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Published in Factoidz
Many people often wonder how a doctor or a psychiatrist, and psychologist decide who has what mental illness and why. It is very tricky because many mental illnesses resemble each other. Sometimes it just does not seem to make any sense. There is a common amusement shared among university professors as they watch first year psychology students read about the different illnesses and then become convinced they have each and every mental illness they read about. Why is that?
Well the first statement about mental illness that can be made is that a mental illness is an exaggeration of the behaviors everyone possesses. The difference between what is considered normal and what is considered abnormal or unhealthy is the degree of that behavior present. This becomes the bottom line for diagnosing mental illness. Everyone of us will get down in the dumps from time to time, but not everyone of us will be so down in the dumps that we cannot eat or sleep or do just about anything. We don’t spend out lives in bed staring up at the ceiling or thinking about death and committing suicide. When people get that far down in the dumps they are diagnosed with major depression, which is a serious mental illness. Having said that, even depression has different levels of severity from mild, to moderate and then severe. Sub classifying a mental disorder according to its severity is done quite frequently and that is because different symptoms or severity of symptoms would be exhibited in these sub divisions.
You may be thinking at this point, what is the big deal, do psychiatrists not have anything better to do with their time than stick labels on people. The answer is these labels are often necessary to understand what is going on with the person in question and to provide the best possible treatment. For example, in the case of depression, major depression is treated with antidepressants to restore the chemical balance in the brain. Mild depression can be treated with a good self talk or talk with a friend, and often doesn’t last very long and moderate depression may require therapy such as cognitive therapy to help the person get back on track. You would not want to avoid giving medication to someone who has major depression because frankly all the other therapies would just not work when a person is that deeply depressed. Nor would you want to give unneeded medication to someone who really doesn’t need it and all they really require is a fresh outlook on life (mild depression) For people who have moderate depression they may need therapy to help them get focused and back on track. Therefore the doctor, psychiatrist, and counselor have to have a standard system to make these classifications.
Standardization is very important otherwise there is chaos. Even with standardization there is room for misdiagnosis so imagine without it. The most common diagnostic tool for mental illness used in North America and different degrees around the world is the Diagnostic Statistical Manual, which was developed by the American Psychiatrist Association. This manual is not only used by the medical community, it is used by government drug regulation agencies and policymakers, and pharmaceutical companies and the legal system also use it. Mental illness will not be accepted in court as a defense for mental illness or as a claim for benefits from the government or insurance company etc, if a lawsuit ensues, without a DSM diagnosis. Clinical studies, which require a certain type of person with a certain mental illness, will rely on the DSM classification to recruit their test subjects.
The DSM is the standard classification system for mental illness and through its history it has received much praise for its level of excellence and perhaps even more controversy for certain conditions listed as mental illness. For example, homosexuality was listed as a mental disorder in the DSM and was taken out in 1987 and no longer listed as a mental disorder.
The DSM was first published in 1952 and many disorders have been added since then while others have been taken out. Some of the modern disorders are the same disorders with new subtypes and others are the same disorders now carrying an entirely new name. For example, what was once known as Manic Depressive Disorder is now called Bipolar Disorder. The manual came about as a compilation medical information and statistical data. It was also based on a manual that was produced by the US army. There have been several revisions since 1952. The last version was the DSM IV published in 1994, with its revised edition the DSM IV-TR in 2000. Altogether there have been five revisions to date and the DSM V is in the works and expected to come out 2012.
International Statistical Classification of Diseases and Related Health Problems
The mental health section of the ICD is also another diagnostic tool that mental health professionals use mostly in Europe. However, the DSM is most commonly used in North America. The DSM and ICD will try to synchronize coding systems but that is not always possible because the editions do not come out at the same time. Many psychiatrists across the world will use the ICD for clinical use and the DSM for research use.
History Behind the DSM
The need to collect and compile clinical statistical information first became important in the late 1880’s. In 1840, a single category on the US census was entitled, “idiocy/insanityâ€. By 1880 there were seven classifications included in the US census which were: mania, monomania, dipsomania, paresis, melancholia, dementia, and epilepsy . By 1917, the National Committee on Mental Hygiene along with the Committee on Statistics now known the American Psychiatric Association, published a new hospital guide called the Statistical Manual for the Use of Institutions for the Insane. At this time there were 22 mental disorders classified. Standard Classified Nomenclature of Disease, was also a classfication system used at the time as a subsection in the US Medical Guide. It was referred to as the “Standardâ€.
