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Monday, 21 April 2014

What’s in a Name? The Effects of Receiving a Mental Health Diagnosis by Chloe Detrick Courtesy of the dxsummit website April 14, 2014




http://dxsummit.org/archives/2024

What’s in a Name? The Effects of Receiving a Mental Health Diagnosis
Chloe Detrick       April 14, 2014

With diagnostic categories on the incline I find it increasingly important to qualitatively research how a person who has received a mental health diagnosis in their culture is affected throughout their life. I will attempt to examine this in the following piece through the work of several scholars in the field, some of which contribute to this very site.
 

Diagnostic Process

The word ‘diagnosis’ stems from the Greek verb ‘diagignoskein,’ which means ‘to discern’ or ‘to distinguish,’ as well as ‘to know thoroughly’ (Harper, 2011). In several handbooks on psychotherapy it is listed that making an accurate diagnosis is crucial to the therapeutic process. Psychiatric classification is thereby seen as a prerequisite for good psychological treatment, but Vanheule (2012) cites several qualitative issues he has with the current DSM system of classification. Vanheule’s critiques revolve around the exclusion of the lived experience of symptoms and complaints, leaving the individual’s subjective interpretation of his own condition out of consideration, neglecting the context of complaints in the individual’s memories, relationships, life narratives, existential events, as well as social and cultural situations, and ignoring the variability in the experience of symptoms and complaints both in one individual and between individuals. He is careful to conclude that he is not against the DSM per se, but believes that the current system of diagnosis through the manual is not workable for psychotherapy.
 

Labeling Theory

Labeling theory predicts that psychotic patients who accept the label of mental illness from the DSM system will have worse functioning than those who reject their diagnosis, while accepted psychotherapeutic theory suggests the exact opposite (Warner et al., 1989). Scheff (1966) believes that labeling and stigma causes subjects to see themselves as damaged and deviant and impairs their self-control, which in turn leads to a pattern of long-term abnormal behavior. In a 1989 study by Warner et al., fifty-four psychotic patients were asked to complete several questionnaires filled with various adjectives they would use to describe themselves. The goal was to measure the degree to which the individual accepted their diagnosis, the individual’s perception of themselves, and the individual’s self-esteem. The findings concluded that participants who accepted the label of mental disorder exhibited lower self-esteem if they perceived high levels of stigma attached to mental illness and that those who accepted a mental disorder diagnosis may assume that they lack mastery over their lives. It also found those who rejected the label had higher self-esteem.
 

The Third Domain

Link (1982) believes there are three domains of possible consequences associated with labeling someone with a psychiatric diagnosis: 1) the label creates the deviant behavior, 2) the label maintains or stabilizes the deviant behavior, and 3) the consequences stem to other areas of a person’s life including jobs, friendships, family relations, and mate selection. Critics of the labeling theory have addressed the first and second domains, but have underemphasized his third domain. This lack of emphasis provides an appropriate segue into the examination of how individuals who are given mental disorder labels are viewed by the population around them. Phillips (1966) interviewed several individuals on their willingness to associate with five hypothetical ex-mental patients who fell under the categories of paranoid schizophrenic, simple schizophrenic, depressed-neurotic, phobic-compulsive, and normal individual. The associations ranged from having the ex-patient as a neighbor to allowing their children to marry. The lowest scores were found in both of the schizophrenic categories where none of the interviewees felt comfortable allowing their children to be married to an ex-patient in either of these hypothetical cases.

In an American study, citizens reported more comfort with individuals who are deaf or have facial disfigurement than people with mental disorders (Hinshaw, 2007). Additionally, people expressed disgust when shown images of individuals who are homeless or abusing substance—behaviors that are often associated with active symptoms of mental disorder (Harris & Fiske, 2006). Media portrayals about persons with mental illness often emphasize a heightened potential for violence, which leads to the stereotype that these individuals are dangerous (Wahl, 1995). In a study aiming to assess the humanity associated with individuals who had received mental disorder labels, participants in an experimental condition were asked to form impressions of a hypothetical target with a mental illness while a controlled condition was asked to form impressions of a hypothetical target with a physical illness. Both participants were given a set of words associated with animality (i.e. wild, beast, untamed) and humanity (i.e. human, citizen, person). The mental illness label triggered decreased ascribed humanity as well as a greater perceived threat by the participants (Martinez et. al, 2011).
 

