Mental Health DSM and mental health v Alphabet soup

[CoffeeDrinker]

This is my idea for a mental heath thread that I've been wanting to ask bluelight a while. What are people's thought's on the DSM, or, more specifically, what are people's thoughts on the increasing categorization and spread of acronymed disorders for the purposes of mental health?

I know I have a lot of ignorance on all the science, but it seems to me that lots of vague anxieties people suffer from could easily be negatively influenced by the constant and reinforced identification with a simple 2-4 letter label for such-and-such disorder. Is it possible that the need for a simple diagnosis code in order to prescribe a drug to treat complex issues could lead to a further deterioration of one's mental state? Do the drugs themselves do more harm than good?

Have other people had my same experience? I had 2 different psychiatrists and a few therapists not qualified to prescribe drugs, and, in each case with the psychiatrists they seemed like the worst listeners I've ever met. Almost like they didn't really need to hear most of what I had to say, only looking for a few key words in my language to determine I legally qualify for this or that anti-psychotic/anti-depressant. I was given the terms OCD, ADHD, GAD, Depressive Disorder, and Borderline or schitzotypal personality disorders have also been mentioned in sessions. Each session with the psychiatrist was no more than 15 minutes long, and I was prescribed a slew of psyche meds on my very first visit after that same amount of time.

It seems to be a little hasty, or possibly misguided on some level. Not to say I'm not crazy, but my crazy wasn't dealing with the identities they wanted to ascribe me very well.

One day, about 2 years ago now, when I decided that I was going to go into suboxone withdrawal, I cut ties with both the suboxone doctor and his psychiatrist friend after about 2 years of being "treated" by them. I cut ties with all the excess druggings along with it, though I have kept the adderal at 20-40mg a day. I feel more comfortable with a low dose of amphetamine to a far greater degree than I felt comfortable with the tricyclics, SS(N)RIs, and anti-psychotics I was given. Certainly haven't felt imminently suicidal in a long time.

It wasn't until some holistic shifts in my perspective and experience took place that I began to feel like I was making any progress in my recovery.

tl;dr
What are your opinions on the issue of the current state of mental health diagnosis and treatment?

 

[herbavore]

I almost merged your thread into this one because the topics and discussion are very similar. I find the whole "medicalizing" of the nuances of personality and nature to be downright terrifying. As I have said many times across this forum, I was not diagnosed with anything because I grew up in a time when these "disorders" and "syndromes" and "illnesses" were part of the continuum of human nature.

I will also plug again one of my favorite books on the subject: Robert Whitaker's Anatomy of an Epidemic

In the psychology community itself the newest DSM is controversial. http://www.psychologytoday.com/blog/rethinking-depression/201110/the-dsm-5-controversy I read one columnist that said this may well be the last DSM simply because it has become so ridiculous, so removed from science, that it is finally being exposed as irrelevant.

The old expression "throwing the baby out with the bathwater" comes to mind in any discussion about this topic, however. The recognition that there are brain differences rather than simply badly behaved individuals or badly parented individuals was certainly a step towards a more enlightened view. Turning those brain differences into illnesses that require heavy drugs is another matter. Telling a kid they have a disorder for which there is a pill is very different from coaching a kid in strategies that can help in dealing with shyness, anxiety, rage, etc.

 

[Pretty_Diamonds]

People who are not being trained to be psychologists or are psychologists should not have access to the DSM-5 or any other previous versions for that matter.

Edit: I went back and read about your experiences. Psychiatrists aren't trained to listen to your problems and provide therapy interventions. Psychologists are trained in therapy and usually team up with psychiatrists if medication is necessary.

 

[herbavore]

People who are not being trained to be psychologists or are psychologists should not have access to the DSM-5 or any other previous versions for that matter.

Edit: I went back and read about your experiences. Psychiatrists aren't trained to listen to your problems and provide therapy interventions. Psychologists are trained in therapy and usually team up with psychiatrists if medication is necessary.

The fact that psychiatrists are not trained to listen to your problems is not completely true (although it is becoming more and more true) and there are many psychiatrists that are horrified that their profession is becoming one of pure pharmacology. Psychiatry used to be a profession that was all about "listening to your problems" and beyond that, problem-solving (analysis). What a concept! Resolving one's struggles oneself with the help of a paid professional trained to guide and provide a more open perspective along with a healthy dose of objectivity.

 

[Pretty_Diamonds]

And then the psychologists came along.

 

[Bluesbreaker]

Psychologist listens to your problems to the maximum of time they can allow you, which is usually half an hour per week, and (s)he knows you in depth due to the regularity of your meetings.

