Everyone on the Couch Today’s psychiatry undermines self-reliance and morality.

City Journal ^ | autumn 2013 | Theodore Dalrymple

[rey]

. . . The DSM is ultimately an instrument for weakening human resilience, self-reliance, fortitude, and resolve. It turns human beings into mechanisms, deprives their conduct of meaning, and makes them prey to entrepreneurs of human misery. . .

[rey]

With this new DSM manual, everything is a psychiatric disorder. It essentially says one in seven suffer from a disorder. It occurs to me, if everything is a disorder, then certain rights may be prohibited or curtailed, such as the right to bear arms.

[Olog-hai]

Didn’t yesterday’s psychiatry do this too?

[billorites]

If everyone is mentally ill, then Thomas Szasz is the only sane guy in the room.

[cornelis]

prey to entrepreneurs of human misery

[CodeToad]

NO mental health professional I know approves of the DSM-V and they weren’t that thrilled with the DSM-IV either.

[cornelis]

. . . the tendency of psychiatric diagnosis to colonize human experience . . .

Politicians without borders!

[Tax-chick]

bttt

[JaguarXKE]

Why are you telling me this?

[JaguarXKE]

I’m not thrilled with the new DSM either and I also believe too many things are classified as “mental illness.” And I speak as a NAMI volunteer and someone with a son diagnosed with a REAL mental illness - Schizoaffective Disorder. When too many things are classified as mental illness, it dilutes the meaning of real mental illnesses and those who have real, actual biological disorders, such as Schizophrenia, Schizoaffective, bipolar and Major Depression.

[cornelis]

Because it's a problem and it helps explain why "depression" is stigmatized.

Psychiatric diagnosis—more overblown, all-inclusive, and shallow in the DSM-5 than ever before—has almost driven the word “unhappy” from the English lexicon. This is hardly surprising: according to the DSM, depression can be diagnosed after only two weeks. Among the thousands of patients who consulted me over a period of 15 years, only three whom I can recall ever used the word “unhappy” (and one was a prisoner, who told me, “I’m not happy in this prison, Doctor”). By contrast, thousands said that they were “depressed.” The semantic change is significant. The word “unhappy” is an implicit call to self-examination; the word “depressed” is, at least nowadays, a call to the doctor. It is no coincidence that the age of the DSM should coincide with a tenth of the population’s taking antidepressants—drugs that, for the most part, are placebos when not outright harmful.

[JaguarXKE]

I’m not thrilled with the new DSM either (see my comment #9 to rey.)

[Chode]

Here is a random list of some of the characteristics that, in the DSM-5, make up personality disorders of various kinds:

and if this doesn't describe to a "T" just about every RAT in America, it don't know what does...

Unjustified suspicions that others are harming, exploiting or deceiving.

Persistently grudge-bearing.

Detachment from social relations and limited expression of emotion.

Behavior or appearance that is odd, eccentric or peculiar.

Deceitfulness.

Persistent irresponsibility.

Indifference to risk to self or others.

Irritability and aggressiveness.

Lack of remorse.

Recurrent suicidal behavior, gestures or threats, or self-mutilation.

Inappropriately intense anger, frequent displays of temper.

Rapidly shifting and shallow expressions of emotion.

Use of physical appearance to draw attention to self.

Self-dramatization, theatricality.

Grandiosity.

Requirement for excessive admiration.

Sense of entitlement.

Interpersonal exploitativeness.

Lack of empathy.

Enviousness of others.

Arrogance and haughtiness.

Unwillingness to become involved with people.

Sense of social ineptitude and inferiority.

Avoidance of risk.

Difficulty in expressing disagreement with others because of fear of disapproval, i.e., pusillanimity.

Feeling of helplessness when alone.

Preoccupation with details, rules, lists, order, organization or schedules.

Excessive devotion to work.

Over-conscientiousness or scrupulousness.

Reluctance to delegate.

Rigidity and stubbornness.

[Wuli]

I have known a number of people in my life who were seeing a psychiatrist regularly, for years, and among them NOT ONE, ever obtained a “solution” to whatever vexed them such that they thought they no longer needed their psychiatrist.

Many many years ago, when it came to so-called “cures” in a bottle, cures that never cured anything, was not that whole area called “snake oil”??

Which is more sane, (a) to admit your foibles, try to improve yourself away from them and where unimproved accept them and get on with life, or (b) to spend your life expecting a “solution” from someone who can never understand you as intimately as you do, someone who you will constantly seek approval from just to remain in their good graces so they will continue to LET you see them, though no solution to what vexes you is ever obtained from the relationship? I vote for the former.

[cornelis]

Haven't read the book, but I can make up so more:

Wanting a second cookie.

Disposition to persuade other people of their wrong thinking.

Frowning. Unjustified belief that you are right.

Inordinate hatred or love of mechanical things.

Interpersonal flatulence.

Thinking you are better or worse than someone else.

Holding a poker face before you've been elected. Having too high and too low an opinion of yourself.

Looking at other people. A nagging sense that elections don't work. Unwillingness to send money. Daily feelings of joy. You don't argue with your spouse.

[Chode]

100%

[Marcella]

I psychologically evaluated people for thirty years using the DSM (whatever version was current at the time).

