Posted by sailor on December 1, 2004, at 21:57:54
In reply to So, Ed, do you have an opinion here?, posted by Racer on December 1, 2004, at 20:07:44
During about 2 years of perusing PB quite regularly, I must say that Ed's initial post, and the responses it evoked, are profoundly meaningful
and provide a much needed context for the current practice of Psychiatry. I worked for 5 years as a crisis intervention specialist for a county mental health center. Most of my time was spent evaluating and "diagnosing" emergency room patients suffering mantal health crises. A significant percent of these clients (my preferred word) were to be screened, among other things, for suicide risk.
Though I was always expected to provide a DSM "diagnosis" in my evaluations, that act was of little value in arriving at a disposition, or recommendation for what to do with the client.
The mere act of labelling clients with a DSM code can foster the illusion that something is then "understood" about that client, and that a plan of action is implied. I took my job seriously, I was told that I was good at it, and I took satisfaction in connecting clients with useful resources.
I came to realize that I rarely ever knew what was really "wrong" with most of these clients, or what really was the cause of their "mental illness". In fact, the more I learned about each client, the deeper I probed, and the more I just listened, the more "different" they became from another person who would qualify (by DSM) for the exact same diagnosis.
Dispositions were decided more by intuition (the wisdom of accumulated experience) than by science or protocol. Looking back, I can see that the DSM was unnecesary and practically worthless in the actual process of helping the client.
I do agree there is some value in these categories in roughly defining groups, or populations of clients. For example, "paranoid schizophrenics" as a group are clearly discernible from "autistics". But when you look inside these arbitrary groupings, you find that for almost any individual, different psychiatrists will have different diagnoses (or variations of the major diagnosis), different explanations for cause, or etiology, and almost always a different treatment--usually consisting of one or more psychoactive drugs.
Is this a condemnation of the field? No, not from me, as I believe most psychiatrists are well intentioned and aware of multiple treatment options. I doubt that most of them could do any better given the tools of their trade and the biases or "protocols" they feel compelled to subscribe to as "professionals."
Let the client beware. Educate yourself, if you are lucky enough that your illness allows you to do that. It doesn't take long to learn as much, or more, than your psychiatrist, about your "diagnosis"--which is no more than the total of your symptoms. The name doesn't change what you "are" or what you "have".
If you're lucky, and if psychotropics are for you, you will find the helpful one(s) early and there's a deserved triumph for the pharmaceutical companies! However, at least half of us are not so lucky and we must rely on persistence, patience and some dumb luck for help.
After more than 30 years of being labelled with Major Depression, I now don't know what I "am", or what caused "it", or what can best help me. I just know how I feel and I know I can and should and deserve to feel better.
And I'm convinced my answer, if I live long enough to see it, will come from advances in evaluating the neurobiological status of each individual, and knowing which psychotropic drug(s) can best adress detected abnormalities.
Wish I could be as concise as Ed. Difficulty focusing or being concise is part of my illness.