Psychiatrist listens to your problems (half an hour too but usually monthly), but has to script your monthly meds according to what the psychologist told them. This is how it (should) works.

Does the DSM go too far though? I don't know. Some diseases can really disturb lives. I do think as science evolves, so does discovering conditions and their medicines.

 

[nuttynutskin]

This is my idea for a mental heath thread that I've been wanting to ask bluelight a while. What are people's thought's on the DSM, or, more specifically, what are people's thoughts on the increasing categorization and spread of acronymed disorders for the purposes of mental health?

I had a whole big post typed out when my computer decided to crash, so I'll just answer this...

Yes I think it's a bit ridiculous all the new disorders coming out. I remember quite a while ago on another mental health forum someone mentioning their psychiatrist prescribing them some more medication on top of their already fairly large cocktail because they were having trouble staying off their cellphone. I mean seriously?

I have no problem with the older diagnoses like depression, bipolar, schizophrenia, etc., but imho its getting out of control with a lot of these other smaller disorders. Now just about anything anyone does could be considered a disorder. I think obviously it's important people try to get help if there's something wrong but I don't see creating a myriad of new disorders as the solution. Imo most of these just stem from a bigger problem and I think it makes more sense for psychiatrists to treat their patients more based on symptoms rather than a label.

 

[pinpoint]

DSM = Disorders as a Source of Money

More disorders = more diagnoses = more revenue. Just look at who creates the DSM.. it's like a who's who of big pharma. I think every psychiatrist/M.D. who signed off on the efficacy of Prozac was financially tied to Pfizer either through stock, kickbacks or just plain bribery. Now, there are some real psychiatric conditions such as schizophrenia that deserve the attention of big pharma.. but to categorize every nuance of the human psyche to correspond to a pharmaceutical treatment is like something out of a science fiction novel.

 

[herbavore]

+1000000000000!

 

[Pretty_Diamonds]

Psychologist listens to your problems to the maximum of time they can allow you, which is usually half an hour per week, and (s)he knows you in depth due to the regularity of your meetings.

Psychiatrist listens to your problems (half an hour too but usually monthly), but has to script your monthly meds according to what the psychologist told them. This is how it (should) works.

Does the DSM go too far though? I don't know. Some diseases can really disturb lives. I do think as science evolves, so does discovering conditions and their medicines.

Not sure. Services are based on your diagnosis, severity, treatment and intervention plan.

 

[CoffeeDrinker]

People who are not being trained to be psychologists or are psychologists should not have access to the DSM-5 or any other previous versions for that matter.

Edit: I went back and read about your experiences. Psychiatrists aren't trained to listen to your problems and provide therapy interventions. Psychologists are trained in therapy and usually team up with psychiatrists if medication is necessary.

What a disappointing conclusion you've brought to the table. What are your beliefs that have lead to such a sweeping statement?

Your mentality strikes me as the same sort that would've preferred Catholic masses to remain in Latin, and the Bible untranslated, yet the prescriptions of the robed men enforced with brutality and swiftness because of their unassailable "rightness". In short, your mentality strikes me as Medieval.

Do you believe the current mental health landscape is the best it could be for the purposes of helping those it purports to?
I've already seen studies where antidepressants have no greater efficacy than a placebo. What is Pretty_Diamond's take on such reports?

I will say that my first psychiatrist told me that I would have to choose between his advice and the advice of the psychologist I was also seeking help from at the time. I sided with the guy with the doctoral degree over the guy with a certificate to practice social work, and still I think that was a huge mistake to this day. I might've never tried to kill myself a couple times if I chose the guy with experience over the guy with the leather couch and a few fancy pieces of paper who kept asking me about my masturbation habits every session. If that was the best help available for the downtrodden and depressed, wouldn't anyone kill themselves?
The more rarefied the degree, the more of a vested interest the degree holders have in assuming their current methods are relevant. This fact is on top of the fact that they already have a vested interest to sell us chemicals due to the nature of the market based system.
What is the difference between a Nurse Practitioner and a Psychiatrist, other than it's much easier to get seen by an NP, and they can only "suggest" medications, and write refills, rather than prescribe them for the first time?

You must've known your stance here would be greeted with skepticism. Please provide more support for your side of it.

 

[Pretty_Diamonds]

What are you asking me exactly? I'm sorry to hear about your experiences. Psychiatrist and psychologists both have doctorate degrees. MD, PhD, and now PsyD. Who's best at what really depends on the person and their education and exposure. Psychologists are more trained in therapy whereas psychiatrists focus mainly on medications and treating symptoms. Psychology is more of an art of healing one from the inside out. Psychologists and psychiatrists often work together if medication in necessary. However, in some states, psychologists are getting/fighting for prescription rights.

