Posted by ed_uk on December 2, 2004, at 6:55:09
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 2, 2004, at 4:37:50
Hello,
I notice that a lot of people have brought up the issue of insurance. Here in the UK this is less relevent because people are treated on the National Health Service. Everyone pays for the NHS through taxes. Psych patients do not pay for their care on the NHS. I get the impression that in the US the DSM is valuable more on a financial level than on a personal level!
It's interesting to note that a lot of people seem to use their DSM diagnosis (eg. ADHD) as an explanation for their problems eg. I didn't succeed at school because I had ADHD. In reality, a DSM diagnosis doesn't really explain anything because each diagnosis is little more than a list of symptoms. Saying 'I didn't succeed because I had ADHD' is no more helpful than simply saying 'I didn't succeed because I found it difficult to concentrate in class'. A DSM label does *not* explain the cause of a persons problems, nor does it tell us whether a person has any responsibility for their own problems. Yesterday, I went on a site about ADHD. A parent said 'I felt responsible for my child's failure at school until he was diagnosed with ADHD'. I found this a very interesting point because the DSM makes no attempt to explain the cause of an individual persons symptoms. It certainly doesn't attempt to tell us whether a parent is responsible!
I often feel that patients are being misled into thinking that their DSM diagnosis is a specific neurological disease. Patients diagnosed with DSM dosorders such as bipolar disorder may well be suffering from neurological problems but it is important not to forget that the DSM diagnosis itself is not neurological is nature. Each diagnosis is based on subjectively measured symptoms and not on the direct measurement of neurological function. To give an example..........In the future, some of the people who are currently diagnosed with bipolar disorder may be found to be suffering from specific genetic diseases but others will not. A genetic problem which may be present in one individual who has received a DSM diagnosis of bipolar disorder may be very different to the genetic problem in another person who has received the same DSM diagnosis. This is the inevitable result of using diagnostic categories which are not based on physiological measurements (such as a blood test or an MRI.) DSM psychiatric diagnoses must not be seen as specific conditions. The DSM should be seen for what it is, an inadequate attempt to divide mental health problems into discrete categories.
So you might ask... if we don't use the DSM how should a diagnosis be made? I am not suggesting that the DSM be abandonned. I think the DSM has a useful place in clinical trials of drugs and may also be useful in other circumstances. It is vital, however, to recognise the DSM for what it is and not to overestimate its value.
A diagnosis of MDD tells us very little. It should not be regarded as an explanation for a persons distress. It does not tell us the cause, it does not tell us which treatment would be best, it does not take a persons psychosocial circumstances into account, nor does it describe the nature of any biological abnormailty which may or may not be present.
In clinical practice, a simple list of a persons problems/symptoms would be more useful and more truthful than a DSM diagnosis. So many times I hear people say things like 'Now I've been diagnosed with major depression I know what my problem is, my doctor says I've got a chemical imbalance'. Well, such a patient may have a chemical imbalance but her doctor certainly doesn't know whether that is the case. Synaptic levels of monoamines are not measured in a psychiatric consultation. In is important that psychiatric theory is recognised as thoery, and not misleadingly presented as fact.
Regards,
Ed.
poster:ed_uk
thread:422741
URL: http://www.dr-bob.org/babble/20041201/msgs/423267.html