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Inside the Battle to Define Mental Illness
January 3, 2011 5:40 AM   Subscribe

Inside the Battle to Define Mental Illness. The DSM-V and its critics. (DSM-V previously)
posted by OmieWise (98 comments total) 33 users marked this as a favorite

 
I see that my campaign to add Cocoa Puffs, Cuckoo For to the diagnostic canon has made little progress.
posted by jonmc at 5:46 AM on January 3, 2011 [38 favorites]


Didn't wotisface from all those action films already obviate the need for treatments of mental illness?
posted by clvrmnky at 6:06 AM on January 3, 2011


This is the first proper edition of the DSM to come out in the internet age, and so there's going to be a battle about it. It used to be put together by a relatively small group in their own philosophical bunker, but now its open to much more public scrutiny.
posted by memebake at 6:13 AM on January 3, 2011 [7 favorites]


The episode about the fight to get homosexuality out of DSM-IV is one of my favorite This American Life episodes ever.
posted by l33tpolicywonk at 6:24 AM on January 3, 2011 [6 favorites]


I already know that I won't have Asperger any more when DSM-V is published - I just wonder if it'll be back in DSM-VI....
posted by DreamerFi at 6:26 AM on January 3, 2011


Super interesting. When did Wired get good again?
posted by anotherpanacea at 6:35 AM on January 3, 2011 [3 favorites]


Were I an enterprising man, I would found the OpenDMS Working Group, and create a wiki version of the DSM editable by practicing and academic psychologists, neurologists, and other mental health professionals.
posted by moonbiter at 6:46 AM on January 3, 2011 [10 favorites]


The episode about the fight to get homosexuality out of DSM-IV is one of my favorite This American Life episodes ever.

I think that was a much earlier edition, DSM-II or III. Still, great episode of TAL.
posted by electroboy at 6:58 AM on January 3, 2011


Were moonbiter an enterprising man, he would be neck-deep in ferocious pedants.
posted by nebulawindphone at 7:01 AM on January 3, 2011 [8 favorites]


psychiatry seems to be a way to make people tolerate some behaviours that they don't want to tolerate (i'm sick. its not my fault) and a way to justify coercing people to stop certain behaviours (they are sick and need to be fixed). as an outsider it looks more like ethics than science.
posted by drscroogemcduck at 7:02 AM on January 3, 2011


I already know that I won't have Asperger any more when DSM-V is published - I just wonder if it'll be back in DSM-VI....

YOU'LL BE CURED! IT'S A CHRISTMAS MIRACLE!
posted by thsmchnekllsfascists at 7:04 AM on January 3, 2011 [5 favorites]


Were I an enterprising man, I would found the OpenDMS Working Group, and create a wiki version of the DSM editable by practicing and academic psychologists, neurologists, and other mental health professionals.

A wiki takes all of 5 minutes to set up these days. I suspect the bulk of your work would be wrangling academics.
posted by thsmchnekllsfascists at 7:05 AM on January 3, 2011


Psychiatry is part ethics, part science, and maybe a dash of formalization of disgust?
posted by BrotherCaine at 7:07 AM on January 3, 2011


and a lot of money.
posted by jonmc at 7:13 AM on January 3, 2011


I truly think it likely at some point in the future we'll look back on modern psychiatry and our concepts of mental disorders as little more valid than phrenology. The fundamental problem is the lack of any coherent underlying theory of mind/consciousness. Without that, you're left assigning names to heuristics regarding the types of dents you've noticed in the black boxes of people's minds

It's becoming increasingly clear the mind is intertwined not just with the body but with the entire surrounding culture and society and context. Just pouring chemicals into it to try to reset it back to 'normal' ignores not just the possibility that it's not the mind that should be the focal point for change, but the entire question, why - it in fact actively shuts down that question, because there is no why. There's just a word for a syndrome that is maybe correlated with certain neurological markers, the ultimate in cargo cult "science"
posted by crayz at 7:32 AM on January 3, 2011 [16 favorites]


I would found the OpenDMS Working Group, and create a wiki version of the DSM

"...well, according to the DSMwiki, the diagnosis is LOL UR GAY, and the charge for treatment is...OVER NINE THOUSAAAAAAAAAAAAND."
posted by Mr. Bad Example at 7:33 AM on January 3, 2011 [14 favorites]


I suspect the bulk of your work would be wrangling academics.

In both senses, eek.
posted by FelliniBlank at 7:35 AM on January 3, 2011


But not in the third, "academics who wrangle [things]" sense. Which is too bad, because it would be seriously entertaining to see some community taken over by a buncha cattle-driving psychoanalysts.
posted by nebulawindphone at 7:38 AM on January 3, 2011


crayz: It's becoming increasingly clear the mind is intertwined not just with the body but with the entire surrounding culture and society and context.

Welcome to the last half century of psychology!

Just pouring chemicals into it to try to reset it back to 'normal' ignores not just the possibility that it's not the mind that should be the focal point for change, but the entire question, why - it in fact actively shuts down that question, because there is no why.

No, psychiatrists don't prescribe chemicals to make the brain 'normal.' They prescribe chemicals to help control symptoms that many people find to be crippling and intolerable.
posted by KirkJobSluder at 7:42 AM on January 3, 2011 [43 favorites]


I truly think it likely at some point in the future we'll look back on modern psychiatry and our concepts of mental disorders as little more valid than phrenology.

More and more during my lifetime, it seems that we're realizing that "cognitive disorder" or "mental illness" is the symptom (or collection of signs) rather than the "disease" itself. When I was a kid, the conventional wisdom was that only schizophrenia and the like were primarily physical problems involving actual organic brain matter, neurology, or neurochemistry.

We don't call cancer a "mood disorder" or "mental illness" simply because one of its direct symptoms or side effects may be massive depression. I hope to live long enough to see neurological problems that affect cognition, affect, and behavior stop being labeled that way as well.
posted by FelliniBlank at 7:43 AM on January 3, 2011 [4 favorites]


cattle-driving psychoanalysts

I'd pay money to watch a bunch of rodeo clowns with PHDs.
posted by thsmchnekllsfascists at 7:43 AM on January 3, 2011 [1 favorite]


They prescribe chemicals to help control symptoms that many people find to be crippling and intolerable.

Are these symptoms which are found to be crippling and intolerable ones the person taking the drugs find crippling and intolerable or ones that someone ELSE finds crippling and intolerable to their sensibilities?

And, are then chemicals better than or just simpler than changing the diet to change behavior?

1/3 of the kids on Ritilin comes to my mind.
posted by rough ashlar at 7:52 AM on January 3, 2011


I have Bipolar 2 disorder, and obsessive-compulsive disorder. I was given this diagnosis about a year ago, after noticing certain patterns of behavior in my life and how they corresponded to my abject and constant inability to earn a living. I wish I had been subject to the early intervention I read about in the article.

