Monday, November 10, 2014

DSM needs to return to its origins

Following my previous post, I just wanted to be clearer about why I am not advocating totally abandoning psychiatric diagnosis. My position may seem surprising as essentially I agree with the critics of psychiatric diagnosis. Biomedical diagnosis has failed in the sense that mental disorder is not due to brain abnormalities. Symptoms and signs in psychiatric assessment are about mental, not bodily functioning. Psychiatric diagnosis and biomedical assessment act as a means of avoiding the uncertainty and pain of people's life stories.

Yet, I'm not the only psychiatrist that has given a priority to personal assessment rather than psychiatric diagnosis. Nor am I the only one that does not see mental illness as a brain disease. There has always been this conflict in modern psychiatry, since the origins of the asylums and the introduction of the anatomoclinical understanding of disease in medicine in general. Particularly in American psychiatry, the biomedical assumption was undermined by the views of Adolf Meyer (eg. see previous post). As Erwin Stengel (see my mention of him in another previous post) wrote in his review of psychiatric classification in 1959:-
Recently, the attitude of many psychiatrists towards the conventional type of classification has become one of ambivalence, if not of cynicism. This attitude derives partly from a low estimation of diagnosis, which in large areas of psychiatry has remained imprecise and has proved a poor guide to prognosis and therapy. Also, the concept of mental disorder, which in Kraepelin's view closely approximated that of physical disease, has changed in such a way that a conventional medical diagnosis no longer seems applicable. In many schools, especially in America, mental disorders are viewed as reactions of the personality to known or unknown pathogenic factors (Stengel, 1959).

In other words, there was a time when psychiatrists were much more aware of the limitations and problems of psychiatric diagnosis. DSM-I used the term 'reaction' throughout the manual, influenced by the ideas of Meyer. For example, functional disorders were called "disorders of psychogenic origin or without clearly defined physical cause or structural change in the brain" and this included manic depressive and schizophrenic reactions. There was no pretence that mental disorder is due to brain abnormalities.

Now that it is apparent that DSM-5 has failed (eg. see previous post), we need to undo each of the steps taken along the way. DSM-IV dropped the functional-organic distinction, which needs to be reinstated (see previous post). DSM-III encouraged a biological view of mental illness and introduced operational criteria, but did not improve diagnostic validity. DSM-II was not too different from DSM-I, but dropped the term 'reaction'. Conceptually the DSM process has been totally misguided, and we need to rethink and return to basic principles if there is ever going to be a DSM-6.

7 comments:

Peter Petrov said...

psychiatry substitute law. Forced psychiatry is always a crime

Peter Petrov said...

Psychiatrists introduce in the usage the terms of a morbid perception and behavior. A person is reacting not correct, not right, morbidly emotionally on the being committed against him abominations. And it means, he is dangerous, because he is sick. The disease is the cause of a danger. They recognize the perfectly natural reaction of a human as a disease. It turns out a man himself is a disease. Well, the treatment is the getting rid the man of such disease. I.e. the getting rid the man of himself. In other words, the destruction of the man. But destruction can not be a treatment of him. That`s why coercive psychiatry is always criminal.

Peter Petrov said...

Dear friends. Not long time ago I saw “The Wolfman” (2010). In general it is the usual entertaining movie. More correctly it WOULD BE the usual entertaining movie, if it wouldn't show with the unmerciful clearance the bestial face of psychiatry. The movie as if tells us, that even a werewolf is much more humane than a psychiatrist. But a psychiatrist has absolutely nothing human in itself. Undoubtedly after “Frances ” and “One Flew Over The Cuckoo's Nest” this movie discloses to the public the real face of psychiatry most honestly.
Yours` sincerely
Rasul Yagudin

Peter Petrov said...

Psychiatry in Russia

Posts victims:
Speech about normal attitude to not guilty people. I was shocked when I got there. Orderlies - dregs scoffed severely. Forced drink urine of the total buckets. Extinguish butts in body. Forced
patient sucking dick in a paralyzed and chained to the bed. Me personally 2 times pricked galoperedol without good reason. On request - give tsiklodol- just smiled and gloated. Chlorpromazine threatened to do. Galoperedol - this is a very terrible thing. For me It was not clear as even possible ?! Very eerie place.