DSM – I (1952)
The need to recruit mentally stable soldiers during World War II brought the focus away from the medical community and onto the army. In 1943, the Medical 203 was created by a team of psychiatrists and Brigadier General William C. Menniger. There were major revisions from the old “Standard†to conform with more modern day thinking and the Medical 203 was widely used throughout the Armed Forces and The Veterans Association which used a variation of the Medical 203.
By 1949, the World Health Association published a section for mental disorders in the ICD making it the very first time an entire section of mental disorders was included.
By 1950, it was evident there was a clear need to develop a system that was standard rather than having so many classification systems to choose from. The DSM-I relied heavily upon the Medical 203 to formulate the DSM-I which was a statistical manual compiling the statistical data from the known medical sources of the time. This manual had 130 medical conditions.
DSM –II (1968)
This version was similar to the first one, and now had 182 conditions including Kreapelin’s System of Classification. The Manual was heavily influenced by the psychodynamic theory dominance of the times. The distinction between neurosis (worry and anxiety) and psychosis (out of touch with really, hallucinations and delusions) were clearly made.
The DSM II was widely controversial due to the signs of the times and the changing social values largely due to the work of Alfred Kinsey (doctor; researcher on human sexuality) and Evelyn Hooker (psychologist studying homosexuality). Their concerns focused on issue of homosexuality being categorized as a mental disorder. By the 7th printing the classification as a mental order was taken out. However, due to the strong influence of psychiatrist Robert Spitizer a new category called Gender Identity Disorder was included.
DSM – III (1980)
Again, the need to maintain standards for diagnostic classification between the European and North American medical community was the focus. Many debates went on as to how mental disorders should be classified and why. The heavy influence on psychodynamic theory was challenged. Some critics wanted to eliminate the term neurosis completely from the manual while others said that it would not be a qualified mental illness standard if psychological considerations rather than just biological based illnesses were excluded. The classification Sexual Orientation Disturbance was changed for Ego-dystonic Homosexuality.
DSM – III-R (1987)
Categorises were renamed and classified while others were deleted. The controversial Pre-menstrual Dysphoric Disorder and Masochistic Personality Disorder were deleted. The very controversial Sexual Identity Disorder was taken out, but its presence was still to be found in “Sexual Disorder not otherwise classified.†You can say that old habits are slow to die.
DSM –IV (1994)
A major difference in this version was the inclusion of a clinical significance requirement for at least half of their categories. The Illness must produce, ““clinically significant distress or impairment in social, occupational, or other important areas of functioningâ€. As you see for homosexuals who are absolutely happy with their sexuality do not fall under this category of mental illness.
DSM – IV-TR (2000)
Has provided more clinical information on the existing mental conditions.
DSM Axes
On axis I you will find the major disorders. They are considered psychological, developmental and learning disorders: such as: Schizophrenia, Bipolar Disorder, depression, phobias, autism, and ADHD.
On axis II you will have the personality disorders such as: Borderline Personality Disorder, Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, Obsessive Compulsive Personality Disorder, and mental retardation.
On axis III you will find brain injuries and other physical conditions, which can affect brain functioning.
On axis IV you will find psychosocial and environment factors that contribute to a disorder
On axis V you will find the Global Assessment of Functioning, or Global Assessment Scale for children under 18.
Sources:
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders
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Comments: 56
I had always noticed that I seem to display symtoms of just about every mental disorder described, but he said that it was a matter of degrees as you have stated.
Maybe you should have a psychiatrist examine us here on Gather for "Gatheroholicism". There, I just named the disease.
The Meaning of Psychological Abnormality
There are others who don't think Autism should be in the manual at all, as it is a neurological condition.
Reminds me somewhat of the stories about people being locked up as insane when it turns out that they merely spoke an obscure dialect, which was interpreted as gibberish because no one understood it.....
All mental illness is poorly understood by the general public....that is true, because the general public, not having the background to understand what is really going on with that person, continues to apply moral judgements to the behavior, rather than seeing it as a symptom.