Stigma

Goffman (1963) adopted the term stigma from the Greeks who defined it as a mark meant to publicly represent immoral status. He noted that some stigmas might be readily apparent (i.e. skin color, body size) or hidden (i.e. religious affiliation, sexual orientation), but that both types often lead to prejudice if observed by a majority group member. Hidden stigmas can be self-promoted, given by others or ascertained based on association; for example, observation of someone leaving a psychiatric clinic might lead to the assumption that the person is mentally ill (Corrigan, 2007). Findings from the National Comorbidity Survey identified several stigmatizing beliefs that might sway people from treatment including concerns about what others might think and the desire to solve one’s own problems (Kessler et al., 2001).
 

Personal Accounts

Studies surrounding mental health can give us some idea of the stigmas associated with these labels, but it is important to look at the experience of a patient who has been labeled mentally ill in their culture first-hand. Judi Chamberlin, an American author and activist, recounts her experience as a patient diagnosed with a mental illness:

    Eleven years ago, I spent about five months as a patient in six mental hospitals. The experience totally demoralized me. I had never thought of myself as a particularly strong person, but after hospitalization, I was convinced of my own worthlessness. I had been told that I could not exist outside an institution. I was terrified that people would find out that I was an ex-patient and look down on me as much as I looked down on myself (Chamberlin, 1978, p. 6).

Prateeksha Sharma, a musician and mental health research in India, details her experience with being diagnosed with bipolar disorder in her particular culture:

    This is a story of my personal journey with Bipolar illness over the last 19 years. For a large part of this time I have wondered if this story is also one of a person with some weakness, for I have often felt like that due to the seeming lack there is within me. I was made to believe that I need to look up at suitable “outsiders” for support, guidance, and inputs at all times to live my life in a “proper” and “balanced” way. Those “outsiders” have been variously pointed out to me as medicines, doctors, analysts, jobs, and relationships in which I should find an anchor for myself and structure my life around, for a life apart from these is not meaningful or entirely feasible for one such as me. There is also the distant presence of my psychologist with whom I have been redefining the narrative structures that have been handed down to me by a system, which sees the psychiatrically ill woman as a “poor girl” or someone to feel sorry for (Sharma, 2011, pp. 3-4).

Overcoming the label

If not pills, though, what is the solution to overcome being labeled mentally ill? In 1796 a man named William Tuke established the York Retreat in England. It was a Quaker-operated religious hospice that is considered to be the birthplace of an approach called moral treatment. Tuke focused on the healing powers of benevolence and charity. Patients were understood to have an innate capacity to heal, empathetic listening was practiced, and the environment was structured to reduce stress and strain in order to promote the patient’s recovery. Centers that began practicing moral treatment in its time saw astounding results with over half of the patients leaving “cured,” “improved,” or “recovered” in all reported cases (Olfman & Robbins, 2012).

Results of a study including 70 mental health consumers were presented at the eighteenth annual Mental Health Services conference in Auckland, New Zealand. The study aimed to assess if the process of being diagnosed with a mental illness was helpful. The results indicated that people had expected the diagnosis to provide hope and an opportunity for recovery, but instead found that being diagnosed opened the door to stigma and discrimination, altered family and other relationships, prejudiced their work and employment possibilities, and reduced their lifestyle opportunities. Some participants found it helpful to get statistics on individuals who had gone through the same experience as them and find out what they went on to do afterwards. The participants agreed what was best for them was a holistic treatment plan developed over time including factors such as talk therapies, physical and creative pursuits, alternative remedies, and spiritual paths (Zoeller, 2008).

The accounts of Chamberlin and Sharma also give us some insight on how patients labeled mentally ill are able to overcome the perceived stigma. Chamberlin found comfort in group settings:

    Gradually I had to recognize that I was not the fragile shell I believed myself to be. It was a long process. I had to fight the crippling belief in my inferiority, a belief that I had been given by the people I once trusted as healers. It was years before I allowed myself to feel anger at a system that had locked me up, denied me warm and meaningful contact with other human beings, drugged me, and so thoroughly confused me that I thought of this treatment as helpful. Of enormous help in digging through the layers of mystification has been my involvement, for the past six years, in a number of mental patients’ liberation groups, in which ex-patients have come together to validate our own pain and anger (Chamberlin, 1978, p.7).

Sharma formed deep relationships with her music and immediate family members:

    I have repeatedly, and with a good measure of obstinacy, refused the labeling and have forever been constructing my own reality—one in which the mainstay of my life is not medicine, but music; where the deepest relationship I have is not with another but my own self. I owe immensely the women in my immediate family a great deal, for all those times that I found myself slipping into the societal traps of psychiatric nomenclature, they have repeatedly pulled me out to remind me of these alternate and less conventional ways of looking at situations (Sharma, 2011, p. 4).

