News Mental Health Diagnosis

[heidi]

This sounds like an interesting subject. I wish I could read through all the posts here.
What I wonder is what is in that thick book?
I mean I can think of maybe 20 disorders that are troublesome and obviously so. Okay maybe thirty.
There had got to be a lot of garbage in there.
I think in reality there are only about 20-30 disorders.

And yes it's scary that not only can medication cause brain injury but that they are being prescribed so frivolously.

 

[anthony]

I have to agree that there are a lot of diagnoses within the DSM and ICD that aren't based on any scientific data. They are purely political, societal or the majority wins voted. There are some that have a lot of medical and scientific analysis to substantiate them, then there are those still sifting and undergoing medical science to validate / invalidate.

I really think mental health needs to adopt a broader approach to diagnosis, ie. anything that is not 95% conclusive, beyond speculative opinion based, should be assessed over a longevity period. Even one visit a month for 12 months is better than what currently happens. Most people recover themselves, without pills or therapy intervention, and they often do it better within society for longevity than within a therapeutic environment.

I also believe this is why diagnosing should be removed from everyone except psychiatrists. They're the only ones who have a medical qualification... psychologists don't. Everyone lesser should provide counselling intervention, and then those who don't respond get bumped up for diagnosis. That removes the pressures upon psychiatrists by having that referral route prior.

 

[intothelight]

I would question even a psychiatrist's diagnosis. Many times they are the person who spends the least amount of time with the patient, and are the one most influenced by the drug companies, as they have the ability to prescribe.

I think people just want to get better in the end. Hopefully somewhere in the maze of medical and informational confusion, people can find the tools, the support, and the belief in themselves they need to proceed.

 

[piratelady]

I have to say, with the way Psychiatry is currently practiced in the states, I disagree. Yes, they are medical based, but because of that they act more like medical doctors. Most psychiatrists only see a patient for about 15 minutes, prescribe their meds and send them on their way. Counselors and Psychologists see their patients for 45-50 minutes. It seems to me IF the psychologist or counselor is qualified they would be more like to arrive at an accurate diagnosis than a psychiatrist.

Again, I don't know that all psychiatrists are that way, and I know of people in other countries who see a psychiatrist for both their counseling and meds - but here (in the US) it is shifting more to a quick relationship: get your meds and go.

The article I read about this said that the only way Psychiatrists could stay afloat, financially, was to see more patients, the same as GP's do; hence the 15 minute appointments and that was part of the reason for this shift in how they work. So...it all comes back to money.

 

[Hashi]

I think this is really tricky. Mental health conditions can be diagnosed and classified in exactly the same way that physical conditions can, so there are arguments for discussion and concensus in drawing these up. Also for using observation to come to a diagnosis. But then how do you avoid conscious and unconscious bias/personal agendas on the part of all concerned?

One obvious answer would be to have more safeguards around diagnosis and treatment decisions. I'm shocked by how little is required for psychiatric drugs to be prescribed, and how easily someone can have their life taken away from them by a diagnosis of mental illness.

The problem is how to address things given the situation we already have, and the - ahem - insanity that seems to be the DSM. It's like trying to get a runaway train back under control.

I'm wondering what NIMH uses?

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.

I can't see much difference between the idea of a chemical inbalance and the idea of a biological problem, in the sense that both are pathologising something that isn't caused (directly) by a physical injury.

I see neurobiological changes as symptoms or concurrent effects rather than causes. For me, that's the explanation why non-medical treatments such as CBT can have a measureable neurobiological effect. It's also why I think a neurobiology-centred approach - with its implications for invasive treatments like deep brain stimulation and neurological blocking - is as risky as the chemical-centred approach and the resultant medication issues.

Even the less invasive approaches like CBT can be used inappropriately if the therapist is wearing science goggles rather than seeing the individual client. I've been retraumatised by CBT treatment with a psychiatrist who thought in statistics. The fact that it was evidence-based wasn't much comfort to me.

