News Mental Health Diagnosis

[anthony]

I think this is one of the most controversial debates around, still lingering ever since the DSM IV hit town nearly 20 years ago; that it turned mental health into a field of profitability which many argue that has hurt mental health more than helped.

Is that the case? Has diagnosis hurt mental health today?

There is certainly a lot of information fore and against this argument, and even depending upon what aspect of the argument you enter upon. For example, some adult diagnoses have been refined or removed. Some childhood diagnoses have been added, to the point where if you take a child near a mental health physician they're labelling them for being a child.

Maybe the more sensible argument is: at what point do you apply a diagnostic label?

There are people, and parents, who want a specific label for monetary or statutory reasons. There are psychicians applying diagnoses to clients and patients after one or two sessions. Can a person really be truly assessed accurately after one or two sessions? I don't think so.

I think many will find this video quite interesting, and eye opening.

Even the DSM V is controversial, before it's even published, as the primary basis for the manuals disorders is agree-ance between psychiatrists globally, not statistical & scientific data. The last five years has seen a lot of statistical data arrive from technology, proving and disproving many facets of mental health. FMRI & MEG are two of the busiest right now, watching brain activity to derive statistical and scientific analysis.

What do you think about mental diagnosis? What evidence do you have to substantiate your thinking?

Maybe another question is the flip side to this... what alternative exists if there weren't standardized diagnoses?

 

[Nicolette]

There are people, and parents, who want a specific label for monetary or statutory reasons. There are psychicians applying diagnoses to clients and patients after one or two sessions. Can a person really be truly assessed accurately after one or two sessions? I don't think so.

There is the opposite side to this though too.... even though minor... you go to get income or life insurance and they ask you if you've been to therapy (not what for etc). Just on this basis alone they now determine you are a higher risk and load your premium. :wtf:

 

[mamachick]

I read somewhere that medications that correct chemical imbalance (which is clearly controversial), actually cause brain injury. As these chemicals are introduced into the body (seratonin, etc), they change the brain chemistry, causing the brain to quit producing them on their own. Once this happens, it is difficult to get off the meds and the brain to resume making these chemicals. So essentially, they were proposing that meds cause brain injury (chemical).

One of the problems that I have seem repeatedly is that anti depressants make the patient more compliant and tolerant to their environment, and without meds being the first line of treatment, the patient may be more inclined to make changes to situations/environments that are uncomfortable or even unbearable.
Abused women will see dr. and be diagnosed as depressed. She is depressed becuase she is abused. She is given an anti depressant, and becomes more tolerant to the abuse. Then she stays with the abuser. We make changes when things are so uncomfortable that we are unwilling to tolerate the circumstances anymore.

However, before we had all these meds, psych ward halls were lined up for shock treatments. Many were involuntary and very traumatic. My mother was in a bad marraige and self medicated with alcohol. At some point she was hospitalized and given shock against her will. From listening to her accounts of shock treatment, it sounded very barbaric and traumatic.

 

[Red Feather]

I'm so glad this is being discussed. I wrote about this when applying for a PhD. I know I need to get much more informed, but this was one of the reasons I avoided doctors for so long. Now I am totally locked up in the medical culture. I guess because things got so bad I needed that help. I am also getting more weary of being on this site for the same reason. Always thinking about the illness, can not be really helpful. There are two sides of the same coin, and it is really easy to lose sight of the other side, where it is clear that nothing is wrong with us.

 

[intothelight]

I watched this and I found it really disturbing. The statistics for suicide were very disconcerting and really to throw a number out there without the underlying research that supports this number is going to make me hold off making a final decision. But to cite 43,000 deaths tied to prescription medication should make everyone sit up and say "What!". We have whole parts of society disturbed and speaking out about gun control laws and war, but nothing but silence about pharmaceutical deaths????

To find out that most diagnostic criteria are "voted" was also a bit shocking. Where is the research? Where are the physiological and neurological components? Is this all just part of a giant conspiracy theory or is it just the "best we can do" as science really is only beginning to understand how the brain works?

One of these discussions that raises so many more questions than answers. One thing it does do though is reinforce the fact that an individual needs to be their own advocate. Question everything and keep digging for answers until you are satisfied. The problem also is by the time most people seek mental health assistance they are the least able to be their own advocate.

For me personally, this discussion and the video reinforced my own decisions, especially regarding certain types of medication. But it also leaves me with a lot of questions and uncertainties about what is "best". I guess somewhere between the two extremes, self-understanding, and learning what works and doesn't work for an individual is the "truth".

