![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by ed_uk on December 1, 2004, at 8:57:15
Hello.......
As you may know, I am not the world's greatest fan of the DSM. I have no doubt that mental health problems exist, but the system used in the DSM is little more than a rather dubious attempt to 'pigeon hole' peoples very individual emotional experiences and problems into a finite number of categories. In reality, there are probably (almost) as many different mental health problems as there are people in the world!
When I was a child, my psychiatrists undestanding of my own problems was always hindered by her tendency to view all my problems in the context of social phobia- a diagnosis which never described me particularly well. More recently, the diagnosis of 'major' depression turned out to be a extraordinarily misleading description of the difficulties that I was experiencing.
I'd very much like to hear peoples views about diagnosis in psychiatry. I also suggest having a look at the DSM. My own copy has provided me with a unexpected amount of entertainmant.
Here is an interesting article..........
By Michael Conner..........
The most common, widely used and nearly mandatory diagnostic system in the United States is the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM). The DSM is published and controlled by the American Psychiatric Association (APA) and has been promoted by the APA as a technological triumph that is based on data and science. The American Psychiatric Association is not the same organization as American Psychological Association (also known as the APA).
The organization and the structure of the DSM presents an image of precise and exacting criteria that can be used to formulate the diagnosis of a mental disorder. This level of precision and the criteria have persuaded many professionals to conclude (without critical evaluation) that the DSM identifies and describes clear and distinct disorders and does so in a manner that is useful and beneficial to professionals and consumers.
The DSM does have merit. When correctly used, the DSM is very highly reliable. But this just means that a group of professionals using the DSM will often reach a similar diagnosis. The concerns expressed by scientists and practitioners are that the conclusions, although reliable, are often wrong and may do more harm than good.
There is considerable overlap among diagnostic categories in the DSM and it is possible to reach a more desirable or less desirable diagnosis depending on the evaluator. Even when there is agreement, many professionals are becoming concerned that the diagnoses and conclusions that follow from the DSM are not very useful. In other words, the diagnosis reached is not much more than a label that is based on an arbitrary set of symptoms. Most of the time a DSM diagnosis does not indicate the best course of action or even what treatment is necessary.
More and more managed care companies are asking professionals to make a diagnosis using the DSM and to provide treatment in a systematic and cost effective manner. For example, if your symptoms fulfill the criteria of a major depressive episode, then managed care wants to know what treatments and/or what drugs should be used for that diagnosis.
Unfortunately there does not appear to be any clearly useful relationship between the DSM diagnosis, treatment and the outcome of treatment. For all the apparent precision and reliability, the DSM diagnostic system minimizes one important fact. The DSM was not constructed scientifically but is based on a consensus building process that is highly political, partially democratic and even resistant to scientific evidence. The mere fact that any diagnostic system is reliable does not mean the process is valid, useful and not harmful.
Another important scientific observation has been the finding that very similar symptoms and behaviors that will result in a specific DSM diagnosis can have several entirely different causes. More importantly, for each cause there can be an entirely different treatment. Diagnosis using the DSM does not indicate what treatment is necessary. The differences between people and their social environments can have a dramatic influence on how symptoms are expressed. A similar source of a problem can be expressed in very different symptoms and behaviors. Culture and ethnicity are powerful moderators that strongly influence how people behave and how symptoms are reported and even experienced.
The diagnostic process employed by the DSM is nowhere near the quality and sophistication of the diagnostic process in medicine - and many physicians argue that the medical diagnostic process is not sufficiently reliable or valid. And while there are similar diagnostic processes in medicine, most medical diagnoses are at least based on objective findings and scientific methods. For example, the diagnoses of the various forms of cancer are based on the observation of distinct physical structures and biochemistry that vary. The diagnosis of pneumonia is based on a bacterial or viral agent of which each have fairly distinct symptoms, histories and responsiveness to treatment. Hypertension is identifiable based on numerical measures of blood pressure and deviation from a numerical norm.
There are only a few areas in medical diagnosis that are based purely on the patient's subjective complaints or vague medical terms. The overall diagnostic process employed in the DSM is not much more sophisticated than those used to reach the most general diagnosis of headache, a stomach ache or inner ear problems. There are many forms of headaches, stomach aches and inner ear problems. There are many things that can cause a headache - a tumor, tension, injury, disease, flu, allergies, a cold or bacterial infections etc.. In mental health, no matter how rigidly we use DSM diagnostic criteria, or how sophisticated the interview process, we are still looking at patterns that have many origins. There can be many sources and causes of a particular problem. For example, one type of traumatic experience can result in many different problems. As a result, there are many potential outcomes and treatment approaches that can vary with each individual, their beliefs, values, attitudes, culture, ethnicity and their resources.