Before I was diagnosed, I heard quite a bit about kids who had been diagnosed with ADD, Bipolar 1 and 2, "learning disorder", and others. I heard a lot of criticism of such things, but never met anyone, seemingly, who had been mis-diagnosed (although I have to wonder about some of the ADD thing as possibly a failure of young adolescents to adapt to the stifling atmosphere of a metropolitan classroom).

There's a lot of nuance in the concept of mental "illness" these days; probably always has been. It is hard for a person who has a disorder to even realize, let alone admit they have one. I had to have my symptoms brought to my attention by friends, the legal system, and sometimes noticing things myself. People and their behaviors are extremely complex, and it is often like looking into a crystal with an very asymmetrical cut; everyone looking in sees something different, and being the crystal is different yet. This process of figuring out the why and how of my life took several years of patient and persistent work, and this is in a small town, where the people who see you can actually get together once in a while and share notes on what they've seen in you.

Before I came here, I lived in a large city in the Southwest, and at times was on the far edge of their homeless population. I was seen by mental health people there, but due to poor continuity of care, poor staffing, and the fragmented nature of relationships in any city, no one ever figured out that I had a problem. They saw my inability to hold a job for more than 3-6 months at a time, my constant evictions as a result, and my frequent mood swings to be simply an irritating part of my personality. But no one ever saw the whole of it, and never really tried.

The problem was also complicated by the strong tendency of American society to blame people for their failures, as if they weren't trying to do better. I definitely tried to do better, and I do not have words to describe the ache of trying and failing for better than 40 years. And it made things worse, apparently. My doctor, who has many years of experience working with folks like me, says attempting to function with untreated bipolar makes the bipolar worse. It's like hitting a wall with your head, repeatedly, and having a crowd of family, friends, and authority figures tell you to get up and do it again; maybe you'll break through this time.

I don't like the tone of the article, and I don't think the author "gets" people who have mental disorders (despite his apparent years of work in the field). The article seems to hold on to the hierarchical view of diagnosis and treatment, and that simply has less value now, given what we have learned about these things. There's a movement right now to more or less "open source" the treatment and diagnosis of mental disorders through the patient's rights movement and the widespread introduction of peer support, which has the ability to greatly improve the lives of people everywhere simply by de-stigmatizing the disorders, and making treatment and medications more widely available so that people like me don't have to go through decades of pain and confusion. And it doesn't always have to be medication, either. Great progress has been made in teaching people with disorder how to function in many cases with minimal or no medication at all.

There also appears to be a move to cut back on as much of Social Security as can be accomplished (rather than tax cuts for the rich, and military spending) amongst some of the tea party types and the new incoming Congress . It's considered folk wisdom on the right that a lot of those collecting disability don't need it and are malingering. Many of them don't even believe in mental disorders at all. We've tried that approach before, and it not only doesn't work, but results in needless and grotesque suffering.

Finally, here's a sample of what it's like living with something like OCD... It has taken me nearly two hours to write just these few short paragraphs, not because I don't have any familiarity with the subject, or because I can't type, but because of my having to constantly go back and revise what I have written; both to remove typos (can't trust spellcheck!), and to provide just the proper wording and syntax. I am a obsessive perfectionist, but am learning after all these years, to tolerate a few misteaks :>).
posted by cybrcamper at 7:57 AM on January 3, 2011 [49 favorites]


A wiki won't work.

You'll eventually have to select members, rather than allowing random spam edits, and right fast. Then comes the fight — do we start fresh or do we use the DSM-IV as the working document? Who gets in? Who decides who gets in?

Who gets to be on that group? Once the group members are known, Big Pharma comes calling, pockets full of coin and samples of forgettol aplenty. Maybe Big Religion, too ... you know that homosexual lifestyle is a self-destructive choice, right? Just one sympathizer is all that is required. And let us not forget the people with axes to grind over various causes. Unless your working group is sequestered on the Moon, pressures will be brought to bear.

So you're on Moon Base Neurosis and then you have to worry about the various pathologies and biases present even in your select members. Is Doctor Jenkins a secret schizoid, personable on the outside, brimming with contempt on the inside? If so, will she attempt to remove various diagnostic criteria depending on solitude?

The world looks like a topologically contiguous madhouse, filled with lunatics and the criminally remorseless. It has no Front Desk to which we can appeal for one sane moment on which to build a way of life for ourselves, much less take the measure of others.
posted by adipocere at 7:58 AM on January 3, 2011


Oh joy. It's that time again when we get to hear from people who don't believe in mental illness because they've been fortunate enough not to have to deal with it.
posted by shponglespore at 8:00 AM on January 3, 2011 [32 favorites]


Before we join the pile-on and say, why yes, the mind is a complex thing that We Cannot Model, and keep those horrible Korporate Khemicals (!) out of my pristine tablua-fucking-rasa societo-environmentally-influenced brain, the fact is that there are, by objective measures (self-harm, inability to eat, inability to function in profoundly obvious ways) serious illnesses that are cured or managed by the (admittedly) ill-understood drugs we prescribe.

PS err...food is chemicals, RA
posted by lalochezia at 8:01 AM on January 3, 2011 [4 favorites]


They prescribe chemicals to help control symptoms that many people find to be crippling and intolerable.

So how is this different than the person who drinks away their sorrows in the bar every night?

Caged rats seem depressed, should we use medication to control their intolerable symptoms? I honestly don't know the answer to that; what I do know is once you start medicating the rat there's a tendency to see the rat and miss the cage
posted by crayz at 8:01 AM on January 3, 2011 [6 favorites]


I'd pay money to watch a bunch of rodeo clowns with PHDs.

Where I work, we call it "tuition."
posted by GenjiandProust at 8:02 AM on January 3, 2011 [39 favorites]


FelliniBlank: More and more during my lifetime, it seems that we're realizing that "cognitive disorder" or "mental illness" is the symptom (or collection of signs) rather than the "disease" itself.

This strikes me as splitting hairs when we have a fair number of disorders (including cancer) which are defined according to the collection of signs they present. The reason why we don't, and probably won't have a cure for cancer is that it doesn't really exist as a single disease with a single causative mechanism.

Meanwhile, there are millions of people who need help now.

rough ashlar: Are these symptoms which are found to be crippling and intolerable ones the person taking the drugs find crippling and intolerable or ones that someone ELSE finds crippling and intolerable to their sensibilities?

Most people who suffer from serious mental illness are deeply closeted and do a fair job of hiding their problems. And personally, I find the deep suffering of people who are experiencing a psychotic break and are on the edge of violent self-harm due to their disordered thinking to be intolerable. But perhaps I just suffer from an excess of empathy.

And, are then chemicals better than or just simpler than changing the diet to change behavior?

In some cases, yes.
posted by KirkJobSluder at 8:04 AM on January 3, 2011 [2 favorites]


crayz: So how is this different than the person who drinks away their sorrows in the bar every night?

Sure, I'll be willing to consider that alcohol might actually have a therapeutic effect if you can avoid the rather ugly side effects.

