Discussion Of Ptsd Diagnosis Discussion

[Crow]

Just throwing this out here 'cause I haven't seen it (but I've only scanned some posts). My pdoc/T considers ptsd a physioneurological condition. Simple as that. Our nervous systems are confused. Get the physical wiring corrected as near as can be done, symptoms decrease. Research shows this type of trauma therapy works across the board with whatever the causation might have been. So yeah, I agree with @KwanYingirl

 

[anthony]

What do you think would be more helpful to people with PTSD: reinventing Criteria A or increasing access to quality care and therapist training in trauma specific interventions?

Both. The first has socio-economic impact to all Government tax dollars. No Government can afford to sustain the health of an entire populous. Most developed countries have systems of quality care already -- with long waiting lists. So is the problem the quality of care or how to remove the waiting lists?

These are philosophical questions, no different that criteria A being a philosophical criterion encompassed in a philosophical diagnosis, contained within a philosophical mental health doctrine manual. There is absolutely zero evidence to support mental health diagnoses to date. ZERO. It is all best guess, theoretical, hypothesis, philosophical discussion.

What if we had a certain amount of money to improve the lives of sufferers? How would that money be best spent?

What if the world was purple? What colour would you dress in each day?

"What if" doesn't solve any of the problems.

Should we get rid of diagnostic manuals completely? I'm all for it. Do it I say. Anyone here on disability for PTSD? You just lost it the moment they get rid of criterion A or PTSD, whichever occurs, if any.

I read in this thread someone mentioned experts using the manuals. Ummm... that isn't right at all. Experts, and I believe Van Der Kolk was used, he diagnoses his clients with diagnoses that do not exist in the manual. DESNOS is his... diagnosed, yet it has not passed any appropriate board for approvals nor was it included in any manual... yet he diagnoses it nonetheless.

This is throwing stones in a glass house. There is a lot wrong with mental health diagnosis. HUGE actually.

So what is your alternative to what we have presently?

Don't tell me experts, because experts of trauma are all off doing their own thing, many of which don't believe in the DSM or ICD and want exactly what is the idealistic outcome -- solid patient care to fix the problems and treat mental health accordingly.

Oh wait... the neuroscience doesn't exist though with those solutions. I don't have them. You don't have them. The experts don't have them.

So what do we do? That is an honest, reliable, accurate question.

My answer: We work with what he have, trying to improve upon it, progressively building a foundation for future accuracy and treatment protocols.

And @Chava, if you continue bitching and whining about me thread banning you from the other discussions, I will ban you from the entire site. That is not a threat, it is a promise to you. I asked in the opening post to not off-topic the discussion. I asked again when a couple of members were getting off-topic to the specifics at hand. Both times, ignored. I then warned. Ignored. I then actioned. You showed absolutely zero respect with my wishes as the thread starter. Other staff reviewed those actions and determined my actions were credible based on the times asked, then warned, and all ignored. Not rocket science. I told you, if you want to complain about it, put it in PC... yet here you are, another thread venting in several posts your disgust. Again, directions ignored. Refer to the promise just made, as this exact nonsense creates discourse across the community where you are blaming your problems upon me. Take responsibility for your actions and accept the consequences. I have been more than lenient thus far. Again, refer to promise. I'm a man of my word, never been anything less than here.

 

[scout86]

There is absolutely zero evidence to support mental health diagnoses to date

What would meet your definition of evidence?

 

[anthony]

Something factual. Something that supports its own weight against rigorous argument. If a counter exists, then it cannot support itself.

 

[scout86]

I'm probably not framing my question real well.

Are you saying there is no evidence to support the existence of mental health conditions, or that there's no evidence that there are discrete mental health conditions, or something different than either of those? I guess I see where just because someone SAYS they are experiencing something, hallucinations, hearing voices, what ever, doesn't mean they are. Would anything other than physical evidence suffice?

 

[anthony]

mental health conditions

The specific conditions, yes. And you answered it yourself, quite wisely I might add, in that mental health relies primarily upon self-assessment is just one of the issues, yet you can apply many different requirements across all mental health diagnoses.

Yes, mental health exists. Yes, we should have classifications for differentiating what we define to be mental health conditions, for ease of use obviously.

But saying that... lets stick with PTSD, if you want to venture out then we can. There is no evidence to support that PTSD is caused by a criterion A stressor. In fact, the majority of research tends to find that symptoms are a result of pre, peri and post traumatic incidents within a persons life uniquely.

Diagnoses today are based on a categorical structure mixed with causation. This entire system has zero validity to quantify itself. In fact, there is actually supporting evidence to say the structure is wrong, yet here we are, still working with a structure that has no evidence to support itself -- it is entirely philosophical in nature. If you look at symptoms through what is called the networking approach, that is an evidence system of mathematical analysis from complex algorithms and determine symptom likeness and how they relate to one another. This system is evidence how symptoms interact and even self-sustain one another, yet it also evidences that if used, the categorical system we currently use with no evidence to support itself, would need to be abolished.

