In part 1, we discussed a broken psychological industry and looked into PTSD’s criterion A concerns. In part 2, we expanded to discussing the key diagnostic and industry issues, as by looking at an issue one can typically find possible solutions. Well, here we are, the final part to this series, the solution debate.
Diagnostic solutions are problems too
Problems are easy to discover — viable solutions on the other hand? This is why we have diverse trauma therapy options. If things were simple, one-size-fits-all would work.
Criterion creep began the same day mental health doctrine was created. Every practitioner has an opinion on what is right for evaluation or diagnostic purpose. They’re not wrong, either, as the entire industry is speculative, philosophical, trial and error on a per patient basis. Who says a small fringe method today won’t be the primary treatment tomorrow?
Then we have progression, and that comes from the industry professionals. Precision medicine is needed more than ever to substantiate mental health, yet we lack the necessary biological knowledge for the brain, and thus we lack any associated tests to validate mental health diagnosis.
Maybe the solution is to remove criterion A? That would elate many industry experts. It would remove the pretense surrounding PTSD, making it available to everyone where trauma is relative to the individual and assessing physician, instead of meeting a specific type or threshold. This freedom would negate societal times being good, bad or otherwise.
Saying that, lessening PTSD traumatic requirement would likely void disability for PTSD diagnosis. PTSD is considered the mental equivalent of losing a limb. Is a relationship breakdown, cheating spouse or tooth extraction equivalent to losing a limb?
This legal and disability component must be factored towards any decision made forthwith. Open PTSD and you either collapse Governments from disability claims, or you collapse those persons lives legitimately disabled by PTSD from catastrophic trauma.
MyPTSD members contributed modifications to harden DSM V criterion (Modified Version), which may solve some problems with the ease PTSD is diagnosed, whilst including regulation for complex trauma sufferers.
Do we continue adding diagnoses to the literature, expanding diagnostic manuals specificity? Rosen, Spitzer and McHugh outline some of the new literature appearing in an attempt to fill such criterion creep void:
New diagnostic categories modeled on PTSD have been proposed, including prolonged duress stress disorder, post-traumatic grief disorder, post-traumatic relationship syndrome, post-traumatic dental care anxiety, and post-traumatic abortion syndrome. Most recently, a new disorder appeared in the professional literature to diagnose individuals impaired by insulting or humiliating events – post-traumatic embitterment disorder.
Does psychological diagnosis need be restricted to psychiatrists? They are the medical doctors who diagnose based on exclusion. Such a requirement may help reduce criterion creep, yet this creates diagnostic delays more than already exist, and psychiatrists are more likely to treat with pharmacology, whereas psychologists rely more on therapeutic technique. Maybe a top down screening process? Visit your GP, referral to psychiatrist, evaluated whether you need psychotherapy (diagnosed), and then you are pushed to a psychologist for psychotherapy.
The network approach adequately demonstrates a broken categorical system of diagnosis currently used. We splash around labels and medication based on reusing the same symptoms for these diagnostic labels. Disorders are a network of interacting symptoms, even self-reinforcing, and not underlying disease entities (categorical) that produce symptoms.
When you suffer symptoms, period, you suffer them. However, looking at symptoms via a network approach may be more beneficial towards therapeutic solutions than diagnostic evaluation?
To understand this conundrum in its simplest form, let’s use depression as an example. Rumination, insomnia, fatigue and concentration difficulties seem causally interconnected. If you ruminate, you’re most likely to experience insomnia. Lack of sleep produces fatigue the following day, which is most likely going to affect your concentration.
Do you really have depression or do you simply ruminate? The cause has become lost in an attempt to label. Do the symptoms sustain themselves uniquely, or are they connected, based on individual situations?
One solution I don’t see right now, is what surrounds our daily lives. Technology. Where is technology in diagnosis? We fill out forms, we have written books with defined limits, we have industry professionals who use emotion as part of their decision process. We have a diagnostic categorical structure with a 50% symptom overlap. Why? There are astounding mathematical minds today putting that math to use within algorithms. Google is a direct example of mathematical genius resulting in an accurate algorithmic outcome.
Would we not obtain a far more accurate diagnostic outcome from a computer system where we input symptoms, environmental effects, what is happening in our lives, using a HD camera assessing our body language, etc, and then calculate an accurate single diagnostic outcome, if not direction to look at what our issue is? Computers are not emotional: they’re going to look at the facts, not be empathetic or sympathetic with self beliefs and complicating contextual factors. The snowball effect is limited, if not removed.
Google already uses a limited AI system in their search algorithm. We already have camer-based lie detector software that uses an algorithm to measure facial and body movements. Such technology already exists and would take mental health diagnosis from best guess to 95% plus accuracy.
Such an approach unites the world towards a single system, with all heads providing the content for an algorithm with which to work. I’m sure Google would love to put their name to a global medical system. Diagnostic delays would be removed, especially if you feed personal data over a period of time to provide the most accurate diagnostic outcome. Such process can all be self performed anywhere with Internet access.
Just add cost to access, and the industry maintains its big business hold on mental health.
Enthusiastic mixed with scary
It’s 2017, and PTSD is seemingly becoming far more complicated than it ever should. Media are not helping by disseminating emotionally charged half-truths for statistical readership. Groups are banding together for change, and when enough noise is made, mixed with half-truths, politicians are being involved in mental health processes. Just look at the American marijuana accessibility laws for PTSD. There are more political decisions being made in its approval than are being based in medical evidence.
What I know is that PTSD, like most mental health disorders, is over-diagnosed and lacks diagnostic consistency. There is too much individualism in diagnostic application, which is what an AI-based networking algorithm would remove entirely, let alone the mis-diagnosis and comorbid over-diagnostic occurrences. Whether or not such a move is the answer to PTSD’s criterion creep crisis is up for debate. What does seem clear is that if nothing is done to stem the flow of its current popularity as a diagnosis for all of life’s natural bumps and bruises, the legitimacy of PTSD, and its legal implications, will be gravely endangered.
Anthony founded MyPTSD in 2005. He is a veteran, writer, and web designer. He lives with his wife and two heinously cute puppies in Melbourne.
Simon earned her writing degree in 2011. She hopes to one day garner a doctorate in composition. You can find her on MyPTSD, where she talks (too much) about her dogs, life, the multiverse, and Everything.