One thing that I do know is that just basic things like: eating right, sleeping enough, exercising, sunlight, eliminating use of cigarettes, and limiting or eliminating the use of caffeine and alcohol, drinking enough water, stress reduction, positive social interaction, meaningful work, etc. can go a lot further in making a person feel better than any one prescription. Things is, it is a lot harder to do these things than it is to take a pill. Or maybe, when we do these things it is a sign that we are better??? The chicken or the egg? But it really doesn't matter, as none of the above will cause damage or death.

 

[piratelady]

Regarding mental diagnosis, so much of it is subjective. I think that makes it difficult to put science behind it. Take me: Therapist 1 was convinced that I had a "chemical imbalance" in my brain and the only hope was anti-depressants. His reasoning: That I need alone time to re-charge and be alone. Therapist 3: He is already seeing improvement from therapy alone and there has been no talk of "chemical imbalances." My point is that because mental health diagnosis is done based on talking and observation it is difficult to make it an exact science. There are therapists out there that suffer from LTS (Lazy Therapist Syndrome..NH and I coined that term), because they are lazy, they want to just make a diagnosis, throw some pills at it and send you on your way. There is no objective science behind the diagnosis. They can't draw some blood and see, conclusively, that someone has bi-polar, or has depression, etc.

I read somewhere that medications that correct chemical imbalance (which is clearly controversial), actually cause brain injury. As these chemicals are introduced into the body (seratonin, etc), they change the brain chemistry, causing the brain to quit producing them on their own. Once this happens, it is difficult to get off the meds and the brain to resume making these chemicals. So essentially, they were proposing that meds cause brain injury (chemical).

I have read something similar. I haven't been able to find it again to post a link or reference it. I will keep looking. Basically the jist was that anti-depressants, in essence, create an addiction. Once you have been on them (I believe it said for over a year) that your brain becomes dependent on the chemicals from the medication and the person is likely to need them forever. Also, here is a link to a fact-sheet that one of my therapists gave me. One thing it says is that CBT can be as effective as Anti-depressants. CBT doesn't have all those side effects of the risk of making a person suicidal.

Link Removed

To Anthony's question: At what point do you apply a diagnostic label. I think that is a question that more and more people are asking themselves. I have always been on the fence about it. Again, for the reasons stated above: A diagnosis is needed to apply for disability, it is needed if you want your insurance company to pay for your therapy. However, with diagnosis comes the potential for higher rates on some insurances, and when others find out you have a diagnosis, they will look at you and treat you differently. Me personally, I weighed the cost against the benefit. I needed treatment, in order for that to happen I needed therapy and so a diagnosis. It may just be a label, but it is a label that carries a lot of weight and has a tendency to follow you.

 

[Meadowsweet]

I think in some way the responsibility for diagnosing anything and everything must fall on media-rich cultures that depict a particular image of 'happiness' as a sign of success, and all else as a sign of failure, weakness, or something being 'wrong' with someone. Because to get any diagnosis, a person must seek help.

At what point are people believing that something is bad enough to seek help? If diagnoses are being given for the grief, anxiety and sadness that occurs from common life experience then either the emotional expectations are misguided, or the emotional upbringing (learning how to deal with emotion) has been messed up. In both of those cases it is a social/cultural problem that needs addressing on mass.

But I feel that a lot more research needs to be done in order to differentiate physiological illness, from emotional distress, emotional disorder and cognitive or developmemtal disorders etc. The reason for making distinctions over the cause of the symptoms is to find the most effective method to treat the cause and not the symptom.

 

[Girl3]

Part of medicine - psychiatric or not - is business. Not because most doctors want it to be a business - doctors want to take care of people. 150 years ago, there was virtually nothing a doctor could do for you.

Good food, calm surroundings, work and leisure structured to help the patient, that was the way mentally ill patients were care for - and the vast majority did not get better. Similarly, talking therapy didn't cure people. The medications as they came along were crude and often discovered inadvertantly. Bipolar patients had no hope until lithium came along. Schizophrenics were doomed until neuroleptics were created. And yes the drugs have side effects.

What a lot of people don't consider though, is that so many of our so called diseases are things that don't require drugs. Reflux in most people can be controlled with diet, weightloss, and lifestyle changes. Hypertension often responds to lifestyle changes: no alcohol, no salt, plenty of exercise, and a spartan diet high in vegetables, fruits, and small amounts of fish and lean meat. Atherosclerosis can be cured by diet and lifestyle changes - want to stop having heart attacks? Quit smoking, exercise, eat a diet of mostly vegetables and smaller amounts of whole grains, fruits, little or no meat, moderate or no alcohol.

Most people with high cholesterol DON'T have familial hypercholesterolemia. Type 2 diabetics can stave off their disease by exercising, keeping weight at an ideal body weight, avoiding high glycemic index foods.

