Friday, May 05, 2006

Premature Diagnostic... problems.

Sexual references henceforth.

Been a bit frantic here lately, Sarah is across the Nullabor and I and the niece (who in this blog wants to go under the name of Ginger, I kid you not), have been slaves of the cats.

However, I have been reading, in my spare time between talking to heroin addicts and giving presentations on urine testing, about borderline personality disorder (BPD). Borderline and bipolar disorder, and where one relates to the other, and so on.

Bipolar, by the way, is BPAD, or bipolar affective disorder. Seasonal affective disorder, where you get deeply depressed at certain times of the year, is appropriately known as SAD. I think the DSM III used to have a class of major affective disorders (bipolar, unipolar, etc.) that rejoiced in the acronym MAD.

If you are an amateur when it comes to psychiatry (and I definitely am) the DSM IV is a dangerous book. You can, if you are not careful, end up using it as a ”spotters guide to the mental illnesses”. You see someone and you check if they have five of the following symptoms from this list, if the symptoms have been there for more than the minimum required time and so on … and pretty soon you can announce “Aha. This person has Insert Disorder Here. Take these tablets. My work is done.”

I don't know if Premature Diagnostic Ejaculation is a recognised psychiatric disorder, but it should be. You see it happen all the time with interns in the ED. The hassled junior doctor goes into the room, gets straight into it, squicks out a diagnosis after a few minutes and leaves, satisfied, probably wrong and utterly unaware that this has not been a mutually satisfying experience.

Obviously that’s a simplification, and completely unlike most people’s experience of presenting to a doctor with mental distress, but it’s not entirely untrue. Medicine is an applied science, it works via quantities and measurable things, and it works best if it is given discrete, anatomized subjects to deal with. This person fits the diagnostic criteria of such and such, the evidence suggests we treat that with so and so, move on. It’s easy, especially when the clinician is pushed for time, or has to get the patient out of there quickly, or never really feel comfortable with psych patients, to slip into flowcharts, protocols, either-or judgements.

I should point out that even doctors know that every person is an individual, and thus every brain and mind and mental illness is an individual. But technology isn’t about what is true, it’s about what works. Every cow is an individual, too, but the meat processor still works. And so do mood stabilizers, and anti-psychotics, and (to a lesser extent) anti-depressants.

But I can't helpo feeing that that is a problem with the use of the DSM IV. It's meant to be a tool so that when doctor A says "this guy has schizophrenia", then Dr B knows what she's talking about. But the truth is that there is no rigid, crystalline barrier between normal and abnormal, healthy and unwell, and that most people move back and forth and in and out of the diagnostic criteria with little regard for the intellectual convenience of the junior doctor.

Anyway, seeking to keep these brief and relatively more frequent. Next post is actually about borderline personality disorder, and how it affects someone close to you.

Thanks for listening,
John

4 Comments:

Blogger Spiritual Recovery said...

Thank you. I enjoyed that.

3:24 PM  
Anonymous Camilla said...

Yup, me too. It's always interesting to read your personal take on things that would otherwise for someone like me remain "on the other side of the glass", experience-wise.

Greetings to Ginger, and the herd of felines!

7:29 PM  
Blogger Foilwoman said...

So how is Ginger getting along with the Fascist Dictatorship? And how is the Fascist Dictatorship?

And, btw, I'm quite sure I have Driven Quite Mad By My Psychotic Not-Soon-Enough-To-Be-Ex-Husband Affective Disorder(DQMBMPNSETBEHAD). What does DSM-IV say about that?

10:50 PM  
Blogger Bronze John said...

Hail all, apologies for the lateness.

Spiritual Recovery, thanks for the comment, and the interesting site - we have read some things in common.

Cam',
Best wishes to ton pere, and the small nation of felines says hello to you to.

FW,
Ginger can't be with us at teh moment, but she says to say she is flourishing under the benevolent guidance of the fascist dictatorship. She also says that she is saying this of her own free will, and that she is not being mistreated in any way, and can I please stop dangling her iPod over the horsetrough.

And DSM may actually stand for Divorce the Stupid Man, so as usual you're ahead of the pack there.

Love,
John

8:14 PM  

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