![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 38. Go back in thread:
Posted by notfred on March 1, 2007, at 10:37:02
In reply to Re: DSM, posted by laima on March 1, 2007, at 10:28:46
DSM is imperfect.
Yep, but I think some people here a too fixed on it (DSM) or their diagnosis.
Posted by laima on March 1, 2007, at 14:26:46
In reply to Re: DSM, posted by notfred on March 1, 2007, at 10:37:02
Oh definately! I think that is one of the big drawbacks. On the one hand, I think DSM can be helpful and legitimizing, ie, mood disorders are medical disorders, not "ordinary ups and downs". On the other hand, reality is usually too fluid to be easily categorized, and like you may be suggesting, taking on a diagnositic label as part of one's identity isn't so helpful. I mean, will I ever feel genuinely my best if I take on "depressed!" as part of my identity, even when in remission? If I am permanently "depressed person", even when I feel good- do I carry inside an idea that I am "not normal", "not like other people"? Do I limit myself? That's a tricky fine line, of course, the answer perhaps both yes and no.
As for diagnoseses-
Recently I've seen news articles suggesting depression might actually be more than one disorder- proponents of the theory pointing to the wide array of causes, wildly different responses to treatment efforts, atypical vs typical, and so on. Especially, should atypical and typical depressions be split into two separate categories, since symptoms and treatments are sufficiently different to warrent a discussion? There is also an interesting but controversial debate going on, I've been reading, as to whether or not "schizophrenia" is even a useful term anymore- that "schizophrenia" is so wide and vague in the way it's currently defined, that the term is arguably an umbrella covering an array of distinct conditions, almost as clinically meaningless as something like "crazy", "neurotic", "burnout", or "nervous breakdown".* In current DSM, having only "negative" symptoms doesn't even count as schizophrenia or warrent any diagnosis (as far as I know) but now some are suggesting that it's in fact a real and distinct disorder itself. (Meanwhile, what are those people who experience only negative symptoms supposed to do? And what happens to them? Do people with only negative symptoms ever end up getting a sedating antipsychotic, since that's the treatment for 'schizophrenia', and since "everyone" knows 'schizophrenia' plus 'stimulant'= psychosis??? I've wondered about that.) So some of these categories seem too murky, broad, and fluid. Hopefully as research advances some of these DSM glitches will be ironed out.*Note to all- I want to be absolutely clear to say I do not doubt in any way, even a tiny bit, that people genuinely suffer from the conditions traditionally associated with these terms, or from schizophrenia. Nor do I have any doubt whatsoever that schizophrenia is comprised of genuine medical disorders. I'm talking about the terms themselves, and how in reality, a wide array of different conditions with a wide variety of causes and appropriate treatments can get lumped under a single term. If this happens, it complicates treatment, for one thing. Hope this makes any sense and isn't totally irrelevant or misconstruable.
>
> Yep, but I think some people here a too fixed on it (DSM) or their diagnosis.
>
>
Posted by laima on March 1, 2007, at 14:27:45
In reply to Re: DSM » notfred, posted by laima on March 1, 2007, at 14:26:46
Perhaps "Procrastinator" should be added to dsm...
Posted by Quintal on March 1, 2007, at 15:11:38
In reply to Re: DSM » notfred, posted by laima on March 1, 2007, at 14:26:46
> Oh definately! I think that is one of the big drawbacks. On the one hand, I think DSM can be helpful and legitimizing, ie, mood disorders are medical disorders, not "ordinary ups and downs". On the other hand, reality is usually too fluid to be easily categorized, and like you may be suggesting, taking on a diagnositic label as part of one's identity isn't so helpful. I mean, will I ever feel genuinely my best if I take on "depressed!" as part of my identity, even when in remission? If I am permanently "depressed person", even when I feel good- do I carry inside an idea that I am "not normal", "not like other people"? Do I limit myself? That's a tricky fine line, of course, the answer perhaps both yes and no.
__________________________________________________Oh that was good. Recovering from mental illness isn't purely down to making a choice to get better as I've seen suggested here not so long ago, but at some point in remission I think mental illness is unique in that there is a point where you can decide not to be ill any more - you can decide to be a healthy person going through a rough patch rather than a depressive having a relapse. And perhaps that's when you really have made a full recovery.