References

Chamberlin, J. (1978). On our own: patient-controlled alternatives to the mental health system. New York: Hawthorn Books.

Corrigan, P. W. (2007). How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness. Social Work, 52(1), 31-39.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.

Harper, D. (2011). Online etymological dictionary. Retrieved from http://www.etymonline.com/index.php?search=diagnosis

Harris, L. T., & Fiske, S. T. (2006). Dehumanizing the lowest of the low: Neuroimaging responses to extreme out-groups. Psychological Science, 17, 847-853.

Hinshaw, S.P. (2007). The mark of shame: Stigma of mental illness and an agenda for change. New York: Oxford University Press.

Kessler, R. C , Berglund, P A., Bruce, M. L., Koch, J. R ., Laska, E.M., Leaf, P.J., Manderscheid, R.W, Rosenheck, R. A., Walters, E. E., & Wang, P S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987-1007.

Link, B. (1982). Mental Patient Status, Work, and Income: An Examination of the Effects of a Psychiatric Label. American Sociological Review, 47(2), 202-215.

Martinez, A. G., Piff, P. K., Mendoza-Denton, R., & Hinshaw, S. P. (2011). The Power of a Label: Mental Illness Diagnoses, Ascribed Humanity, and Social Rejection. Journal of Social and Clinical Psychology, 30(1), 1-23.

Olfman, S., & Robbins, B. (2012). Drugging our children: how profiteers are pushing antipsychotics on our youngest, and what we can do to stop it. Santa Barbara, Calif.: Praeger.

Phillips, D. L. (1966). Public identification and acceptance of the mentally ill.. American Journal of Public Health and the Nations Health, 56(5), 755-763.

Scheff, T. J. (1966). Being mentally ill: A sociological theory. Chicago: Aldine

Sharma, P. (2012). Mending the Broken Frame: Self-Narration in a Constructionist Framework. Psychological Studies, 57(2), 189-194.

Vanheule, S. (2012). Diagnosis in the field of psychotherapy: A plea for an alternative to the DSM-5.x. Psychology and Psychotherapy: Theory, Research and Practice, 85(2), 128-142.

Wahl, O. F. (1995). Media madness: Public images of mental illness. New Brunswick, NJ: Rutgers University Press.

Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance Of The Mental

Illness Label By Psychotic Patients. American Journal of Orthopsychiatry, 59(3), 398-409.

Zoeller, R. (2008). Mental Health Diagnosis A Label. Austrailian Nursing Journal, 16(4), 47.

Sunday, 13 April 2014

All Aound the World Poem by Dave Traxson - Dubious Diagnoses for Kids is a Safeguarding Issue.


PSYCHO-ECONOMIC IMPERIALISM = the biochemical colonisation of young developing minds for huge profit and social control. 
A child leaves alone.
 

Once clinicked,
Having been white coated
Or diagnosed all too quickly;
Milgrammed -
Not with higher voltage
But with a higher dosage,
Than any child should be given
At such a vulnerable growth stage,
As it interferes with their living…..
Their light diminished…..
Their soul extinguished…..
Their personality giving
In to someonelse’s….
Model of conformity.
 

A child leaves alone.

Sunday, 6 April 2014

ADHD drugs Prescribed Too Frequently to Kids - A Call for a Review of Prescribing in Wales from The Association of Educational Psychologists - Kate Fallon General Secretary - By Nelli Bird BBC News - April 2014 - There was a steep rise in drugs prescribed for ADHD in Wales - LISTEN TO CLIPS ON WAKE UP WALES PROGRAMME



Kate Fallon General secretary of AEP makes call for a review of practice.
CLICK ON LINK TO LISTEN TO PROGRAMME: Kate Fallon of the AEP is on item at 8.0 mins to 15 mins and answering questions live at 2 hrs7.30 mins.  USE SLIDE BAR BELOW:


ADHD drugs review call in Wales from psychologists
By Nelli Bird BBC News
There was a steep rise in drugs prescribed for ADHD in Wales

The way drugs to treat a common childhood disorder affecting behaviour are prescribed in Wales should be reviewed, said psychologists.

There was a 57% rise in prescriptions for the most common drug to treat attention deficit hyperactivity disorder (ADHD) between 2007 and 2013.

Experts say the long-term effects of methylphenidate are unknown.

The Welsh government said drug treatment should only be by professionals with ADHD expertise.

Concerns about how ADHD is diagnosed have also been raised by the Association of Education Psychologists.

It is estimated that ADHD affects between 2 to 5% of children and young people.


