Saturday, October 18, 2014

Psychiatric diagnostic uncertainty

Mary Boyle and Lucy Johnstone (@clinpsychlucy) argue for alternatives to psychiatric diagnosis in a Lancet Psychiatry comment. As I have said in an article, Mary has contributed significantly to the critique of psychiatric diagnosis. Lucy has as well, particularly in her recent A straight talking guide to psychiatric diagnosis. As I also said in my article, "The problem with biomedical diagnosis is that it potentially produces the facade that [personal] understanding has been created".

However, my article also suggested that the proposal to abandon psychiatric diagnosis is potentially misleading. Joseph Hayes and Vaughan Bell (@vaughanbell) in their comment in response to Mary and Lucy point out that formulation and diagnosis are complementary. I worry though about their inability to see the difference between functional and organic mental disorders (eg. see previous post). I do think that DSM has been so overtaken by biomedical assumptions that it should be abandoned (eg. see another previous post). But, as I said in response to Peter Kinderman's new book (see post), psychiatric diagnosis needs to be recognised for what it is. Peter essentially agrees with Mary and Lucy. The process of psychiatric assessment is primarily psychosocial not biomedical.


Anonymous said...

I couldn't agree more.
Psychiatry has nothing to do with science. The DSM is largely a tool that can be used to gain a diagnosis for insurance reimbursement.
Psychiatry has been trying to gain serious status as an actual "science" for hundreds of years. It still attempts to do that by inventing causal relationships(lack of serotonin, "bio-markers")and "treatments" when there are none. The greatest fault in psychiatry is their masquerading as a legitimate science and pushing medications that have little proven efficacy and many side effects that are never fully explained to patients or even taken seriously by the profession itself. There is little long-term effect research done on any of the classes of medication (anti-depressants, stimulants, anti-psychotics) and what does exist is not done by the profession or isn't favorable to the profession. This is inexcusable considering the sheer number of this class of drugs prescribed in a years time. And also, because the psychiatric profession is now targeting children and teens with the same chemicals. Even when they know it can cause unacceptable risks (suicidal risk increase, increased aggression, physical dependence). It also perplexes me that the psychiatric profession doesn't seem to advocate for people when they are negatively impacted by such things.
The DSM is a nightmare. There are so many over lapping symptoms that it's ridiculous. This is to the advantage of the profession as I see it because the area of symptoms being expanded aids the process of applying multiple diagnosis. The DSM overlooks anything that doesn't fit the professions concrete idea of how a symptom presents (self-injury usually doesn't include tattoos or body piercing which is the socially acceptable form of self-injury widely in use).
The use of the DSM should be ended. It supports ignorance and a process whereby individuals are not given the chance to be seen as people but only a collection of symptoms. And, without any scientific basis or accuracy in doing so (multiple diagnosis, wrong diagnosis, multiple failed medication attempts, etc). Psychiatry itself should be moved to philosophy until it can actually function without doing harm.

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Norman Hoffman said...

Psychiatric diagnosis describe disorders not diseases. THey were not meant to be used as implying etiology, but should be used only as rough guidelines. A major issue wuth modern psychiatry is the misuse of diagnoses.