Funny how I'm no longer get ill since I decided not to be. I'm going through a rough patch right now, and I'm sure I could turn this into a relapse - a depressive episode, if I was in the frame of mind where searched for and held every negative emotion up as validity of my disorder. In the frame of mind I'm in now, it's just a passing cloud and that's all part of life. I think I have enough wisdom, experience of this whatever it is, and patience to know the sun will come out again another day, so long as I let it.
There's also the advantage of coming back from every small setback a little more resilient than the last, that's how you build up strength I think. I've just been out driving on the moors around here - it's beautiful but bleak and desolate. It's left me feeling lost - from where do people find the strength and inspiration to live in places like this? There are tiny farmhouses tens of miles from the nearest human contact and many of the people that live there are alone without telephones and internet. It appears some don't even have mains electric or water yet. How do they do it?
It was a shock to realize that to many of you people who live in American cities my home would be just as isolated as that - the nearest McDonald's is twelve miles away, yet somehow I've managed to find a way. Hope springs faith eternal?
Yours Wistfully,
Q
Posted by Declan on March 1, 2007, at 16:47:57
In reply to Re: DSM, posted by laima on March 1, 2007, at 14:27:45
I tend to think if they had any guts they'd still call being gay an illness, but since we can't have that I'm happy to plead gulty to procrastination (whole life of it). I'd like some really interesting diagnoses like (of course) 'Depleted Narcissism'.
Can anyone think of any others. (Suffering from 'Executive Dysfunction' here. Is that in the DSM?)
Posted by notfred on March 1, 2007, at 17:01:59
In reply to Diagnoses, interesting and otherwise, posted by Declan on March 1, 2007, at 16:47:57
> I tend to think if they had any guts they'd still call being gay an illness,
that was removed by the American Psychiatric Association in 1973, after that point it was not considered an illness.
Posted by Declan on March 1, 2007, at 17:20:24
In reply to Re: Diagnoses, interesting and otherwise, posted by notfred on March 1, 2007, at 17:01:59
An interesting thing to study would be comparative ideas of illness and health over time and in different cultures.
Posted by randermin on March 1, 2007, at 17:22:39
In reply to Re: DSM, posted by Quintal on March 1, 2007, at 15:11:38
Okay...
The DSM is a deluded attempt from a (rightly) qualitative field to disguise itself as a hard
science by organizing hopelessly vague and unfounded ideas into something with the appearance
of empirical knowledge. Of course some of it is helpful as a field guide to those "big" conditions
that are already validated by collective experience, but it's mostly misguided, arrogant,
autocratically minded, misleading and useless if not harmful nonsense. It is really only here for aesthetic,
self-validating purposes and has almost no value as a scientific or therapeutic text.
Posted by Quintal on March 1, 2007, at 17:42:15
In reply to Diagnoses, interesting and otherwise, posted by Declan on March 1, 2007, at 16:47:57
>I tend to think if they had any guts they'd still call being gay an illness,
My psychiatrist did, but regretted 'that isn't something we usually treat'. He was a devout Muslim and was exercising his right to declare his personal biases on current medical practise. I know what you mean though, at a time when some of the most trivial differences in behaviour and thinking between people are being pathologized it's odd that homosexuality escapes any serious attention as an illness.
Q
Posted by laima on March 1, 2007, at 18:20:55
In reply to Re: Diagnoses, interesting and otherwise » Declan, posted by Quintal on March 1, 2007, at 17:42:15
Um, well speaking as a straight person (as if that even matters)- I fail to even remotely comprehend how being gay could possibly be considered an illness or disorder?I think it's purely a cultural thing as to whether or not it's approved of. In some cultures it's no issue whatsoever, sometimes even considered a sort of third gender, in some others, it is considered an abomination against god's plan to populate the earth. Something like that. Some people get suspicious that there is a gay conspiracy to make other people gay, but that is ludicrous beyond even being worthy of discussion. Being gay itself doesn't interfere with one's ability to lead a happy, healthy productive life, to be a responsable and ethical citizen, productive member of society, intelligence- anything. Some might even argue it's a solution to the overpopulation problem.