Caged rats seem depressed, should we use medication to control their intolerable symptoms? I honestly don't know the answer to that; what I do know is once you start medicating the rat there's a tendency to see the rat and miss the cage

And what I know is that most treatment for mental illness (or any other illness these days) is going to look at environmental and behavioral factors in addition to medical control of the symptoms. The whole "medicine or environment" argument is a false dichotomy.
posted by KirkJobSluder at 8:11 AM on January 3, 2011 [8 favorites]


And, are then chemicals better than or just simpler than changing the diet to change behavior?

1/3 of the kids on Ritilin comes to my mind.
posted by rough ashlar at 10:52 AM on January 3


First of all, there is absolutely nothing wrong with the corn and petrochemical slurry our kids eat, and to suggest otherwise merely identifies you as some sort of unstable radical agitator. What would you have children eat? Something "organic"? That grew outside in the dirt where bugs pee? You're sick, that what you are.

Furthermore, the DSM and psychiatry in general play a vital role in maintaining the illusion of free will while simultaneously instilling that hyperactive, hypercritical superego that has been a cornerstone of social control in the post-capitalist era.

Those of you concerned that your existing diagnoses will be obsoleted by the DSM-5 can rest assured that we've included are a whole host of new and innovative syndromes with which you are undoubtedly afflicted.
posted by Pastabagel at 8:14 AM on January 3, 2011 [5 favorites]


Yes, Pastabagel, the ants that I feel crawling under my skin is just a creation of the man keeping me down! Viva la revolucion!
posted by KirkJobSluder at 8:17 AM on January 3, 2011 [9 favorites]


the ants that I feel crawling under my skin

IANAD, but I'm pretty sure you might wanna get that checked out.
posted by thsmchnekllsfascists at 8:21 AM on January 3, 2011


Yeah, personally, I'm pro-anti-psychotics.

So... I'm psychotics? Hmm...
posted by maryr at 8:27 AM on January 3, 2011 [2 favorites]


rough ashlar: "And, are then chemicals better than or just simpler than changing the diet to change behavior?

1/3 of the kids on Ritilin comes to my mind.
"

I never had attention problems in school, nor do I have children, but I suspect untreated ADD is crippling for children. Short term, they're reprimanded for things beyond their control. Long term, they're missing out on an education.

A not insignificant number of elementary schools have eliminated recess. I understand that it is difficult to get a child to pay attention when s/he doesn't get the opportunity to "burn off" some energy. Most public school lunch programs are abysmal. So, sadly, it is easier to turn to medication than to change the system.
posted by giraffe at 8:28 AM on January 3, 2011 [5 favorites]


They prescribe chemicals to help control symptoms that many people find to be crippling and intolerable.

Are these symptoms which are found to be crippling and intolerable ones the person taking the drugs find crippling and intolerable or ones that someone ELSE finds crippling and intolerable to their sensibilities?

And, are then chemicals better than or just simpler than changing the diet to change behavior?


I find being bipolar very hard work as do those around me, especially when I am in a long long depression. Do I want the chemicals? Yes, very much I do. To deny me access to what I know works and what is legally available would be cruel and inhumane. And if someone said that I did not need them, that my behaviour did not warrant then as I lost control and began self-injuring and suicidal thoughts increased then that someone may change their mind especially when if I did kill myself they would have to answer for not giving me what I needed and should have been given.

Diet? Hasn't worked so far and I doubt it will for me going on past events. And it could be the case that forcing a diet is just as bad as not giving tablets.
posted by episodic at 8:30 AM on January 3, 2011 [11 favorites]


Yes, Pastabagel, the ants that I feel crawling under my skin is just a creation of the man keeping me down! Viva la revolucion!
posted by KirkJobSluder at 11:17 AM on January 3


Well, no, those are real ants. Thousands of them. And they're hungry.
posted by Pastabagel at 8:34 AM on January 3, 2011 [1 favorite]


IANAD, but I'm pretty sure you might wanna get that checked out.

Actually it's a nice warning system that something is seriously screwed up.
posted by KirkJobSluder at 8:43 AM on January 3, 2011 [1 favorite]


I don't think anyone believes that there aren't people who have serious mental conditions that need medicinal help. I think if you're coming to this discussion thinking that there is a class of people who think all mental illnesses are hokum, then you're going to get sidetracked away from the real issues.

The issue I see is over-diagnosing of mental illnesses, and the complicity of psychiatrists who apply these over-diagnoses in the face of kickbacks and pressure from big pharma.

Sometimes people are ill. Nobody denies that. But the difficulties in detecting various mental conditions is worrying. And the fact that the rise in these diagnoses seems to match exactly the provision of various remedies should give everyone pause for thought.

disclosure
I am in the "sometimes people think they're ADD or autistic or bipolar when they aren't & way too many people pop pills they shouldn't to dampen normal human variance" camp.
/disclosure
posted by seanyboy at 8:48 AM on January 3, 2011 [3 favorites]


And while we're on the subject. Whoever it was on metafilter that told me I was probably suffering from ADHD... I've been worrying about that for months now. Thanks a freaking lot. You turned me into a god-damned hypochondriac.
posted by seanyboy at 8:50 AM on January 3, 2011 [1 favorite]


Don't forget the pressure from insurance companies, while we're at it - as noted in the article, if you don't have a name to your symptoms, it can be impossible to get your treatment (be it drugsdrugsdrugs or simply the talking cure) paid for.
posted by maryr at 8:57 AM on January 3, 2011


The issue I see is over-diagnosing of mental illnesses, and the complicity of psychiatrists who apply these over-diagnoses in the face of kickbacks and pressure from big pharma.

Really? I've seen little evidence of dramatic over-diagnosis and a fair of people who are fucked up in a bad way and don't get help because of sigmas associated with getting it.
posted by KirkJobSluder at 9:00 AM on January 3, 2011 [19 favorites]


It's a huge mess. Blame Freud, Jung, or any of the rest of them who create models based on myth and their own personal histories. Much of the mental illness I've seen can be described as various amounts of anxiety, impulse control, activity level, cognition, avoidance of pain whether emotional or physical, socialization, acceptance of realities, anger and joy. These categories aren't specific enough. We're starting to see how medications affect these states, and have just begun to have the ability to treat symptoms, albeit with a hammer, not with any finesse. It's so much better than locking away schizophrenics and calling them cursed. But it's just the beginning.

The DSM is an elaborate storybook; they're fighting over the numbers of toads under the giant mushroom. Meanwhile, real people, with real problems rooted in both mind and body, are suffering.
posted by theora55 at 9:03 AM on January 3, 2011 [2 favorites]


@ episodic: Don't stop taking your meds. But don't give up on diet, either. Wellness regimens can help, for some of us. I have seen them help for people who have extremely profound symptoms. Not just diet, but wellness. I wouldn't make changes and expect to go off meds at the same time, if ever. It is possible to see improvements, and to see reductions in medication, but it's not really a case of substituting one for another. Just take the best care of yourself you possibly can (that is, if you're not already).

The formula seems to be, find out what makes you feel good, and do that. Find out what makes you feel bad (triggers), and put the biggest wall you can find between you and them. Figure out what indicates symptomatic behavior to you, and pay attention to how you feel so you can tell when things are getting bad before they get too bad.