What is Ritalin

  • Brand name for methylphenidate
  • A stimulant that affects certain chemicals in the brain which may help to reduce some of the symptoms of attention-deficit hyperactivity disorder
  • First used to treat ADHD in 1960s
  • Possible side effects include loss of appetite, nausea, headaches, blurred vision

Source: BBC/NHS

Common symptoms of the disorder, which is normally diagnosed between the ages of three and seven, include inattentiveness, hyperactivity and impulsiveness.

It can be treated with therapy or medication and the most common prescribed drug is methylphenidate, also known as Ritalin.

Figures seen by BBC Wales show there are big variations in the number of prescriptions being given out across Wales.

In the Abertawe Bro Morgannwg University Health Board area - which covers Swansea, Neath Port Talbot and Bridgend - there was an 88% rise to 12,446 from 2007 to 2013.



CASE STUDY: DYLAN PIPER


Zoe Piper from Bridgend, has a 10-year-old son, Dylan, who was diagnosed at the age of six.

Before he was diagnosed he was expelled from one school after three weeks.

"He was going under the tables, apparently hitting children, he was wetting himself - he actually painted himself green one day," said his mother.

"That was five years ago and everybody still knows him as the naughty child.

"It was a really hard decision for us to put Dylan on medication but weighing it up, it was a case of we had to try the medication or he couldn't continue in the school.

"Once we put him on medication we thought it would completely change him.

"But it didn't change him, the only thing it did was dampen down the extremes of the excitability.

"He still had his little wicked sense of humour, he still had all that going for him.

"The problem was that he was getting used to a dosage so we were going up and up but obviously the higher you go, the more weight you could lose.

"Dylan did get to the point where it was quite dangerous - he lost half a stone - he's under four stone now.

"I made the decision to take him off the methylphenidate and now I've put him onto another drug."

Betsi Cadwaladr Health Board, covering north Wales, produced the most prescriptions - 21,111 in 2013 - with the number rising by 78% since 2007.

Over the last seven years, the Welsh NHS spent over £13m on prescriptions.

Kate Fallon, general secretary of the Association of Education Psychologists,
said: "We don't actually have enough research to know what are the long-term effects, particularly of the long-term usage of the drugs, and what effect that might have on these very vulnerable brains of these children if they are being given the drugs at such a young age."

Data on exactly who the prescriptions are going to and how long they have been prescribed the drug are not available.

Ms Fallon added: "You've got some very bald figures here and without knowing the ages of the children or the length of time that the children are on them, then you can't really get a proper picture to say if we tried to implement some of the sorts of programmes might we be able to bring down the use of these drugs.

"I'd be very keen to talk to the Welsh government about suggesting to them that they do look at those figures, and the Welsh government could lead the field in this, in tackling this whole issue of the diagnosis of ADHD and the prescription of drugs and perhaps show to England how it might be done."

A Welsh government spokesperson said: "Drug treatment should only be initiated by an appropriately-qualified healthcare professional with expertise in ADHD and should be based on a comprehensive assessment and diagnosis.

"Child and adolescent mental health services in Wales have strong working relationships with schools and others agencies to enable any problems to be highlighted and addressed at an early stage."
Health Board
2007
2008
2009
2010
2011
2012
2013
Figures from NHS Wales Shared Services Partnership
Abertawe Bro Morgannwg
6660
7456
8200
9201
10890
11941
12446
Aneurin Bevan
3869
4193
4422
4545
4952
5282
5157
Betsi Cadwaladr
11854
13357
14814
16162
18245
19662
21111
Cardiff and Vale
4106
3606
3947
4053
4121
4868
5673
Cwm Taf
5786
6978
7337
7773
7972
7604
7543
Hywel Dda
4701
5341
5796
6362
6402
6693
6821
Powys
1679
1670
1850
2006
2026
2077
1928







60679
TOTAL
38655
42601
46366
50002
54608

58127



Ritalin and other psychotropic medication for children are a “quick fix” and the government should urgently review their use, psychologists have urged.