People talk about a best case approach per person, patient care, whats best for the sufferer. Evidence of the networking approach actually shows that we should use a computer system, which has no emotion or bias, input what symptoms are experienced, to be output what we should be focused upon. What is unique versus sustained by another symptom? All based upon our individual circumstance.

That is the only evidenced approach I am aware of to date, which actually supports itself. But it comes with no diagnostic categories or such, because every person would be assessed differently based on their experience and what they endure.

To demonstrate self-sustaining.... do you really have depression? Is every symptom individually sustaining OR are symptoms sustaining one another? If you loose sleep because you ruminate, what happens? You wake up cranky, moody, the next day. Lack of sleep is directly connected to concentration difficulties, memory recollection problems, mood, and so forth. Low and behold, most of these are symptoms of depression. So are you actually depressed? Or do you just ruminate which is causing this to look like what we have categorically defined, a mental health diagnosis of Depression?

Therapists are going to try and treat you with serotonin drugs, all sorts of mind altering chemical compositions, therapeutic techniques, yet all miss the actual problem of which you aren't depressed, you just need help with ruminating which is causing you to lose sleep. Too much thinking on things, in essence. Change how you sleep, suddenly everything else goes away... as those symptoms are no longer being self-sustained by you losing sleep.

How many people do you think are mis-diagnosed with mental health conditions based on this evidenced logic?

 

[scout86]

@anthony , I'm glad I asked the question, because I think I've been totally misunderstanding your position on all of this. I've seen a number of people arrive at this forum, saying they "have" PTSD "from" something that doesn't meet Criteria A, and then get told in no uncertain terms that they "can't have, or get, PTSD from something like that. That's led me to believe you were rather attached to the current system. And I'm not real fond of the current system, myself.

Therapists are going to try and treat you with serotonin drugs, all sorts of mind altering chemical compositions

Some therapists at any rate. Mine not only does do that, he encourages avoiding mild altering chemicals of all sorts. But, I imagine he is using what he thinks of as a therapeutic technique. These days, mostly, that seems to involve how to get better quality sleep and more of it.

 

[katz]

I'm not sure if this fits in with this thread...I had always thought that I was crazy. My family and a lot of doctors told me that it was "just me". I blamed myself for years, and I mean years! After 3 trips to the hospital. I decided that it was all me and must be my fault.

Then one time, I was checked in for something else. I was in the hospital for a week. I was hooked up to an EEG and even microphones and video. The doctor watched and listened and tested me. In the end she had taken me off all but one of my meds. She was also able to officially diagnose me with my PTSD. I was so relieved to know this. Finally, I had physical proof that my "problems" were not my fault. Since then, I have been doing much better. I know now that it is all--and I mean all--their fault. (my many "demons")

I have also done a lot of reading on the diagnosis procedure. I have been back to see the doctor and she was able to confirm--again--that the problem is physical, in my brain, as well as emotional. The physical changes that take place in the human brain, especially in child hood, are down at the level of chemicals, and misalignments as the brain develops.
I have a lot of memory problems, both remembering the past as well as the present. I talked some more with another doctor as well as a chemist and now have a much better understanding of how the human brain develops as it grows, and what a difference of "trauma" can make-at a chemical and developmental level.

I just wanted to share this with you. Sorry again if I am in the wrong thread.

 

[Friday]

My 2.02

Taxonomy is super important to me. Defining what a thing is, to the best of our ability, is what allows us to deal with it appropriately.

Case in Point : Someone is crying and rocking in an alley. What do you do? Approach cautiously! Why? Because at that point you have no idea how they're going to respond to being approached.

So let's say as you approach that they leap out, scream, and assault you. Why did they do that?

- They've just been raped, and mistake you for their rapist come back for more.
- They're high on drugs.
- They haven't slept for 3 days and are hallucinating
- They've just been in a car accident down the road, and have sustained a head injury.
- They're out of their mind with grief.
- They're racist, and you insert racial slur here dare intrude on them? They'll teach you!
- The voices told them to.
- The crying is bait. This is how they lure victims into an alley to rob/ rape/ etc.
- They have a sprained/broken ankle from a pothole in the alley, and the leap was a lurch, the scream of pain as they come down on their ankle, and the assault was them trying to catch their balance and you just so happened to be in the way.
- et cetera

Each of those causes? Needs to be handled differently, to be best handled. And then within each of those causes? There are different "best" options, depending on the individual themselves. Could just treat them all the same. But to be best dealt with, you don't treat a rape victim the same way you treat someone in violent psychosis who feels no pain on angel dust. And to be even better handled? You don't treat all rape victims the same, and you don't treat all people high on drugs the same. There are subcategories within the main category.