I don't think people who are not trained in psychology should be buying the DSM because people shouldn't be diagnosing themselves or other people without any training.

 

[nuttynutskin]

I don't think people who are not trained in psychology should be buying the DSM because people shouldn't be diagnosing themselves or other people without any training.

Why shouldn't the information be available to anyone who wants it? Without going back through the whole thread I don't remember anyone mentioning having access to the DSM so they could diagnose people.

 

[CoffeeDrinker]

What are you asking me exactly? I'm sorry to hear about your experiences. Psychiatrist and psychologists both have doctorate degrees. MD, PhD, and now PsyD. Who's best at what really depends on the person and their education and exposure. Psychologists are more trained in therapy whereas psychiatrists focus mainly on medications and treating symptoms. Psychology is more of an art of healing one from the inside out. Psychologists and psychiatrists often work together if medication in necessary. However, in some states, psychologists are getting/fighting for prescription rights.

I don't think people who are not trained in psychology should be buying the DSM because people shouldn't be diagnosing themselves or other people without any training.

I guess I was asking you to read what I was saying and respond to my point. But thanks for the info and the sympathy.

 

[herbavore]

Do you believe the current mental health landscape is the best it could be for the purposes of helping those it purports to?

I think this is the crux of the matter and one direction i would like to see the discussion move in is the split in the psychiatric field itself over the DSM and the underlying myths that it validates ("medIcalizing" personality to disorder). In my county, the entire mental health system was revamped based on a new psychiatrist that rejected the way his field was headed (no, not headed, firmly entrenched) having become in essence just pharmacological practicioners. Even a good general practice MD expects to be more than that; understanding the connection between mind and body as well as wanting to prevent an over-dependence on drugs.

Many psychiatrists themselves complain about the fact that their education no longer even includes teaching them how to approach patients as anything other than ill people in need of strong medications. Again, this is not what the field was traditionally. Analysis, for all its limits and flaws was based on talking and listening--rarely using medication at all.

Here is an intersting article: http://www.psychologytoday.com/blog/addiction-in-society/201106/the-psychiatric-revolution-is-over to add to the discussion.

And let's remember that there need not be anything personal in this. It's a discussion and everyone is entitled and encouraged to voice their opinions--that's what makes it good! Passionate debate need not be taken personally.

For me, this subject is very passionate and close to my heart. I feel very strongly that we are over-using medications (understatement) in this country and this last DSM by all reports has even made it worse. The cartoon of the kid on the playground being bullied because he does not have a diagnosed disorder is not even funny because it is too near the truth. When you have experts that you have to trust telling you that your 7 year old needs to be put on amphetimines and then maybe an AD for when he feels suicidal in the comedowns, things have gotten more than out of whack--they have gotten insane. I see this scenario at my elementary school more and more.

 

[CoffeeDrinker]

Pink Diamonds is basically talking about the status quo position, deference to the authority and all that. I would like him or anyone else to support the validity or legitimacy of the status quo in this case. Also keep in mind I'm not talking about the basic things like bipolar, schizophrenia, genuine psychosis. Those are clearly chemical imbalances of some kind, as are others, and I don't want people to think I'm anti-science in any degree. I just happen to think the science doesn't necessarily support the validity of the current state of things. The soft science of economics, maybe. I was hoping for some kind of rebuttal against the arguments that have been made recently that antidepressants are no more effective than a placebo, yet they make real alterations in the brain activity and really do cause suicidal ideation.
Here's something from the Psychology Today article herbavore posted:

placebo produces roughly 85% of the benefits of the actual drugs.

Very serious men with very serious PhDs use to put very real humans under very serious shock treatments back in the 60s and earlier. My grandmother for one. I just assumed all old people in the nursing homes were supposed to be vegetable like back when I was a 5 year old. My mother says she was like that since the 70's, but before the shock treatments, boy was she a character! That was the status quo once, as was the lobotomy. It seems like we've sat on our collective laurels, and allowed something maybe not as permanently destructive to the brain as the old electroshock treatments or even older lobotomies, but certainly shapes behavior and sets a certain standard about how to deal with problems, these habits could spiral into destructive patterns later on in life. I guess more science needs to be done to prove the lat bit of speculation.

They say there aren't nearly enough psychiatrists available to treat the current population's demand. Is this demand curve inflated to an unhealthy degree?

Does this all stem back from the old Catholic ideal that we're all sinners, with something inherently wrong with us? Did we replace the priest with the medicine man? Need I mention blood letting here people?

