Posted by Larry Hoover on December 2, 2004, at 8:31:05
In reply to Re: The artificial nature of psychiatric diagnosis, posted by ed_uk on December 2, 2004, at 6:55:09
> A diagnosis of MDD tells us very little. It should not be regarded as an explanation for a persons distress. It does not tell us the cause, it does not tell us which treatment would be best, it does not take a persons psychosocial circumstances into account, nor does it describe the nature of any biological abnormailty which may or may not be present.
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> In clinical practice, a simple list of a persons problems/symptoms would be more useful and more truthful than a DSM diagnosis. So many times I hear people say things like 'Now I've been diagnosed with major depression I know what my problem is, my doctor says I've got a chemical imbalance'. Well, such a patient may have a chemical imbalance but her doctor certainly doesn't know whether that is the case. Synaptic levels of monoamines are not measured in a psychiatric consultation. In is important that psychiatric theory is recognised as thoery, and not misleadingly presented as fact.
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> Regards,
> Ed.I've made similar points many times. MDD is a symptom cluster, not a disease. What brought this symptom cluster to the fore in patient A may be totally unrelated to the causes in patient B, whether on a symptom by symptom comparison, or as a whole.
Where it really falls apart, IMHO, is in attempts to match treatment to diagnosis, rather that by symptoms. A subject ought not to be treated because of a diagnosis of MDD, but because of specific presenting symptoms.
In drug trials for e.g. an antidepressant used against MDD, there is no evidence to suggest that the subjects even are suffering from the same underlying problem. It is similar, but responders and non-responders may be distinguished, perhaps, not by diagnosis itself, but instead, by underlying physiological disturbance.
If you collected together a group of cars that won't start, and came at them with battery booster cables, perhaps some would have an excellent response to that treatment, and off they go. Others, though, e.g. those which are out of fuel, will not have a similar response. The failing in this "experiment" is by inappropriately collecting together cars with dissimilar deficiencies under an overly broad "diagnosis". I believe we have a similar problem in mental health. Too many people who are out of gas getting booster cables.
Lar
poster:Larry Hoover
thread:422741
URL: http://www.dr-bob.org/babble/20041201/msgs/423286.html