4 ms·

DanBC is talking about the diagnosis of addiction (or indeed most mental illnesses), not diagnosing any disease. For example, a patient would likely not be dia

by eivarv 11y ago

DanBC is talking about the diagnosis of addiction (or indeed most mental illnesses), not diagnosing any disease. For example, a patient would likely not be diagnosed with an anxiety disorder if symptoms did not have a marked effect on their day to day living. This means that the disease model can not be said to be a tool used to enforce normative cognition or behavior, but a model to help decrease suffering.

wpietri 11y ago
Could you perhaps point me to a link? When I look at Generalized Anxiety Disorder, I don't see that one: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#DSM-5_criteria https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#D... "Excessive" is normative, there. And Oppositional Defiant Disorder seems quite clearly designed to enforce normal behavior: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder https://en.wikipedia.org/wiki/Oppositional_defiant_disorder And there are scads of articles critical of the way ADD is treated in the US, and specifically critical of how the diagnosis and medication are used to create classroom compliance. A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.
- eivarv 11y ago
  That's the problem with attempting to use Wikipedia as an authoritative expert source: it's not, and it's not what it attempts to be. The part about marked effect on the life of a would-be patient would not be explicitly stated amongst DSM diagnostic criteria, as it is not a symptom of the illness in question, but rather something most mental illnesses have in common (i.e. a large part of the reason for viewing mental disorders as illnesses). However, the second sentence in the Wikipedia page on GAD (to which you linked) starts "This excessive worry often interferes with daily functioning". Seeing "excessive" used in the context of the listed symptoms (DSM-5, your link), I'm hard pressed to view this as any sort of attempt to cull diversity. As it is rather late in my timezone, I'm not going to go trawling for definitions, but if you're interested in reading more I can recommend NAMI, NIMH, the Mayo Clinic, etc. as good starting points. As this isn't my area of expertise, I'm in no position to argue the specifics of ODD, but it has always been somewhat controversial [1], and particularly around the release of DSM-5, IIRC. But even if the whole world were to agree that ODD was poorly defined, or pehaps even concede that it was "designed to enforce normal behavior", it would not really say anything at all about neither the disease model, nor the field in its entirety. Regarding ADD, the major controversy seems to be about possible overdiagnosis, and to some extent about relying too much on medications as opposed to therapy, AFAIK. I think there are several legitimate issues here, some of which are likely specific to culture, some to specific socio-economic contexts, others perhaps to the handling of ADD at large. [0]: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder https://en.wikipedia.org/wiki/Generalized_anxiety_disorder [1]: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#History https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#...
  - wpietri 11y ago
    I'm not saying it's an attempt to cull diversity. I'm saying that when the disease model is all you have, it's easy to say, "there is a difference we don't like, therefore it must be a disease". I think we both agree it happens, though.
- DanBC 11y ago