And have fun. Life is too goddamn short not to.
posted by cybrcamper at 9:08 AM on January 3, 2011 [1 favorite]


So how is this different than the person who drinks away their sorrows in the bar every night?

1. Alcohol is available to most people, and publicly encouraged, unlike medicine which requires diagnosis and prescription from a trained physician.
2. Alcohol generally has a diminishing effect upon judgment, memory retention, and impulse control - three things you want to improve for most people.

Here's a better strawman: "How is this different than dosing on heroin? LOL!"

You know, it's totally possible to hold both beliefs that the DSM has been used in the past as a tool of exploitation and oppression (hysteria!, wanting equal rights = crazy!), AND that there are a lot of people who need treatment and medicine.

People keep putting up this false dichotomy that you have to either buy into the system and all of it's problems 100% or that the system is completely useless.
posted by yeloson at 9:12 AM on January 3, 2011 [15 favorites]


Reminds me of the time I was talking to my mother about finally coping with my decades-long depression and getting treatment. Her response was, "Well, when your father left, I spent the longest time deeply depressed. Then, one morning, I decided I wasn't going to be depressed anymore." To which I replied, "That's amazing. I don't know why people with the flu, or AIDS, or who are missing a limb don't just decide to get better!" She meant well; a lot of people who downplay mental illness do. But a lifetime of sublimation and suppression doesn't make you healthy, or even asymptomatic. It just changes the symptoms, only sometimes for the better.

The problem is this: The brain is too smart. We're conscious, but we're still animal enough to be driven by our biochemistry (needs, desires, the id, etc.). And it programs itself, chemically and neurologically, based on its experience. When you've been depressed for a long time, your brain chemistry changes. Sometimes it takes a chemical kick to get you out of a rut and into a groove. Sometimes you can reprogram it with therapy. Usually, it takes a combination of therapy, attitude, and sometimes chemical (dietary, if you're lucky) to reprogram buggy brain code. And sometimes you just have to settle for a workaround.

Sorry for the inconvenience, healthy people. That's just how it is.
posted by Eideteker at 9:19 AM on January 3, 2011 [15 favorites]


So how is this different than the person who drinks away their sorrows in the bar every night?

This is an interesting question, as alcohol is a psychotropic drug, and it has been prescribed in the past to treat certain medical ailments, such as hysteria, shock, hypothermia, depression, anxiety and Soldier's Heart.

Even today, heavy drinkers are often described as "self-medicating", as in attempting to treat their mental illness with the strongest medicine available to them without medical supervision.

So, that's the answer -

Medical.
Fucking.
Supervision.

That means professionals who understand psychology, neurology and pharmacology, and who's understanding is built on decades of peer-reviewed science, constantly updated advanced medical training, and hard-won experience.

That's the difference between drinking the blues away and treatment for a psychological disorder.

HTH.
posted by Slap*Happy at 9:19 AM on January 3, 2011 [3 favorites]


KirkJobSluder: There was a case ages ago when three people checked themselves into an asylum and couldn't get out. There was the Silicon Valley Autism epidemic from the early '00s. From the Article linked above there was the information that "bipolar diagnoses among children had increased 40-fold" and "In 2007, a series of investigative reports revealed that an influential advocate for diagnosing bipolar disorder in kids, the Harvard psychiatrist Joseph Biederman, failed to disclose money he’d received from Johnson & Johnson, makers of the bipolar drug Risperdal, or risperidone. "

On a personal front, I've seen a woman who was placed (at her mothers behest) on anti-depressants at a very young age, and I believe this has had serious repercussions in later life. I'm also aware that I myself tick a huge number of boxes in the psychiatrists handbook, and it frustrates me that despite being a functioning though eccentic member of society, I could easily have been marked up for medication. I don't know what would have happened to me if I'd gone down the medicinal path.

I think you make a valid point though. There is a lack of care for people who need care, and I may be conflating an explosion in internet driven self-diagnosis (just look at ask-metafilter) with actual diagnoses.
posted by seanyboy at 9:24 AM on January 3, 2011 [1 favorite]


yeloson: People keep putting up this false dichotomy that you have to either buy into the system and all of it's problems 100% or that the system is completely useless.

Yes, the system has problems. And the DSM5 has some serious problems, but none of the canard-wavers here have hit any of them.
posted by KirkJobSluder at 9:24 AM on January 3, 2011 [4 favorites]


It's becoming increasingly clear

Indeed, just look at the case of hysterical paroxysm. The technology to (dis)prove mental disorders has changed, many of the ideas haven't.
posted by squeak at 9:30 AM on January 3, 2011


Yes, the system has problems. And the DSM5 has some serious problems, but none of the canard-wavers here have hit any of them.

So some unspecified things said in the thread are wrong, some other unspecified things are also wrong, and we're to guess what these are or your point is proved?
Did I parse that correctly?

Also - What's a canard waver?

I'd prefer if we hit the issues in contention one at a time so at least I can learn something. Your comment just read as "You're wrong if you disagree, and I'm too bored to explain."
posted by seanyboy at 9:58 AM on January 3, 2011 [1 favorite]


I think we should include a statement of first principles with every psychiatry-related thread...
  1. Everyone deserves to be happy, healthy, and well-adjusted.
    • Not everyone can be, for a variety of reasons, including inherited tendencies, life experiences, and other environmental influences.

  2. Not everyone with a brain that works slightly differently from whomever you believe to be well-adjusted has a mental illness.
    • Many, however, do.

  3. We have lots of treatment options that can help.
    • Some of them are really not much better than placebo.
    • Many of them work better than placebo.
      • This is true even though many pharmaceutical companies and some physicians and researchers act in untoward ways.
      • This is true even though, for the most part, we have no idea how these treatments work.
posted by greatgefilte at 10:13 AM on January 3, 2011 [23 favorites]


There is a lack of care for people who need care, and I may be conflating an explosion in internet driven self-diagnosis (just look at ask-metafilter) with actual diagnoses.

There's a lot of handwaving between "people who need care" and "people who self-diagnose because it's trendy."

Who are the people who need care? How do you define them? Are they allowed to decide that their eccentricities are more than eccentricities and need some sort of psychiatric/psychotherapeutic intervention? If so, and they go to a doctor and the doctor examines them and prescribes meds, are they then just dupes of Big Pharma?

These are all questions we (metafilter we and society-at-large we) struggle with. We have more information now about mental illness than we did 100 years ago, and there is more help for people with mental illnesses (especially if you have insurance!). There's also quackery, and wrong diagnoses, just like 100 years ago.
posted by rtha at 10:14 AM on January 3, 2011 [2 favorites]


So how is this different than the person who drinks away their sorrows in the bar every night?

The drunk in the bar is operating under the delusion that other people give a shit about their lives. By contrast, the psychiatric patient fully understands that their life is so dull and insipid that they have to pay someone $300 an hour to hear about it.
posted by Pastabagel at 10:18 AM on January 3, 2011


"I could easily have been marked up for medication."