I hope you guys are kidding.
> >I tend to think if they had any guts they'd still call being gay an illness,
>
> My psychiatrist did, but regretted 'that isn't something we usually treat'. He was a devout Muslim and was exercising his right to declare his personal biases on current medical practise. I know what you mean though, at a time when some of the most trivial differences in behaviour and thinking between people are being pathologized it's odd that homosexuality escapes any serious attention as an illness.
>
> Q
Posted by laima on March 1, 2007, at 18:23:01
In reply to Re: DSM, posted by randermin on March 1, 2007, at 17:22:39
I think it's a work in progress, continually refined, and with lots of promise.
> Okay...
> The DSM is a deluded attempt from a (rightly) qualitative field to disguise itself as a hard
> science by organizing hopelessly vague and unfounded ideas into something with the appearance
> of empirical knowledge. Of course some of it is helpful as a field guide to those "big" conditions
> that are already validated by collective experience, but it's mostly misguided, arrogant,
> autocratically minded, misleading and useless if not harmful nonsense. It is really only here for aesthetic,
> self-validating purposes and has almost no value as a scientific or therapeutic text.
Posted by laima on March 1, 2007, at 18:33:46
In reply to Re: DSM, posted by Quintal on March 1, 2007, at 15:11:38
Thanks. :)I've thought a lot about it. It's tricky. Yes, a biological illness-can't just "will out of it". But once relief, remission comes, whether or not on medication, it might be helpful, in practical living-life terms, to not actively define oneself as "ill". Put aside feeling a handicap or whatever the case may be, and give self a break. Rejoice for feeling better. (Whether or not any of this is technically accurate or not.) But very tricky- I almost half expect aprehensively someone will pop up now to claim there is no such thing as mental illness...
__________________________________________________
>
> Oh that was good. Recovering from mental illness isn't purely down to making a choice to get better as I've seen suggested here not so long ago, but at some point in remission I think mental illness is unique in that there is a point where you can decide not to be ill any more - you can decide to be a healthy person going through a rough patch rather than a depressive having a relapse. And perhaps that's when you really have made a full recovery.
>
> Funny how I'm no longer get ill since I decided not to be. I'm going through a rough patch right now, and I'm sure I could turn this into a relapse - a depressive episode, if I was in the frame of mind where searched for and held every negative emotion up as validity of my disorder. In the frame of mind I'm in now, it's just a passing cloud and that's all part of life. I think I have enough wisdom, experience of this whatever it is, and patience to know the sun will come out again another day, so long as I let it.
>
> There's also the advantage of coming back from every small setback a little more resilient than the last, that's how you build up strength I think. I've just been out driving on the moors around here - it's beautiful but bleak and desolate. It's left me feeling lost - from where do people find the strength and inspiration to live in places like this? There are tiny farmhouses tens of miles from the nearest human contact and many of the people that live there are alone without telephones and internet. It appears some don't even have mains electric or water yet. How do they do it?
>
> It was a shock to realize that to many of you people who live in American cities my home would be just as isolated as that - the nearest McDonald's is twelve miles away, yet somehow I've managed to find a way. Hope springs faith eternal?
>
> Yours Wistfully,
> Q
Posted by Declan on March 1, 2007, at 19:09:58
In reply to Re: Diagnoses, interesting and otherwise, posted by laima on March 1, 2007, at 18:20:55
is what I meant. Being gay, innapropriate fear or whatever else. I'm just expressing my reservations about the industry in my usual oblique and irritating style.
Where does health end and illness begin?
In Traditional Chinese medicine there are observable patterns such that you can say 'I am spleen deficient' and you know when you say that that you are referring to a pattern of symptoms. I'm not sure that is the same as saying 'I have depression'. Clearly some people with depression are very ill and have a chemical imbalance (if that cuts any ice). When we understand these things biochemically it may be better.
I think the tendancy to embrace these labels makes me uneasy. Maybe that's what I'm trying to say.
Our suffering is our own, not for someone else to define. I wish I could think.