What I'm getting at is that much of what is self-induced illness, is in fact people not taking care of themselves. I don't care if you can measure the amount of coronary artery disease someone has, the truth is that most of it is reversible through diet. Dean Ornish, MD proved that. The problem is that people would rather take a few pills, get a few stents, have open heart surgery - rather than get their diet under control.

As for the DSM - I have many problems with it because it has made diseases of things that are not. But there ARE mental illnesses, that absolutely respond to treatment. Treatments of all types aren't perfect.

Do you take a beta-blocker for your blood pressure? Then plan on developing type 2 diabetes. Take HCTZ for your hypertension - well, you can get gout from that. Take any kind of blood pressure medicine - you'll lose your libido and your ability to perform. Take a steroid for your rheumatoid arthritis? You can look forward to hypertension, renal failure, and diabetes.

I think you get my point. Reality is somewhere in the murk. Be careful of propaganda regardless from where it comes. But this is also why I participate in studies - we are just now entering the enlightened age of medicine, especially as regards psychiatry.

Imagine if they did this entire video from the standpoint of attack obese people. Or smokers. Or alcholics. Just quit. Just quit being crazy. Just quit being fat. Quit being angry or depressed.

One final note - this video is highly suspicious for being Scientology propoganda. The Scientologists do not believe in psychiatry or psychiatric meds (or labor epidurals...) but they do believe in brain washing people.

 

[Zef]

It seems to me that diagnoses are becoming less and less useful, at least to patients, as the frequency, quality and advancement of brain-related research has grown. Clinicians cannot keep up unless they specialize.

Diagnoses seem to be primarily useful for bureaucratic reasons. . .insurance, government, etc. While it can be comforting to have a label that fits, in the end, all we care about is getting the proper treatment for our symptoms. The insurance company and the DSM can call my symptoms 'Excessive Crow's Feet' for all I care, as long as I get treated and the treatment is paid for by the company I contracted with to pay for it.

The one issue that is concerning, at least in America, is the amount of influence that drug companies have, both in policy and in diagnosis. General Practitioners (Family docs) get rewarded by drug companies for diagnosing and prescribing the company's meds and there is also new evidence that doctors are getting pressured to prescribe meds when a company feels like they aren't prescribing enough.

When I first went to get help, it was a GP who diagnosed me with Major Depression and prescribed an anti-depressant. Frankly, it was much easier to get the anti-depressant than it has ever been to get pain meds, no matter how evident my pain was.

Call me a socialist. . . :) . . .but some things should not be privatized or for profit, health care, schools, prisons, Congress. . .

 

[ericaboo]

I feel like there is a side of it where... without the DSM, mental illness is/was not believed. If you look at history, and the way people were treated before these fields of science, it was so horrific. I hope we will get better and better at understanding the brain.

I think they should still keep trying to fine tune diagnoses - I guess it's what we do with them that get's pretty scary. Honestly, having grown up knowing about the field (mom and grandfather were in it), I think progress is being made, slowly but surely.

It's reassuring to get any benefits at all for a problem that you can't take just do a blood test or x-ray for...

 

[Girl3]

My psychiatrist left Germany because he couldn't take care of patients, get funding for research, or do any of the amazing things that he now does in the US. He gets funding primarily from the DOD and NIH, but has also had industry funding. He takes care of patients who cannot afford psychiatric care as well as those who have insurance or pay privately. He isn't getting rich. No pharmaceutical company owns him. He put me on clonidine for sleep and decresing my startle response because it's 4.00 a month and it works. When I did take an antidepressant, he put me on the lowest dose of duloxetine - not because it was expensive, but because there was some scientific evidence that it would help with my anxiety as well as my pain.

 

[anthony]

I think anyone who thinks this video plays on the emotions of the viewer, is absolutely spot on. There is an issue with mental health diagnosis, no questions asked, major problems. Is it all nonsense though? Absolutely not. Is it best guess? Absolutely. Saying that, the best guess is based on statistical data.

Some mental health diagnoses are absolute garbage. There are a proportion of physicians within the industry who play upon this as a business model, with little regard for client well-being. If there wasn't, then people wouldn't show-up here stating they got diagnosed with PTSD from a relationship break-up or such normal life experiences.

Here is another video I've always found quite helpful on this topic.

Physicians are only really just piecing medical science together nowadays to confirm or deny specifics in mental health. The whole chemical imbalance has been empirically disproven from MEG; basically pharmaceutical companies are shot to shit with that one now. Saying that, neurobiology is finding a lot of scientific data to substantiate what has already been diagnosed, or simply having to slightly modify aspects.

PTSD is one example, where PTSD has shifted from a chemical imbalance to a biological problem located in the pre-frontal cortex. What exactly is unknown today, though MEG has empirically narrowed the issue.