Mental health professionals can rarely make a diagnosis based on identifiable changes or deviations in the structure or functions of the human body. With the exception of injury, aging, disease or forms of poisoning, very few mental health problems are medically related. Depending on who you ask, between 70 and 90% of all diagnoses are the result of social, psychological and cultural factors that influences our lives. In sharp contrast, the pharmaceutical companies, which support a great deal of research and medical training, generally promote the assumption that disorders are the result of defective biology or genetics. But even when problems are psychological, drug companies promote that disorders can still be treated safely and in a cost effective manner with drugs as an alternative or as as an adjunct to psychotherapy.
Other issues created by the use of DSM are more subtle, but they are real and they are important. For one thing, some professionals are losing sight of the patient as human being. They are also losing site of the diagnostic labels and the impact on patient rights and the risks associated with using health insurance. Professionals can become involved in a diagnostic process that does little more than expose consumers to significant risk in order to generate an authorization for payment from a managed care company. Of greater concern is the growing pressure by managed care to treat the symptoms of a DSM diagnosis and not the patient. The lifestyle, values and process that creates or sustains a patient’s distress are ignored when the focus is on management or reduction of DSM defined symptoms. In the world of managed mental health care there is a growing emphasis of quick diagnosis and the treatment of symptoms and not the causes. When the initial set of symptoms are initially managed, the underlying cause may be missed. For instance, a cyclical mood disorder, such as cyclothymia, can co-exist with another diagnosis such as obsessive compulsive disorder or rare hormonal condition.
The growing emphasis on DSM diagnosis has made the practice of counseling, psychotherapy and evaluation intricate, superficial and complicated, as well as increasingly meaningless to managed care, professionals and consumers. Patients should find no real comfort in a diagnosis that is reliable and specific if there is no real relationship to appropriate treatment, the outcome and quality of life.
Posted by ladyofthelamp on December 1, 2004, at 9:06:23
In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15
A man after my own heart!I couldn't agree more.We are individuals who are coming from many different directions.I spit on the 'great book of pigeon holes'!!!!LOL
Posted by ed_uk on December 1, 2004, at 10:07:06
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 1, 2004, at 9:06:23
Hello,
Overall, I think that the DSM is probably useful in clinical trials but that's about it!
Each diagnosis is essentially a list of rather subjective symptoms. 'Depressed mood' can be used as an example. So, what exactly is meant by 'depressed mood'. Surely everyone's experience of 'depressed mood' is different. Every psychiatrists definition of 'depressed mood' will be different........ Oddly, although these diagnoses are made based on symtoms, two people with the same diagnosis might have a completely different set of symptoms. Due to the fact that only 'x' out of 'y' criteria must be present in order to make a diagnosis, one person might have criteria 1,2,3 and 4 whereas someone else might have 5,6,7 and 8 and get the exact same diagnosis.
It is often argued that psychiatric diagnosis is needed in order to choose an appropriate medication. In reality, diagnosis is often of little help in choosing a drug since drugs seem to be effective in treating particular target symptoms rather than diagnoses. For example, whether a delusional individual has been diagnosed with MDD with psychotic features, schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder NOS is of little help in choosing which antipsychotic would be most suitable. Other factors unrelated to diagnosis are often more important when it comes to medication choice eg. amisulpride might be a suitable first line AP for an obese person whereas Zyprexa would be undesirable.
Although many mental health problems may well be associated with physiological/biological problems this is not an argument in favour of the DSM............ In order to make a DSM diagnosis of schizophrenia, for example, known medical causes of psychosis must first be ruled out. Diagnosing a patient with 'psychosis of unknown cause' would be much more truthful than diagnosing schizophrenia.
Knowing a persons DSM diagnosis creates the misleading impression that you actually know something about that person when infact you know very little. If I was to tell someone that I was suffering from MDD it wouldn't tell them anything more about me than telling them that I was unhappy. It wouldn't tell them what my symptoms were, it wouldn't tell them what caused my symptoms, it wouldn't tell them which treatment would be best.... in fact, it would be considerably less misleading just to tell them that I was unhappy!
There is substantial overlap between the DSM categories.... for example the anxiety disorder overlap with each other, they also overlap with the mood disorders. The mood disorders overlap with the psychotic disorders and so on.......
