Sunday, July 16, 2006

Who Wants A Diagnosis?

[posted by dinah]

It started back on Out of The Office when TheTundraPa commented that she didn't socialize with her depressed patients--too needy and I suppose they aren't good company. This didn't sit so well with Neonursechic who responded, "Just made me feel like because I have depression, then nobody wants to be friends with me -" Sarebear, too, feels her mental illness interferes with her ability to make friends. Please forgive me if I misinterpreted anyone, and hey, that's what the comment section is for.

Then we move along to the posts on Whining, and my esteemed co-blogger Roy confesses that his wife thinks he has ADD because he leaves household projects unfinished, he denies the diagnosis, and like a good friend, I pipe in with the unsolicited opinion, based on nearly a decade of observation in a variety of settings, but no formal psychiatric evaluation, that Roy does not have ADD, that his office is a mess because he is a Slob. Off blog, he told me he'd rather have ADD than be a slob, and back on blog, he's now commenting about whether Slob will be in DSM-5 and can it be labeled Messiness, NOS.

So, who wants a diagnosis and what does it mean?

For Roy, I'm left perplexed that he would want a psychiatric diagnosis, a damaged brain that would impair his ability to function. He wants to opt out of responsibility for his behavior, be able to drop those dirty sock anywhere and have an excuse. If a diagnosis doesn't exist, damn it, he'll make one. Might I suggest that as long as I don't have to live with Roy, that it's fine if he's a Slob? A certain degree of neatness is expected in the little box, and if one chooses to be sloppy, perhaps that's fine. He's rationalized it all away (too busy to be bothered), so why does he need a now socially-sanctioned diagnosis to relieve him of responsibility for a behavior he admits he's chosen?

It is estimated that over 26% of people suffer from a psychiatric disorder in any given year, the
lifetime prevalence is much higher. If TheTundraPa is able to avoid friendships with people with depression, or any other mental illness, my best guess is that this may be a function of under-diagnosis and treatment out there on the Alaskan tundra, it seems to me that all one has to do to find people with mental illnesses is to look-- or to mention at a party that you're a psychiatrist. While people with Axis I diagnoses may have periods where they are less interested in friendships or less available to participate in friendships, the mere existence of a psychiatric diagnosis doesn't chase people away-- in fact, when people advertise their diagnosis they often serve as magnets for others who are suffering from the same problems and are thrilled to find someone who understands. I'll requote Shiny Happy Person (see the whining post for her link): "Having a mental illness deprives you of the right to be a weirdo." I'll add to that magnificent thought: Perhaps having a mental illness deprives you of the right to be a slob, or to be an unlikeable person, but I don't think so.

18 comments:

Sarebear said...

My husband gives me a dx of, excellent cook, WMAHE, EBRKT. (When motivated And Has Energey, Everything But Rice Krispies Treats.)

Those last, are harder than hockey pucks, and less tasty than those as well (I'm guessing! Never licked a hockey puck.)

I often struggle with the issue of wondering what dx I have, and does that mean I'm looking for a personal accountability escape hatch . . . OR, does it mean that I'd rather know what's going on with me so I don't feel so much at the mercy of things that are a mystery . . . the things I've pushed hard and tried my whole life and still succumb to, still get drowned by. Is there something understood, known, and studied about this to the point where there's a DX, and then knowing if/that I had that, then I would KNOW that I could be helped and it isn't just all me, isn't just all my failures.

Anyhoo, there's alot in my mind in between those two ends of, is it escaping responsibility, or is it looking for an understanding of what's going on so I can feel a sense of mastery about it, as my ologist would put it.

Great post, and thanks for reflecting back the essence of what I said.

It's actually this very issue that my iatrist (whom I see Tuesday, EEEEE! Prayers please, if that is your thing . .. ) called me WHACKED for, repeatedly, stridently, and in my face. I actually want to explore various dx so as we hopefully eliminate them (most, there's a few that it's the only reason I can think of for some of the ways I am, and without that, I'd well I don't know), I wouldn't have to WORRY about them anymore.

