Diagnosis, he says, is “part of the magic,” part of the power to heal patients—and to convince them to endure the difficulties of treatment. The sun is up now, and Frances is working on his first Diet Coke of the day. “You know those medieval maps?” he says. “In the places where they didn’t know what was going on, they wrote ‘Dragons live here.’”
He went on: “We have a dragon’s world here. But you wouldn’t want to be without that map.”
The fact that diseases can be invented (or, as with homosexuality, uninvented) and their criteria tweaked in response to social conditions is exactly what worries critics like Frances about some of the disorders proposed for the DSM-5—not only attenuated psychotic symptoms syndrome but also binge eating disorder, temper dysregulation disorder, and other “sub-threshold” diagnoses. To harness the power of medicine in service of kids with hallucinations, or compulsive overeaters, or 8-year-olds who throw frequent tantrums, is to command attention and resources for suffering that is undeniable. But it is also to increase psychiatry’s intrusion into everyday life, even as it gives us tidy names for our eternally messy problems.
I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted the DSM-IV and concluded that the patient had obsessive-compulsive disorder.
“Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.
“So what would you say was the value of the diagnosis?”
It sounds to me that this is more of an insurance problem than a medical problem. Insurance isn't likely to pay for treatment if there isn't a diagnosis.
Unfortunately, most people want a quick fix. The insurance certainly want a quick fix. The schools funnel kids to the doctor's offices for quick fixes for things that most likely aren't broken in the first place. I've personally dealt with tons of bullshit on this where it comes to my son.
But when drugs are in order, they're in order. Mental illness is illness.
It sounds to me that this is more of an insurance problem than a medical problem. Insurance isn't likely to pay for treatment if there isn't a diagnosis. Mental illness is illness.
Mental illness is illness and people are suffering so it's a medical problem. Forget insurance for a moment. Let's say all of us are very rich and we can pay any sum to any doctor to make us better. Who do you trust? Why?
I would predict that neurobiologically based biomarkers and other objective tests will emerge from current research, along with a greater appreciation of the role of neural circuits in the origins of mental disorders.
He's certainly not the only one predicting that!
In the overall scheme of things neurobiology was born about a minute and a half ago. We're making huge strides but we have a long, long way to go. I think we'll eventually have individualized treatment. On another thread the other day I said that I thought that in the future when we went to the doctor for any kind of problem that was not an obvious physical injury that the first referral we'd get is to a neurologist.
For me, reading about neurobiology was very personal. I came across some information about the effect of corticosteroids on the limbic system of infant brains that led me in an interesting direction.
When my son started school the teachers all tried to pigeon hole him as ADD but I knew better. Eventually they wore me down and I took him to be tested (really tested, not go to the doctor and have her fill out some idiotic checklist that would satisfy the school (luckily I have a FABULOUS doctor who got us where we needed to go)). His diagnosis was NOT ADD.
But even that didn't shut them up about ADD. (Talk about crazy!)
But that's all a very long way of saying that I too think the DSM tries too hard to categorize behavior.
I watched this old show the other day, I think you'd find it very interesting:
I just watched that video and I really can get angry over the fact that teachers are the initiators of a diagnosis they have no medical background for. Not only are they the initiators they are also pressuring reluctant parents into believing that their "diagnosis" has validity.
Even more disturbing is the fact that they're switching now from ADD and ADHD to bi-polar disorder and have an increase of 4000% in diagnoses for
children as young as 2 years old.
What the hell is wrong with society!
I am so glad, boomer, that you withstood the teachers "diagnosis" of Mo
and have not medicated Mo, despite repeated pressure from teachers/schools.
What I don't understand: the United States is the most litigious nation,
why the hell don't parents sue the ass off teachers who diagnose children without any merit and any medical background? I certainly would!
I think a lot of times parents are complicit in it. They don't want to deal with things and drugging them is simply easier. The "diagnosis" gets them off the hook.
My experience says many parents are steamrolled into a diagnosis.
When I would question Mo's behavior (he had some behavior issues but not like ADD type behaviors) people told me repeatedly that once he starts school the teacher would know if there was a problem -- that they see all kinds of kids so they have a lot to compare behaviors too.
Then almost immediately the teachers started in with their "diagnosis".
It went so far as for them to insinuate that I was a bad parent for not giving in to drugging Mo; that I was doing irreparable harm to him by not drugging him. They get you to doubt yourself.
That video was sickening. The faces of these parents as they spoke are burned in my memory. Today I saw an article somewhere that nursing home Alzheimers patients are taken off these drugs because they destroy their brains.
These are people with NO brains left to destroy.
Doing the same thing to growing children somehow is NO crime under the law. Nobody can sue anybody without showing cause like breach of law or breach of contract or breach of fiduciary duty or of due diligence.
Frying kids' brains isn't criminal. They're defenseless in the face of this onslaught of "expert opinion". I admire you no end Boomerang for standing up for your own.
I'm sorry but I had a run in with someone even more malevolent than your video on another thread and I don't think I'll want to post here again any time soon. I stopped by to wish you all a happy new year 2011.