Psycho-Babble Medication Thread 422741

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Re: The artificial nature of psychiatric diagnosis

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.

 

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.

Lar

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis Larry Hoover

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.


 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis

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 school

What 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.

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis

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

 

Re: The artificial nature of psychiatric diagnosis

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

 

So, Ed, do you have an opinion here?

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?

 

Re: So, Ed, do you have an opinion here?

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

 

Re: So, Ed, do you have an opinion here?

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

 

Sheesh, tell us how you really feel... :-) (nm) Shalom34Israel

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

 

Re: The artificial nature of psychiatric diagnosis Shalom34Israel

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!

 

Re: So, Ed, do you have an opinion here? Shalom34Israel

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.
>
> 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
>

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis

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.

 

Re: The artificial nature of psychiatric diagnosis ed_uk

Posted by Larry Hoover on December 2, 2004, at 8:02:43

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 12:30:28

> I feel that people are angry with me. Am I being paranoid?
>
> Ed.

I'm not angry in the slightest, speaking for myself.

Lar

 

Re: The artificial nature of psychiatric diagnosis ed_uk

Posted by Larry Hoover on December 2, 2004, at 8:31:05

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 2, 2004, at 6:55:09

> 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.

I've made similar points many times. MDD is a symptom cluster, not a disease. What brought this symptom cluster to the fore in patient A may be totally unrelated to the causes in patient B, whether on a symptom by symptom comparison, or as a whole.

Where it really falls apart, IMHO, is in attempts to match treatment to diagnosis, rather that by symptoms. A subject ought not to be treated because of a diagnosis of MDD, but because of specific presenting symptoms.

In drug trials for e.g. an antidepressant used against MDD, there is no evidence to suggest that the subjects even are suffering from the same underlying problem. It is similar, but responders and non-responders may be distinguished, perhaps, not by diagnosis itself, but instead, by underlying physiological disturbance.

If you collected together a group of cars that won't start, and came at them with battery booster cables, perhaps some would have an excellent response to that treatment, and off they go. Others, though, e.g. those which are out of fuel, will not have a similar response. The failing in this "experiment" is by inappropriately collecting together cars with dissimilar deficiencies under an overly broad "diagnosis". I believe we have a similar problem in mental health. Too many people who are out of gas getting booster cables.

Lar

 

Re: The artificial nature of psychiatric diagnosis

Posted by SLS on December 2, 2004, at 10:27:07

In reply to The artificial nature of psychiatric diagnosis, posted by ed_uk on December 1, 2004, at 8:57:15

I think the DSM is an incredibly detailed piece of work that has made the diagnoses and treatment of mental illness much more exacting than it was previously. It is a very impressive book. While not perfect, it does work. It is a statistical evaluation of what has been observed empiracally. It makes no claims to describing etiologies. It leaves that to research ongoing. Let's see what the DSM V has to offer.


- Scott

 

Larry - EXCELLENT analogy!! (nm)

Posted by dazedandconfused on December 2, 2004, at 12:06:20

In reply to Re: The artificial nature of psychiatric diagnosis ed_uk, posted by Larry Hoover on December 2, 2004, at 8:31:05

 

Re: The artificial nature of psychiatric diagnosis

Posted by ed_uk on December 2, 2004, at 15:29:52

In reply to Re: The artificial nature of psychiatric diagnosis ed_uk, posted by Larry Hoover on December 2, 2004, at 8:02:43

To Larry, Scott and everyone else,

I do believe that the DSM has its uses. I am not suggesting that we get rid of it! I do feel, however, that it is misunderstood by patients and professionals alike. In some cases it may do more harm than good. Each diagnosis describes a cluster of symptoms which often occur together, yet each diagnosis is not a specific disease. We could construct many other DSM diagnoses based on clusters of symptoms which tend to occur together. The DSM is only really useful to those who appreciate its inadequacies, many people do not. Misuse of the DSM may harm both individual patients and psychiatric research alike. Larry gave an excellent summary of some of the problems which we face.

Regards,
Ed.

 

Re: To Sailor: diagnosis

Posted by ed_uk on December 2, 2004, at 15:54:17

In reply to Re: The artificial nature of psychiatric diagnosis, posted by ladyofthelamp on December 2, 2004, at 4:37:50

Hi!

Thank you for your post. :-)

I've often noticed than when I have known a person for 5 minutes, their problems seem to fit perfectly into a DSM category, but after I've known that person for 5 hours they don't fit the diagnosis at all! The more you learn about a person, the more individual and complicated their problems become.

Personally, I've received scores of different DSM diagnoses. Describing me as an anxious, obsessional neurotic would provide almost as much information!

Regards,
Ed.


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