JUST what I'm going to tell him on Tuesday!

Anyhoo, sorry so long. And this post cheered me up so much, I feel like quacking!!! It's contagious, ahhhhh!

quack

jw said...

I have an Essential Tremor: ET. It's one of the movement disorders and in my case is the genetic variety (Familial Tremor). OK, you say, see a neuro, which I do.

The thing is, ET is almost always accompanied by anxiety disorder. There are very few cases where there is ET (genetic or unknown cause) wherein there is not also an anxiety problem. One of the secondary treatments for ET is the benzodiazepines.

Which is the cause? Does ET cause anxiety or does anxiety cause ET? Or does something else cause both? No one knows ...

How come when I mentioned ET to a pscyh he/she always gives me a blank look as in "Why are you telling me this?" Uhm ... Either ET is a known genetic cause of anxiety or some other way around: Either way, ET sits on the boundary between psych & neuro and both should be aware of it: Sadly, I've never met a psych who is aware.

So, in my mind (as I keep harping on about) diagnoses seem to be a bit of a problem to begin with. This, psych diagnoses, is my pet peeve (I use a nice leash for my pet peeve).

How can we, the public, trust the psychs when diagnoses is so uncertain? So filled with error?

Look at it from my point of view:

- psych demands that there are no female offender / male victim rapes so I must be psychotic: An M.Ed. knows all about the problem, including the problem with the psychs.

- Dr. demands that noise from dental appliance cannot happen so I must be psychotic: Denturist fixes problem in a few minutes while chuckling at "dumb" Dr..

- psych cannot, apparently, understand that ET & anxiety are intertwined in a complex and as yet unknown genetic manner: Neuro knows lots about the problem, including the problem with psychs.

Put those together and what would YOU think about diagnoses?

sarebear: I'm the cook in our family. When I make oatmeal chocolate cookies my wife looks like a four-year-old, cookies in both hands and chocolate on her face ... I didn't think grammas were supposed to get messy.

Dinah said...

I feel like they're reading my mind. From today's Baltimore Sun
"Behaving Badly has a disorder to call it's own" re Intermittant Explosive Disorder.
Link to article: http://www.baltimoresun.com/news/health/bal-te.anger17jul17,0,2064994.story?coll=bal-home-headlines

from the article:
"Is it me, or does it seem like good old-fashioned bad behavior - rudeness, obsession, violence - is being increasingly explained away by doctors and pharmaceutical companies as some kind of mental illness du jour?" asked columnist Daniel Vasquez in the South Florida Sun-Sentinel.

Sarebear said...

That's funny. Kinda meshes with the guest post a few posts back, too.

NeoNurseChic said...
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Dinah said...

This has absolutely nothing to do with psychiatry, but it needs to be said: It's not normal for a cat to turn on a stove. Animals should not be cooking while their owners sleep.

healthpsych said...

Interesting post.

I'd missed all the kerfuffle about avoiding socialising with depressed people. Hope that was a misinterpretation else that person might have a very narrow social circle! No wonder stigmatisation of mental illness continues.

Seems to be that many people are looking for a label to justify their behaviour these days and avoid taking responsibility for their choices/actions.

If Roy insists on getting Slob in DSM-V, better get Whingy for me too :)

NeoNurseChic said...
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NeoNurseChic said...
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On the Same Page said...

I have an Australian colleague friend who frequently - no, make that quite regularly - gives the one-line response to many - no, make that most - of the things I say: "You're an idiot." In tandem with her other (though considerably less frequent) response, "Shut your head," I am somehow encouraged to suspect there might actually be something amiss. Is it me or am I merely the object of misplaced projection? I assure you that I'd rather have ADD than be an idiot. Could I actually be an idiot? If a cat can turn on a stove, who, I ask, exactly is to say?

Sarebear said...

She'a just wearing her idiot-filter glasses. Everybody looks like an idiot through those. You can breathe easy.

Hee hee hee.

Very brave, Carrie! As I push forward on the results of what started w/talking with my state governor over the radio about the poor state of mental health care in this state (scored D on NAMI report), I hope to have some of that courage.