It is often claimed that diagnoses such as bipolar disorder and schizophrenia are biological in nature. This is probably true in some cases but not all. For example, if you consider a family with a strong history of bipolar disorder you might suspect that the disorder was genetic in nature. This is all very well but it doesn't mean that the genetic anomoly present in one family is the same as the genetic anomoly which may or may not be present in another family afflicted with similar problems. Although bipolar disorder has been associated with genetic factors, it it not a discrete entity! Single gene genetic disorders are quite different because the diagnosis is actually made based on the presence of a specific gene variant.
I have always wondered whether my own problems were the result of some biological/genetic abnormality. I will probably never know! What I do know is that many of the people who have received the exact same DSM diagnoses as me probably have very different biological and psychological problems.
A single cause for bipolar disorder or for schizophrenia will never be identified because these diagnoses are vague and variable. They cause much suffering, but that does nothing to demonstrate their existence as discrete entities. Bipolar disorder, for example, might be better thought of as a collection of many different problems in very different individuals..... although a certain amount of symptoms overlap occurs.Some of the DSM categories are more specific than others. ADHD is especially vague. According to the DSM criteria, it would probably be possible to diagnose almost everyone with (inattentive) ADD!! On the other hand, other diagnoses such as gender identity disorder are rather more specific.
All the best,Ed.
Posted by ed_uk on December 1, 2004, at 10:39:51
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 10:07:06
I've decided to re-name some of the DSM disorders to give them more truthful names.
This is how it works...
a) the DSM disorder
b) Ed's new name for the disorder
a) Conduct disorder
b) Unpleasant child syndromea) Schizophrenia
b) Undiagnosable psychosisa) Histrionic personality disorder
b) Theatrical personalitya) Antisocial personality disorder
b) Psychopatha) Oppositional defiant disorder
b) Normal (but rather annoying) childa) Sexual aversion disorder
b) Paxil-induced asexuallya) Schizotypal personality disorder
b) Mildly eccentric persona) Generalised anxiety disorder
b) Someone who worries about 'normal' things but to an excessive degreea) Asperger's disorder
b) Me as a child (perhaps!)a) Mental retardation
b) Learning difficultiesa) Body dysmorphic disorder
b) Ed's syndromeI'd also like to introduce some new DSM categories.........
SSRI dependence
Neuroleptic dependence
Pharm rep-induced delusional disorder... psychiatrists are said to be particularly vulnerable
Serotonergic laziness disorder
Ed.
Posted by ed_uk on December 1, 2004, at 10:49:20
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 10:39:51
Lets have a look at the DSM ADHD inattention criteria.........
Six or more of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activitiesOften has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work or homework)
Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)Is often easily distracted by extraneous stimuli
Is often forgetful in daily activities
Six or more of the following symptoms of hyperactivity/impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level
What do you think? Don't most children have these problems? Mmm, perhaps because school is too boring! Probably most adults also have these symptoms.
Posted by Larry Hoover on December 1, 2004, at 10:57:47
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 10:49:20
> to a degree that is maladaptive and inconsistent with developmental level
That is a very important part of the diagnosis.
Lar
Posted by ed_uk on December 1, 2004, at 11:05:15
In reply to Re: The artificial nature of psychiatric diagnosis » ed_uk, posted by Larry Hoover on December 1, 2004, at 10:57:47
> 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.
Posted by ed_uk on December 1, 2004, at 11:22:06
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 11:05:15
Hello :-)
Perhaps people might misunderstand me, I would not want that.
I have suffered from mental health problems all my life. I am sympathetic to others who also have problems. But I am not satisfied with the way in which psychiatric problems are classified. Are you?Many of the people who have been diagnosed with conditions such as ADHD undoubtedly have problems. I was not suggesting otherwise.
A message to everyone.........
Look at the DSM. Do you really believe that these categories are adequate?
I look forward to the day when more specific methods of diagnosis are available. In the mean time, although we should always take peoples individual mental health problems seriously, perhaps it would be wise to take their DSM diagnosis a little less seriously.
Regards,
Ed.
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.
Lar
Posted by vwoolf on December 1, 2004, at 11:27:07
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 10:49:20
Sounds like my son. Except that he was evaluated by a psychologist who categorically ruled out ADHD. SO where did that leave us? With an exceptionally bright kid who was not achieving at school.