Posted by Declan on March 1, 2007, at 19:12:24
In reply to Re: DSM » Quintal, posted by laima on March 1, 2007, at 18:33:46
>I almost half expect aprehensively someone will pop up now to claim there is no such thing as mental illness...<
I promise I won't.
Posted by Quintal on March 1, 2007, at 20:30:09
In reply to Re: Diagnoses, interesting and otherwise, posted by laima on March 1, 2007, at 18:20:55
>Um, well speaking as a straight person (as if that even matters)- I fail to even remotely comprehend how being gay could possibly be considered an illness or disorder?
Well as a gay person I think it's easy to see how homosexuality could be considered an illness by a system that (for example), categorises the inability to concentrate for long periods accompanied by impulsive and hyperactive behaviour with poor organization an illness needing treatment with stimulants. How could they not consider something seemingly so plainly aberrant as homosexuality an illness, or completely unworthy of categorization? As Declan says, how do you decide what is illness and what is healthy? Curious.
Homosexuality leads to a lot of anxiety and depression for most gay people. You could even go as far as to say it might be the root cause of a lot of the anxiety and depression of most of the male babblers here, so treating it might be the most direct and effective way of achieving a full recovery. It is postulated in my mother's 1950's psychology textbook that homosexuality may be caused by a hormone imbalance (I believe there is some evidence for this - exposure to excess testosterone in the womb for example) analogous to the neurotransmitter imbalances popular today accounting for mood and anxiety disorders. So how can they allow this to escape the DSM altogether? Surely there's a place for it, if only as a type of personality disorder or neurological problem?
On what grounds exactly did they remove homosexuality from the DSM? Are there such things as heterosexigens and homolytics?
Q
Posted by laima on March 1, 2007, at 21:02:01
In reply to Re: Diagnoses, interesting and otherwise, posted by Quintal on March 1, 2007, at 20:30:09
Well, I am relieved to hear that you guys weren't suggesting "being gay" in and of itself is an illness. Of course I realize that the gay population has suffered greatly from prejudices and the like, as you have explained.Seems to me "being gay" was removed from dsm on the grounds that "being gay" is not a pathological condition in and of itself. Ie, it is not something inherently in need of any fixing or curing. What could ultimately stand some fixing or curing would be some societal attitudes, instead, I'd say. I don't believe there was any denial that it could cause suffering.
I can't prove it, but my rough impression is that there has been a general positive trend to stop considering individuals and populations who don't fit the dominant societies' social values or norms as "ill". And that instead, there has been more attention placed on looking at how an individual is able to function, feel, and think- are they hallucinating? Are they wildly and undeniably delusional? Are moods appropriate? Are they coherent? Are they safe to themselves and others? Are they self destructive? That sort of thing.
No, DSM still not perfect. Far from it. The recent addition of "internet addiction" as a separate category, in particular, perpexes me. Why isn't that a manifestation of some kind of avoidance or procrastination, instead? Or just plain a behavioral addiction, or compulsion? Ie, why not a type of OCD? I don't understand.
Posted by notfred on March 2, 2007, at 0:01:41
In reply to Re: Diagnoses, interesting and otherwise, posted by Quintal on March 1, 2007, at 20:30:09
"So how can they allow this to escape the DSM altogether? Surely there's a place for it, if only as a type of personality disorder or neurological problem?
>
> On what grounds exactly did they remove homosexuality from the DSM? Are there such things as heterosexigens and homolytics?"
The DSM still mentions homosexuality in the context of an adjustment disorder.
The first study I know if is Evelyn Hookers, in 1957, which "challenged the sickness model of homosexuality then prevalent, and helped pave the way for the modern gay rights movement". Using
matched pairs of gay and str8 men she came up with
unexpected results (for that era):"She administered three personality tests, including the Rorshach ink-blot test, to thirty pairs of men--one homosexual, one not--matched by IQ level, age, and other factors. These tests were accepted by the community of medical and mental health professionals as indicating the presence of emotional and mental disorders. Presumably, homosexual persons would be easy to differentiate owing to the presence of pathology.
