I have
joined the campaign to abolish psychiatric diagnostic systems like DSM called "No more psychiatric labels". There is an overemphasis on biomedical diagnosis in psychiatry (eg. see
my article with this title). Psychiatry does need to recognise diagnosis for what it is (eg. see
presentation from a talk of mine).
Even Allen Francis, Chair of the DSM-IV taskforce, is critical of the approval of new fad diagnoses in DSM-5 (eg.
It's not too late to save 'normal' and a
more recent Psychiatric Times article). I think we'd be better off without any psychiatric diagnostic system at all for a while rather than go along with DSM-5.
Word up—would that psychiatry only recognize *all things* for what they really are: theories about biochemical imbalances and genetic vulnerabilities as "working hypotheses" (supported perhaps by the oxymoron of "anecdotal evidence"), the biomedicalization of extreme psychological distress as a primarily palliative and controlling when not explicitly punitive function of society, doctors as merely the (often ill-trained) assigned guardians/caretakers of the behaviorally disturbed, antidepressants as combination emotional anasthetic/physiological stimulant, antipsychotics and/or mood stabilizers as affect "flatteners", pharmaceutical companies as rapacious profiteering enterprises all too happy to exploits the suffering, fear and anxieties of the general public, psychiatry itself as a pseudo-science all too willing to sell itself out for the emoluments of being seen as a "real" branch of medical science, etc.?
ReplyDelete"The distress is real, the diagnosis a fiction" - Dana Becker.
ReplyDeleteIt's often the PD labels that are the most pernicious and are nothing more than medicalised terms of abuse. It seems almost immoral to have a label bible for the human condition.
It would make life so much easier for everyone if psychologically ill people arriving at emergency departments were not set up with a psychiatrist for a "diagnosis" to decide if they should be admitted. Why can't they be asked some simple questions about what they are experiencing that made them feel so bad that they've come to ER? Plus a few time-limited observations of what they're doing, maybe some feedback from a friend or relative who has seen them in the last few days. It's the internal distress being acted upon that is the problem here- not what you call it. I can remember patients on a psych ward who were there for ages, waiting for a label before treatment began in earnest. As a researcher of a non-psychotic group on the same ward, I sometimes had occasion to talk to these poor "stranded" creatures. It's amazing how far a kind word went- for instance a wild looking woman approached me saying "Get the devil off me, get'im off!" & all I could say was "The sooner we get rid of him the better- it must be terrible having him hanging around all day". She calmed down pretty quickly and began talking much more sensibly to me. It was obvious what was wrong with her- why were the doctors bothering to argue about it? It didn't matter to her whether she had "manic features"- she just needed this thing that was bothering her removed as far as possible! It's also very distressing for people to have leather restraints put on them, just because they don't want to lie down- if they're not being violent to anyone, just let them sit up until they collapse with exhaustion. The same labeling problem happens in school systems where a child has to have X symptoms and not Y. One miss and you're out- no one gives you proper educational treatment. So a hyperlexic 12 year-old who has an untestably high IQ, has taught himself Japanese and Hebrew, but still manages to soil himself half the time, is classified as "too bright" for a Special Highschool class. He's too big to stay in primary school, can read anything and operate a computer perfectly, so he can't go there any more- what's with labeling him? He needs help! I'm happy with the science that IS in psychiatry, but it doesn't have to interfere with helping humans in acute distress.
ReplyDeleteI couldn't agree more.
ReplyDeleteI quite liked the old DSM-IV, but DSM-V seems to suffer from a normalitiy compuslison. If we cry once in a blue moon, we are now ill (OK, I exaggerate--or do I?). Diagnosises haunt patients for a life-time (whether or not the actual diagnosis was correct or not in the first place, as you say, what we regard as "symptoms"is much a matter of personal and collective, well, tastes). Don't get me wrong, a good diagnosis and treatment plan can indeed be helpful, however, as a transpersonal therapist, I find solace in the Jungian model, which sees distortions as something to work through and heal as part of our own personal journey, held in hope and love, knowing that we can get beyond merely being "symptom free" towards a meaningful life (beyond a DSM-V label).
Agree totally with Murfomurf. The fact is these "diagnoses" are invalid and therefore patients etc could object to them under Privacy Legislation because most of the time they are not relevant or accurate.
ReplyDeleteWe have a big problem in that people think these issues are "diseases"
A wrong diagnosis can be hard to shake off, and crippling.
ReplyDeleteI know I've been depressed, and since a major trauma probably suffering from some form of PTSD, however was that what the psychiatry team treating me said? - No!
Because I am bright, female and prepared to speak my mind I naturally must have a Borderline Personality Disorder despite being perfectly happy with who I was and the fact I was prepared to be a whistleblower or contradict authority. My depression came from another source entirely, and the feelings of anxiety were completely related to the accident.
Feelings of thinking through fog could be explained as migraine postdrome, or as a result of fibromyalgia. I did not split, nor did I see things only in terms of black and white. In fact all the things that made the difference between Major Depression and Borderline Depression had medical causes, but the psychiatric team did not see it that way.
I got myself well when I realised the diagnosis was wrong, and what I knew was wrong all along was the case. Psychiatrists can make you sicker than you already were. I still have black days, but one person I won't visit will be a shrink.
Word up—would that psychiatry only recognize *all things* for what they really are: theories about biochemical imbalances and genetic vulnerabilities as "working hypotheses" (supported perhaps by the oxymoron of "anecdotal evidence"), the biomedicalization of extreme psychological distress as a primarily palliative and controlling when not explicitly punitive function of society, doctors as merely the (often ill-trained) assigned guardians/caretakers of the behaviorally disturbed, antidepressants as combination emotional anasthetic/physiological stimulant, antipsychotics and/or mood stabilizers as affect "flatteners", pharmaceutical companies as rapacious profiteering enterprises all too happy to exploits the suffering, fear and anxieties of the general public, psychiatry itself as a pseudo-science all too willing to sell itself out for the emoluments of being seen as a "real" branch of medical science, etc.?
ReplyDelete