 

[CoffeeDrinker]

Also do you think peoples diagnosis can do more harm than good, when it comes to these dubious new disorders? A form of confirmation bias and placebo within the patient themselves? Such as people getting told they are borderline personality disorder suddenly acting out far worse than they otherwise would have? Like people who've never heard of PAWS don't complain about it as much, no matter how high of a dose of drugs they were w/d from, but people who do read too much internet can complain of paws for months even if they just broke a 5mg of Oxycodone a day habit.

 

[Shrooms00087]

Also do you think peoples diagnosis can do more harm than good, when it comes to these dubious new disorders? A form of confirmation bias and placebo within the patient themselves? Such as people getting told they are borderline personality disorder suddenly acting out far worse than they otherwise would have? Like people who've never heard of PAWS don't complain about it as much, no matter how high of a dose of drugs they were w/d from, but people who do read too much internet can complain of paws for months even if they just broke a 5mg of Oxycodone a day habit.

Diagnosis should have no real impact good or bad, ideally. It should only confirm or deny your struggle. Where real problems start to take root is treatment. I can see where your line of thought comes in though --that they give you a damnable permanence with their diagnosis (in some cases). But the fact is, if you are out seeking a diagnosis you have already sensed something was 'wrong'. So the knowledge of this damnable permanence isn't anymore unbearable than the reason that brought you to go get diagnosed in the first place.

Does this all stem back from the old Catholic ideal that we're all sinners, with something inherently wrong with us? Did we replace the priest with the medicine man?

The medicine man was first the priest. The primary goal of both the priest and the doctor is to get you within defined terms of normalcy (happiness, sense of purpose, etc). As with any institution it builds on technology to conform to it's primary goal. Blood letting, mercury, shock treatment, lobotomy, anti-psychotics, etc.

Awesome related Jung quote:

NSFW:

“People forget that even doctors have moral scruples and that certain patients’ confessions are hard even for a doctor to swallow. Yet the patient does not feel himself accepted unless the very worst in him is accepted too. No one can bring this about by mere words, it comes only through reflexion and through the doctors attitude towards himself and his own dark side.

If the doctor wants to guide another or even accompany him a step of the way, he must feel with that person’s psyche. He never feels it when he passes judgment. wether he puts his judgment into words or keeps them to himself makes not the slightest difference. To take the opposite position and to agree with the patient off-hand is also of no use, but estranges him as much as condemnation. This feeling comes only through unprejudiced objectivity.

This sounds almost like a scientific precept and it could be confused with a purely intellectual abstract attitude of mind, but what I mean is something quite different.

It is a human quality, a kind of deep respect for the facts, for the man who suffers from them, and for the riddle of such a man’s life. The truly religious person has this attitude: he knows that god has brought all sorts of strange and inconceivable things to pass and seeks in the most curious of ways to enter a mans heart. He therefore senses in everything the unseen presence of the divine will. This is what I mean by unprejudiced objectivity, it is a moral achievement on the part of the doctor, who ought not to be repelled by sickness and corruption.

We cannot change anything unless we accept it. Condemnation does not liberate, it oppresses and I am the oppressor of the person I condemn, not his friend and fellow sufferer. I do not in the least mean to say that we must never pass judgment when we desire to help and improve, but if the doctor wishes to help a human being he must be able to accept him as he is, and he can do this in reality only when he has already seen and accepted himself as he is.

Perhaps this sounds very simple, but simple things are always the most difficult.

In actual life it requires the greatest art to be simple, and so acceptance of one’s self is the essence of the moral problem and the acid test of one’s whole outlook on life. That I feed the beggar, that I forgive an insult, that I love my enemy in the name of Christ; all these are undoubtedly great virtues. What I do unto the least of my brethren, that I do unto Christ.

But what if I should discover that the least amongst them all, the poorest of all beggars, the most imputed of all offenders, yay that the very fiend himself, that these are within me, and that I myself stand in need of my own kindness, that I myself am the enemy who must be loved, what then?

Then, as a rule, the whole truth of Christianity is reversed. there is then no more talk of love and long-suffering. We say to the brother within us: “raka!” and condemn and rage against ourselves. We hide him from the world, we deny ever having met this least of the lowly in ourselves, and had it been God himself who drew near to us in this despicable form, we should have denied him a thousand times before a single cock had crowed.”

I also believe everyone should have the DSM. For a good laugh when you stroll through their views of drugs and the hypocrisy of their oath to do good and then you see their section on marijuana. Making the DSM specific to only trained professionals would only add to its dubious content.

 

[herbavore]

Also do you think peoples diagnosis can do more harm than good, when it comes to these dubious new disorders? A form of confirmation bias and placebo within the patient themselves? Such as people getting told they are borderline personality disorder suddenly acting out far worse than they otherwise would have? Like people who've never heard of PAWS don't complain about it as much, no matter how high of a dose of drugs they were w/d from, but people who do read too much internet can complain of paws for months even if they just broke a 5mg of Oxycodone a day habit.