The experts concluded that the gay males were no worse, and sometimes better adjusted than the rest, and proved unable to identify correctly the gay male in each pair."
http://www.glbtq.com/social-sciences/hooker_e.html
I think this study had something to do with the change in the DSM, in 1979:
Masters, W.H. & Johnson, V.E. (1979), Homosexuality in Perspective. Boston: Little, Brown.Dr. Robert Spitzer was a key player in changing the DSM, odd considering his later research:
http://www.answers.com/topic/robert-spitzer
Here is a bit more history:
Posted by laima on March 2, 2007, at 8:04:31
In reply to Re: Diagnoses, interesting and otherwise, posted by notfred on March 2, 2007, at 0:01:41
Well, this is all very interesting, thank you for providing the information.I just personally don't find any of my gay friends to be-I don't even know what word to use which won't push buttons-so here's an old one which used to be tossed about, but most of us now recognize as obsolete (I hope it's obsolete): "deviant", or otherwise "abnormal" in any way, and that's why I found it appalling when I learned that this distinction, being gay, was ever considered a psychiatric disorder. Yes, some of my friends suffer from depression and/or other problems, some of it directly attributal to issues related to their being gay, such as taunting, feeling unsafe, estranged from or rejected by some family members--but that-depression, anxiety, etc- should be, and is, their diagnosis(es), in my belief. My friends are lovely people.
> "So how can they allow this to escape the DSM altogether? Surely there's a place for it, if only as a type of personality disorder or neurological problem?
> >
> > On what grounds exactly did they remove homosexuality from the DSM? Are there such things as heterosexigens and homolytics?"
>
>
> The DSM still mentions homosexuality in the context of an adjustment disorder.
>
>
> The first study I know if is Evelyn Hookers, in 1957, which "challenged the sickness model of homosexuality then prevalent, and helped pave the way for the modern gay rights movement". Using
> matched pairs of gay and str8 men she came up with
> unexpected results (for that era):
>
> "She administered three personality tests, including the Rorshach ink-blot test, to thirty pairs of men--one homosexual, one not--matched by IQ level, age, and other factors. These tests were accepted by the community of medical and mental health professionals as indicating the presence of emotional and mental disorders. Presumably, homosexual persons would be easy to differentiate owing to the presence of pathology.
>
> The experts concluded that the gay males were no worse, and sometimes better adjusted than the rest, and proved unable to identify correctly the gay male in each pair."
>
> http://www.glbtq.com/social-sciences/hooker_e.html
>
> I think this study had something to do with the change in the DSM, in 1979:
> Masters, W.H. & Johnson, V.E. (1979), Homosexuality in Perspective. Boston: Little, Brown.
>
> Dr. Robert Spitzer was a key player in changing the DSM, odd considering his later research:
>
> http://www.answers.com/topic/robert-spitzer
>
> Here is a bit more history:
>
> http://www.rainbowhistory.org/APA.htm
Posted by Meri-Tuuli on March 2, 2007, at 9:32:01
In reply to Re: Diagnoses, interesting and otherwise, posted by notfred on March 2, 2007, at 0:01:41
Hey, well I'm with declan on this one- its like whos to say we're the ones who are ill/abnormal? If the whole world were populated by depressives, then the 'normal' ones would get treated! Like ADHD - I think some people are just like that, whos the say that they are 'abnormal' etc etc? Why do you have to force eveyone to become the same? Just because (for instance) ADHDers are the minority, doesn't mean they're ill. Its just society isn't set up to ADHDers reality, so they're forced to sit and concentrate etc. You know what I'm saying?
Posted by laima on March 2, 2007, at 13:57:48
In reply to Re: Diagnoses, interesting and otherwise, posted by Meri-Tuuli on March 2, 2007, at 9:32:01
I still think there is a legitimate argument to be made for one being able to FUNCTION in a normal, culturally appropriate way. But some matters of what it means to be able to function are absoluetly basic to any human, anywhere, anytime.Ie, being unable to get out of bed because of wanting to die is not ok, no matter how many people feel it. Being unable to utter a coherent sentenece or to think at all, causing serious harm to self or others, having constant and severe hallucinations and attacks of paranoia without trigger is not functional, not normal. Being unable to eat, despite food being available, starving oneself to death due to eating disorder, believing self to be fat at 50 pounds is not functional or normal. Having a fetish or compulsion to murder others is not functional, not normal. Having a manic episode which causes one to impulsively and over-optimistically spend their life savings overnight gambeling, etc, is not functional, not normal.