The Association of Educational Psychologists (AEP) fears there is insufficient data on the effects such drugs have on child development and the functioning of the developing childrens' brain. Further research is urgently needed, it says to establish the risks. The AEP’s demand is despite the fact that a European Medicines Agency (EMA) investigation into methylphenidate drugs, which include psychotropics Ritalin, Concerta, Equasym, Medikinet and Rubifen – had previously stated that the benefits of such drugs usually outweigh any negative effects for children diagnosed with ADHD and other conduct disorders.. Plus, UK doctors have been advised by the National Institute for Health and Clinical Excellence not to prescribe methylphenidate as a first-line treatment for children diagnosed with ADHD.
But the AEP – which represents UK educational psychologists – fears there will be an increase of methylphenidate prescribing because the number of official psychological disorders for children is set to increase. The American Psychiatric Association is working on its 2013 review of the Diagnostic and Statistical Manual of Mental Disorders ( i.e. DSMV)


in which additional psychological disorders for children are due to be added. These include Post-traumatic Stress Disorder in Preschool Children, Temper Dysregulation Disorder with Dysphoria, Callous and Unemotional Specifier for Conduct Disorder, Non-Suicidal Self Injury, and Non-Suicidal Self Injury,Shyness and Sadness all not previously specified.


“These could lead to more young people being referred for treatment with these psychotropic medications,” said Kate Fallon, AEP’s general secretary. She said: “There is a danger that we rely on the ‘quick fix’ for children with conditions such as ADHD, which frequently means the prescription of medication such as Ritalin instead of a number of other possible interventions.” Medicine regulators in European member states had in 2007 requested EMA’s mediation because of concerns over cardiovascular and cerebrovascular effects of methylphenidate – such as heart rate and blood pressure increases and sudden heart attack. A review was carried out by the EMA’s committee for medicinal products for human use. It was based on reported side effects and all studies on methylphenidate since the fifties. The committee also investigated any link between methylphenidate and psychiatric problems, reduced growth and sexual maturation. An urgent restriction to methylphenidate prescribing was not needed, the committee concluded but there were issues needing to be addressed such as more rigorously applying the NICE guidelines in the U.K. especially for stopping the prescribing to the under sixes.

http://psychminded.co.uk/news/news2011/june11/Ritalin-for-children-is-quick-fix-and-should-be-reviewed-demand-educational-psychologists001.ht


Association of Educational Psychologists: Support for a national review of the use of psychotropic drugs for school aged children in the UK - FULL STATEMENT:

The Association of Educational Psychologists (AEP) considers that a national review into the use of psychotropic drugs, such as Ritalin, on school aged children in the UK is urgently needed.

This is in agreement with the views publicly expressed by individual educational psychologists and the British Psychological Society (BPS).

The AEP has significant concerns that the neurological impact of psychotropic drugs on the developing brains of children has not been fully researched. The potential damage that such drugs could cause needs further investigation.



The AEP is also concerned about child treatment with psychotropics ahead of the introduction of new diagnostic criteria, DSM5, in 2013.  These criteria will result in more inclusive definitions of mental health, and could consequently lead to more young people being referred for treatment with these medications

Therefore, prior to the introduction of DSM5, the AEP calls on the Government to urgently establish a national review into the standard intervention practices for children and young people considered to have issues of mental health – and further calls for this review to consider seriously the potential damage caused by psychotropics when contrasted with other available therapies.

Wednesday, 2 April 2014

Diagnosis and the DSM: A Critical Review by Stijn Vanheule Courtesy of the excellent dxsummit.org website


DSM-5 - Is no longer used by the NIMH as a research tool due to its lack of scientific validity.
Diagnosis and the DSM: A Critical Review - click on link : http://dxsummit.org/archives/1995

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is a widely used instrument for diagnosing psychopathology. The DSM is used for diverse purposes, including mental health care planning, insurance matters, legal decisions and research.  The DSM provides professionals and service users with a system of classifying and labelling mental health conditions: it thus, also, names the condition or experience an individual struggles with. Yet, what’s in a name? Considered critically, a diagnostic instrument is only of value if it provides a basis for adequate and consistent decision-making and fits within a coherent theoretical framework about psychopathology.


In 2013 the American Psychiatric Association launched the fifth edition of its diagnostic handbook: the DSM-5. The publication of the DSM-5 mobilized me to review the assumptions and evidence underlying the manual and discuss the social and cultural context within which the handbook is developed and used. End users often take for granted that an instrument like the DSM-5 (an impressive 991-page book published by a highly prestigious professional society) provides us with an accurate basis upon which to draw far-reaching conclusions about people’s mental health. Indeed, by means of this respected handbook, professionals and laypersons alike make important decisions about the presence or absence of psychological conditions in themselves and in others.


In popular press, the DSM is frequently coined as ‘the bible of psychiatry’ and this is precisely how the handbook seems to function: people believe in its accuracy and legitimacy, largely without question. The manual could also be said to function somewhat at the base of the economy of psychiatry. After all, the DSM not only facilitates a belief system, but also survives as an important economic device for managing the flow of money invested into mental health care. It is on the basis of this classificatory system that decisions are made on issues such as the reimbursement of treatments, the right to financial aid and the allocation of means across health care providers.


