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davywavyA few years ago, one of the mental health charities had a poster campaign on the tube which aimed to bring home just how many people had problems with the slogan "More people in the UK suffer from mental health problems than watch Big Brother".
The only effect this had on me was to make me wonder, every time I saw it, what a Venn diagram of the two groups would look like.
Back when I was a student I would idle away the hours (sometimes days) between lectures in the library, reading the psychiatric literature. As it was a psychology course we had plenty of the stuff and you'd be surprised how entertaining some of it was - like all medical practitioners psychiatrists quickly develop a very black sense of humour which comes out strongly in the stuff which isn't produced for publication in offical journals.
Amongst the stuff which I read for actual research rather than just merriment was the bible of psychiatric diagnosis, the Diagnostic and Statistical Manual (DSM), which is produced by American Psychiatrists and is used internationally to try and generate consistent diagnoses of mental illness. This is periodically updated to reflect current thinking in mental illness and so we had copies of several editions; the DSM II, the DSM III and the DSM III (revised), and one thing I noticed as I read was how the definitions and diagnostic criteria appeared to have expanded with every edition. It kinda seemed like in the original DSM you needed to dress up as Napoleon and stalk the streets of Whitechapel with an axe before you got diagnosed as having something wrong with you, but with every subsequent edition it took less and less to be identified as insane and needing treatment or even medication.
Now, leaving aside any pithy comments about whether it's a good idea for the leading diagnostic manual to be written by the same people whose financial interests are served by finding as many insane people as possible, it struck me at the time that this was a long term trend which might not be good and so I was interested to learn last week that the latest edition of the DSM - the DSM V - is on its final draft now. I wondered if the trend had continued, and when I looked into it I found that it has already generated a good deal of controversy. You see the DSM V now contains not only criteria for diagnosing people who have a mental illness, but also people who don't.
It's called "Psychosis Risk Syndrome" (or possible the less catchy "Attenuated Psychotic Symptoms Syndrome"), and basically anyone - anyone at all, even if they've never had any sign or symptom of mental illness in their life - can be diagnosed with it. Things which were once considered not unusual or at worst a bit eccentric are now grounds for diagnosis of being at risk of psychosis, and even the doctors involved admit that there is a 70 - 90% chance of false positives, meaning that people who do not have and will never have any sort of mental illness in their entire lives can still be diagnosed as having a problem and be liable for - gosh! - expensive treatment.
Other possible new critieria for mental illness include "Binge Eating", which comes as a a relief to me as that means I wasn't a greedy little bugger last weekend but instead just had a psychotic episode with a box of florentines, so at least there's something good come out of it.
The only effect this had on me was to make me wonder, every time I saw it, what a Venn diagram of the two groups would look like.
Back when I was a student I would idle away the hours (sometimes days) between lectures in the library, reading the psychiatric literature. As it was a psychology course we had plenty of the stuff and you'd be surprised how entertaining some of it was - like all medical practitioners psychiatrists quickly develop a very black sense of humour which comes out strongly in the stuff which isn't produced for publication in offical journals.
Amongst the stuff which I read for actual research rather than just merriment was the bible of psychiatric diagnosis, the Diagnostic and Statistical Manual (DSM), which is produced by American Psychiatrists and is used internationally to try and generate consistent diagnoses of mental illness. This is periodically updated to reflect current thinking in mental illness and so we had copies of several editions; the DSM II, the DSM III and the DSM III (revised), and one thing I noticed as I read was how the definitions and diagnostic criteria appeared to have expanded with every edition. It kinda seemed like in the original DSM you needed to dress up as Napoleon and stalk the streets of Whitechapel with an axe before you got diagnosed as having something wrong with you, but with every subsequent edition it took less and less to be identified as insane and needing treatment or even medication.
Now, leaving aside any pithy comments about whether it's a good idea for the leading diagnostic manual to be written by the same people whose financial interests are served by finding as many insane people as possible, it struck me at the time that this was a long term trend which might not be good and so I was interested to learn last week that the latest edition of the DSM - the DSM V - is on its final draft now. I wondered if the trend had continued, and when I looked into it I found that it has already generated a good deal of controversy. You see the DSM V now contains not only criteria for diagnosing people who have a mental illness, but also people who don't.
It's called "Psychosis Risk Syndrome" (or possible the less catchy "Attenuated Psychotic Symptoms Syndrome"), and basically anyone - anyone at all, even if they've never had any sign or symptom of mental illness in their life - can be diagnosed with it. Things which were once considered not unusual or at worst a bit eccentric are now grounds for diagnosis of being at risk of psychosis, and even the doctors involved admit that there is a 70 - 90% chance of false positives, meaning that people who do not have and will never have any sort of mental illness in their entire lives can still be diagnosed as having a problem and be liable for - gosh! - expensive treatment.