What Lydia--and other ASD folks deal with--is the acceptance of the idea that ASD implies retardation or complete inability to communicate by researchers and mental health professionals involved in treatment.
Their fight for acceptance has really only begun and the rise of computer technology and the Internet has made it possible for new avenues of communication to open up and provided more opportunities for 'auties' and 'aspies' to make themselves heard and understood. The 'problem' may not necessarily be with their communication methods, it may be with 'normal' folks' lack of imagination in discovering their 'language'.
Linda, you seem to have a pretty clear grasp of the situation.
: )
frustrating.
-- I now have all of the disorders that you described
-- thanx!
~~~
I definitely agree with that statement. You can put the same person in front of three different psychiatrists on three different days and depending on what is going on with that person on each of those days, you will most likely get three different diagnoses...and the one who is considered 'right' is the one whose prescription works best to relieve symptoms.
That having been said, I will say that the psychiatrists I have run into who practice as if psychiatry is both an art and a science are the ones with the most compassion and are more likely to be able to provide the most effective help.
When I was in school getting my degree, behavioral theory was predominant and treatment focused on eliminating the undesirable behaviors without ever addressing the underlying causes. For instance, my parents and I went into counseling together when I was a teenager; treatment focused on stopping me from expressing anger--no change in the way my parents treated me was required. I wanted to talk about their drinking--they didn't, guess what? the therapist didn't, either. Turns out he was an alcoholic and didn't want to talk about ANYONE'S drinking--too close to home for him. After about six months of this, I walked out and never went back.
The therapist later wrote a book in which he 'fessed up to his addiction to alcohol and acknowledged the damage he had done to those patients who had come to him trying to cope with the issue of familial addiction.
Cognitive behavioral therapy seems much more humane to me; it was just coming into professional awareness by the time I finished school.
We are near the centers of Cambridge and we know a ton of psychiatrists, we always joke that they are the worst doctors and the worst people.
People can gain a great deal of insight from a good therapist, they need to look into books, groups, and many different types of therapy to help them.
The Northeast US - particularly Boston and New York are holdouts for the outdated Freudian model, and unfortunately you can find thousands of practitioners who still are mired in Freud's anti-woman and 'blame the victim' philosophy - through 'psychodynamic' therapy.
Cognitive therapy begun by Burns offers more hope.
Many of the newer antipsychotics do not work as well as the older ones but they do have less deleterious effects on the brain, but they can cause diabetes, which has beocme the number one killer of bipolar patients, not suicide.
People often go to a therapist feeling something is wrong with them. They feel depressed, anxious, inferior, and not successful in life. They feel unattractive (they may be beautiful), they feel split off from their body or their selves.
Still sadly many therapists attach labels to these feelings that do not help the person and only serve to reinforce the cruel Freudian models.
Many people who feel this way feel this way because they they were abused physically, emotionally, verbally, to varying extents.
People who are shy and who do not get out much in life suffer feelings of inadequacy out of proportion to their abilities. Shy people worry. Life is harder for shy people. I have many ESL students who are shy and they come to me because despite previous lessons in English, they are afraid to make mistakes.
If a person feels inadequate, the root reason is often that their family mistreated them.
Work, whether paid or not, gives people something valuable to do and nearly always increases a person's self confidence. But that is not enough.
People are social. People must connect with others daily. Getting out in the world = even the virtual world - helps people feel welcomed, loved, liked. This is necessary for all people.
Elephants die and parrots go mad when deprived of social contact.
So while medication and therapy can help, reading books is also very helpful.
Many patients become addicted to therapy or a therapist, even sometimes sticking with a therapist who is not ideal.
A good fit is essential. If you or someone has been to a therapist and you didn't feel it clicked, get out.
Find someone with whom you click. Many times a therapist can only know what is in his or her life experience.
If your culture differs vastly from theirs and if you do not feel their is a fit, find someone with a culture that is closer to yours.
This was recognized in the US as a very important point in the last 20 years.
Feel useful. Volunteer. Helping people not only helps others but also yourself.