With this book I argue that the value of the DSM-5, and previous versions of the handbook, should not be taken for granted: the manual should be closely assessed and discussed. End users of the DSM-5 should not assume that the handbook is ‘good’ or ‘useful,’ but become cognisant of its strengths and weaknesses, including its theoretical underpinnings and its position in historical debates on the scientific status of psychiatry and clinical psychology.

This book consists of two chapters in which I discuss the reliability and validity of the DSM.

The first chapter focuses on the reliability of the DSM-5 and previous versions of the handbook. In the early days of psychiatry, diagnosis didn’t begin from checklists of symptoms, but from elaborate prototypical descriptions of a diverse range of psychopathology. Guided by administrative purposes these descriptions gave rise to classification systems such as the DSM. An important impetus for the switch to checklist-based diagnosis can be found in harsh discussions on the fundaments and the practice of psychiatry during the nineteen sixties and seventies. In these years, psychiatry was in crisis: several academic researchers demonstrated that psychiatric diagnosis was unreliable, critical scholars pointed to weak points in the overall ethos of psychiatry, and societal changes challenged the practice of psychiatry. A group of so-called neo-Kraepelinian psychiatrists responded to the malaise in the discipline by defining psychiatry as a strictly medical discipline and thus replacing the method of diagnosis with a criteria-based system. Checklist-based diagnosis is often believed to be more scientifically sound than narrative-based diagnosis. However, in this chapter I demonstrate that this is not the case: anno 2013 psychiatric diagnosis is by no means more statistically reliable than it was 40 years ago. The main thing to have changed in the last decades is the standard upon which statistical reliability is based and evaluated. If the fact of the ever-increasing relaxation of these statistical standards of evaluation continues to be ignored, we simply continue to invest in the fantasy that psychiatric diagnosis with the DSM is more reliable than ever before. Moreover, to this day the plethora of problems addressed by critical researchers in the nineteen seventies (such as the issue of hasty decision-making and the problem of reification) remain entirely unresolved and, thus, continue to pose a fundamental challenge for contemporary psychiatric diagnosis.

The second chapter focuses on how the DSM-5 takes context into account and discusses the kind of entity the DSM considers mental disorders to be. The main argument I make is that in the DSM the context of the individual (i.e., the life history, social circumstances, and cultural background) is thought to play only a minor moderating role in relation to symptom formation and expression. Moreover, as the manual follows a sign-based logic it coheres with the assumption that biological irregularities lie at the basis of mental distress. In this way the DSM cultivates a rather na├»ve essentialistic view of mental disorders, which is certainly not supported by relevant evidence. In this chapter, starting from phenomenological psychiatry and Lacanian psychoanalysis, I make a plea for a ‘reflexive’ approach to psychopathology. Such an approach does not neglect problem-specific or disorder-specific regularities, but assumes that typical configurations never (unequivocally) apply to single cases, thus demanding a casuistic approach to diagnosis.

The theoretical assumptions underlying diagnostic systems like the DSM are rarely reflected upon or questioned. This might be why people rarely propose an alternative system of diagnosis, one that could accommodate a broader understanding of mental health problems. It is my hope that this book will, at the very least, motivate a more critical discussion of psychiatric diagnosis.


About Stijn Vanheule

Stijn Vanheule, Ph.D., is a clinical psychologist, associate professor at Ghent University (Belgium), and psychoanalyst in private practice (member New Lacanian School for Psychoanalysis). He is the author of the book The Subject of Psychosis: A Lacanian perspective, and of multiple papers on Lacanian and Freudian psychoanalysis, psychoanalytic research into psychopathology, and clinical diagnosis.

Tuesday, 1 April 2014

Back to Normal Practical advice on avoiding over-medication by Allen J. Frances - March 2014 - Courtesy of the Psychology Today website - Click link for full article




http://www.psychologytoday.com/blog/dsm5-in-distress/201307/back-normal


Back to Normal
Practical advice on avoiding over-medication
Published on July 3, 2013 by Allen J. Frances, M.D. in DSM5 in Distress


We have become a pill popping society. It makes absolutely no sense that twenty percent of our population regularly uses a psychotropic medicine and that the United States has more deaths each year from overdose with prescription drugs than from street drugs.

The causes of excessive medication use are numerous- the diagnostic system is too loose; some doctors are trigger happy in their prescribing habits; the drug companies have sold a misleading bill of goods that all life's problems are mental disorders requiring a pill solution; and the insurance companies make the mistake of encouraging quick diagnosis on the first visit.