This has nothing at all to do with insisting everyone be the same- note how it's a good thing "gay" was finally recognized to NOT be a disfunction, or a disorder, in and of itself. Gay people do not need to be made straight, do not need any "improvement" or "cure" for being gay, despite the feelings of some conformative extremists.
I am not a fan of certain politicians or political persuasions, but as much as I dislike them, or think their ideas are folly, even dangerous- I can't consider them mentally ill, because they are technically functioning well, as themselves, with each other, and as much as I hate to say it, in general per the norms of society, too. (Ie, in theory they follow the electoral procedures, participate in organizations, other rules; at least don't rant or hallucinate...) I just disagree with their values and/or methods. Yet can recognize that they are coherent, can reason, are highly functioning, etc. Their brains scans likely look just like any others. (Well, there may be some borderline cases and exceptions...)
I am not a fan of certain religious groups, but for the most of them, there is no way they can be considered ill, as strange or unpleasant as I judge them to be- because they are able to function well-as themselves and in society.
Levels of intelligence, wealth, poverty, race, gender, marital status--all thankfully now are not considered illnesses or reasons to consider a person as "less". I guess some of this is murky-meaning in particular: cases of intelligence so low that functioning is impaired. Yes, wealth could stand to be equalized, but poor people are not "mentally ill" despite not fitting societal ideals- and that race, gender, or marital statuses are not considered by intelligent people to not be illnesses or reasons to disqualify anyone's credibility are so obvious today no further comment need be made.
No reasonable person today will consider members of the wackiest seeming subcultures to be ill, if they can function and speak and think coherently and without major delusions or hallucinations, etc.
Artists are no longer suspect societal devients.
Single independent women in Europe used to be suspected as witches once, when religion, rather than any sort of recognition of psychology, let alone psychiatry, was used in judgement of "normalcy".
Yet even hundreds of years ago in that era, interesting that a person who walked around uttering gibberish and talking to inanimate objects was considered abnormal, unwell- though maybe said to be possed by demons rather than suffering from psychosis.
I am not going to go through my closets looking for my undergraduate anthropology and abnormal psych notebooks, but can assure you of vividly remembering professional PHD anthropologists and PHD Psycholgy professors explaining to the occasional undergrad that manifestations of "mental illness", as conditions of being "not ok", "not normal"- have occured in wildly varied societies. The New Age story of how "schizophrenics" were revered as shamans with "visions" in "tribal societies" is utter unsubstanciated nonsense.
Do you see what I mean? Some frowned upon behaviors and conditions are culturally determined, others are biological problems, cross-culturally recognized as problems- whether the explanaition be demons or biology--others remain murky.
Sure- ADD/ADHD is one of the controversial categories- but you can't tell someone whose distractions and spaciness and impulsiveness are severe enough that they cause their relationships to be damaged, cause them to be unable to hold a job, or complete simple tasks, etc that they don't have a problem. And this can lead to severe depression and sense of personal failure. If I am not mistaken, brain scans do show some sort of difference, just as brain scans of depressed people do. There seems to be a dopamine association, or an "executive function" disfunction. Of course, other possibilities, ie, too much sugar, need to be ruled out. One can argue for behavioral interventions, and that can help--of course, some claim even severe depression and anxiety can be completely 100% taken care of with behavior modifications and "attitude changes".
And I think we both know that's not quite the case?
I've had an ADD inattentive problem my whole life, and it causes problems even when I do not have to sit still at any desk job. I still have to be able to organize my day, my finances, remember to do what I need to do, answer phone calls, not lose stuff or forget things on the bus, finish tasks without getting sidetracked by new ones, not to spoil conversations because I was thinking about something else while someone was talking, perhaps distracted by something across the room and just blurt out a comment. I have to be able to concentrate no matter what I am doing, without being distracted by the noises outside, wondering if I remembered everything I need to do, etc. It's hard to feel engaged without being able to pay attention well, which makes flow states kinda tough to achieve. I've felt pretty darn incompetent and get depressed from this kind of thing, and am grateful for medication that has made a world of difference. Therapy helped- to only a point. Oh sure- creativity is a great side of this- but medication doesn't dim it- it helps me actually follow through with my ideas.