Unless you are dangerously insane, no respectable physician/clinician is going to force you to take anything. If they do, seek another doctor.

1. Do you want treatment?
2. Is the treatment helping you?

These are the two main questions. If you're functioning effectively in life, able to work, feed yourself, get out of bed in the morning, then you're probably ok. You can always work at getting better; how is up to you.
posted by Eideteker at 10:20 AM on January 3, 2011 [5 favorites]


seanyboy: I'd prefer if we hit the issues in contention one at a time so at least I can learn something. Your comment just read as "You're wrong if you disagree, and I'm too bored to explain."

I've provided detailed criticism above in multiple places. It is not generally the case that mental health professionals ignore behavioral and environmental factors, prescribe treatment to make people 'normal,' are guilty of homogenizing human variance, or are agents of the man surprising political dissent.
posted by KirkJobSluder at 10:23 AM on January 3, 2011 [1 favorite]


Money quote:
"We made mistakes that had terrible consequences," he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.
posted by Mental Wimp at 10:26 AM on January 3, 2011


A person's diagnosis matters because of the Law. If I - as someone who is bipolar - commit a crime they might bear this in mind and when considering penalties they might too. How I can or cannot be treated would be determined and a psychiatrist asked for an opinion. The DSM and ICD could be used.

But what if these documents say someone cannot be treated? What if they say someone has a personality disorder? How do they reach this diagnosis? This matters hugely because it could mean indefinite detention for someone who genuinely does not deserve that (indefinite because you can't treat them but you can't release them because of risk to self/others/property so you "keep them safe"). So the words they use here are important for me and others like me but they are vastly more important where it becomes more vague. And vague can lead to the law being wrongly used but with something like the DSM being used as backup. And it will be used wrongly.


- @cybrcamper - thanks :)
posted by episodic at 10:28 AM on January 3, 2011 [1 favorite]


By contrast, the psychiatric patient fully understands that their life is so dull and insipid that they have to pay someone $300 an hour to hear about it.

I've never paid more than $75 an hour for therapy. I talked to my therapist about stuff I didn't want to talk to my friends or family about because some or all of what I wanted to talk about was those friends and family. A lot of it helped me shortcut a process that was otherwise full of false starts and dead ends, and so I was able to feel better and be better in relationships in a shorter time, rather than bumbling around for years.

But it's good to hear from someone who's so rational about therapy and why people need it - thanks.
posted by rtha at 10:29 AM on January 3, 2011 [10 favorites]


So how is this different than the person who drinks away their sorrows in the bar every night?

Let's talk about a typical case of bipolar I (seen from personal experience). A pajama-clad person gets brought into the ER babbling at scarcely comprehensible speed about his plan to bring about world peace and restart the space program. He sounds like he's had a hell of a lot of cocaine, but no, something in his own head got him to this point. We could put this in some different diagnostic box, but would you deny that this person has a real problem?

Slow him down with some powerful drugs, therapy and time and you'll find that what's caused him the most pain in his life isn't the berserker highs but the depressed lows. Those troughs do look a bit like bottomed out alchoholism, but without the alcohol. Why do you want to deny that this is also a real problem?

Thanks for blaming the victim, crays.


Are these symptoms which are found to be crippling and intolerable ones the person taking the drugs find crippling and intolerable or ones that someone ELSE finds crippling and intolerable to their sensibilities?

Keep in mind that mental illness can distort judgment. It feels fantastic to be the smartest man in the world, even as you lose your job, savings and marriage, at least until you crash.


What's a canard waver?

A duck shaker?
posted by justsomebodythatyouusedtoknow at 10:30 AM on January 3, 2011 [3 favorites]


Reminds me of the time I was talking to my mother about finally coping with my decades-long depression and getting treatment. Her response was, "Well, when your father left, I spent the longest time deeply depressed. Then, one morning, I decided I wasn't going to be depressed anymore."

I had a very similar experience with my father; every once in a while, he still pointedly mentions how his depression lifts when he takes melatonin or omega-3 or the latest hot OTC supplement. It used to make me furious, until a friend pointed out that he probably feels at least somewhat guilty about his own role -- via nature, nurture, or both -- in setting up the circumstances for my own depression. Which surprised me, since I never thought of it in that way. I don't know many people with depression or bipolar or ADD or whatever who do blame anyone else, or use the diagnosis as a get-out-of-jail-free card. Like most people, we're generally just trying to function as best we can.

Usually, it takes a combination of therapy, attitude, and sometimes chemical (dietary, if you're lucky) to reprogram buggy brain code. And sometimes you just have to settle for a workaround.

Yep. It was depressing (ha!) to realize that my faulty wiring would never be "fixed" -- I'd just get better surge-protectors, learn to fix minor short-outs before the whole thing burst into flames, etc. For years I fought taking meds, because I hated thinking of myself as someone who needed them, someone who was weak and sick and defective. I still struggle with those labels, even though I'm reconciled to taking meds for, probably, the rest of my life. I also pay attention to my diet and my activity levels, and I consistently use all the internal responses I've learned will help make that ugly voice in my head shut up for a minute. But I know from experience that's not enough. To have people say that it's really not necessary to take the stuff that makes it possible for me to experience my life as something more than a razor-lined gerbil wheel of self-loathing, or that I could do without it if I really wanted to--well, it's not helpful. It just reinforces that lying, hateful voice I'm trying not to listen to.
posted by dogrose at 10:32 AM on January 3, 2011 [6 favorites]


Psychology, as a field, has done marvelous things in understanding learning and motivation through careful experimentation. When it comes to treatment of human misery, though, they have relied on witchcraft and anecdote more than anything. Developing careful ways of identifying disorders (and I don't mean simple-minded checklists; preferable would be biological tests) is the first step to being able to develop reliable treatments, verified by randomized trials. Depending upon how you interpret the literature you could make a case that no treatments for depression or any of its related disorders has been shown to be more effective than doing nothing. Meta-analyses have been controversial and, in any event, must combine skewed collections of seriously flawed studies by necessity. There are plenty of targets for blame: the profession for not demanding rigor, the drug companies for doing what would make them money the fastest, and the FDA for buckling to pressure from the other two.
posted by Mental Wimp at 10:35 AM on January 3, 2011


I had a really fascinating experience earlier this summer. My gyno inserted a Mirena IUD (the kind of IUD that releases hormones) in an attempt to reduce the extremely heavy bleeding that was undermining my health and wrecking my life. About a week after it was inserted, I became suicidally depressed. I woke up in the morning unable to move; my partner said, "Good morning," and it was almost more than I could do to summon up the energy to answer him. I wasn't actively suicidal, but I pretty much spent the day lying in bed thinking things like, "maybe I'll get one of those cancers that kills you in three weeks, that would be great." Two terrible days later, the doctor removed the IUD, and I woke up normal the very next morning.

It was really eye-opening. I thought I'd been depressed before; I'd been diagnosed with post-partum depression after my oldest son was born, for instance, though my primary symptom was more like anxiety, something I've struggled with my whole life. I'd read memoirs by people with major depression. Etc.

