Posted by pseudoname on July 2, 2006, at 16:39:33
In reply to Re: finding 4-P pdocs » pseudoname, posted by llrrrpp on July 2, 2006, at 13:10:31
Hiya, ll!
I guess I'm thinking of where I'd like to see psychiatry go over the next 100 years. I doubt that many of the diagnoses we are currently offered as unitary biological conditions actually exist that way. I suspect that depression, bipolar, schizophrenia are more varied than "infection" or "cancer".
I'm willing to concede that others better understand how useful the diagnoses are. Maybe I'm just talking out of my nose. But my impression is that they do not help in any situation more than considering the individual symptoms would AND (I think) they are more likely to be counterproductive.
> One other thing I think is that it's important to take clusters of symptoms into account.
Symptoms do cluster, but statistically in a population, not determinatively in an individual. If I have 5 out of 8 symptoms in a known cluster, I'm no more likely to get one specific remaining symptom than anyone else is. (Somebody please correct me if I misunderstand that.)
If I have some depressive symptoms but not others and anxiety about some social situations but not others, I don't think I'm in an identifiable subtype for treatment or physiology or prognosis. If not, what are we doing with these many clusters? Researchers can use them, but clinicians?
> For instance, anxiety in the presence of methamphetamine abuse should probably be treated differently than anxiety in the presence of Cushing's disease, depression, cancer, etc.
Yes; good point! But while symptoms don't occur in a vacuum, I don't think the DSM clusters or categories help at all in the treatment. The DSM just keeps expanding the classifications and subtypes to the point where it would as it approaches infinity have a category for every single situation. Ballooning toward a defacto symptomatic approach. Maybe I'm wrong.
I imagine a pdoc of a more desirable future saying, "We can remove your anxieties this way, but that may increase your cynicism that way; or we can reduce some anxieties this other way and leave room for improving your feelings of connection to others."
> I suggest this, especially since the current therapies do not (usually) target just one symptom. The drugs are dirty
Yeah, that's very true. I'm hoping things will change as the technologies get better. Then again, in the 1980s I thought we'd be there now. For now, I don't think the drugs target diagnostic clusters very well, either.
> I'm not sure if I interpreted you correctly when you suggest that "pdocery should always (?) target discrete symptoms..."
I guess I want pdocs to think more freely about the unique details of the individuals in front of them. I think that the DSM clusters and these overarching, vague diagnostic categories don't differentiate treatments any more than the symptoms considered individually would. Instead, current diagnoses produce LABELS that are more likely to mislead and obscure than understand and help the wild-type humans. ;-)
Just my bile, maybe. Thanks for dialogin'.
poster:pseudoname
thread:663492
URL: http://www.dr-bob.org/babble/20060701/msgs/663601.html