Posted by llrrrpp on July 2, 2006, at 17:44:38
In reply to symptoms and clusters » llrrrpp, posted by pseudoname on July 2, 2006, at 16:39:33
Hi Pseudo,
you're most welcome for dialoging. Apologies for being unclear. My brain is pretty fuzzy today. *yawn*Human minds are adapted to use categories in their reasoning. It allows us to use a little bit of data to make a lot of predictions. For example, show me a photograph of a cat, and I can predict that the cat likes to eat fish, was not hatched from an egg, and is not a happy swimmer. This is because I have a schema of "cat" that allows me to draw a lot of generalizations about any individual cat based on what I know about the category "cat" as a whole. [nevermind that *my* cat prefers muffins over salmon...]
Similarly, my pdoc looks at me, an individual, complaining of x,y, and z. Asks me a few more questions, asks me if there's anything relevant that he should know about (I never know what I should mention here- depression pretty much affected most of my body's systems and most of my social interactions). Pdoc asks me about my family history- again, what's relevant? Grandpa's alcoholism? Father's explosive temper? My sweet great-grandmother who lived until her late 90's with no dementia?
Like most instances of human reasoning, practitioners use categories to make the most efficient use of limited data. The problem may be in the nature of using DSM criteria as rigid categories, rather than examining natural variation along a continuum. It's important for practictioners in various mental health endeavors to have a common vocabulary, so that when an individual has "anorexia" on his or her chart, a new pdoc can come into the scene, read the chart, and know how to structure an interview with a new patient. It's fascinating that what we call major depression has been characterized as melancholia even in ancient times, with similar discription of symptoms. Likewise it's fascinating that acute psychosis has been associated with the affected individual acting under the power of demons. The demons may be specific to China, or Salem Mass., or Western Europe, but the gross descriptions are remarkably consistent.
As a fellow wild-type human :) I derive some comfort in knowing that the symptoms I experience have been experienced before. That there's a name for it, and a drug that is approved to treat it. At this point my comfort evaporates. I ask my pdoc what's the matter with me? Pdoc says that it's probably an interaction between my genetic material and my current and past environment. That the current ways of diagnosing individuals doesn't really help pdocs decide which drugs will work best for which individuals. Brain imaging techniques can suggest that certain individuals have abnormal activity or structure, but do not specify how that abnormality came to be. Furthermore, presence of biological markers currently does not provide better indication differential response to treatment than a clinical interview, in many cases for many disorders.
In the meanwhile, I am happy that my pdoc considers my insomnia in light of the fact that I also have anhedonia, apathy, sadness, etc. We each get to do our own experiments, sample size of one. Treatment effects often difficult to distinguish from placebo effects, many uncontrolled confounding variables (Was it the increase in AD dosage, or the approach my T used with me this week? The fact that there is more daylight than last month, The fact that my workload has increased? -- what's the cause? what's the effect?). We also have to expect that a treatment that worked in the past may not affect us the same way in the future. I hope that everyone's pdoc recognizes the individuality and subjective experiences of their patients.
I already think we've come a long way in considering the entire biology of an individual, which includes their brains, and their minds; rather than treating their "mental symptoms" and their "physical side-effects" [and vice-versa] as 2 completely separate systems contained within an "individual"
*yawn* my physical weakness and my mental sleepiness suggest that I need to take a nap.
ciao pseudo,
-ll
poster:llrrrpp
thread:663492
URL: http://www.dr-bob.org/babble/20060701/msgs/663609.html