Finally, you wrote:
" If the whole world were populated by depressives, then the 'normal' ones would get treated!" Um, what about in places like Iraq? That's not the whole world, and I haven't been there, but I will go out on a limb to speculate that a whole lotta people there are suffering from severe anxiety, depression, despair, fear, anger--if that turns out to be most of the population- should they just be considered "normal", you know, "normal for an Iraqi- no need to treat"?Yes, I see and agree with the legitimate concern of how "abnormal" or "ill" is defined and who gets to do it, and understand that cultural and societal values seep in. But that doesn't negate the fact that there are legitimate and undisputable mental illnesses, with biological basises or markers (which we still know so little about). I really think being able to function as a human being is one good key way to start sorting it out, while also keeping an eye on how behavioral choices may or may not be contributing to the disfunction. Researchers are pretty active looking for accurate biological markers.
The field of psychiatry is still a bit of a murky mess, so many factors to consider. So little known about the brain. But the plus side of attempting to codify what is normal or not normal medically in an evolving document like dsm is...to codify. Hope fully to help codify appropriate treatments... What's the alternative?
> Hey, well I'm with declan on this one- its like whos to say we're the ones who are ill/abnormal? If the whole world were populated by depressives, then the 'normal' ones would get treated! Like ADHD - I think some people are just like that, whos the say that they are 'abnormal' etc etc? Why do you have to force eveyone to become the same? Just because (for instance) ADHDers are the minority, doesn't mean they're ill. Its just society isn't set up to ADHDers reality, so they're forced to sit and concentrate etc. You know what I'm saying?
Posted by laima on March 2, 2007, at 14:09:14
In reply to Re: Diagnoses, interesting and otherwise » Meri-Tuuli, posted by laima on March 2, 2007, at 13:57:48
I'd like to point out that even something like "stress"- whether behaviorlly or situationally induced, can cause biological changes- hormones, and in brain...leading to depression, anxiety, and per some, even schizophrenia for those who have other risk factors for it.
Posted by Declan on March 2, 2007, at 14:31:48
In reply to Re: Diagnoses, interesting and otherwise, posted by laima on March 2, 2007, at 14:09:14
I just had a bad upbringing, terrible school, stuff like that, went to a shrink.
In those days there was only neurosis, psychosis and clinical depression.
Going to a shrink was a bad move. He wasn't a bad shrink particularly, but being neurotic I was given minor tranquillisers. (They've given me a chemical imbalance).
Nowdays no decent shrink would treat someone like me with drugs, not that it mattered crically...I would have found them on my own.There's just 2 things for me.
Firstly that there is no such thing as normal.
Secondly, the process of classifying suffering is not without risks, for the recipient of the help.I like the word 'suffering', the balance between acceptance and pain that the word implies.
And laima, you have a point....I can't easily imagine a (decent) shrink who would apply the DSM in a doctrinaire fashion.
Posted by laima on March 2, 2007, at 15:10:08
In reply to Re: Diagnoses, interesting and otherwise, posted by Declan on March 2, 2007, at 14:31:48
Hey thanks.
I do think that there are some good doctors out there who are excellent and critical thinkers, who could still put an accurate dsm to good use, a good starting point, as a reference to review. But I imagine that the brightest of them are quite aware of the dangers of categorizing people very rigidly, and would use it as a guide, not as doctrine, anyway. It's not like a typical patient would have one exact condition and no other issue... and then causes vary, etc.
But think- if it could finally become specific and accurate- that could be so helpful for zeroing in on direction for helpful treatment. Rather than simply- "neurosis?" Give a sedative. "Psychotic? Give a sedative. etc. Imagine: "Atypical depression with some situationally induced anxiety and a sleep disorder?" Sounds like we should start by trying an maoi with some (whatever). Hmm, let's think about that in conjunction with this patient's particular circumstances. What did I initially get with those conditions? Prozac. Which made me an even more "active" sleeper than before, ultimately making depression worse. For prozac was for "depression". Fine-tuning treatment strategies as a result of better dsm- that would be fantastic. So would be some cross-referencing feature for help in designing treatments for people with overlapping conditions.