Posted by ed_uk on December 1, 2004, at 11:45:11
In reply to Re: The artificial nature of psychiatric diagnosis » ed_uk, posted by Larry Hoover on December 1, 2004, at 11:23:26
Hello,
ADHD is a set of symptoms. It is not a specific condition. I do not believe in the validity of any current psychiatric (not organic) diagnosis as a specific entity.
In many ways, rather than attemting to categorise, it might be best to simply list a persons problems.
You could apply this to schizophrenia for example............
Josephine Bloggs... suffers from paranoid delusions, auditory hallucinations and is socially withdrawn. She has been continuously ill for two years. The cause of her symptoms is unknown. Her symptoms first appeared one month after her divorce.
In many cases such as this, perhaps it would be best (and more honest) not to make a dignosis at all.
You said: 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.
I agree with this completely. This was not the reason why I was questioning the validity of diagnostic categories. The only reason that I mentioned the subjective nature of the decision to make a diagnosis was because you said that this statement was the most important...
'to a degree that is maladaptive and inconsistent with developmental level'.
Regards,
Ed.
Posted by raaven on December 1, 2004, at 11:48:57
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 11:05:15
An old friend of mine has an axiom: "You can't take apart the pliers with the pliers." but when the pliers become too complex for the pliers repair people to understand, and/or when the system is too cumbersome for the pliers repair people to devote the proper time and patience to getting to know your particular pair of pliers, well, then it's time to start building your own set of specialized pliers repair tools. In my opinion, all the meds can do is help supply you with energy for this arduous and time-consuming task.
In ages past people were handed simplistic answers that depended upon the abandonment of self-knowledge (personal myth-making) in favor of canned myths that purported to explain you - without, of course, ever actually encountering you. This naturally led to a personal condition that could be called totalitarian, except for the fact that once programmed a person no longer needed policing from above; he/she policed herself/himself. See Orwell, "1984."
The evolution to psychiatry was a step away from this abdication of existential responsibilities, but, unfortunately, the clinical environment inevitably became bureaucratized and dumbed-down as it tried to apply itself to more and more people. This brief shining moment of humanistic hope was crushed by the twin realities that (1) only the elite could afford in-depth psychoanalysis, and (2) that the Overlords of Society realized very quickly that psychiatry could be used as a medium of mind control - assuming, of course, that it was not intended to be this from the very beginning.
We are now entering an age when people will have to start taking responsibility for their own construction and ownership or become part of the ever-growing mass of hypnotized, televisionized Pod People, who choose to live in a world of absurd illusions rather than grow up. This is really no different from the condition described above, except that the programming now comes from the corporate-controlled state, via the Idiot Box and the newspapers, rather than from the church-controlled state, via the pulpit and the bible.
A person who is well schooled in the array of psychoactive drugs now easily available to virtually anyone, can make informed decisions about their own chemical energy aids. Then it is only a (usually simple) matter of obtaining these drugs - either via the Internet or, if it is more viable, from a doctor savvy enough to understand that he/she has been reduced to a pill-dispensing machine, and who decides to take advantage of that fact for personal gain. It's a win-win situation. Or win-win-win-win when you include the drug and insurance companies in the equation.
Posted by ed_uk on December 1, 2004, at 12:02:26
In reply to Re: The artificial nature of psychiatric diagnosis, posted by vwoolf on December 1, 2004, at 11:27:07
Hi Vwoolf,
The criteria listed in the DSM as symptoms of ADHD can be very problematic for a child at school. It would be quite possible to define ADHD by a different set of symptoms however.
In many ways, it is impossible to 'rule out' ADHD because it is not a specific entity. Each individual symptom can be problematic in its own right but the diagnosis itself is an artifical construction of the APA.A diagnosis of ADHD is not necessary in order for a person to be helped.
If your son struggled in school due to a poor attention span then that alone is a valid reason for not achieving.
The symptoms listed in the DSM under ADHD have a tendency to occur together. This is why they were chosen as the official criteria. It would be quite possible, however, to invent many new DSM diagnoses on the same basis, in fact I could invent a new disorder now!
DSM criteria for Edwards' syndrome.
At least 3 of the following criteria muct be present on a regular basis for at least 6 months...
1. Has a tendency to daydream in class
2. Finds it difficult to 'get started' with schoolwork.
3. Displays excessive pleasure seeking behaviour
4. Gets bored easily
5. Frequenly gets tired at schoolWhat I am trying to say is that everyones mental health problems are individual. This is why the DSM categories are so artificial.
Regards,
Ed.
Regards,
Ed.
