Well, give that the author of the article isn’t a medical doctor (or the other kind either), I’m not sure why his opinion on the psychiatry profession should matter to me.
I think at best, psychiatry is a difficult branch of the medical professional to provide tangible metrics for success. For the most part, doctors can tell pretty easily if you do or do not have cancer or heart disease or a busted leg. And it’s easy to tell if the treatment did or did not work.
Psychiatry deals with the mind. So right there you have an issue measuring success as it is dependent on feedback from a patient whose perceptions may be…off.
And what constitutes a “mental illness” is highly subjective. Is someone clinically depressed or just sad? Do they have ADHD or do they just get bored easily? Is someone suffering from narcissistic personality disorder or are they just sort of a jerk?
This is part of the problem with conveying what the disorders are to the lay public. It is a common reaction for someone to say exactly this. ADHD isn’t real because everyone gets bored. Depression isn’t real because everyone feels sad sometimes. It’s also a common phenomenon when people are first learning about the disorders to read the criteria and believe that they have one or more disorders themselves. It really is initially tricky, apparently, for people to understand that you have to show a constellation of symptoms to meet criteria, not just one or another specific individual criterion.
For instance, the criteria for ADHD is not just “gets bored easily.” There are 18 specific criteria, and one has to show at least 6 of them within a specific period of time as well as having significant impairment associated with them. Again, if this were just pathologizing normal experience, then when the criteria were used in the general population, we should get about 50% or so meeting criteria, right? Or at least some significant portion of the population.
Large population studies, however, do not result in anywhere near this rate, and instead come in somewhere about 6% or so for ADHD during childhood.
(As a tangential note, there’s also no good evidence for the lay assertion that we have some kind of epidemic of overprescription of ADHD medication. In studies, only about 50% at best of those who fully meet criteria for the disorder have a history of having received medication for it.)
Refining the classifications of mental disorders helps to try and find the underlying causes. When disorders were lumped into a few different categories, research and testing had limited usefulness when the underlying causes were greatly different for a group of people diagnosed with depression who could actual be a mix of people with depression, bipolar disorder, and various other problems. The further refinement of the definitions for these disorders allows research to detect genetic and environmental components, and effective treatments. So some of the DSM details may seem pointless, but it is the proper way to do science. OTOH, the practice of psychiatry is often a mess.
Excellent postNP. I’m no mental health professional, but I read their reports and speak with diagnosed/treated folk daily. And I’ve regularly consulted the past several editions of the DSM.
My sense is that there is a segment of the profession that has a bias for characterizing behaviors as diagnosable, treatable, and compensable impairments, rather than points along the continuum of normal human nature. And there is a strong motivation for many people to attribute their situation to a “disability”, rather than their nature, choices etc.
One proposal in DSM5 that I found troubling was the elimination of bereavement from major depression. And I’ve long ceased to be shocked and disgusted by mental heath whores who will gladly diagnose and prescribe based on nothing more than subjective allegations during a one-time interview.
IMO psychiatry is a noble profession - but it becomes less so as its practitioners attempt to ever broaden its applicability. Many folk need and should get meds, counseling, etc. Many more need a good kick in the pants. IMO, too often the mental health profession fails to adequately distinguish between the two.
I can’t even get past the ridiculous title of that article.
Or the hoarding argument. Of course causes matter in regards to treatment:
Obsessive Hoarding - The hoarder doesn’t like it, but can’t stop
Compulsive Hoarding - The hoarder can’t stop buying new shit, clutter gathers
Depressive Hoarding - The mess is insurmountable, the hoarder can’t clean up
PTSD Hoarding - Losing any item causes too much grief, so clutter gathers
Animal Hoarding - Different altogether, but may present simultaneously
Functional Hoarding - It doesn’t cause impairment, so who cares?
Functional MRI is being studied to help with identifying abnormal brain activity in some mental illness. I definitely think that as our understanding of mental illness deepens then more objective criteria to help categorize it will emerge.
I think a lot of people don’t realize that medicine overall has made a lot of progress over the last century or so. Our understanding of things like heart disease was laughable 50 years ago. 100 years ago, type I diabetes was invariably fatal because we couldn’t synthesize insulin.
Psychiatry is just a bit behind other specialties because #1 the brain is a very complex organ and #2 there is a tremendous amount of stigma on mental illness.
There are still a lot of people who harbor superstitious nonsense beliefs such as that psychotic people are possessed by demons or that depressed people just need to snap out of it. I hope that as time goes on people will start to develop a fuller understanding.
I only ask because reading a thread about mental illness makes me paranoid after a while, but – can everyone else see that weird symbol in Dinsdale’s post? Tell me it’s not visible only to me? :eek:
As a point of comparison, in medicine as a whole, some studies show that misdiagnosis affects as many as 20% of patients’ cases. So a certain level of indeterminacy is not unique to psychiatry.
I don’t think anyone is possessed of demons. If you believe your brain can be unbalanced and that is the cause mental illness, then explain what you mean by unbalanced. I don’t know of any mental illness being cured by pills. Counseling is good if the counselor is free from mental illness. I would like to see a definition of mental illness that meant something. I believe if you are having problems go to a close friend and talk about them then read some good self-help books.
The accusations don’t talk about prescriptions to those who do meet the criteria, but about prescribing to people who do not, in order to “calm them down”. Of course, what people in this particular case do not understand is that ADHD medications have the exact opposite effect on those who do not have ADHD.
This doesn’t help much. What is the point you are contending in regards to psychiatry being dishonest or disorders not being valid?
But people who prescribe medications know very well what the effects are. What’s missing is any evidence whatsoever that overprescription is happening. Do you have any evidence of such?
Be careful, by the way. Evidence of increasing numbers of prescriptions is not evidence of “overprescription.” Also, evidence of individuals abusing ADHD medications without a prescription is not evidence of overprescription.
(Tangent: Meta-analyses suggest that individuals without ADHD who take ADHD stimulant medication get essentially no benefits on cognitive performance from doing so.)
Me, I’m not contending anything, I’m translating astro’s paragraph. There are cases where symptomatic treatment is the right thing, cases where it’s a “hold this in place while I get paid” thing, and cases where it’s the wrong thing to do as it actually hinders the healing of the root problem. It’s important to know which is which.
And for the second, again it’s not my criticism, and if you’d read all the way you would’a noticed I point out that criticism is completely and evidently wrong (heck, it’s in the part you quoted). Have some coffee, ok?
I felt no particular affect when I wrote that post, and in scanning it back again, I cannot see any indications of irritability or hostility. In order to have a discussion or debate, it simply has to be okay to take up contrary positions and to ask questions. There’s no need to imply any hostility in my having done so.