  Here's the DSM 4 criteria for GAD: http://behavenet.com/node/21591 http://behavenet.com/node/21591 > E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. I get what you're saying. We used to lock people up for many years just because they had an abortion at 17 and liked wearing yellow tights. But "Does this interfere with your day to day life? What do you want to change?" is an important part of diagnosis. I think the problem I have with what you're saying is that I see, very often, people (mis)using psychiatric language to describe behaviour they don't like in other people. Asshole boss? Sociopath. Asshole employee? Asperger's. Asshole with a gun? Psychopath. (Or, worse, psychotic.) > A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there. Over-diagnosis is probably a problem, especially in the US. I don't know how diagnosis works over there. Over here it's probably too hard to get a diagnosis. But I'd be interested to know what a statistician would say about a class of pupils who were all on medication. We'd expect some clumpiness. And unless you know that 10% is evenly distributed (is there any reason to believe it is) you'd expect even more clumpiness.
  - wpietri 11y ago
    I think we broadly agree. What I'm pointing at is that the GAD criteria, as with the criteria for many diseases, is not, "Hey patient, is this a problem for you?" It's a judgment by the clinician over whether the impairment is significant. That's generally fine with wise clinical judgment and clear signals of illness. (E.g., there's little dispute over whether a broken leg is a problem.) But I think there are issues when things are only a problem for other people, or only a problem because other people are different. There I think applying the disease model can be mixed, both helpful (when it allows addicts to get the support they need) and harmful (when different people are treated as broken). See, for example, the literature on medicalization of deviance: https://scholar.google.com/scholar?q=deviance+and+medicalization https://scholar.google.com/scholar?q=deviance+and+medicaliza... This is especially problematic in the US because medicalization is not just socially convenient, but frequently profitable. I also agree that people casually using diagnostic language is a problem. Indeed, I think it's closely related to the problem that concerns me, where people take traits that are helpful in some contexts and harmful in others and declare them to be diseases.
wpietri 11y ago
Regarding addiction, it would seem to me pretty obvious that it can be diagnosed even when the person doesn't admit that it affects their day to day living. I've met homeless drunks who swear to me that they don't have a problem with alcohol, and denial is a large part of addiction. And then there's the category of high-functioning alcoholics [1], where even outside observers can say it doesn't affect their day to day living. [1] https://en.wikipedia.org/wiki/High-functioning_alcoholic https://en.wikipedia.org/wiki/High-functioning_alcoholic
- eivarv 11y ago
  As I'm sure you realize, what is admitted, what is observed and what truly is are not necessarily the same.
  - wpietri 11y ago
    Sure, which is my point. DanBC is claiming that the person with the nominal disease is the source of deciding whether it affects day-to-day life. I'm saying that's not the case. Other people get to decide whether it's a disease based on what's normal to them. An example others brought up was that homosexuality was defined as a mental illness for many years. That's the same dynamic I'm pointing at.
    - eivarv 11y ago
      That's not the case, though. Clients are typically asked to assess to what extent the perceived symptoms affects their day-to-day life, any changes, etc., in addition to conferring with friends/family for their point of view on this. These are considered in addition to an absolute deviance from the "average spectrum" and diagnostic criteria. I don't really think the pathologization of homosexuality is comparable to modern issues, as the reasons for this were very much informed by its historical context (its history as an immoral concept in christian/western culture, the state of psychology and psychiatry as fields at the time vs. now, etc.) in a way modern diagnoses aren't. Also, according to Wikipedia [0], APA members were critical to homosexuality as a disorder at least from its inclusion in the first DSM. [0]: https://en.wikipedia.org/wiki/Homosexuality#Psychology https://en.wikipedia.org/wiki/Homosexuality#Psychology