But until I woke up that morning, I really had no idea what it could be like. I wasn't just blue, it wasn't just hard to do things. I really couldn't do much more than lie there weeping. I had almost no physical energy and little will. I was very lucky that my partner was able to stay home from work to care for the children, because I don't know that I could so much as hand them a box of crackers to subsist on.

Now, when somebody tells me that they've spent most of their adult life wrestling with depression and suicidal ideation, I get it in a way I never did before. And it's not that I had been unsympathetic or unbelieving. I just really didn't get it. Sometimes when I talk about this, people express sympathy, but I'm not sorry it happened at all. I feel like I got a glimpse into something I'd never really understood, although I'd tried.
posted by not that girl at 10:39 AM on January 3, 2011 [32 favorites]


not that girl - I would love to see more genuine research done on the impact of hormones on neurotransmitter levels. As I woman, I honestly feel like science has failed me here. We know that various chemical birth control methods alter hormone levels and we know that in some women this causes (or in some cases, alleviates!) depression and mood swings. I really don't have the proper background to understand more about this (I suppose, I could, but neuroscience just seems so fuzzy compared to molecular biology...), but it seems like such an obvious research area... I don't know why we don't know more about the relationship between things like progesterone and serotonin.
posted by maryr at 10:51 AM on January 3, 2011 [2 favorites]


Addendum: When I say "We know that various chemical birth control methods alter hormone levels..." I mean that most women know this anecdotally - either they (as in ntg's case) or a friend (in my own case) have had a friend either start or stop taking one Pill or another because of its effect on her mood.
posted by maryr at 10:54 AM on January 3, 2011


Maryr, as a woman who can't use hormonal birth control without losing my mind as described above I would also like to see more focus on hormonal effects. It seems to me that a lot of people would benefit.
posted by fshgrl at 11:19 AM on January 3, 2011


marry, there was an AskMe question last week by a woman whose temperament had changed dramatically, and most of the answers were women saying, "It could be your birth control," and describing their experiences with it. I found it very affirming! But frustrating--until my Mirena experience, it didn't occur to anyone that the serious mood swings I'd been having the last 2 years were from birth control pills. I thought I was having problems from perimenopause and the pills weren't helping; now that I'm off all hormones, it's clear the pills were the problem. Wish we'd figured it out much sooner.
posted by not that girl at 11:20 AM on January 3, 2011


Oh joy. It's that time again when we get to hear from people who don't believe in mental illness because they've been fortunate enough not to have to deal with it.

I've dealt with it, both personally (within my own biosphere) and in my immediate family and community. So, yes, I believe in it. But as greatgefilte points out very well above, there's all kinds of grey area when it comes to deciding how best to diagnose and deal with it.

Personally, the only medications I ever took for the two significant periods of my life when I was seriously afflicted with depression etc were self-administered. And the only other "help" I ever sought was via a sort of guile. That is, I never directly let on to anyone how fucked up I was, just pursued the issue in all manner of indirect ways (research, conversation etc). Fortunately (or perhaps not) my symptoms were never so LOUD that other people took acute notice, beyond the occasional, "Man, why so serious all the time?"

Long story made short: my ultimate journey out of the deep hole I was in (I haven't been what I'd call "depressed" in almost thirty years) was much more "spiritual" (for lack of a better word) than psychological. No, I didn't find GOD (certainly not by any name I've ever heard), but I did find something that allowed me to not just accept my apparently profound insignificance in relation to nature-circumstance-randomness, but to roll with it, allow it to propel my curiosity and imagination.

Blah-blah-blah.

Like I said, it's a long story, and fact is, I'm pretty damned sure I wouldn't have it to tell if I'd been hastily diagnosed and prescribed way back when. Yes, I'd have a different story to tell in its stead but something tells me it would be much more contained (neurotic?), limited, lacking in passion, poetry, plenty (other things that start with "p").
posted by philip-random at 11:34 AM on January 3, 2011


not that girl: I feel like I got a glimpse into something I'd never really understood, although I'd tried.

I wish that every person in this thread who is telling me that getting a diagnosis that allows for me to be prescribed medication means I'm just looking for a way to get people to "tolerate" my behavior (I'm sick; it's not my fault), or that my taking said medication in order to help me get the fuck out of bed in the morning makes me the same as an alcoholic, could have an experience like yours, not that girl. The loss of the dismissive and ignorant attitudes of so many of the mentally healthy would be one less problem those of us who have serious mental illnesses would have to deal with every single day. It would only be a drop in the bucket of the problems we have to deal with every day, though a not-insignificant one. But hey, maybe I just need to snap out of it.
posted by tzikeh at 12:04 PM on January 3, 2011 [13 favorites]


"Other people need to suffer because I value their diversity" is not the empowering stance you seem to think it is.
posted by mayhap at 12:21 PM on January 3, 2011 [12 favorites]


I suspect untreated ADD is crippling for children
and
PS err...food is chemicals, RA

Not only is food a chemical so is Vitamin D-3.

But you don't get State or Insurance coverage for food changes do ya?
posted by rough ashlar at 12:32 PM on January 3, 2011


I would also like to see more focus on hormonal effects. It seems to me that a lot of people would benefit.

Yes, but if that research was done and it turned out plastics->BPA and the chemicals in the water from pills->human waste->water cycle was, in part, to blame....what then?
posted by rough ashlar at 12:35 PM on January 3, 2011


philip-random: Like I said, it's a long story, and fact is, I'm pretty damned sure I wouldn't have it to tell if I'd been hastily diagnosed and prescribed way back when.

Bootstraps! Bootstraps!

Two problematic assumptions loaded in this sentence 1) people who get help don't have interesting stories of their own about survival and recovery and 2) diagnosis and prescription is hasty.

Yes, I'd have a different story to tell in its stead but something tells me it would be much more contained (neurotic?), limited, lacking in passion, poetry, plenty (other things that start with "p").

And this is just a nasty stereotype.

rough ashlar: But you don't get State or Insurance coverage for food changes do ya?

If food and dietary changes help and are sufficient, that's wonderful. A good doctor will recommend those changes.
posted by KirkJobSluder at 12:40 PM on January 3, 2011 [1 favorite]


See, here's the thing. The shrinks I know (good ones) will admit to you baldly that the purpose of the DSM is to get paid by the insurance companies. They know how to diagnose and WHAT to diagnose but also what label to slap on the paperwork so they get paid. I can live -and for a period DID live-with that.


Yes, the edges are blurry on a lot of these disorders. Diagnosis is an art, not necessarily a science. If people are coping better, or are getting well, or are functioning better, treatment is successful whatever you want to call it treatment FOR.
posted by St. Alia of the Bunnies at 12:50 PM on January 3, 2011 [1 favorite]


And this is just a nasty stereotype.