I would not give two cents for psychodynamic freudian garbage but I do feel freud did contribute a great deal to psychology I agree with all your points.
psychiatrists are very detached from their patient's a freudian technique, then there are the nut cases that play god, the psychiatrist which of course was the head of the team at the douglas hospital where I worked was a very nice man, however the patients complained they never got to see him, he had the rest of us dealing with the patients they patients only went to see him if they had a problem with their medication and then it was in and out.
Psychiatrists are MDs heavily grounded in the Freudian model. I have grown up with these people and wouldn't trust my soul to them on a good or bad day.
Most Psychiatrists do little more these days than write a script.
Psychologists are heavily trained in Jungian and other psychological theories and are often a vast improvement over psychiatrists.
But many male psychiatrists are not very social and are sort of geeky, ill-equipped persons in the real world.
Again, my husband is a psycholoogist, but most of his male friends are social workers. My husband is also a jock and a great looking guy with a great sense of humor - not all the psychologists fit into that model - many are dweeby.
Do you want a dweeby, a-social person talking to you about your soul? Not me.
Social workers are very different people from either psychiatrists or psychologists.
They are more social. As social people, they value the social elements in life and in people.
The Freudian model still in use today calls people by their last name Miss Jones or Mrs. Ms. Brown and simply says:
Sit down Mrs. Jones. then they wait for the client, whom they call a patient, to start talking.
This makes the client feel ill at ease and is a completely UNNATURAL situation in a social situtation.
When the client spills their life story, the psychologist may say: I see.
While this is an attempt to 'join' with the client whom the psychologist and most definitely the psychiatrist refers to as the patient, it is still a distancing move.
Remember that people go into the mental health field for the same reason people become patients or clients - to get HELP.
It has been said that the healer who seeks help is better than the healer who does not seek help.
And people go into a profession for the ego.
A person should feel buoyed not worse when they are in therapy.
Experiment with several types and read, read, read and join, join, join.
Eventually, perhaps with medication, a person often feels better about themselves. If they felt ugly before they now feel more attractive. The more we get out and are with people, the more attractive we feel. When we are at home alone, we don't feel as attractive.
Eye contact - even virtual eye contact - helps a person reaffirm that they are worthy.
anywho.
What do you mean by virtual eye contact? People like me HATE to look into someone's eyes because many of us feel like our souls are being sucked out when we do. Looking into someone's eyes feels very intimate, and I don't care to be that intimate with most people.
I may seem tired sometimes but, I always make myself get up for my kids.
And, after they go to school, I still do things that stimulate my brain. Such as reading, writing, walking our dog, something, anything to keep from focusing on my bad mood, or my awful thoughts of doom.
I guess my fighting instincts keep kicking in.
Never give up, never surrender.
That's how you fight and win, another day.
on the other we all know the problems with being misdiagnosed as well
Perhaps the worry of ordinary people around a patient (say bipolar) is to spot the change in behavior during initial stages of an attack. By the time they realize, the patient is 'down in the gutter'.
I am indeed one of those people who has a family member with clinical depression -- it is my brother. And I have found out about the illness through caring for him.
Kathryn E. is also right that a mental health professional - be they counselor of any sort or a psychiatrist (or for that matter a neurologist doing any sort of work with a patient who has mental illness) - needs to be well educated AND good with their patients. Anything less, and in this particular set of fields, they really fall into a category that I call "shouldn't be allowed to see live patients without direct supervision at all times". This is one category of care where anything less than ideal care can easily go from "just OK" to flat out deadly and due to things like how information is communicated or because of a provider who's a good communicator but who hasn't the slightest clue how to do their job. I've seen many of both and ended up badly destabilized.
There are also many in mental health care that are HORRIBLY unprofessional - and it's almost as if the industry has some sort of self protecting interest in protecting bad professionals even if it's just by pretending they don't exist. No one wants to hear about it. Or such has been my experience on the West Coast. The clinics where they work don't want to hear it. The oversight agencies at the regional level don't want to hear it. State licensing boards don't care - unless someone dies, nearly dies or a felony type of abuse is involved. Attorneys don't want to get involved in mental health malpractice unless the same sort of stuff is involved that would get the state licensing boards involved. And forget the psychiatric and various counseling industry groups' quality and ethics boards. This all doesn't seem to matter much if you're the patient or the patient's family either.
