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I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is he

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

rrsp 1y ago
Why does psychiatry need to have an ‘equivalent’ of a sprained ankle? Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first hand in patients I see.
- jychang 1y ago
  That sounds like not the psychologist’s fault. Don’t blame the doctor if their patient makes a sprained ankle their identity. If someone smokes a lot of cigarettes and gets lung cancer, we don’t blame the doctor for the lung cancer. This shit is the patient’s responsibility.
- gmokki 1y ago
  If there is no sprained ankle diagnostics and doctors just tell you to ignore not being well: just jump and run around as normal there is nothing seriously wrong. And doctors only react when you can no longer use your legs for a year, otherwise they must be amputated. Or would you rather have an earlier disgnostic with instructions to reduce extreme loads and try to take it easy. Let's check again in a week.
pyuser583 1y ago
> What’s the psychiatric equivalent of a sprained ankle? Not sleeping a night.
deleted 1y ago
[deleted]
bjornsing 1y ago
I think it will be hard to expand psychiatry to that level while keeping it professional. The fundamental issue is that people ascribe personality flaws to others instinctually and also have strong feelings around being subjected to such treatment, in a way that they don’t have around sprained ankles. In everyday life it’s called badmouthing or trash-talking. It’s a part of human nature.
Retric 1y ago
> What’s the psychiatric equivalent of a sprained ankle? A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.
- sedivy94 1y ago
  What’s the right word to differentiate this from a psychiatric diagnosis? Neurological?
  - zeckalpha 1y ago
    Not in my understanding. The line between neurological and psychiatric is more about history than about anatomy. Instead, I would point to the physical trauma of a concussion as the differentiating factor.
    - Retric 1y ago
      There’s underlying physical causes for psychiatric conditions including in some cases physical trauma.
ssivark 1y ago
Doesn't that presume that human psychology (cognitive functioning) is uniform at a level that would obviate the need even for personalities and styles? Our physiological system does have that uniformity across the population but our psychological system does not seem to. Isn't it then misguided to try characterizing small deviations when we don't even have a uniform "background" to subtract?
- Retric 1y ago
  I think you’re overlooking the difference between diversity and changes to an individual. Some people can’t get stranded ankles because they don’t have legs, so you don’t necessarily need a universal baseline across all of humanity when diagnosing conditions. Someone who is still within normal ranges but significantly doing worse than they where can quite reasonably seek treatment.
suggestion 1y ago
There isn't one because a sprained ankle is a binary diagnosis. One of the biggest problems with psychiatry is that every diagnosis is a spectrum, and over time it's become more and more obvious that the boundaries for what is considered "neurotypical" are way too narrow. Depression being a chemical imbalance was a complete lie to sell more medication, and how prolific this type of occurrence is within the industry is not hard to see. At the very least, a plurality of phycological diagnoses are manifestations of physical behavior: diet, exercise, exposure to sunlight, etc We're so overprescribed on medications to try to feel a certain way within far too narrow of a spectrum. Why do you presume that there has to be an equivalent to a sprained ankle? Maybe the answer to your question is yes, only the catastrophic is worth addressing. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030318 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
- KPGv2 1y ago
  > only the catastrophic is worth addressing This is a very privileged view of the mind. I have ADHD (and autism). But I also have a quite high IQ, if one cares about such things. I'm pretty successful, professionally. But it took until around 40yo to get the ADHD diagnosis and get a prescription for medication that has been life-altering. Was I suffering from catastrophic failures? Absolutely not: married, have kids, in the 1%, etc. But have the meds had an incredibly positive influence on my life? Hell yes. I can do things that everyone else acted like was normal, but I straight up couldn't do it before. Housework is a prime example. It was like torture. Sitting around waiting for people to finish their sentences because they're "talking as slow as molasses" made for often unenjoyable social experiences. But with the meds, this stuff is either tolerable or fun. My life is significantly better thanks to medical interventions. Instead of my wife blowing up because I didn't do something like mop the kitchen floor, I actually get it done (without meds I straight up cannot hold that kind of task in my mind if I'm not in the room looking at the mess; I will flit between ten other things in a different part of the house, then walk through the kitchen to get into my car to pick up the kids, see the kitchen, and think "ah, fuck me") I'm happy that you're neurotypical and have a great life, but that's not true for a lot of us, and the idea that "only catastrophic mental issues should be dealt with by professionals" is you just telling on yourself and your ignorances.

