[ultramar]

Below are excerpts from some interesting thoughts written by two psychiatrists responding to an article in the New York Times Magazine about psychiatric diagnoses. To read the article and all reader responses:

http://www.nytimes.com/2013/03/24/op...=0&ref=opinion

Excerpt from letter to the NYT:

Dr. Pies says, “For many patients, learning the name of their disorder may relieve years of anxious uncertainty.” It’s all very well for a patient to know what he “has.” But what he really needs is to know who he is. When that happens, the “diagnosis” tends to disappear. It’s just too little an idea to account for human complexity.

Excerpt from letter to the NYT:

Sigmund Freud taught us an important lesson: The border between the normal and the abnormal is not as distinct as we think. There are many shades of gray. Mental health professionals should approach each patient as a unique individual and together decide on the best treatment.

So what do you guys think? Treating the unique individual, taking into account the vast complexity of the human condition...? Is this very different from your experience with psychiatry?

[tinyrabbit]

I see a psychotherapist, not a psychiatrist, but I have been struck by his emphasis on treating the person and am coming around, very much, to the idea that therapy is for people and not problems.

I am 99.9% sure I have complex PTSD and my T has been quite resistant to applying a label.

I think diagnoses are an indication of what a person may need.

[Perna]

I don't know, the article topic was, "Readers discuss criticisms of how conditions are diagnosed."

I kind of agree with the person commenting on Dr. Pies, how learning who one is, the diagnosis disappears; I think this is because diagnosis is based on symptoms and you don't need the symptoms anymore when you can solve your life difficulties as they occur, which I think is what good therapy does.

As to how "conditions" are diagnosed, I think for many conditions, such as "anxiety" (which I was diagnoses with) and "depression", etc. there's no magic in the diagnosis because it's not very controversial; very few people argue with or are surprised when diagnosed "depressed" for example or told they have an anxiety disorder. It's when you get to the gray area dificulties like some forms of bipolar and personality disorders and developmental/growth disorders (ADD/ADHD come to mind) where there's a bit of leeway and uncertainty that matters and you start doing multiple diagnoses such that all you end up with is an organized muddle (presumably diagnoses help with how to start/approach treatment with the "worst" of a multiple diagnosed person's difficulties first and then on down the line).

But as diagnoses can only be about symptoms/observations from outside, not giving a name to them, just working on what one sees/agrees is the worst and trying to ameliorate that, could be effective, I don't know; I didn't work on my symptoms though, just myself (in 30 years worth of work) and my symptoms did the "disappear" act, making a diagnosis not important anymore.

[ultramar]

Originally Posted by Perna

I don't know, the article topic was, "Readers discuss criticisms of how conditions are diagnosed."

I kind of agree with the person commenting on Dr. Pies, how learning who one is, the diagnosis disappears; I think this is because diagnosis is based on symptoms and you don't need the symptoms anymore when you can solve your life difficulties as they occur, which I think is what good therapy does.

As to how "conditions" are diagnosed, I think for many conditions, such as "anxiety" (which I was diagnoses with) and "depression", etc. there's no magic in the diagnosis because it's not very controversial; very few people argue with or are surprised when diagnosed "depressed" for example or told they have an anxiety disorder. It's when you get to the gray area dificulties like some forms of bipolar and personality disorders and developmental/growth disorders (ADD/ADHD come to mind) where there's a bit of leeway and uncertainty that matters and you start doing multiple diagnoses such that all you end up with is an organized muddle (presumably diagnoses help with how to start/approach treatment with the "worst" of a multiple diagnosed person's difficulties first and then on down the line).

But as diagnoses can only be about symptoms/observations from outside, not giving a name to them, just working on what one sees/agrees is the worst and trying to ameliorate that, could be effective, I don't know; I didn't work on my symptoms though, just myself (in 30 years worth of work) and my symptoms did the "disappear" act, making a diagnosis not important anymore.

I agree, Perna, that the difficulties (in the context of this article and letters) more lie in the 'gray area' diagnoses and multiple diagnoses. I think one of the problems can be how one may be treated by psychiatrists (a set of symptoms, diagnoses, not a unique, complex person) and also what diagnosis does to people psychologically -how it makes people feel about themselves, their identity, how they understand and interpret their feelings and behaviors, if through the lens of illness/diagnosis.

[archipelago]

I may have a slightly unusual experience in that over the years I've seen analysts who were also psychiatrists. All were reluctant to "use" diagnosis, perhaps because they were depth oriented analysts so didn't really believe that system of labeling really meant all that much. Even at the very beginning when I needed more meds, they went with what they thought would work, and it wasn't really based on standards of a diagnosis, so some off-label types of things.

Now I see a relational analyst. Even though I had seen his friends and colleagues previously, he did a full intake and took time to formulate his impression of me. He did not rely on any previous diagnosis made and in fact rejected them in consultations he had early on. I no longer need meds, except for sleep and occasional anxiety. So even though a psychiatrist he works primarily as a therapist.

We have had many discussions about diagnosis and how it works and how it doesn't. For some people, a diagnosis, at least at first, can help them understand how a set of seemingly unrelated things they do or feel are tied together. It does have some initial explanatory power and can be a relief for some people.

But there are no people in the DSM. And it is not the "bible" as some psychologists say it is. I have found that psychologists are more attached to these things than psychiatrists. I think there is envy in the psychology community about not being real "doctors" so they like to be called "doctor" anyway. And I've found that they sometimes have slightly off views about psychiatrists and also about the use of medications, but these views don't seem founded on any real understanding when I have heard them expressed. Many view psychiatrists as pill-pushers only and pawns of the pharmaceutical companies. This is patently false. So many psychiatrists actively resent the way they have been boxed in. And even if they are primarily prescribers, they still often use the free samples from the companies to give to patients to help them out.

But like I said my experience might be unusual because the psychiatrists I know or have seen myself are all also analysts which I do think changes things. Since you have to undergo your own lengthy analysis to become an analyst, this probably deeply affects the way they approach people. And I'm not talking about typical Freudian views. Most of these people are engaged in contemporary analysis which is quite different than old fashioned views. Analysts in fact have other ways of understanding and tend to use those rather than DSM categories. It's only when it comes to billing or other things that they resort to standard labels.

[LovelaceF]

I think that labels can be very damaging in some instances and think it wise to avoid applying these labels unnecessarily. Diagnostic labels are also extremely loosely based on scientific data, if at all, at this time, which to me is all the more reason to avoid them where possible. For instance, a child can be slapped with an "ODD" diagnosis and then become trapped in "alternative" or "special needs" schooling, which can further harm the child.