Cooking cat brings new meaning to the phrase, "Gourmet Pet Food". It's not just kitty kibbles in a can anymore, now your kitty does the cooking FOR YOU (please excuse that hairball in your soup . . . )

jw said...

Hmmm, none of our cats cook. One loves going online so we have to password protect the screensaver. I'm not entirely sure what he's looking for when he does go online ...

He also likes to hear the printer run so it is turned off, (he knows what that big green button does). If one of us forgets to turn it off we'll come into the office to find many blank pages laying in the out bin.

NeoNurseChic said...
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Murky Thoughts said...

To the extent psychiatry is a science, this post is a disturbing a perspective. A diagnosis should aspire to do nothing more than explain, and if psychiatry weren't still in the stone age nearly all of us would have a diagnosis--is my feeling. I'm glad to have no romantic notions of being a linebacker or being able to fly if I just flap my arms hard enough. Is this gladness ignorance? Would I be happier if I'd grown up with such notions? I don't think so. I think the post's perspective is a traditional moralistic one that exists to counter a common neurotic urge to give up on a worthy goal that remains practical but for issues of esteem. Well, good that we counter that, but sometimes it's really in our interests to give up and try something else. We ought to seek to make rational choices. Knowing our height helps to do that with regard to pro basketball. Knowing how our individual brain and emotional responses work stands to help with everything. I guess the poster is a pure cognitive therapist, because the psychoanalytic school I think aims for self understanding and advocates analysis for everybody, not just people who are unhappy or seem to have stepped right out of the DSM. Well, as I said, I find the perspective disturbing. Maybe it's the culture wars or spending the day with my mother. Naturally, I accept full personal responsibility for my mouthing off as well.

Roy said...

Dang! See what I miss when I'm off doing RL stuff (working too hard... now that's a choice, not a diagnosis... why?).

Dinah's on target here with this behavior-as-choice-vs-trapped-by-my-genes dichotomy. I suspect the medical advances coming up, many enabled by the Human Genome Project and Craig Venter, will authorize many more to say "my SNPs made me do it."

Carrie's right... I'd rather pick up the duckie than pick up the socks (well, you know what I mean). But even with solidly genetic disorders, one needs to take responsibility for the intersection between genes and choices. If anything, genomic advances should INCREASE responsibility, not decrease it. If you know you have the gene for antitrypsin deficiency, you should be particularly cognizant about not smoking... and doubly foolhardy if you start.

Murky Thoughts said...

Come now, it's not only genes that functionally limit us. We all know brains develop post-natally and that critical periods characterize all kinds of stuff. Nobody learns to speak a second language like a native after childhood. I bet there are neuroses or or that there is some category of pathologic psycho-circuitry that are in effect hard-wired post puberty. Actually, isn't there an allergy-like a "sensitization" theory of depression? If you get depressed a few times early in life it takes little to depress you later? Genes schmenes. Are we responsible for neurocircuitry or molecular neuroanatomy that isn't easily reversed? I say no, but somehow I don't expect that to hold up in court.

Roy said...

see these comments, which I converted to its own post.

Sarebear said...

Roy, that'd be called, "Workaholic".

Does the DSMV IV have a Dx anywhere in there for Overly Silly?

Seriously. I bet it does, somewhere. You probably can't tell me, though, but that's ok.

Wait, isn't that mania? Well, MY mania anyway, part of it . . .

It's kinda like some drunks are friendly drunks, some are violent, angry, or sad drunks . . . seems to me there's a variety of types of manics - violent, too trusting/friendly, angry, sad . . . wait, that seems like the drunk list . . . . (I've often wondered about the similarity in both things impairing judgement, not that I've ever been drunk; I've only ever had two fuzzy navels and 1 fruity wine cooler, when I was being reckless (for a mormon, that's reckless lol but considering what ELSE I was doing w/wine cooler in hand, that makes it look like Kool-Aid . . . I was WAY over the edge).

Woops. Way off topic.

Ok, time for bed, I'm up past my bedtime. (I don't have a bedtime . . .)