To make such a claim ignores that fact that diet CAN have a difference. Its why I posted a link from the Feingold site. If you can't trust a Congressman....who can you trust?
posted by rough ashlar at 12:51 PM on January 3, 2011


rough ashlar: I don't understand (it must be the drugs). Why did you choose to quote a line that has absolutely nothing to do with diet rather than the line that does and agrees with you?
posted by KirkJobSluder at 1:00 PM on January 3, 2011


I think anecdotes about getting treated or not are pretty pointless unless you know the cause of your symptoms. And it is very obvious that there are different causes for the most common symptoms of mental illness; for quite a few women depression can be relieved by avoiding BC but that's unlikely to help men, depression can be seasonal, situational or just chronic, psychosis can be drug induced as well as spontaneous etc etc. Until the root causes of what we now call "mental illness" are more easily diagnosd treatment will continue to consistent of the treat the symptoms approach we currently have. Which is obviously better than nothing.

A lot of the posts here are the equivalent of someone saying "i had a headache and i had to have brain surgery" and someone else replying "well I had a headache and it went away on its own."
posted by fshgrl at 1:12 PM on January 3, 2011 [3 favorites]


If you can't trust a Congressman....who can you trust?

This part's a joke, right?
posted by maryr at 1:13 PM on January 3, 2011


There's a lot of incredibly privileged and ignorant thinking going on in this thread about the reality of the situation for people who are mentally ill. A way of thinking that interprets mental illness as some kind of societal construct, and believes we live in a world where pills and treatment are passed out like candy to everyone who wants them - because there's no acknowledgment of the stigma around reaching out for help, or crippling fear that keeps so many people from doing so. It's this kind of thinking that helps perpetuate an already messed-up system.

I would love to live in a place where all it took was enough willpower and the right vegetables to keep people from attempting suicide, or keep me and many people I care about from having to deal with this stuff every day, when we could all be dealing with other things. It would be a much easier place.

But that place doesn't exist, and ignoring that truth and the lived reality of people with mental illness is really unproductive.
posted by Pochemuchka at 1:38 PM on January 3, 2011 [7 favorites]


I would love to live in a place where all it took was enough willpower and the right vegetables to keep people from attempting suicide, or keep me and many people I care about from having to deal with this stuff every day, when we could all be dealing with other things. It would be a much easier place.

But that place doesn't exist, and ignoring that truth and the lived reality of people with mental illness is really unproductive.


I've linked to greatgefilte's comment once already in this thread. I'll do it again, because it embraces a lot of necessary grey area.

I don't for a second deny that mental illness is a devastating affliction and that, for many, medication is very helpful, even a lifeline. I don't just have the evidence presented by people in this thread. I've seen it in my immediate family and community.

But my own personal experience speaks to a situation where I recovered from my "final" affliction without institutionalization, medication, or even consultation. It wasn't remotely easy. It wasn't like a head ache that just went away one day. It was more like falling into what felt like a bottomless pit, but slowly I got a grasp on something and stopped the fall. But then I was just stuck in the pit, in darkness and peril. But bit by bit I stumbled, clawed, crawled, saw a bit of illumination and eventually found my way out, not to return again (29 years and counting).

And, no I can't prove it in any scientifically demonstrable way, but I'm pretty sure that the main reason I haven't relapsed and fallen into that hole again is because the process of dragging myself out made me emotionally stronger somehow, produced scar tissue (or whatever).

Does this make me better than people who use medication etc? No, but it does color my perspective on the issue.
posted by philip-random at 2:40 PM on January 3, 2011 [1 favorite]


this reminds me of the blog http://behaviorismandmentalhealth.com/ which also decries the DSM as a tool for Big Pharma
posted by rebent at 2:49 PM on January 3, 2011


And, are then chemicals better than or just simpler than changing the diet to change behavior?

You assume people haven't tried this. By the time I finally ended up at a psychiatrist, I had tried everything to manage my chaotic life, including various diets, for decades. In the end therapy and medication worked better than anything I had tried on my own, although there is still a lot of work to do. Still, it's better than suffering for the sake of some anti-psychiatric abstract principle, which never really improved my life at all.
posted by krinklyfig at 4:58 PM on January 3, 2011 [1 favorite]


See, here's the thing. The shrinks I know (good ones) will admit to you baldly that the purpose of the DSM is to get paid by the insurance companies. They know how to diagnose and WHAT to diagnose but also what label to slap on the paperwork so they get paid.

I am no fan of insurance companies, but this is a crock. The purpose of the DSM is to help diagnose and treat mental disorders. The fact that insurance companies require it to qualify for payments for treatment of such disorders is hardly surprising. It's not a conspiracy, however. it's simply the standard by which the profession operates. Here's an idea, if it bothers you - let's take the insurance companies out of the equation altogether and make a healthcare system that serves us instead of for-profit financial companies. I guarantee you that the DSM will still exist.
posted by krinklyfig at 5:07 PM on January 3, 2011


And, no I can't prove it in any scientifically demonstrable way, but I'm pretty sure that the main reason I haven't relapsed and fallen into that hole again is because the process of dragging myself out made me emotionally stronger somehow, produced scar tissue (or whatever).

Does this make me better than people who use medication etc? No, but it does color my perspective on the issue.


I'm very glad you've found a non-meds solution that works for you, and of course you're free to think anything at all about the choices other people make. But I'm not sure why you think sharing your perspective here is useful or helpful for anyone who's made a different choice. You may think you're not expressing any judgment but you are.

You're assuming, first, that it's never occurred to those of us in the meds crew that we ought to try clawing our way out of the pit through sheer force of will, that we haven't tried, that trying and failing over and over again hasn't added to the original problem.

You're further assuming that our struggles haven't "produced scar tissue (or whatever)." They have. In many cases, the scar tissue only limits our ability to deal with the original problem and reinforces unhealthy and unhelpful thoughts and actions; in all cases, it doesn't enable us to function well enough on its own. Personally, I focus less on "scar tissue" and more on resiliency, which can be learned, which I'm always trying to learn.

Finally, you haven't offered anything concrete in the way of alternative solutions. You're basically reciting the standard response, a version of "what doesn't kill you makes you stronger," or "if you wanted to, you could get better," or "quit your whining and straighten yourself out." Not helpful.
posted by dogrose at 6:40 PM on January 3, 2011 [10 favorites]


The human mind is complex. The DSM is a work in progress. This latest DSM will be more refined in the future. The DSM can never be perfectly perfect
posted by ovvl at 6:59 PM on January 3, 2011


I am no fan of insurance companies, but this is a crock. The purpose of the DSM is to help diagnose and treat mental disorders. The fact that insurance companies require it to qualify for payments for treatment of such disorders is hardly surprising. It's not a conspiracy, however. it's simply the standard by which the profession operates. Here's an idea, if it bothers you - let's take the insurance companies out of the equation altogether and make a healthcare system that serves us instead of for-profit financial companies. I guarantee you that the DSM will still exist.

