Posted by noa on March 7, 2004, at 19:47:40
In reply to Re: ???s about Borderline dx, posted by gardenergirl on March 7, 2004, at 13:43:10
My philosophy has come to be that diagnoses are not real things in and of themselves. They are man-made constructs to help organize symptoms into clusters to try to make sense of them in order to provide treatment.
Sometimes, new biological research comes along to support the idea that there is an underlying biological basis for validating one construct or another. But I think for the most part, the psychiatric diagnoses are all still waiting on that.
Take for example whether my depressive illness is unipolar or in the bipolar family. Who knows? At one point, my previous pdoc hypothesized that it might be, I think in part to explain the recurrences, but also in part to point to a new strategy to try---augmenting with lithium. But at the same time, he also said that lithium could help with depressive symptoms whether I had bipolar II or not. So in the end what difference did it make for me how to conceptualize my diagnosis? Most of psychopharm is trial and error anyway!
And therapy? I think they did studies that show that different kinds of therapy are actually more alike than different and that the healing aspects of therapy were those that are shared across the methods.
But sometimes I guess having a diagnosis could lead to a particular approach to treatment and that is when the diagnosis is the most relevant and useful.
Some of these diagnoses are based on concepts organized at an earlier time in the history of psychiatry, and therefore influenced by one school of thought or another, and that needs to be taken into consideration, as well.
OK, so all these different people, a rather diverse group, are clustered together because they share some symptoms. Perhaps this is a valid way to group them, perhaps not.
The biggest question for me is whether grouping them this way is helpful. Is the particular diagnosis helpful? Will it lead to a treatment plan that will work to help the person with their symptoms and problems?
Otherwise, diagnoses are rather useless at best, and can be used harmfully, as you related to us from your experience.
Some people find comfort in having a diagnosis and they feel better understood. But others feel shamed by it. So I say, if it helps, it is useful. If not, it is just an idea dreamed up by a bunch of psychiatrists sitting around a conference table decades ago. That is all it is. There is no evidence that conceptualizing things in this way is biologically valid.
I think sometimes MH people like to use the Borderline dx when they are working with challenging patients--it helps them distance themselves from the patients and helps them explain away their anxiety about being challenged.
But other times, it seems from what I've read here, the dx can be used with genuine care and professionalism, and with empathy for the patient's diagnosis.
If it is used as a weapon, obviously it isn't useful. If it helps someone feel understood and hopeful about finding relief--then to me, it is a valid and useful diagnosis.
BTW, there are some researchers who see BPD as falling into the bipolar spectrum, with rapid cycling explaining some of the emotional ups and downs. And some see hormones as a factor, too.
poster:noa
thread:321635
URL: http://www.dr-bob.org/babble/psycho/20040303/msgs/321768.html