People get all bent out of shape over "labels" & "judging". :meh: Please, please, please, please let someone use their judgment on me and take me to a hospital for my head injury instead of beating the shit out of me! Please please please please let them have the kind of training to be able to recognize the difference between a distraught trauma victim who needs ABC help, and someone high on drugs who needs XYZ help! Please, please, please, please, please let there be training in the first place... Because people have taken the time to "label" different causes, and experiment with different treatments and approaches! Not just lump everyone together as violent or crazy, but actually determine the cause!

I would be knocked on my ass surprised if ANY diagnosis in the DSM is actually correct. I'd be even more surprised if we get even some (much less most) of them correct in the next few generations. Like trying to describe germ-theory without microscopes to prove microbes exist, much less what differentiates one microbe from another... All we can do is observe the results. Exposure to some makes us sick, but not others. Soap kills some but not others. Some we can get sick with many many times, others only sick once. But does that mean we should just say, f*ck it! Can't prove any of this shit, so why bother trying? Why use soap to wash hands at all if it only works sometimes? Why refrigerate food if some food can still go bad in the cold, and other food can sit on a counter for 5 years and still not make us sick? Or do we go ahead and use our best understanding to try and taxonomize?

Clearly, I'm a huge fan working with what we've got. Of trying to better understand. Of attempting to triage/recognize/treat things the best way they can be.

The DSM-# is our best current understanding.

It's an attempt to describe, to group, like to like. To handle them as best we can. And it's a living document. It changes, constantly, as our understanding changes.

That it can't be perfect? That we're going to make mistakes? That some things are going to be wrong? That we plain and simple haven't invented microscopes, yet? That's not a reason to stop attempting to taxonomize, to define closer. That's all the more reason, IMO, to keep striving for better understanding.

 

[scout86]

I'm not sure if this fits in with this thread.

For right now, let's think of this as "the thread where everything fits", how's that. So, did your doctor explain exactly what they were basing their diagnosis on?

And it's a living document. It changes, constantly, as our understanding changes.

That right there, for me, is a REALLY important idea. Science is a process. Many things we think we know today, we'll find out tomorrow, or farther down the road, are different than we thought. It doesn't make sense to get too firmly attached to today's ideas about this stuff.

 

[anthony]

@scout86 you only need ask me to get my opinion. Yet what @FridayJones says also rings true. I work with what we have, not with what I would like to have. I use the expert consensus, not an expert that I value their words.

People spew their trauma idols around here at times in a way that it seems they only believe what this one persons says. To me, that's dangerous and naive.

Every person here ever diagnosed with cPTSD is basically seeing a therapist or psychiatrist that is working outside the rule book. Especially any American. ICD 11 cPTSD is in trials in specific UK and European locations (last 6 - 12 months), but we have primarily USA persons here claiming a diagnosis that does not exist. DSM applies to Americans. In these diagnostic threads I have read members claim they abhore rogue physicians in one breathe, yet claim to be diagnosed with something only a rogue physician could be telling them, diagnosed well before recent ICD trials.

Basically, the system is broken but it's the only system we have. So when people question why we would be playing with the diagnostic structure ourselves... Well, we can't really get it further wrong than what we already have - being a philosophical system.

This diagnosis is broken. Me personally, I believe that an algorithmic approach would serve much better than the categorical system we have. You input causation/s and appropriate symptoms and let a mathematical AI work out the most likely diagnosis using true relativity and relational aspects of symptoms vs cause.

We actually have the technology, it just isn't used for mental health. But that is explained when I release my article.

If you want my opinion, just ask. My opinion may differ greatly than what we have in use now. But my opinion is not what I use in answering things because that is not the factual matter if present tense. I use the expert consensus / current doctrine. I'm not a psych expert, I use their knowledge, not my opinion.

 

[scout86]

you only need ask me to get my opinion.

I have no doubt about that, what so ever! LOL

This diagnosis is broken.

I really tend to agree with that. At least I don't think it's the final word on the subject. I'm not a huge fan of reducing people to numbers, but I CAN see how you could probably use math to come up with subjective criteria.

As far as all the "experts" go, I don't have much of an opinion, myself. My T says I meet the criteria for PTSD, I imagine that's what he's told the insurance company, now that I have insurance. He says I have a couple other issues as well, but he's not big on labels. We work pretty well together because we are both what he calls, "process people". I see bits and pieces of a lot of things in what he does. He talks some about what he does, as well as how and why he does it. Sounds like he gathers information from a variety of sources and fits it together with the personality and needs of the individual client in mind. Probably more of an art than a science the way he does it. But it's art based on science.

As far as I'm concerned, the "making a diagnosis" topic is mostly an interesting mental exercise and it's interesting to me to see how different people see things, whether I agree with them or not. I've got my own thoughts, nearly always open to the possibility of learning, but don't really have a dog in the hunt.`