I've endured things that ranged from having a psychiatrist involve my now almost ex spouse in my care as if he has Power of Attorney over me - when he didn't - and ignore me as if I were incompetent - which I wasn't - with this combination of things along with my ex's lies leading to a diagnosis of paranoid delusions that took my ex getting caught doing the denied behaviors in front of other doctors to get it removed. It's involved doctors who rewrote my history to fit what they were doing - and who got caught in the act. It's involved docs who looked at my medical records and asked ME for the "answer key". Counselors who seemed to get perverse joy out of asking for intimate details of a trauma I've endured while offering no guidance or relief. Even a doc who thought it "helpful" to tell me that my next two years would be limited to little more than sitting at home twiddling my thumbs and seeing her (no doing my own shopping, no vacations, no doing much of anything else) - and all because of a bad medication reaction. An estimation that, by the way, bore no medical support. Oh, and even agencies that violated HIPAA and the laws of WA about patient treatment and privacy. So you'd think SOMEONE would care.
It does however make me a bit wary that so many involved in the writing of the DSM have so many ties to the pharmaceutical companies. That seems like it should be an ethics concern.
brain illnesses respond to different medication, if you give antidepressants to someone who has bipolar disorder you might make the bipolar symptoms worse because bipolar disorder required mood stabilizers as the first treatment, sometimes antidepressants are included but lithium and certain other medications do both and that is what a person with bipolar disorder needs.
But I totally get the thing about needing to get treatment right and how that requires getting diagnosis correct. Thanks to how my ex got involved in my treatment for a while, what finally turned out to be temporal lobe seizures, depression and really bad PTSD spent the longest time under the care of what had to be some of the west coast's worst psychiatrists who kept calling it all "bipolar 1, severe, extremely rapid cycling (because the neurological stuff is hormonally triggered at ovulation AND my menstrual cycle), with psychotic features including paranoid delusions" and all of them kept putting me on atypical antipsychotics as mood stabilizers. Finally I learned to just put up with twitching like a crackhead and having more visual hallucinations ON meds than I'd ever had OFF of them - because mentioning the problems to my psychiatrists would just get me a higher dose of my antipsychotic or switched to a new one that would just cause the same problems all over again. I also know that not all illnesses can be treated with or at least not primarily with medication - like PTSD requires counseling done by someone who KNOWS what they're doing and medications are an add-on treatment.
again
a dog is a dog is a dog, but is a huskie the same as a french poodle, or chihuahua? You might say yes,
but dog lovers want the distinction made, they are all dogs, but if you are looking for a working dog you may not want a french poodle and if you are looking for a small pet you may not want a st.Bernard and so on.
So for you it may be splliting hairs because a dog is a dog, but to someone looking for just the right dog it is very important.
A lot of it has to do with things that have been said to me and others I know because of how the public perceives mental illness to all be "in our heads" or about "bad choices" or something else we could simple "get control of" and "get over". Oh, how I'd love to just "get over" PTSD. I really wish it were that simple. I know one thing though, it wasn't MY choices or my behaviors that caused my PTSD - it was the behaviors and choices of others towards me.
But ultimately there are many within the communities of the mentally ill that would love to see the terminology changed to quit saying mentally ill - since it implies choice or even problems with our intelligence - and to also quit calling psychiatry "behavioral health" as if psychiatry were like a special education program for adults with behavioral problems. There are many I know who like the term "brain based".
Like with autism, if it started in the DSM, why not leave it there? This was all a question brought to mind by someone else's comment above about moving it out of the DSM and to neurology. I've seen many parents on other forums actively pushing for that - and all because they don't want the stigma of mental illness on their child...or the rest of the family. The people I've seen that want the change have generally been quite open about it. ALL of us have the same problems with stigma and discrimination - changing names and words doesn't help.
but look at the term closely mental illness an illness that has to do with the brain, the mind in particular as opposed to a physical illness like cancer, are a brain injury so there is a difference.
illness means it is not something you can wish away, the general does not understand and that is the sad part, it is important that the doctors and counsellors and therapists understand.
The general public is very intolerant to all of things whether it is physical or mental. When people are totally healthy they can see that other people are not,
They are not understanding or compassionate and that is a very big problem.