One of my docs was on the cutting edge and kept up with all the latest research, etc. He was always telling me where and when the DSM got it wrong with my own illness. His treatment of me worked and he always listened to me instead of trying to shoehorn me into a DSM subcategory. And in fact he was the one who explained to me that the DSM categories were more a way of keeping the insurance companies happy than being totally accurate with the conditions it purported to describe.
posted by St. Alia of the Bunnies at 7:05 PM on January 3, 2011


PS the DSM would have you believe that bipolar disorder can never be cured. Mine was. By prayer. I was released by the shrink I had at the time because he, a secular doc, told me there was no reason for me to come back. He'd already seen be healthy and well and without meds for months, (as he was determined to keep an eye on me and not take my word for it at first. Which was entirely sensible on his part.)

I am so grateful for the meds I needed when I needed them. But the categories are so fuzzy, and the fact that brain chemicals AND our social support system or lack thereof AND our emotional makeup AND our spiritual situation all ebb and flow together to make us who we are, sick or well....means that there probably will never be total treatment recipes to help or heal any one particular individual. These illnesses aren't JUST mental or JUST physical or JUST emotional or JUST spiritual. They are an amalgamation.
posted by St. Alia of the Bunnies at 7:10 PM on January 3, 2011 [2 favorites]


changing the diet to change behavior?

Watching someone cite diet as the magic wand to cure psychiatric illness in a thread where psychiatry is compared to phrenology is probably both the funniest and saddest thing I've read in some time. Because if psychiatry is no better than phrenology, diet shills (such as Wakefield) are somewhere out in the land of placing your hands on your TV while sending money to teleevangelists.
posted by rodgerd at 10:48 PM on January 3, 2011


There's been some interesting stuff in this post, and the cited article is interesting too, but I really wish people who state that meds are needed for some people, mental health issues exist, but they have misgivings about diagnosis weren't categorised as awful unempathic monsters who want to take all psychiatric medicines away.
posted by seanyboy at 12:22 AM on January 4, 2011 [1 favorite]


The human mind is complex. The DSM is a work in progress. This latest DSM will be more refined in the future. The DSM can never be perfectly perfect

I'm not sure what to think about this statement. It presents itself as a moderate informed opinion, but actually, on closer inspection, is neither. On the one hand, it assumes that the status quo is good enough, completely sidestepping the point of the criticism leveled in the article. On the other, it assumes a teleology to the development of the DSM which is not necessarily present. What's the basis for asserting that the DSM is getting better and better? What's the evidence that the nosology chosen by the DSM is the appropriate way to categorize mental illness?

If you want to weigh in to say that you think the DSM process is without substantial flaws, which is what your comment boils down to, then you should say that without hiding behind aspirational passivity.
posted by OmieWise at 9:38 AM on January 4, 2011


This suddenly reminds me of Michael Curtis's documentary The Trap (highly, highly recommended). To make a 3-part 3-hour story short, it explores "... the concept and definition of freedom, specifically, how a simplistic model of human beings as self-seeking, almost robotic, creatures led to today's idea of freedom".

One thing that pops up in THE TRAP more than once is how pretty much the entire orthodoxy of the western mental health establishment has got it WRONG in the past, and more than once. And all hail good science here, because all it really took to affect positive change was one or two experiments, properly conducted, reported, verified.

So anyway, the lesson I take away from it is to beware assuming that the orthodoxy is ever inherently correct, about anything. This doesn't mean it's inherently wrong either, just that it must be questioned constantly.
posted by philip-random at 10:48 AM on January 4, 2011


I don't know anyone who's not questioning existing models, but surely we can do so without falling onto the equally orthodox ideology that treatment turns people into zombies who are "limited, lacking in passion, poetry, plenty (other things that start with "p")."
posted by KirkJobSluder at 11:28 AM on January 4, 2011


PS the DSM would have you believe that bipolar disorder can never be cured. Mine was. By prayer.

OK, good for you, but surely you can see how this wouldn't be a good idea to get into from a clinical perspective? Most therapists of any type will tell you that spiritual development is beneficial, but nobody with any integrity is going to tell you that you can cure your medical issues through prayer.

These illnesses aren't JUST mental or JUST physical or JUST emotional or JUST spiritual. They are an amalgamation.

Sometimes that can be true. But many other times, there is a major overriding issue like a chemical imbalance, or unresolved trauma in someone's past. I think the most you can personally do is let people do what works for them without passing judgment. And again, most therapists will tell you that just using meds by themselves won't work as a long term solution to anything, even though for some people it can be the catalyst to a better life or even a long-term benefit. I think the straw man most people are objecting to is the idea that people just get psychiatric meds and don't do any other work to get better, or that there is something wrong with the whole idea of taking meds for many mental issues/disorders. I used to assume the same thing, that is before I dealt with it personally.
posted by krinklyfig at 6:07 PM on January 4, 2011 [1 favorite]


So anyway, the lesson I take away from it is to beware assuming that the orthodoxy is ever inherently correct, about anything. This doesn't mean it's inherently wrong either, just that it must be questioned constantly.

The trap is being cynical, because when it comes to your health that can produce some spectacularly bad results. Being credulous is just ignorant. Of course you have a responsibility for your own health, but you have to put some faith in medical science, because nobody can do all the research on their own, not even people who work in the profession. By "faith," I mean faith that the scientific method produces the best result, in a way which can be reproduced and verified, not faith in a particular practitioner or pharmaceutical.
posted by krinklyfig at 6:14 PM on January 4, 2011


but surely we can do so without falling onto the equally orthodox ideology that treatment turns people into zombies who are "limited, lacking in passion, poetry, plenty (other things that start with "p")."

kirk, you've taken a statement I made in qualified way (preceded by stuff like "... there's all kinds of grey area") added a preface of your own to it ("turning people in zombies") and presented it as evidence that I ascribe to an orthodox ideology about treatment, which I don't.

Please don't put words in my mouth. I've got an overload already.
posted by philip-random at 6:41 PM on January 4, 2011


These illnesses aren't JUST mental or JUST physical or JUST emotional or JUST spiritual. They are an amalgamation.

What is the difference between the mind and the spirit please?

Also, how can a spirit have an illness? Contracted from a succubus perhaps?
posted by rebent at 7:12 PM on January 4, 2011


Mind is what you think (involves your brain, solves math problems).
Spirit is what you feel inside (involves your soul, makes you cry at the end of Lord of the Rings).
If you don't believe in soul, you haven't listened to enough Ray Charles.
posted by philip-random at 8:04 PM on January 4, 2011


That means professionals who understand psychology, neurology and pharmacology, and who's understanding is built on decades of peer-reviewed science, constantly updated advanced medical training, and hard-won experience.

That's the difference between drinking the blues away and treatment for a psychological disorder.


Unless you have insurance. If you have insurance, you can get any drug you want that aren't painkillers. You know how all those commercials say "Ask your doctor"? Seriously, that's all it takes. The Nurse Practitioner I saw for a recommendation talked to me for less than a minute before she wrote me a prescription for the meds herself. She wrote it with a pen that had the name of a drug on it. My experience with her was not unique.

I guess that counts as medical supervision?
posted by Uther Bentrazor at 8:23 AM on January 5, 2011 [1 favorite]


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