by eivarv 11y ago

wpietri 11y ago

Could you perhaps point me to a link? When I look at Generalized Anxiety Disorder, I don't see that one: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#DSM-5_criteria https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#D... "Excessive" is normative, there. And Oppositional Defiant Disorder seems quite clearly designed to enforce normal behavior: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder https://en.wikipedia.org/wiki/Oppositional_defiant_disorder And there are scads of articles critical of the way ADD is treated in the US, and specifically critical of how the diagnosis and medication are used to create classroom compliance. A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.

eivarv 11y ago
That's the problem with attempting to use Wikipedia as an authoritative expert source: it's not, and it's not what it attempts to be. The part about marked effect on the life of a would-be patient would not be explicitly stated amongst DSM diagnostic criteria, as it is not a symptom of the illness in question, but rather something most mental illnesses have in common (i.e. a large part of the reason for viewing mental disorders as illnesses). However, the second sentence in the Wikipedia page on GAD (to which you linked) starts "This excessive worry often interferes with daily functioning". Seeing "excessive" used in the context of the listed symptoms (DSM-5, your link), I'm hard pressed to view this as any sort of attempt to cull diversity. As it is rather late in my timezone, I'm not going to go trawling for definitions, but if you're interested in reading more I can recommend NAMI, NIMH, the Mayo Clinic, etc. as good starting points. As this isn't my area of expertise, I'm in no position to argue the specifics of ODD, but it has always been somewhat controversial [1], and particularly around the release of DSM-5, IIRC. But even if the whole world were to agree that ODD was poorly defined, or pehaps even concede that it was "designed to enforce normal behavior", it would not really say anything at all about neither the disease model, nor the field in its entirety. Regarding ADD, the major controversy seems to be about possible overdiagnosis, and to some extent about relying too much on medications as opposed to therapy, AFAIK. I think there are several legitimate issues here, some of which are likely specific to culture, some to specific socio-economic contexts, others perhaps to the handling of ADD at large. [0]: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder https://en.wikipedia.org/wiki/Generalized_anxiety_disorder [1]: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#History https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#...
- wpietri 11y ago
  I'm not saying it's an attempt to cull diversity. I'm saying that when the disease model is all you have, it's easy to say, "there is a difference we don't like, therefore it must be a disease". I think we both agree it happens, though.
DanBC 11y ago
Here's the DSM 4 criteria for GAD: http://behavenet.com/node/21591 http://behavenet.com/node/21591 > E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. I get what you're saying. We used to lock people up for many years just because they had an abortion at 17 and liked wearing yellow tights. But "Does this interfere with your day to day life? What do you want to change?" is an important part of diagnosis. I think the problem I have with what you're saying is that I see, very often, people (mis)using psychiatric language to describe behaviour they don't like in other people. Asshole boss? Sociopath. Asshole employee? Asperger's. Asshole with a gun? Psychopath. (Or, worse, psychotic.) > A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there. Over-diagnosis is probably a problem, especially in the US. I don't know how diagnosis works over there. Over here it's probably too hard to get a diagnosis. But I'd be interested to know what a statistician would say about a class of pupils who were all on medication. We'd expect some clumpiness. And unless you know that 10% is evenly distributed (is there any reason to believe it is) you'd expect even more clumpiness.
- wpietri 11y ago
  I think we broadly agree. What I'm pointing at is that the GAD criteria, as with the criteria for many diseases, is not, "Hey patient, is this a problem for you?" It's a judgment by the clinician over whether the impairment is significant. That's generally fine with wise clinical judgment and clear signals of illness. (E.g., there's little dispute over whether a broken leg is a problem.) But I think there are issues when things are only a problem for other people, or only a problem because other people are different. There I think applying the disease model can be mixed, both helpful (when it allows addicts to get the support they need) and harmful (when different people are treated as broken). See, for example, the literature on medicalization of deviance: https://scholar.google.com/scholar?q=deviance+and+medicalization https://scholar.google.com/scholar?q=deviance+and+medicaliza... This is especially problematic in the US because medicalization is not just socially convenient, but frequently profitable. I also agree that people casually using diagnostic language is a problem. Indeed, I think it's closely related to the problem that concerns me, where people take traits that are helpful in some contexts and harmful in others and declare them to be diseases.

wpietri 11y ago

Regarding addiction, it would seem to me pretty obvious that it can be diagnosed even when the person doesn't admit that it affects their day to day living. I've met homeless drunks who swear to me that they don't have a problem with alcohol, and denial is a large part of addiction. And then there's the category of high-functioning alcoholics [1], where even outside observers can say it doesn't affect their day to day living. [1] https://en.wikipedia.org/wiki/High-functioning_alcoholic https://en.wikipedia.org/wiki/High-functioning_alcoholic

eivarv 11y ago
As I'm sure you realize, what is admitted, what is observed and what truly is are not necessarily the same.
- wpietri 11y ago
  Sure, which is my point. DanBC is claiming that the person with the nominal disease is the source of deciding whether it affects day-to-day life. I'm saying that's not the case. Other people get to decide whether it's a disease based on what's normal to them. An example others brought up was that homosexuality was defined as a mental illness for many years. That's the same dynamic I'm pointing at.
  - eivarv 11y ago
    That's not the case, though. Clients are typically asked to assess to what extent the perceived symptoms affects their day-to-day life, any changes, etc., in addition to conferring with friends/family for their point of view on this. These are considered in addition to an absolute deviance from the "average spectrum" and diagnostic criteria. I don't really think the pathologization of homosexuality is comparable to modern issues, as the reasons for this were very much informed by its historical context (its history as an immoral concept in christian/western culture, the state of psychology and psychiatry as fields at the time vs. now, etc.) in a way modern diagnoses aren't. Also, according to Wikipedia [0], APA members were critical to homosexuality as a disorder at least from its inclusion in the first DSM. [0]: https://en.wikipedia.org/wiki/Homosexuality#Psychology https://en.wikipedia.org/wiki/Homosexuality#Psychology