Heroes of Uncertainty

[postatomic]

Mental diseases are not really understood the way, say, liver diseases are understood, as a pathology of the body and its tissues and cells. Researchers understand the underlying structure of very few mental ailments. What psychiatrists call a disease is usually just a label for a group of symptoms. As the eminent psychiatrist Allen Frances writes in his book, “Saving Normal,” a word like schizophrenia is a useful construct, not a disease: “It is a description of a particular set of psychiatric problems, not an explanation of their cause.”

http://www.nytimes.com/2013/05/28/opinion/brooks-heroes-of-uncertainty.html?_r=0

A short read. An Op Ed piece.

I've often felt that slapping a label or two on me wasn't productive. Making me feel 'normal' again. Making me happy. This is all I've ever wanted. I know that labels are needed to decide which drug cocktail to throw at someone. But after that, what?

[olddots]

1. I agree

mental health seems to be a few thousand years behind physical health.

[postatomic]

3. I honestly don't know why

Perhaps it's because data is so hard to obtain and when it is there isn't a set formula to apply it to.

[HereSince1628]

2. Many folks seriously distrust clinical psychology, add in Allen Frances'

comments in his personal war against the dsm-5 and David Brooks, a guy whose editorials suggest he is an expert on everything, gets to chime in with a lament on the dangers of authoritative attitude in clinical science.

[postatomic]

4. Who isn't an expert these days?

The one thing that stood out for me....

The best psychiatrists are not coming up with abstract rules that homogenize treatments. They are combining an awareness of common patterns with an acute attention to the specific circumstances of a unique human being. They certainly are not inventing new diseases in order to medicalize the moderate ailments of the worried well.

[HereSince1628]

5. Yet that quote hangs on Brooks being expert enough to recognize the 'best' psychiatrists

Without some special knowledge, that quote by Brooks is merely an assertion that nicely squares with his fondness of the conservative. Publication of an opinion by an editorial writer for the NYT shouldn't be considered sufficient evidence of expertise.

What is it about the dsm-5 that is really eating at Brooks? I wish I could really know. Does he have meaningful objections or is Brooks merely lamenting the sorts of things that yield up the anathema to change that typify classical conservatism? Does Brooks really object to the possibility of increasing clinical sensitivity that generally typifies medical progress and leads to identification of new illnesses and the earlier recognition (and earlier treatment) of known disease processes?

Consider that in 2013 PTSD is one of the best known mental illnesses. Fifty years ago it didn't exist within psychiatry. Should it have remained unrecognized, unnamed and non-taxing on society's resources? Should understanding of PTSD ever have been allowed to advance so that it became an entire field of with multiple distinguishable mental illnesses and a new area of research? Should veterans, disaster victims, and the children of abuse just suck it up and act more like stout hearted conservatives whose perseverance and long suffering made America great?

It's curious to me that Brooks praises the palliative and ameliorative capacity of his 'heroes of uncertainty' yet disdains changes in the dsm-5 (and psychiatric practice) that would, for example, facilitate persons with life disrupting prolonged grief from getting insurance coverage for treatment. Let's be honest, the dsm's aren't just about diagnosing, they are also about defining illness and providing direction for decision making of insurance companies whose policies make that palliative and ameliorative care accessible.

[Neoma]

6. PTSD has changed names a lot though.

[HereSince1628]

7. Yes, but maybe not...

Shell shock was related to trench warfare. Battle fatigue was about too many days exposed to combat. Both were about illness with onsets in -active- duty soldiers.

As I understand the history, PTSD as a distinct diagnosis originated with female fire victims. Similar problems were later recognized in victims of accidents and violent crime and ultimately the connection to combat was made...and it became an iconic mental illness associated with Vietnam veterans.

PTSD diagnoses have centered around reactions to -single- traumatic events...consequently, battle fatigue doesn't really fit that as it implies a consequence of longer term exposure. It's also unclear whether shell shock related only to being on the receiving end of a single artillery bombardment.

One of the diagnostic features of PTSD has been its onset within a limited number of weeks after the single traumatic event that triggers it. Consequently, similar problems which emerge much later aren't really what has been considered PTSD.

Currently there is now 'complex' PTSD aka cPTSD which relates to prolonged exposures to trauma and which, consequently, encompasses things such as prolonged abuse and traumatic neglect. The psycho-social dysfunction of cPTSD, doesn't necessarily have onsets within short periods of time after the initial traumatic event.

Several other illnesses with triggers in life changing ambient events have also been proposed as related to post-event resolution of events that are traumatically life-changing.

So, yes, PTSD, at least in popular understanding, has been associated with a number of other names for generally similar but actually discernibly different etiologies.

on edit, it's also now proposed that PTSD symptoms don't have to follow an in person exposure to a traumatic event, vicarious exposures through the media may be sufficient