: The artificial nature of psychiatric diagnosis ed_uk

Posted by Larry Hoover on December 1, 2004, at 11:23:26

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 11:05:15

> > to a degree that is maladaptive and inconsistent with developmental level
> Hi,
> It is highly subjective. It is impossible to draw a line between what should be considered maladaptive and what should be considered to be 'normal'.
> Regards,
> Ed.

Of course it's subjective. The difficulty inherent in making the judgment should not be used to deny the validity of the diagnosis itself. When we view human behaviour on a continuum, we may be unable to agree on where the division between normal or maladaptive is, precisely, but we can come to some concensus on the extreme itself.

We end up relying on training and experience for those discriminations. It's all we have, absent some non-behavioural metric.

I'm somewhat leary of diagnosing children based on our expectations of them, but childhood is characterized by undeveloped insight mechanisms.

In adult disorders, the phrasing is different. It's typically something like: "disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning".

This tends to rely somewhat on the patient's insight. Then we have the case where insight itself is lost, as a symptom of the putative disorder. Psychosis, as an example. We then rely once more solely on the experience and training of the assessor.

Unless someone's got a better idea how to do this diagnosis thing, it remains our best resort, impaired as it is by the bias, deficiencies, and inattentiveness of the designated assessors themselves. Attempts have been made to objectify diagnosis (e.g. MMPI-1 and -2), but those darn patients are a varied lot, and it's hard to find the right way to describe them uniquely.

It's evolving. At least, it's not static.





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