Absolutely.

 

[CoffeeDrinker]

Diagnosis should have no real impact good or bad, ideally. It should only confirm or deny your struggle. Where real problems start to take root is treatment. I can see where your line of thought comes in though --that they give you a damnable permanence with their diagnosis (in some cases). But the fact is, if you are out seeking a diagnosis you have already sensed something was 'wrong'. So the knowledge of this damnable permanence isn't anymore unbearable than the reason that brought you to go get diagnosed in the first place.


The medicine man was first the priest. The primary goal of both the priest and the doctor is to get you within defined terms of normalcy (happiness, sense of purpose, etc). As with any institution it builds on technology to conform to it's primary goal. Blood letting, mercury, shock treatment, lobotomy, anti-psychotics, etc.

Awesome related Jung quote:

NSFW:

“People forget that even doctors have moral scruples and that certain patients’ confessions are hard even for a doctor to swallow. Yet the patient does not feel himself accepted unless the very worst in him is accepted too. No one can bring this about by mere words, it comes only through reflexion and through the doctors attitude towards himself and his own dark side.

If the doctor wants to guide another or even accompany him a step of the way, he must feel with that person’s psyche. He never feels it when he passes judgment. wether he puts his judgment into words or keeps them to himself makes not the slightest difference. To take the opposite position and to agree with the patient off-hand is also of no use, but estranges him as much as condemnation. This feeling comes only through unprejudiced objectivity.

This sounds almost like a scientific precept and it could be confused with a purely intellectual abstract attitude of mind, but what I mean is something quite different.

It is a human quality, a kind of deep respect for the facts, for the man who suffers from them, and for the riddle of such a man’s life. The truly religious person has this attitude: he knows that god has brought all sorts of strange and inconceivable things to pass and seeks in the most curious of ways to enter a mans heart. He therefore senses in everything the unseen presence of the divine will. This is what I mean by unprejudiced objectivity, it is a moral achievement on the part of the doctor, who ought not to be repelled by sickness and corruption.

We cannot change anything unless we accept it. Condemnation does not liberate, it oppresses and I am the oppressor of the person I condemn, not his friend and fellow sufferer. I do not in the least mean to say that we must never pass judgment when we desire to help and improve, but if the doctor wishes to help a human being he must be able to accept him as he is, and he can do this in reality only when he has already seen and accepted himself as he is.

Perhaps this sounds very simple, but simple things are always the most difficult.

In actual life it requires the greatest art to be simple, and so acceptance of one’s self is the essence of the moral problem and the acid test of one’s whole outlook on life. That I feed the beggar, that I forgive an insult, that I love my enemy in the name of Christ; all these are undoubtedly great virtues. What I do unto the least of my brethren, that I do unto Christ.

But what if I should discover that the least amongst them all, the poorest of all beggars, the most imputed of all offenders, yay that the very fiend himself, that these are within me, and that I myself stand in need of my own kindness, that I myself am the enemy who must be loved, what then?

Then, as a rule, the whole truth of Christianity is reversed. there is then no more talk of love and long-suffering. We say to the brother within us: “raka!” and condemn and rage against ourselves. We hide him from the world, we deny ever having met this least of the lowly in ourselves, and had it been God himself who drew near to us in this despicable form, we should have denied him a thousand times before a single cock had crowed.”

I also believe everyone should have the DSM. For a good laugh when you stroll through their views of drugs and the hypocrisy of their oath to do good and then you see their section on marijuana. Making the DSM specific to only trained professionals would only add to its dubious content.

I like this post, but my point about the old catholic idea of inherent sin was referring to the motivations people have in themselves to conclude things like "something must be wrong with me." This line of thinking might be implicit in the culture, and instilled over generations, manifesting itself in infinite ways, one of which could be the idea many people have "that something must be seriously wrong, and it's crazy to think that the very system which we stake our entire selves on is the thing that wrong, so it must be me, and therefore I must just inherently need lexapro".

The diagnosis, in this instance, could be like a waving a red flag at the problem, goading it on, causing the bull to charge until it's dead. The matador would be the psychiatrist in this case, and the arena would be filled with Pfizer and Merck shareholders.

I guess it wouldn't be called capitalism if people weren't capitalizing on people's weaknesses.

What then, would be the bull? The real problem? I guess if I was advocating any moral, it would be to encourage people to take command of their minds and their lives as much as possible without needing to consume a socially acceptable cocktail of drugs.