My purpose here is to advise individuals on how best to deal with the risks of over-diagnosis and over-treatment. Elsewhere I have suggested the things government needs to do. (http://m.psychologytoday.com/blog/saving-normal/201306/can-congress)


A diagnosis, if accurate, can be the turning point to a much better life. A diagnosis, if inaccurate, can haunt you (perhaps for life) with unnecessary treatments and stigma.

Spend at least as much effort ensuring you have the right diagnosis as you would in buying a house. Become a fully informed consumer, ask lots of questions, and expect clear and convincing answers from any clinician who offers a diagnosis and recommends a treatment. If the diagnosis doesn't seem to fit, get second or third opinions.

Never accept medication after receiving only a brief diagnostic evaluation, especially if it has been done by a primary care physician who may not be expert in psychiatry and may be too influenced by drug salesmen.

Don't believe drug company advertisements that end with, 'Ask your doctor.' Drug companies profit if they can convince you that you have a psychiatric disorder and need medication. They portray the expected problems of everyday life as mental illnesses due to a chemical imbalance because this sells pills and makes money- not to help you.

There is a strange paradox in our country. Perhaps half the people taking psychiatric medicines don't need them, while more than half the people who do need them are not taking them. Symptoms that are severe and persistent should be an immediate call to diagnosis and treatment. Symptoms that are mild and in reaction to a life stress will usually go away on their own.

People visit the clinician on what may be one of the worst days of their lives. Time, resilience, support and changing circumstances often result in dramatic improvement, without the need for diagnosis or treatment. But if you immediately start medication and later feel better, you will likely think the pill did the trick and continue taking it even if it was just along for the ride and isn't really necessary.

So, watchful waiting beats diagnosis and treatment for mild symptoms' while immediate diagnosis and active treatment is required for severe symptoms.

How do you decide where you fit. If symptoms are new, in reaction to real problems in your life, and don't interfere with your functioning, give time a chance. But get help fast if the symptoms are markedly distressing, prolonged, incapacitating, or dangerous.

Study up so that you can have an informed opinion, but don't make these judgments all alone. Get the advice of clinicians and family. And a decision about treatment, made either way, is not once and for all. You can always start treatment later or decide to stop it as more information becomes available or if conditions change.

If you are on medicine already, don't ever try to stop it on your own because you may really need it and also because many medicines cause withdrawal symptoms when stopped abruptly. The decision to end a treatment is as important as the one to start it. Get help with both but also always be an engaged and informed consumer.

DSM – The ‘Psychiatric Bible’ Responsible for Over Medicating the Population - Courtesy of the NaturalSociety website




http://naturalsociety.com/dsm-the-psychiatric-bible-responsible-for-over-medicating-the-population/

DSM – The ‘Psychiatric Bible’ Responsible for Over Medicating the Population
Mike Barrett
by Mike Barrett
December 29th, 2011

Read more: http://naturalsociety.com/dsm-the-psychiatric-bible-responsible-for-over-medicating-the-population/#ixzz2xcXjjJuX



If you are a parent then there is a good chance your child has been labeled with some type of disorder, whether it be mental, depressive, or hyperactive. But even if your child is “lucky” enough to dodge the onslaught of disease labeling, you can be sure that most other children around weren’t as fortunate. While there are numerous reasons for the influx of disorder-labeling such as additives in the food, toxins in the water, and chemicals in the air, one of the main reasons actually has everything to do with a simple stroke of a pen in a book known as the Diagnostic and Statistical Manual of Mental Disorders, or DSM.
You May Have a New Disorder with the Stroke of a Pen

The Diagnostic and Statistical Manual of Mental Disorders is the bible of mental health as far as psychiatrists are concerned. This book possesses the definition of every single disorder known to man, and also every disorder invented by man. Similar to how lawyers are often thought to have their own language which no normal person would fully understand, this book holds a language of its own to classify people into certain categories. If you are a 296.22, you have experienced a single mild episode of major depressive disorder, while if you are a 301.83 you very close to having personality disorder.

As the decades have gone by, the amount of disorders someone can possibly have has gone up by the hundreds. Most notably, homosexuality was battled for inclusion, describing people as having a “sociopathic personality disturbance.” Later, it was replaced with a disorder called “ego-dystonic homosexuality,” a problem specifically surfacing from a source of distress.

