I’ve spent many an hour hearing how people’s diagnosis
changes every time they have changed physician. I’ve heard them complain that
they don’t know what’s wrong with them and that the physician doesn’t know what
they’re doing and I’ve never really understood why that should be so.
I’ve never seen a diagnosis as anything other than a
physicians’ tool, a description of the symptoms that I have. As there a limited
number of diagnosis possibilities it does not surprise me that a diagnosis does
not define all of the symptoms I am suffering from exactly, or that it might
change. I consider the change a progression of ideas but not a confusion. That a different representation of my symptoms and
there relative impact on my life may alter what may be considered the ‘best fit’
diagnosis I see as reasonable.
I am me and I have these symptoms and whether I am labelled
bi-polar or schizophrenic my treatment is being tailored to them, its’ name was
never of any interest to me. In fact the only use it has been is as a short cut
introduction to new physicians to guide them as to what they might expect my
symptoms to be. That each time I have been asked to give a thorough case
history has only highlighted to me that is of little importance to me.
So why does it matter what it is?
Well it probably wouldn’t if each illness had the same recommended treatments, however that is not the case. There is overlap between the different recommendations based on the symptoms displayed and diagnosis, and some treatment plans work better than others, which is why a diagnosis guide is helpful. Though you may wish your physician to know everything there is to know about your particular illness it is unlikely that they will and ready information can be useful and though it may not work for you specifically it does not follow that for the next person it will not either.
The usefulness of a diagnosis guide is limited by the number
of different categories versus the number of different treatments and what
specific problems they treat.
For instance if you only had a few broad spectrum treatments
that were applicable to most illnesses you would not need very specific
descriptions of the problems because they would all be given very similar
treatments.
However with so many different treatments that have targeted
effects on certain symptoms or groups of symptoms the more specific your
categories/diagnosis need to be to be able to assign people to the right
treatment and hence the DSM. http://www.dsm5.org/Pages/Default.aspx
As knowledge and
increasing treatment regimes have become apparent so too must the number of
descriptors increase i.e. different diagnosis and therefore it also becomes
important for each person using it to diagnosis in a similar manor to assign patients
to the most applicable program. http://www.guardian.co.uk/society/2012/feb/09/us-mental-health-manual
So why are the new descriptors/ diagnosis causing physicians to complain?
Mainly because these new descriptors seem to be including normal
emotional responses that if left would resolve themselves without need of
intervention from drugs or therapy. The problem for me is that although they
may be normal it does not follow that everyone will resolve them and return to
a happy and healthy emotional balance and there is no way to find out whether
they will except to wait and see.
I look at the complaints in the media of which these are a couple
Millions of
healthy people - including shy or defiant children, grieving relatives and
people with fetishes - may be wrongly labeled mentally ill by a new
international diagnostic manual, specialists said on Thursday
In
essence only our tears, heartache, grief and loss are to be evaluated minus the
under lying reason for those feelings, the loss of a loved one. Therefore
placing the natural grief process into a neat little mental health disorder
that is to be treated with drugs
with some scorn and I slam all for what seems the perpetual comment that all mental ill health is treated with
drugs, which has not been my experience. I see them as foolish and as silly
as they seem to believe the new diagnoses are.
I honestly believe that these diagnoses have been taken out
of context. Unfortunately I cannot be sure that they have and I worry just like
the medical professionals that the literal and obvious translation they have
made is what was intended and as such would indeed do what they suggest and
this would be tragic.
No one would wish a diagnosis on someone who is not ill
however
Could not shyness be seen in adults as social with drawl/isolation
Oppositional
defiant disorder of children be seen in adults as perpetual aggression and destruction.http://en.wikipedia.org/wiki/Oppositional_defiant_disorder
Both of which are most definitely symptoms of mental ill
health.
It is not that I think they should go in but just that I
feel conclusions have been jumped to based on a system that does treat all mental
ill health with drugs and never allows people to have recovered.
If a new descriptor should come into play it is that
recovery of good mental health can be achieved and that as time passes such
diagnosis from childhood can be lost into the ether like juvenile convictions.
I would wish to see distinctions being made between people who have had years
of good mental health and that they would be treated differently than those who
have been in and out of hospital in the near past. It seems ridiculous in this
day and age that I or anyone else would have to answer to
‘do I now or have I ever suffered from mental ill health’
Especially when I am treated exactly the same regardless of
whether I have had any problems recently. Should
I not at some point be deemed recovered?
That we cannot adequately define what mental ill health or
mental good health is, is surely fuelling the arguments about what should be
included and what not. What for one person may be ill health for another may
not and as such whatever is written down should be taken in the context and
understanding of the person to whom the diagnosis is being given. And only time
and good evaluation will tell if the person is or is not mentally ill and it
seems that time is what we lack, as physicians, as parents, as teachers and as
social workers, which is probably why there is so much furore about the new DSM
edition because it may well be used instead of the time it takes to come to a
reasonable diagnosis.
When it comes to mental ill health the questions for me are
·
should we wait and see?
·
should we watch and evaluate?
·
how long should we wait before we do something?
The costs for
getting it wrong are in lives scarred with mental ill health and as such it carries
a heavy burden if you get it wrong equally to over diagnose carries its' own costs and they are largely unknown and I am left wondering which is worst? However I do not see how this manual and whatever is printed in it will radically change what is already happening in the world at large. It is just one book and hopefully its influence will be limited and governed by the common sense of the medical professionals who are tasked to use it and whom seem to be thoroughly questioning its' content. Surely a very good sign that it will remain a help rather than a hindrance.
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