rrsp 1y ago

Why does psychiatry need to have an ‘equivalent’ of a sprained ankle? Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first hand in patients I see.

jychang 1y ago
That sounds like not the psychologist’s fault. Don’t blame the doctor if their patient makes a sprained ankle their identity. If someone smokes a lot of cigarettes and gets lung cancer, we don’t blame the doctor for the lung cancer. This shit is the patient’s responsibility.
gmokki 1y ago
If there is no sprained ankle diagnostics and doctors just tell you to ignore not being well: just jump and run around as normal there is nothing seriously wrong. And doctors only react when you can no longer use your legs for a year, otherwise they must be amputated. Or would you rather have an earlier disgnostic with instructions to reduce extreme loads and try to take it easy. Let's check again in a week.

pyuser583 1y ago

> What’s the psychiatric equivalent of a sprained ankle? Not sleeping a night.

deleted 1y ago

[deleted]

bjornsing 1y ago

I think it will be hard to expand psychiatry to that level while keeping it professional. The fundamental issue is that people ascribe personality flaws to others instinctually and also have strong feelings around being subjected to such treatment, in a way that they don’t have around sprained ankles. In everyday life it’s called badmouthing or trash-talking. It’s a part of human nature.

Retric 1y ago

> What’s the psychiatric equivalent of a sprained ankle? A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.

sedivy94 1y ago
What’s the right word to differentiate this from a psychiatric diagnosis? Neurological?
- zeckalpha 1y ago
  Not in my understanding. The line between neurological and psychiatric is more about history than about anatomy. Instead, I would point to the physical trauma of a concussion as the differentiating factor.
  - Retric 1y ago
    There’s underlying physical causes for psychiatric conditions including in some cases physical trauma.

ssivark 1y ago

Doesn't that presume that human psychology (cognitive functioning) is uniform at a level that would obviate the need even for personalities and styles? Our physiological system does have that uniformity across the population but our psychological system does not seem to. Isn't it then misguided to try characterizing small deviations when we don't even have a uniform "background" to subtract?

Retric 1y ago
I think you’re overlooking the difference between diversity and changes to an individual. Some people can’t get stranded ankles because they don’t have legs, so you don’t necessarily need a universal baseline across all of humanity when diagnosing conditions. Someone who is still within normal ranges but significantly doing worse than they where can quite reasonably seek treatment.

suggestion 1y ago

There isn't one because a sprained ankle is a binary diagnosis. One of the biggest problems with psychiatry is that every diagnosis is a spectrum, and over time it's become more and more obvious that the boundaries for what is considered "neurotypical" are way too narrow. Depression being a chemical imbalance was a complete lie to sell more medication, and how prolific this type of occurrence is within the industry is not hard to see. At the very least, a plurality of phycological diagnoses are manifestations of physical behavior: diet, exercise, exposure to sunlight, etc We're so overprescribed on medications to try to feel a certain way within far too narrow of a spectrum. Why do you presume that there has to be an equivalent to a sprained ankle? Maybe the answer to your question is yes, only the catastrophic is worth addressing. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030318 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

KPGv2 1y ago
> only the catastrophic is worth addressing This is a very privileged view of the mind. I have ADHD (and autism). But I also have a quite high IQ, if one cares about such things. I'm pretty successful, professionally. But it took until around 40yo to get the ADHD diagnosis and get a prescription for medication that has been life-altering. Was I suffering from catastrophic failures? Absolutely not: married, have kids, in the 1%, etc. But have the meds had an incredibly positive influence on my life? Hell yes. I can do things that everyone else acted like was normal, but I straight up couldn't do it before. Housework is a prime example. It was like torture. Sitting around waiting for people to finish their sentences because they're "talking as slow as molasses" made for often unenjoyable social experiences. But with the meds, this stuff is either tolerable or fun. My life is significantly better thanks to medical interventions. Instead of my wife blowing up because I didn't do something like mop the kitchen floor, I actually get it done (without meds I straight up cannot hold that kind of task in my mind if I'm not in the room looking at the mess; I will flit between ten other things in a different part of the house, then walk through the kitchen to get into my car to pick up the kids, see the kitchen, and think "ah, fuck me") I'm happy that you're neurotypical and have a great life, but that's not true for a lot of us, and the idea that "only catastrophic mental issues should be dealt with by professionals" is you just telling on yourself and your ignorances.