Posted by ed_uk on December 1, 2004, at 12:16:59
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 12:02:26
The symptoms of mental illness are very real, but a psychiatric diagnosis is an artificial construction.
DSM criterion E for schizophrenia.....
Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
The diagnosis is esentially a list of distressing/problematic symptoms which may or may not occur together and that are causing an impairment. The same is true of most psychiatric diagnoses.
Ed.
Posted by ed_uk on December 1, 2004, at 12:30:28
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 12:16:59
I feel that people are angry with me. Am I being paranoid?
Ed.
Posted by vwoolf on December 1, 2004, at 13:40:53
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 12:30:28
Definitely NOT angry with you. Just trying to make a bit a sense of what happened with my son. He has an IQ of over 160, won an international scholarship towards tertiary education at age 12, and has been totally unmotivated at school ever since. I wish it were possible to find an easy diagnosis like ADHD. Without one, I have spent years blaming myself for his lack of achievement.
Posted by Emily Elizabeth on December 1, 2004, at 19:39:09
In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15
Without a doubt, the DSM is a highly flawed system. However, I must say that personally, it actually felt better when my pdoc gave what I was experiencing a name. It made me feel like what I was dealing with was not just me being overly sensitive or anything like that. She recognized my problem and it was a disorder that other people experienced too. Just my 2 cents. ;)
EE
Posted by Shalom34Israel on December 1, 2004, at 19:43:03
In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15
The artificial nature of psychiatric diagnoses will go away in ten or twenty more years when functional neuroimaging and genetic testing is factored into psychiatry. In all likelihood, psychiatry is going to cease to exist in twenty or thirty more years and eventually will become a part of Neurology. Serious mental illnesses will be seen as nothing more than Neurological diseases of the brain, that show up on a functional MRI scan or a SPECT or PET scan. And will be treated accordingly, probably by future trained Neurologists who subspecialize in "Neuropsychiatric" diseases.
The DSM is crap, psychiatry is crap and its only a matter of time before high technology forces psychiatry to fundamentally change its backward ways.
Shalom
Posted by Racer on December 1, 2004, at 20:07:44
In reply to Re: The artificial nature of psychiatric diagnosis, posted by Shalom34Israel on December 1, 2004, at 19:43:03
I agree that the DSM criteria are arbitrary, and based less on rigorous science than on consensus. But it's what we've got, and something was needed. Sure, it's got problems, which are addressed with every edition, but until something better comes along, let's agree to use the tools we've got, huh?
Yes, there is a real danger that the patient will be lost in the dx, but you know what? My father was given a couple of rounds of antibiotics for lung cancer before it was finally diagnosed. Even when there are pretty hard and fast guides to diagnosis, the doctor still has to be good enough to make an accurate diagnosis, right?
YOU may not find any solace in having a diagnostic code written after your name, but there are many people in this world who do find it a relief. The insurance companies are never really going to pay out for "Ed gets really gloomy" or "Joe is just plain Froot Loops". And how can anyone do any valid research on mental disorders if everyone uses different terminology for each symptom or disorder? There is a need for some form of standardization, and the DSM -- however imperfect -- is what is available now.
Let's not throw the baby out with the bathwater, OK?
Posted by Shalom34Israel on December 1, 2004, at 21:21:38
In reply to So, Ed, do you have an opinion here?, posted by Racer on December 1, 2004, at 20:07:44
>
>
> YOU may not find any solace in having a diagnostic code written after your name, but there are many people in this world who do find it a relief.I dont mind at all having a diagnostic code written after my name as long as it is accurate and correct. In fact, I WANT one. I want to be diagnosed correctly, with an individualized diagnosis. I want everything individualized. I dont like this "one size fits all" canned approach that psychiatry has.
The problem is that the DSM is way too generalized and not an accurate enough way to diagnose people and get it right the first time around. Being placed on the wrong class of psychiatry drug can tear a person's brain down faster than anything. Examples; a bipolar person initially misdiagnosed with unipolar major depression or anxiety and placed on an SSRI without a mood stabilizer. They go manic and end up hospitalized. That shouldnt happen...psychiatrists should be able to predict better what the reactions to their meds will be.
Psychiatry is fifty years behind the times and its time for it to be tossed out completely. It is a waste of time, money and has a bad name. It should be formally merged into Neurology and should cease to exist as a separate branch of medicine.
Shalom
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.