To me, we're just going down the same kind of road yet again, and it takes understanding and resources away from other possible approaches. I know there's some positive research about the effectiveness of neurobiological treatments. We've also been told - along with the whole medical/pharma/insurance industry - about the positive research into the effectiveness of antidepressants and anti-psychotic drugs. Even in the cases where the intended result is achieved (eg lowered anxiety), with any medical treatment it's always a trade-off against the risks and unwanted effects.

Just my personal view.

 

[anthony]

I can't see much difference between the idea of a chemical inbalance and the idea of a biological problem, in the sense that both are pathologising something that isn't caused (directly) by a physical injury.

It was a fairly significant change IMHO, being pharmaceutical companies had derived PTSD to be a chemical imbalance between the left and right brain hemisphere, when in fact MEG dictated that PTSD is caused by a small part of the pre-frontal cortex. Obviously they can't open up brains and play around whilst the person is living, and they are pretty useless I guess when dead for such data.

My point is more... the original hypothethis was about adding drugs to rebalance an imbalance, when in fact quite the opposite is now proven, there is no balance or imbalance, nor a requirement for any drug interaction directly.

Agreed, a psychological problem caused a biological problem. Just a vast difference in the actual problem caused, its location and how it should be treated, and then what treatments are best for it.

Step back just five years, and PTSD was concentrated on the amydala and hippocampus, when neither are part of the issue with PTSD. Their functions are impaired as a result, though they're an effect, not part of the cause or the issue. Just the same as depression with PTSD has been shown not to be about serotonin synapses at all, like pharmaceutical companies dictate, and instead neurobiological imaging is showing it to be mood based, not biological based. Another "effect" and not an individual cause.

In other words, no longer are anti-depressants / SSRI's considered the first line treatment. Instead, behavioural change to lifestyle, limited and specific psycho therapy types and then if required, medication based at anxiety moderation only which corrects the mood simultaneously. Possibly anti-psychotics for severe cases to manage anxiety with manic episodes, all due to trauma.

I think it is all going to be quite interesting where things go as more science is a requisite to mental health, to demonstrate a validity within diagnoses. Maybe science may force many of them out of the book as nothing more than social inadequacies versus mental health conditions.

 

[lisamarie]

I have to say, with the way Psychiatry is currently practiced in the states, I disagree. Yes, they are medical based, but because of that they act more like medical doctors. Most psychiatrists only see a patient for about 15 minutes, prescribe their meds and send them on their way. Counselors and Psychologists see their patients for 45-50 minutes. It seems to me IF the psychologist or counselor is qualified they would be more like to arrive at an accurate diagnosis than a psychiatrist.

I would question even a psychiatrist's diagnosis. Many times they are the person who spends the least amount of time with the patient, and are the one most influenced by the drug companies, as they have the ability to prescribe.

I couldn't agree more with both of these posts.

I work in the human services field (as a counselor) and the diagnoses I have seen come out of a "psychiatric evaluation" -- which often lasts only minutes are like, WHAT?? LOL. Each psychiatrist I've worked with over the years has had their own diagnoses that they slap on each person....one psych said everyone had Schizoaffective Disorder. Really? Because I think that's actually kinda rare. Ironic thing was that I ended up working with that psych at TWO different jobs and he came to my second job and changed people's diagnoses to Schizoaffective. Crazy. Psychs often miss a lot too because of the VERY brief contact they have with patients....its a joke.

I have issues with some diagnoses in the DSM. As Anthony said, diagnosing people with a "disorder" for acting like a child. My brother's generation was the "ADD" generation. Literally three quarters of his classmates were on some type of ADD medication. Really???

Many of the diagnostic criteria has so much crossover between disorders. Like I just finished a long psychoeducational series in one of my groups about PTSD. I had to explain to the patients that so many of the symptoms of PTSD crossover with other mental health disorders...GAD, Major Depressive Disorder, Panic Disorder, Bipolar, and so on.

