Posted on 06/28/2005 6:39:43 PM PDT by neverdem
Last of three articles
John Zeber recently examined one of the nation's largest databases of psychiatric cases to evaluate how doctors diagnose schizophrenia, a disorder that often portends years of powerful brain-altering drugs, social ostracism and forced hospitalizations.
Although schizophrenia has been shown to affect all ethnic groups at the same rate, the scientist found that blacks in the United States were more than four times as likely to be diagnosed with the disorder as whites. Hispanics were more than three times as likely to be diagnosed as whites.
Zeber, who studies quality, cost and access issues for the U.S. Department of Veterans Affairs, found that differences in wealth, drug addiction and other variables could not explain the disparity in diagnoses: "The only factor that was truly important was race."
The analysis of 134,523 mentally ill patients in a VA registry is by far the largest national sample to show broad ethnic disparities in the diagnosis of serious mental disorders in the United States.
The data confirm the fears of experts who have warned for years that minorities are more likely to be misdiagnosed as having serious psychiatric problems. "Bias is a very real issue," said Francis Lu, a psychiatrist at the University of California at San Francisco. "We don't talk about it -- it's upsetting. We see ourselves as unbiased and rational and scientific."
As the ranks of America's patients and doctors become more diverse, psychiatrists such as Lu are spearheading a movement to address the problem. Clinicians need to be trained in "cultural competence," they say, to prevent misdiagnosis and harm.
Psychiatrist Heather Hall, a colleague of Lu's, said she had to correct the diagnoses of about 40 minorities over a two-year period. She estimated that one in 10 patients referred to her came with a misdiagnosis such...
(Excerpt) Read more at washingtonpost.com ...
There are different susceptibilities by race after all. Just consider sickle cell anemia.
Then there are cultural norms. If cultural norms tend toward behavior consistent with a schitzophrenal diagnoses, the doctors are not racist to make that diagnosis more often with that race.
Forgive me, but this makes no sense whatsoever:
"Although schizophrenia has been shown to affect all ethnic groups at the same rate, the scientist found that blacks in the United States were more than four times as likely to be diagnosed with the disorder as whites."
Been shown HOW?
By WHOM?
The only way to "show" this sort of thing is by cases.
If there are four times as many cases per capita of blacks having schizophrenia than whites, than this shows that blacks are four times as likely to have schizophrenia.
We don't have access to a "Real Truth Bong Tree" that we can consult that tells us how things REALLY are, so that we can compare the results we have in medical records with
"the real truth". Absent some sort of divine revelation, with the Archangel Raphael standing there and saying "Well, actually, God afflicts all races equally per capita with schizophrenia", we can't bloody well "show" schizophrenia to "affect all races equally" can we?
All we can use are what the medical records show.
There isn't any other source that shows us anything.
Did you read the whole article?
Comment# 4. same question
I was hospitalized with schizophrenia and was forced to take depakote.
I was never depressed, had a job, had a fight with my parents and threw a picture and was hospitalized.
The drugs I was given made me depressed. I was forced to take depakote, the drug made me limp as hell.
Big pharma and doctors making a lot of money and are ruining young lives in the process.
"Although schizophrenia has been shown to affect all ethnic groups at the same rate, the scientist found that blacks in the United States were more than four times as likely to be diagnosed with the disorder as whites. Hispanics were more than three times as likely to be diagnosed as whites."
Well, this goes a long way towards explaining all the crazy white people running around out there.
Yes, I read the whole article.
What I read is that psychiatry is a word game, with the "winner" determined by the subjective opinion of the doctor who sits in the Alex Trebesch seat.
But then, I hear voices and see faces sometimes, so I can be discounted. Which is better than being burnt at the stake, I suppose.
My sister is an epileptic, and I am bipolar. We have both found "big pharma" and doctors, using depakote, have given us our lives back. It's the diagnosis, not the medication that is to blame. A correct diagnosis is foremost in receiving the right medical attention.
Is it your opinion that psychiatry is basically a poor field or "scam".
And no I'm not being insulting or making a Tom Cruise referance.
I'm glad you read the whole story. If you want, I'll get the first two parts of the story. I put misdiagnosis in the keyword section for a reason.
Schizophrenia, major depression, aka depression and major depressive disorder, and manic depression, aka bipolar disorder, are the big three diagnoses in Psychiatry with the potential to do harm to themselves or someone else. Their medical treatment is totally from each other. The point of the story was cultural awareness enabled the misdiagnosis to be corrected.
Not exactly.
I look at what the practice of medicine is. Regular old internal medicine (not surgery).
It could almost be done by computer.
What does the budding young doctor learn?
Lists and lists of symptoms.
The symptoms are name labels of specific things.
"clubbing of the fingers", "non-productive cough".
Certain symptoms are dead giveaways for the word label of the illness.
Example: a red, raised ring of irritation on the flesh with a whitish interior: "ringworm".
The doctor learns volumes of symptoms, and learns to assort them and eliminate and focus, based on the symptoms, with the word name of the illness. That's the diagnosis.
Next, take the diagnosis and cross reference that named illness in the Physician's Desk Reference to see which parts of the pharmacopea are indicated for the treatment of that drug.
And voila!
Symptom identification.
Diagnosis based on the matrix of symptoms.
Prescription based on the diagnosis.
Nobody can pretend that learning all of that is easy, but what the lion's share of it is, is taxonomy. (The same thing is true in law and most other things in life: education is the process of getting the right word label for the sight picture.)
