Everybody has Something: The Problems of Diagnosis Creep

When I was first studying psychology, I read and pretty much had to memorize a tome called the "DSM IV". This stands for "Diagnostic and statistical manual". The title is important--it is NOT a compendium of measurable diseases and symptoms and treatments such as the _Merck Manual_ I grew up with. It is, indeed, a book of statistics and symptom clusters--by which we really mean sets of moods and behaviors. I recall feeling as if, at any given moment, I could qualify for any number of these diagnoses, absent only a phrase such as  "clinically significant stress or impairment." So these diagnoses require a determination of clinical significance prior to being diagnosed, unlike a cold, which is still a cold regardless of whether it keeps you in bed.   

These days, we see more and more diagnoses, both of psychological ills and medical ones. Too many school children are taking one or more psychiatric drugs. Too many adults are, as well. But too many adults and children are also taking drugs for medical conditions. This would not be a such problem except for diagnosis creep. How many medical patients realize that what constitutes hypertension these days is not the same as what used to be hypertension? The criteria have gotten lower. The same goes for diabetes and high cholesterol. Results can also vary by doctor, as I discovered to my horror when a now-fired optometrist diagnosed me with macular degeneration and had me frantic that I was going blind. The specialist to whom  I went running said I had no such, but a small particle of what my grandmother would have called "schmutz" on my retina, that was unlikely to affect my vision soon if ever.  Diagnosis creep. Whether the reason is a surplus of caution on the part of a doc, a mistake, or a new set of rules from the AMA, more people have more diagnoses these days and it is NOT a good thing.

Is there a Pill for That?

I'll start by admitting something; medications scare me. Not all medications and not in all cases, but many. Perhaps this diminishes my credibility as a psychologist who fancies herself quite scientific, but there are reasons for my atypical stance. Allow me to state for the record that I am not a prescribing physician, and what follows is my opinion, which mostly consists of: "Buyer beware".

 In the years since I have been practicing psychology, I have seen a startling number of serious, damaging reactions to medications. In addition, I have also seen no small number of similarly bad reactions to street drugs. Years of observing and reading have thus led me to a very conservative stance regarding attempts to pharmaceutically solve health problems, both physical and psychological, as well as the ones sitting on the border thereof. Some examples follow, after which I'll provide some details about how I work with my clients in light of my observations.

Is Mental Illness a Myth?

Have I piqued your interest or accidentally insulted you? I did not make this question up. Thinkers and physicians for many years have wondered the same thing. Mental illness is confusing. It is not diagnosed as is physical illness via tests for microbes, probing for damaged or diseased tissue, nor compiling a list of objectively measurable symptoms. Mental illness is diagnosed via a system of symptom clusters published in one or another manual, the contents of which are agreed upon by scholars in the field. The problems arise when the contents of those manuals change over time, because mental issues are not clear-cut diseases as are physical illnesses. Things are added and subtracted over time--but we could not imagine a time when influenza would stop being called a disease!

Science tries, year after year, to isolate specific markers for mental illness. Tests come and go, but the construct remains elusive. We can objectively test for the flu or cancer or diabetes or a broken leg, but we cannot test in a way that never changes, for depression, schizophrenia, or anxiety. This does not mean that you are not suffering with your problem. It only means in this context, that your problem is mislabeled by being lumped in with physical illness. This is important for many reasons. I hope you are still with me as I elucidate why I, and others like me, believe calling mental problems "diseases" hurts those who suffer with them.

Exciting news: New Article Published

I had the pleasure of working with Irving Kirsch, PhD on an article for the American Journal of Clinical Hypnosis on a pet topic of mine-- why psychotherapy is superior to medication in the treatment of depression. Dr. Kirsch has been the author of many meta-analyses (taking the results of various research studies and combining them to increase the effect size and draw general conclusions)( The Emperor's New Drugs , Irving Kirsch: Deja Vu all Over Again , Listening to Prozac and Hearing Placebo).

The conclusion of these many studies continues to be that antidepressant medications involve a high risk of side effects with little potential for gain, while psychotherapy, including psychotherapy using clinical hypnosis, is safer and more effective. I enjoying being part of the following article and offer it for your edification:

Suggestion in the Treatment of Depression
Irving Kirsch, Carol B. Low
American Journal of Clinical Hypnosis
Vol. 55, Iss. 3, 2013 221-229.

Abstract

Meta-analyses consistently reveal that most of the response to antidepressant treatment can be obtained by placebo, and the difference between response to the drug and the response to any treatment is not clinically significant for most individuals diagnosed with major depressive disorder. Furthermore, the best predictor of antidepressant efficacy is the response to placebo during the so-called placebo run-in period. It can also be shown that a significant portion of the placebo effect is expectancy. These data thus indicate that suggestion is a central factor in treating depression. Therefore, the use of hypnosis, which is based on suggestion, as a treatment adjunct can be expected to enhance treatment outcome.

Happy New Year--we can help you enhance your mood: call 630-249-9183 or write Dr. Low today.