And not to mention that making a diagnosis is so subjective. It is all up to the diagnoser's perceptions.

The other issue I have -- working in a drug treatment facility -- is that many of my patients are slapped with a mental health diagnosis with like a day clean (or while still actively using). Well, yeah, he's got irritability and mood swings, HE'S SHOOTING COCAINE, LOL. Not to mention that if the patient IS sober they are likely suffering from post-acute withdrawal syndrome.....don't even get me started.

I also understand the need for disorders to be labeled, to a certain extent. For one, if there was no labeling, we would all just be walking around with a list of symptoms. For two, assumedly, once a disorder is labeled, an evidence-based treatment can be suggested.

 

[anthony]

Yer, the current generation is Autism and such... any slight social abnormality with a child today, they get this or another similar diagnosis, all because they're developing slower, shy, quiet, etc etc. You can't be a quiet child nowadays without some adult asking what is wrong with them. How wrong is that? A direct example of societal influence in diagnosis.

I agree that psychiatrists aren't doing their job correctly at present. Saying that, if they changed the system where nobody but psychiatrist could diagnose, and instead opted for a minimum time frame in therapy first with a psychologist / counselling role, then only those with the most difficult cases would get through to psychiatrists, thus more time and effort could be put into an assessment period.

The whole system is broken to some degree and needs rebuilding IMHO.

 

[Meadowsweet]

I agree that psychiatrists aren't doing their job correctly at present. Saying that, if they changed the system where nobody but psychiatrist could diagnose, and instead opted for a minimum time frame in therapy first with a psychologist / counselling role, then only those with the most difficult cases would get through to psychiatrists, thus more time and effort could be put into an assessment period.

One problem with this is that when a patient starts opening up to a counsellor enough to determine the severity or complexity of their case, it can increase symptoms. If the more severe case can be passed from a counsellor to a psychiatrist within 2 weeks, then it could work.

But the time of a psychiatrist costs a lot financially, so an employer such as the NHS couldn't justify paying psychiatrists to leave time available for new patients. So a psychiatrist will have a full workload and this creates waiting lists. For the patient, waiting without knowing what's wrong with you or having a therapist indicate that your case is too complex for them creates further distress, which is detrimental to mental health.

However, it could perhaps work the other way around. If everybody was to see a pychiatrist for a limited number of diagnostic sessions, then they could be passed on to the therapy most suited to their needs.

 

[DharmaGirl]

When I first watched this, it sounded to me like a Scientology training film. I looked around the internet a bit, and it is. Yikes is all I have to say.

 

[anthony]

When I first watched this, it sounded to me like a Scientology training film. I looked around the internet a bit, and it is. Yikes is all I have to say.

The second one isn't, yet still raises similar / same issues. Most things can have some level of truth, regardless of its original purpose. I do not know whether this was made for scientology or not, though I doubt it, as it still recognises mental illness and the issues being faced, which I thought scientology did not.

The points are quite clear, that mental health has crept into a sphere of social and lifestyle aspects, stating they're a mental illness.

Politics should not be involved in any medical form of diagnosis IMHO. It should all have science behind it. As science changes, medical diagnosis and treatment changes. There is already lots of good science behind a proportion of mental health, though there is a lot that there isn't either.

 

[DharmaGirl]

It is a division of Scientology who made the film. They recognise lifestyle problems which can be cured with auditing. I do agree that psychiatrists drug too fast, but this film puts forth that normal behavior, such as being depressed from a bad breakup is being diagnosed as Major Depressive Disorder which it is not. Being active on the stock trading floor is being diagnosed as bipolar in a manic state. I don't think this happens. The main reason is that you would not seek help if you weren't uncomfortable. I lived with PTSD for many years before I sought help, and was diagnosed. The diagnoses are not just made up and voted on, they come from observations of behavior, which may or may not be a mental illness. I would think that the lifestyle aspects would have to be pretty severe for people to seek help from them. I would like to investigate this further, it is an interesting subject.