Now let's move over to psychiatry.
Same thing.
But here is where it differs, and it is crucial.
With internal medicine, there is an organic problem. Some material thing is breaking down, causing a material failure of an organ that leads to degraded performance of a mechanical mechanism. An internist is a very sophisticated plumber of a very sophisticated system of pipes, and there is an OBJECTIVE norm. Broken arm doesn't work, and there's a bone sticking through the skin and blood going everywhere. Patient is howling in pain. Need to fix the bone, stanch the bleeding, anesthetize the pain.
But with psychiatry, while there may (or may not) be an organic breakdown (it is assumed that there is, but that is an assumption only), that which constitutes a SYMPTOM of an AILMENT - both things are subjectively defined.
What is a mental ILLNESS? What is it that DEFINES "illness" when it comes to thoughts and the mind?
Nothing objective.
Rather, the subjective values of the evaluator.
So, is an adult male lusting after adult females a mental ILLNESS? No?
What if the females are aged 16?
It might be criminal to act on that impulse, but is it a mental ILLNESS?
No.
What if the female is age 13?
Hmmmm...that starts to depend on how mature the female looks, doesn't it? If she looks 20, it's not a mental illness, though acting on the impulse can land the guy in prison for 15 to 20.
What if the female is 6?
That's a mental illness.
Why?
Because we think it's disgusting.
Same thing if it's a 6 year old boy.
What if it's a 15 year old boy?
We are markedly more inclined to conclude "Mental illness" (and be completely unsympathetic).
Now, what if our male patient lusts for 35 year old men.
20 years ago, he was diagnosed with the mental illness of homosexuality.
Today, that is not a mental illness at all.
Why?
Changing social mores. We have decided, as a society, that is ok, therefore to want to do that is not a mental illness. But if the boy is 15, it is.
What exactly is "Attention Deficit Disorder" in a boy?
Is it a mental illness?
Or is it called "Being a boy?" Especially "Being a boy who had Count Chocula for breakfast and is wired on sugar."
Well, our psychiatrists, pressed along no doubt by societal mores that want silent children in class, have decided that being a high-energy boy is a SYMPTOM, that the ILLNESS is ADD, and that the treatment in the pharmacopea is Ritalin.
And because they are PROFESSIONALS, with degrees, for someone not so diplomated to say "You are medicating something that is not illness, and defining normality as a symptom of something" is met with a handwave and a sneer.
The medical science of psychiatry is dangerously like politics through medication.
But, what about true screaming schizophrenics...people who see things, hear voices, talk to spirits, that sort of thing. People like ME, for instance.
I am not crazy. There are spirits. (Religions have been telling you this all your life.) I do not need to be MEDICATED. It is not a SYMPTOM that I can hear angels and the doctor can't, any more than it is a SYMPTOM that he can read Latin and I can't. People who hear spirits and drown their children are not mentally ill for hearing the spirits. There are demons enough in this world. The problem is that they do not have the spiritual anchoring to be able to run for help to people who will help them fend off the demons.
Manson admits that he's no Satanist and never heard any voices. He just found himself with followers and pressed it. No doubt he lost all control because of drugs and brain damage letting his evil impulses fly, and others followed him off the cliff because of his charisma and their own lack of formation. We treat crimes as illnesses (except when we're really mad at the criminal, then we don't).
That is a long and meandering answer to say that psychiatrists serve two functions: for minor things, they are the dispensers of medication to club down the more spirited into political correctness, and for major things they are the modern substitute for an exorcist. Of course, in the latter case medication is just masking a symptom. Nothing wrong with that, if the alternative is mayhem.
Boys don't need Ritalin. They need a diet change and exercise.
That woman who drowned all of her children didn't need Prozac, she needed a close knit support group of friends and family around her a lot. Absent that, since people don't have the time for sane, normal, mammalian relationships that are expected and desired by our limbic brains, it is better to club down the symptoms of murderous depression with drugs than to bury the dead.
But it's just clubbing down a symptom, not treating the cause: a "dietary" lack of close human emotional contact, which we need like we need air itself, which opens the way for demons to enter.
There's an answer to hate in so many ways.
Of course which medicine to take is trial and error. Several studies have shown that on average, pharmecological solutions actually make people worse - with undeniable dramatic successes. The diagnosis are an art, and one which is still exceptionally poorly understood, with each persons individual chemistry significantly at variance from the "norm" - thus the trial and error approach to medication that is common.
Heck, therapy in general is shown to have as its most consistant and prominent effect the psychological addiction to therapy. Most uses of psychologists eforts are as little more than a "paid friend". That said, there are clearly cases where it is of profound use and benefit.
In all of this we are generally trusting a profession whose mental stability is among the worst of any major occupation, or even course of study, to diagnose and treat our minds. Kindof ironic.
A further consideration is that of "what is the actual goal?" Is it to make us more mentally "healthy"; feel better about our perceived place; or to be more functional?
Mental health has been my goal. But, I also use the unconventional method of ECT to treat my profound depression. As for "therapy", it may have its benefits, my insurance precludes my use of it. I found group therapy to be beneficial, because I could learn from others in the same situation. But, every patient must take their own path when it comes to mental health treatment. No patient should blindly follow the "experts". I advocate learning about treatments, asking lots of questions, reading and following your instincts. Just my two cents.
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