The book is currently on its fourth edition, but the DSM-5′s planned release is coming in May of 2013. As the DSM editions continue to be released, the criteria for labeling a person for many disorders becomes much lower. Psychiatrists, the pharmaceutical industry and all of their ties love these changes, as medications are prescribed with even less effort on the medical establishment’s part. With a few simple strokes in this book, every single person in the country could soon be labeled as having a disorder, whether caught by medical “professionals” or not.
The Diagnostic and Statistical Manual of Mental Disorders is Leading to Unnecessary Medication Use

During the 1990′s childhood ADD, a disorder ridiculously common today, exploded so much that a 700 percent increase in Ritalin and other stimulants use was seen. You may or may not be surprised to know that your child “has ADD” so long as 6 of 9 boxes from a list of symptoms are checked, symptoms like “often does not seem to listen when spoken to directly” or “often fidgets with hands or feet or squirms in seat.” Two other proposed disorders for the DSM-5 are “mild neurocognitive disorder” in the elderly and “disruptive mood dysregulation disorder” in kids. With the approval of these disorders, there will undoubtedly be a dramatics increase in powerful antipsychotic drug use. These drugs which breed overweight, diabetic children, rose to the top in 2008 with over $14 billion in sales, and have been pushed on millions of children since 2009 alone.

Whether more disorders are added to DSM-5 or not, it is more than expected that criteria be lowered for already existing disorders. No matter the final decision, this book has been helping the pharmaceutical industry for decades while causing millions of people to suffer from unnecessary medications. The vicious profit-driven cycle brought to you by the pharmaceutical industry only leads you to become dependent on their products while heavily contributing to the decline of legitimate health practices.

Additional Sources:

Allpsyche

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BBC NEWSROUND - 'Not enough' done on mental health say charities - we need to use psychological therapies first as recommended by N.I.C.E.



Click on link to see article

http://www.bbc.co.uk/newsbeat/25689065


'Not enough' done on mental health say charities

Page last updated at 09:03 GMT, Monday, 13 January 2014
Sophie Dennis Sophie Dennis says early signs of her illness went undiagnosed and untreated

Several leading charities are warning not enough is being done to spot the early signs of mental health problems in young people.

Organisations including Rethink Mental Illness, the Mental Health Foundation and Sane say lives are being put at risk.

They want more training for people like teachers and GPs.

They also say it is crucial to raise awareness among parents and teenagers to know what signs to look out for.

People not going to school or failing to turn up at work are all possible indicators of mental health problems.
'Serious problems'

These are symptoms Sophie Dennis from Bristol can relate to.

The 22-year-old says she began to suffer mental health problems including paranoia, delusions and obsessive compulsive disorder (OCD) during her mid-teens.
Young people and mental health
Continue reading the main story

    One in 10 children has a diagnosed mental health disorder
    Half of all mental health problems have roots in childhood
    Prevention and intervention are key to making a difference

Source: Mental Health Foundation

She says she didn't get any effective treatment until she was 20, in part because the symptoms weren't spotted early enough.

"Self harming once led me to have to go to hospital and that [had] a big impact on my family as well," she said.

"That's something that made me feel quite guilty about, what I put other people through.

"I'm happy now that I've managed to feel like I'm managing to deal with them [her mental health problems] a lot better now. I just regret I had to deal with them for so long."
'Tough job'

Barbara McIntosh, who works for charity the Mental Health Foundation, says teachers can play a role in helping spot mental health problems among teenagers.

She also thinks everyone who comes into contact with children should know more about what signs to look for.
Continue reading the main story

    A lot of people don't realise mental health problems are completely treatable and you can recover

Rachel Hobbs Rethink

"I think they [teachers] have a really tough job and they don't always get the right support," she said.

"They're asked to do an incredibly important and difficult job without the right tools [but] you can buy in support form a range of organisations."

It is not just teachers though that charities say need help in learning to spot symptoms of possible mental health disorders.

Parents, GPs, friends and anyone who comes into contact with children are being urged by charities to know what to look for.
'Completely treatable'

Rachel Hobbs, from charity Rethink, said: "All the evidence shows that the sooner a mental health problem is diagnosed and treated the less likely it is to go on to develop to become more problematic in later life and the more chance you have of a full recovery.

"A lot of people don't realise mental health problems are completely treatable and you can recover. The earlier you spot it the more likely that is to happen."

Mei, 23, suffered from depression when she was at university but was fortunate that her mental health problems were spotted early.

With help from one of her tutors she managed to get treatment.

"If I hadn't got help when I did, I would probably have suffered a lot longer than I needed to and that would probably have had a much more detrimental effect on my university outcome," she said.

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