I appreciate that having depression officially listed as a medical condition has helped many of the skeptics who felt it's nothing more than an "attitude problem" understand that it's actually kind of more than that. And can help someone who tries in vain to "adjust the attitide" give him or herself a break, and feel ok about taking medication which could actually bring relief.
I also appreciate the general trend of eliminating people deemed to be social undesirables by society from the category of "ill".
You have a good point, "no such thing as normal"- I have to agree. But yet surely some consensus could eventually be reached about what counts as eccentricity/quirky personality/choice/lifestyle/diversity versus what counts as pathological, and/or in need of repair?
But it's still definately a work in progress. My understanding is that when a new edition is due, there is a lot of group discussion, debate, and arguing between loads of them about what should or should not be included, and why.
Still a long way to go!
Some of the existing difficulties surely must be due to the politics of whatever organization is in control of the content.
Another area of difficulty is obviously that much, if not the entire territory, is very murky and debatable- even for those with the most knowledge.
And even doctors and scientists can't help but have some aspects of the values of their own culture seep deep into their psyches, affecting judgement and perception. I think good scientists must know this, though. Probably not all of them do though. It can be hard to detect, even in oneself.
> There's just 2 things for me.
> Firstly that there is no such thing as normal.
> Secondly, the process of classifying suffering is not without risks, for the recipient of the help.
>
> I like the word 'suffering', the balance between acceptance and pain that the word implies.
>
> And laima, you have a point....I can't easily imagine a (decent) shrink who would apply the DSM in a doctrinaire fashion.
Posted by laima on March 2, 2007, at 15:26:41
In reply to Re: Diagnoses, interesting and otherwise, posted by Declan on March 2, 2007, at 14:31:48
Declan,
You bring up some interesting points about suffering, I think.
Your story is thought-provoking.
And make me get an "aha" about how/why psychology and psychiatry are distinguished.
Some suffering, is surely approprately treated with good psychological intervention, and can be worsened by inappropriate drug treatment. Drugs do come with side effects and consequences, of course. The pros of using them must outweigh cons.
Some, I'm sure, overlaps- because behavior and thoughts, stress, etc, can eventually induce changes in hormones and in brain, creating a mood disorder.
Some, would be folly to "treat"- like if I over-react and think I am "suffering" because I missed the bus.
Some, might be an ethical judgement. Ie, grief, if a loved one passes. Grief would be a "normal" reaction- would pass on it's own for some people in due course, or for others, it could induce or worsen depression. And regardless, how to judge soundly when the suffering caused by something like appropriate grief should be treated medically? Counseling, of course. Suffering isn't good- but totally eliminating all bad feelings would be odd.
Not sure.
> I just had a bad upbringing, terrible school, stuff like that, went to a shrink.
> In those days there was only neurosis, psychosis and clinical depression.
> Going to a shrink was a bad move. He wasn't a bad shrink particularly, but being neurotic I was given minor tranquillisers. (They've given me a chemical imbalance).
> Nowdays no decent shrink would treat someone like me with drugs, not that it mattered crically...I would have found them on my own.
>
> There's just 2 things for me.
> Firstly that there is no such thing as normal.
> Secondly, the process of classifying suffering is not without risks, for the recipient of the help.
>
> I like the word 'suffering', the balance between acceptance and pain that the word implies.
>
> And laima, you have a point....I can't easily imagine a (decent) shrink who would apply the DSM in a doctrinaire fashion.
Posted by Meri-Tuuli on March 3, 2007, at 6:26:06
In reply to Re: Diagnoses, interesting and otherwise » Meri-Tuuli, posted by laima on March 2, 2007, at 13:57:48
I think you kinda miss my point (I'm guessing).
But laima what I was trying to say is this: why should society dictate to an ADHDer that they must hold down a 9-5 job, be organised etc etc....? Surely its the non-ADHD society forcing the ADHDer to behave as the rest of the non-ADHD population? If everyone were ADHD then we'd have working cultures that were supportive of the ADHD way of working! Do you see what I'm saying?
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