Let’s go back to why anyone would be psychologically examined as that is where people outside the profession are in error in dumping on mental health professionals.

The most important sentence in that article is this:
“C: The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.”

The operative words are “significant...impairment”. The only reason a person would be evaluated is if the impairment is so significant the person CAN’T FUNCTION well enough to carry on his/her life.

If one can’t function from day to day over a period of time, then something is wrong. I had a patient who could not sleep and only had minutes of cat naps occasionally. She was of college age and a Rehab. agency was working with her and wanted her to get a driver’s license but she could not get one since she could not sleep and couldn’t function due to that - would not be a safe driver.

After several appointments as I gathered background from her, I determined she could not sleep as she had made her bedroom a graveyard with her deceased father in there and was afraid he would come alive in that room so she could not sleep. When I told her the bedroom was a graveyard, she smiled and said to me, “You are really smart.” She KNEW the room was a graveyard. Father had hanged himself from a tree in a public park and she thought she was the reason he had hanged himself.

I told her we needed to dismantle that graveyard in her room. There was a large vase with silk flowers in there and in her mind those were in the graveyard, her room. I asked her if she could take the vase out of the room. She said, “I can’t, I would die.” So, we determined she could take out ONE flower and take it to the place her hanged himself. She did that one flower at a time until the vase was empty. I had her open the curtains in the room. Gradually, the room was not a graveyard and she started sleeping many hours at a time and got her driver’s license and started college.

I tell you that story so you know there are cases where the patient can’t function well enough to live a normal life. Those are the patients mental health professionals can help.

I had a patient who could do her daily job, but couldn’t function otherwise. She was safe in her office, but not outside the office. She would rush to her car after work, lock all the doors, be afraid to drive as someone outside the car might shoot her. When she arrived home, she rushed in the house and made sure all doors were locked and all curtains pulled so no one would know where she was in the house. She would go in a certain room, lock that door and not leave that room. She had the same dream every night which frightened her. Together, we worked through why that was happening, which included drawing that dream, and she was able to stop the horror she was living in.

I had a patient who stayed in the corner of her bed all day with a shotgun beside her. There was a reason for that, too.

I tested a PTSD veteran who was in a mental hospital and after testing, I knew he was going to explode. After he left, I found out the doctor had dismissed him from the hospital. Then, the doctor went out of town. He had turned his patients over to a psychologist friend of mine and I went to him, explained the vet was going to have a breakout (rather than breakdown), and likely kill his mother. Sure enough, the next day, he barricaded himself in his mother’s house and the mom managed to get out and the vet was in a shooting match with the cops who were outside his house. I could not have known that was going to happen if I had not tested him the day before. You bet the PTSD diagnosis was him.

You can have any problem you want but if you are normally functioning every day, you don’t need mental help unless you want it. No one is going to grab you and test you and give you a mental diagnosis.

Diagnosing:
When I tested someone which usually took four hours, if I made a written diagnosis, I had better be able to defend that in court if for any reason this case went to court. It usually took me three days of going over my test reports and considering what the patient said, what the patient had done in his/her background, to come up with a diagnosis I was ready to defend.

I never, ever, made a snap diagnosis. My goal with all of my patients, was to help them be able to run their own life so they didn’t have to see me anymore.

I know it’s popular to dump on mental health workers and I dump on psychiatrists who just give pills and that’s it, send the patient on their way until they need more pills. Pills would not have helped most of the patients with whom I dealt. Their thinking had to change, not be drugged up so they couldn’t think.

[cornelis]

A great defense. It's good, Marcella, the good work you do.

But then again, that's not the problem here.

[Marcella]

“But then again, that's not the problem here.”

Yes, it is. The article was suggesting that that mental health workers are slapping the DMS labels on people and that shouldn't be done and all of us would end up with a diagnosis. I heard this same argument every time a new DSM came out. My point was NO ONE gets a diagnosis unless they go to be evaluated. My point was, as long as you are functioning, you have NO reason to get a diagnosis. You can't be evaluated if you say, NO. You have to respond verbally to personality tests and if you don't say a word, no test can be done and no label given.

I also gave examples why some people need mental help. If no one ever evaluated these people, they still would not have a diagnosis.

A family doctor cannot give you a diagnosis out of the DSM. Testing has to be done first. You family doctor cannot do that so the DSM means nothing to you.

A few months ago, there was another such thread as this one. Again, those posters thought someone was going to give them a label but they had never been tested and never would be (unless they started staring at the wall for weeks and someone carried them in). They would have to not be functioning to get a label.

Worrying about the DSM is wasting time on nothing. Obamacare is something to worry about, not the DSM.

[cornelis]

The federal takeover of health is keenly interested in the colonization of human experience. Preferably they will reject any self-diagnosing of “functioning.”

[cornelis]

I found no suggestion that mental health workers are slapping DMS labels on people. I did find some helpful observations about how descriptions of behavior are being confused with medical diagnosis. In other words, normal people might be concerned that a profession is not infallible in their practice. When you say worrying about the DSM is pointless, you must have a particular people group in mind. It certainly wouldn’t be an Allen Frances or other APA decision maker responsible for standardizing diagnoses.