Peter Petrov said...


Psychiatry in Russia
Posts victims: I was being treated with klopsikol, haloperidol, if somebody knows what they are, but they complicated the situation else more,
people twice were pulling me from loops.
About klopsicol, haloperidol.
In general, I would not advise these medicines even to
an enemy - in any case, following the example of the effect on me! In my case
it was any strange incident! Instead of providing a therapeutic effect,
haloperidol placed me in a hinge and evacuated me from the external world for a
month, in parallel causing any horrifying
influence on my psyche, at first day I was walking, as if I had smoked
marihuana, pardon for my slang, I terribly was wanting to sleep! At next days
something terrible began, I could not sit on a one place, was literally rolling
on the flat (after the injection they discharged me to the home mode), it
seemed to me, that either the ceiling will fall on me or tomorrow a nuclear war
will begin. It was very, very strong fear in front of everything! During a
month I did not go even in the staircase and, moreover, never even turned on
the television, but was lying on a bed either in a seizure or chained by the fear, that something will
start now… in short in a some moment I had come in Internet in order that to
find a site about methods of suicide and when I did, you can not even imagine, but I felt better at the
thought, that tomorrow all will end for me and I even was smiling for those
days. Generally it is even impossible to imagine and describe, how it was
happening!
But when I at last went on a street, I
started having epilepticus
seizures, contusion,
my legs were completely paralyzed, and for example I could go five kilometers
from home and get stuck there for five hours, owing that I could not move my
leg, and I was standing in
the middle of the street, fearfully looking at pedestrians, moreover, in this time my neck was being fixed in one
position, stretched up as in patients with paralysis, and I was not able to
move it a single inch to the right or left, so I was limping slowly a meter per
hour! These two drugs were similar in the horrors, moreover, klopsikol in
addition gave me to gain weight from 76 kg to 96 kg for 1.5 months, but now my
weight is 84 kg and I am thin!

Peter Petrov said...

Psychiatry in Russia

Posts victims: .. And now imagine. You go into an institution to visit someone. Suppose you were allowed to go on an exceptional basis. A crowd of boys, six to ten years, surrounding you on all sides. Everyone wants your attention, everyone wants to speak - adult came. And one happily reports: "And here we give a pill." What?
- Chlorpromazine, phenazepam, haloperidol, and this ... sonapaks parkopan.
(Names clatter as rhyme)
- Why give?
- When we behave badly.
- It's like you're driving yourself bad?
- Well, fight, smoke, swear obscenities, educators rude someone ...

Boy about seven years. If it round the clock to keep under lock and key - he will try to get out at any cost.
Will he answer back, be rude, fight not as we would like an adult? Just need to put yourself in his place.
And everything becomes clear to ugliness. The actual scene in quite a decent psychiatric hospital for children. I mean that when it comes to the orphaned children, they are likely out of this circle is not freed. The gas chambers were merciful. The Nazis killed at least once, not tortured ...

Peter Petrov said...

The psychiatric terror in Russia continues. Vladimir Chugunov disappeared in September. Already during long years he selflessly fights criminals of psychiatry and justice. Yet several times he was forcibly hospitalized and subjected to the damaging 'treatment'. And all of this is for his love of truth, the unwillingness to tolerate meanness of the authorities. In October his judicial appeal against previous unlawful judicial solutions had to be examined in a court. But before the deadline of the judicial examination Vladimir disappeared. And still his location is unknown, though the numerous requests were being send in various administrative authorities, Supervisory bodies and bodies of health. Officials are cynically silent.
Not long time ago was revealed another arbitrariness of officials from games of crooked justice and psychiatric quacks – on 20th October Rafael Usmanov was kidnapped right from the home and forcibly placed on psychiatric examination in the mental hospital of Kirov city. During already many years he too fights for his trampled rights. Already ten years he had been tortured in the nuthouse. And bastards again are preparing a violence. They impute to him unacceptably dangerous behavior – he had dared to call empowered criminals by their real names! This way damn bastards will write in crazy all decent people. Only complete cynics and servile opportunists will stay. Citizens, do not stay indifferent in any country!
Translated from Russian by Rasul Yagudin.