Regards, Sailor
Posted by gardenergirl on December 1, 2004, at 22:15:10
In reply to Re: The artificial nature of psychiatric diagnosis, posted by Shalom34Israel on December 1, 2004, at 19:43:03
Posted by Kristel on December 2, 2004, at 1:46:59
In reply to Re: The artificial nature of psychiatric diagnosis, posted by Shalom34Israel on December 1, 2004, at 19:43:03
Huh?! Are you kidding me now? Do you really think that a fMRI machine or something similar to it would see your thoughts?!!!
If that wouldhappen it might be i 100 years!
Yes such tech might be useful for the diagnosis of neurological disorders such as ADHD or epilepsy. But not psychiatric disorders that have to do mostly with thoughts.
I work with fMRIs and PETs and I see how inprecise they can be at times. They only show which parts of the brain are more activitated than other. But that advancement would happen and make them being able to see thoughts, sound like science fiction!
DSM is absolutely necessary. I hope you guys have not got a "desired diagnosis" that don't meet the criteria in DDM and thus upset.
Take care!
Posted by Kristel on December 2, 2004, at 2:01:32
In reply to Re: So, Ed, do you have an opinion here?, posted by Shalom34Israel on December 1, 2004, at 21:21:38
I can't understand how you justify that?!!!!!
They are ppl there out there that would really suuffer if their problems get reduced to neuroloical disorders.
Many patients in psychiatry have "deffective thouhgts" and psychiatry have the responsibilty to deal with that.
Would be really funny if a patient goes to a neurologist about say depresson and the neurologist starts talking about "medial frontal lobe" or "anterioir hypothalamus" " or "septohippocampal complex"... In fact, as far as today, this has no clinical significance. A day might come when we would start to set chips into the brain but for now this sounds like science fiction! What about developing crazy chips? nazi chips? crime chips? or some freak would take a depression chip and hack it into "popular guy" chip? WeLL, ALL THIS SOUNDS LIKE SCIENCE FICTION TO ME, and might bring disasters to humanity!!!!! And I think many scientists would agree that this is really far away. PLEASE REMEMBBER THAT EVEN THE MECHANISMS BY WHICH ANTI DEPRESSANTS HELP DEPRESSION ARE STILL UNKNOWN. We know about uptake and so on, but how this leads improvement.. we know about changes in the synapse (down and up regualtion is one hypothesis) but yet how this really works, anyone's guess.
> >
> >
> > YOU may not find any solace in having a diagnostic code written after your name, but there are many people in this world who do find it a relief.
>
> I dont mind at all having a diagnostic code written after my name as long as it is accurate and correct. In fact, I WANT one. I want to be diagnosed correctly, with an individualized diagnosis. I want everything individualized. I dont like this "one size fits all" canned approach that psychiatry has.
>
> The problem is that the DSM is way too generalized and not an accurate enough way to diagnose people and get it right the first time around. Being placed on the wrong class of psychiatry drug can tear a person's brain down faster than anything. Examples; a bipolar person initially misdiagnosed with unipolar major depression or anxiety and placed on an SSRI without a mood stabilizer. They go manic and end up hospitalized. That shouldnt happen...psychiatrists should be able to predict better what the reactions to their meds will be.
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> Psychiatry is fifty years behind the times and its time for it to be tossed out completely. It is a waste of time, money and has a bad name. It should be formally merged into Neurology and should cease to exist as a separate branch of medicine.
>
> Shalom
>
Posted by ladyofthelamp on December 2, 2004, at 4:37:50
In reply to Re: The artificial nature of psychiatric diagnosis » Shalom34Israel, posted by Kristel on December 2, 2004, at 1:46:59
In my humble opinion,lots of people may be 'happy'with their diagnosis because it gets the right words on a form,either for sick benefit or in the USA for insurance,but what if you are given a label at a time in your life where things are difficult.I am thinking of the positively damning title of personality disorder in its many guises.In mt teen years that is 'probably' what i was thought to have as i was angry,depressed and very difficult.I now have reams of notes on me that are innapropriate to say the least but the stigma just wont go away.If you wanted to label me now i expect i would be Bipolar with the anxiety state that accompanies my somewhat odd behaviour from time to time.Yes i do have an anxious personality and mild agoraphobia when i am ill but i am also outgoing and overly social to the point of getting myself into 'scrapes'.But suprise suprise i can never shake off my past history which incidentaly was only in my mid teens.This information haunts me but it never goes away.I also believe 'personality disorder' is more often given to females, and men who exhibit similar symptoms are given a different and less damning diagnosis...Best wishes to everyone.
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