Other possible new critieria for mental illness include "Binge Eating", which comes as a a relief to me as that means I wasn't a greedy little bugger last weekend but instead just had a psychotic episode with a box of florentines, so at least there's something good come out of it.
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no subject
Date: 2010-08-04 10:19 am (UTC)Most of the people we know are probably in serious trouble.
no subject
Date: 2010-08-04 10:20 am (UTC)no subject
Date: 2010-08-04 10:32 am (UTC)And then I shall rule you all
H
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Date: 2010-08-04 10:49 am (UTC)no subject
Date: 2010-08-04 11:10 am (UTC)H
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Date: 2010-08-04 11:11 am (UTC)no subject
Date: 2010-08-04 10:33 am (UTC)http://en.wikipedia.org/wiki/Gender_identity_disorder
no subject
Date: 2010-08-04 11:30 am (UTC)You also have to bear in mind that it is very important that extensive psychiatric investigation needs to take place prior to gender re-assignment to ensure that the desire isn't sympomatic of something else.
no subject
Date: 2010-08-04 11:40 am (UTC)no subject
Date: 2010-08-04 11:47 am (UTC)no subject
Date: 2010-08-04 11:50 am (UTC)(mentally ill here)
no subject
Date: 2010-08-04 12:05 pm (UTC)Diagnosis can be incredibly helpful for dealing with issues, feeling and thoughts that might otherwise be confusing and destressing.
If you think of GiD as being compared with being 'ill' then certainly it seems offensive, compare it instead with something like Autism, which is included on the DSM for obvious reasons.
no subject
Date: 2010-08-04 12:13 pm (UTC)no subject
Date: 2010-08-04 12:20 pm (UTC)Psychiatrists don't roam the streets diagnosing and selling drugs (well, maybe in the states). Especially with something like "Attenuated Psychotic Symptoms Syndrome", if someone comes in with mental health issues, its something you put on their file to say 'at risk of psychosis', so when someone *starts* to exhibit psychotic signs, you might be able to begin treatment before the go the full hog and start asking God's advice over whether or not the post office are spying on them.
no subject
Date: 2010-08-04 12:33 pm (UTC)no subject
Date: 2010-08-04 01:21 pm (UTC)I'm not sure the changes to the DSM will make it anymore likely for you to be diagnosed with something, merely change the options for what they can assign to you if they feel like it.
no subject
Date: 2010-08-04 01:24 pm (UTC)Gosh, who'd've thought that.
no subject
Date: 2010-08-04 01:40 pm (UTC)no subject
Date: 2010-08-04 01:46 pm (UTC)If the NHS did what Clement Atlee said it would when he founded it I'd be a bigger fan of it than I am.
no subject
Date: 2010-08-04 02:26 pm (UTC)no subject
Date: 2010-08-04 02:33 pm (UTC)The bureaucracy will expand to meet the needs of the expanding bureaucracy.
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Date: 2010-08-04 04:00 pm (UTC)no subject
Date: 2010-08-04 11:35 am (UTC)For example, Bipolar disorder currently has 3 forms (I, II and cyclithmia), with distinct criteria for each however individual cases of Bipolar symptoms rarely fit neatly into these categories. The DSM V is likely to reclasify it as a spectrum disorder like Autism, making identification and treatment easier on an individual basis.
Even with the current DSM you can diagnose pretty much anyone with something. The rule of thumb remains that it is genuine 'crazy' when it starts to interfere with your life.
A number of people who could be classified as having 'anti-social personality disorder' (pyschopaths if you will) live perfectly normal lives as successful businessmen/total dicks and require no treatment at all.
no subject
Date: 2010-08-04 11:41 am (UTC)Sociopaths usually resist treatment anyway, unfortunately.
no subject
Date: 2010-08-04 12:05 pm (UTC)H
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Date: 2010-08-04 12:31 pm (UTC)no subject
Date: 2010-08-04 12:47 pm (UTC)no subject
Date: 2010-08-04 11:56 am (UTC)I envy them.
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Date: 2010-08-04 12:21 pm (UTC)no subject
Date: 2010-08-04 12:31 pm (UTC)no subject
Date: 2010-08-04 12:48 pm (UTC)no subject
Date: 2010-08-04 12:56 pm (UTC)no subject
Date: 2010-08-04 09:10 pm (UTC)I remain very unconvinced in the therapeutic value of a diagnosis though, in almost all cases, I think they are expensive and not worthwhile.