Mind Over Manual

NY Times ^ | September 13, 2007 | SALLY SATEL

[neverdem]

EARLIER this summer, the American Psychiatric Association announced that a 27-member panel will update its official diagnostic handbook, the Diagnostic and Statistical Manual of Mental Disorders. The fifth edition, which is scheduled to come out in 2012, is likely to add new mental illnesses and refine some existing ones.

High on the agenda will be the controversial diagnosis of childhood bipolar disorder. Recent data show that office visits by children and adolescents treated for the condition jumped 40-fold from 1994 to 2003. We still don’t know how much of this increase represents long-overdue care of mentally ill youth and how much comes from facile labeling of youngsters who are merely irritable and moody.

Part of the confusion stems from the lack of a discrete definition of juvenile bipolar illness in the diagnostic manual. But there is a deeper problem: despite the great progress being made in neuroscience, we still don’t have a clear picture of the brain mechanisms underlying bipolar illness — or most other mental illnesses.

For perspective, we must return to 1980, when the revolutionary third edition of the handbook, the D.S.M. III, was published. In a radical break from earlier editions, which had been based largely on psychoanalytic principles of unconscious conflict and stunted sexual development, the D.S.M. III categorized illnesses based on symptoms. A patient was said to have a condition if he or she had a certain number of the classic symptoms for a certain period of time. This approach promoted “inter-rater reliability” — the odds that two examiners would agree on what diagnosis to assign a patient.

Yet the manual remained silent on what caused the symptoms. The diagnosis of, say, schizophrenia did not reflect a known cause in the way syphilis is known to be an infection with a spirochete bacterium. The writers...

[neverdem]

Bipolar Illness Soars as a Diagnosis for the Young

[JamesP81]

bttt

[cinives]

Why aren’t we closer to understanding the relationship between manifest illness and its underlying causes? One obstacle is the staggering complexity of the brain. Another may be what Dr. First calls the “unfortunate rigidity” that all-or-nothing diagnostic checklists and sharply bounded categories impose. In order for the condition of a patient to meet the definition of clinical depression, for example, he or she must have five out of nine symptoms. But does a patient with only four symptoms have a different disorder, or no disorder at all?

The state of modern psychiatry - illnesses defined by the votes of a committee and subjective or self-reporting behavioral observation. And they give powerful, permanent, brain-altering drugs based on checklists.

[crazyshrink]

“subjective or self-reporting behavioral observation”

Kind of like when you go to a dentist, chiropractor, internist, cardiologist, etc. isn’t it?

DSM is a darn tough “write job”. I am glad I don’t have to do it. I have enuf probs with just using it.

Things like classifying alcoholism as a disease are what get me. I do realize that by doing it that way, it opens up all the money in health care system to “fixing it”.

[hinckley buzzard]

illnesses defined by the votes of a committee and subjective or self-reporting behavioral observation

I was involved in the revision of the PTSD diagnosis for the DSM III-R edition. The process was about what you describe-- a large committee of "experts" met in Manhattan, discussing and reaching some general consensus on symptoms and symptom clusters. The biggest discussion involved the first Criterion: What constitutes a "traumatic event." The end result was reasonably useful clinically but the process was neither pretty nor impressive.

[cinives]

I remember reading an article - wish I could remember where and the title of it - by a female psychiatrist who was outraged when menopause and other normal female-type “maladies” were voted into “disorder” status so she wrote a parody of a disorder that described all arrogant, self-important middle aged men.

It was a hoot.

I know that psychiatry can do some very good things, but its long, frightening history of forced incarcerations, service to dictators like Hitler and Stalin, bizarre treatments like lobotomies and now all the new drugs that permanently alter brain chemistry makes it a profession with way too much power to do harm, especially when there is nothing but a subjective checklist of behaviors standing between you and a diagnosis.

[neverdem]

I remember reading an article - wish I could remember where and the title of it - by a female psychiatrist who was outraged when menopause and other normal female-type “maladies” were voted into “disorder” status so she wrote a parody of a disorder that described all arrogant, self-important middle aged men.

Sally Satel, M.D.

Could it be this author? She's quite prolific.

[Erasmus]

BDS really needs to go into the DSM.

[neverdem]

Scientists’ Good News: Earth May Survive Sun’s Demise in 5 Billion Years

Football player's cooling treatment is experimental, but also tried for stroke, brain injury

FReepmail me if you want on or off my health and science ping list.

[SunkenCiv]

Thanks neverdem.

Hey, isn’t schizophrenia caused by cat litter boxes? ;’)