Congratualtions Par!

So easy to be ranty.... sigh.

An interesting (but comprehensive) view is given in the stanford encyclopedia of philosophy. And yes, I do need a new hobby. I encourage any interested parties to refer to the original article, which is quite well written.

"many theorists have argued that our current diagnostic categories, as compiled into DSM-IV-T-R (American Psychiatric Association 2000), are faulty because they are derived from observable variables rather than underlying physical pathologies. These theorists are sceptical about many existing psychiatric diagnoses, and not just on empirical grounds; they see DSM diagnoses as collections of symptoms rather seeing them as medicine understands diseases—in terms of destructive processes realized in bodily tissues. Genuine mental illnesses, on this view, are not just sets of co-occurring symptoms but destructive processes taking place in biological systems......But we often know very little about the mental illnesses that psychiatrists study, and much explanation in psychiatry involves case studies or narrative accounts that cite the characteristics of a disorder, rather than underlying systems."

http://plato.stanford.edu/entries/psychiatry/

Which is to say that I agree with Par that mental illnesses are better described as syndromes (which don't presuppose a known underlying cause) than as diseases. While certain symptoms cluster together, we can't necessarily say why they do, or by what mechanism they occur. The backwards extrapolation from an effective treatment (ie. an antidepressant) to assuming the basic pathophysiology of a disease is troublesome and prone to logical error.

My last word on this subject.

And, many congratulations Dr. P. Welcome to the world of gainful employment.

Paras! Yeah!!!

Alison, I'm so out of the loop, I don't know who that is in the picture, please inform!

Al, you like big bots

that is all.

Or he would...

I hear he is quirky as hell in real life as he is on the show.

I have a comment in this medicine/psychology symptom/cause debate, but it keeps coming out ranty. ... so I'm holding off for now.

Instead, I have this.

Do you think he was edited in, or actually attending?
I can't picture him wearing the bow tie & tweed jacket of his own volition.

That's funny that the part Matt liked the most was the part I wanted to disagree with, if only slightly and from perhaps a different angle.

I think it's a little vague to describe all psychiatric diagnoses as symptoms rather than syndromes. For example, hallucinations are a symptom and, though we initially treat them with similar medications regardless of the cause, the constellation of symptoms around it leads us to elucidate a cause and helps us, ultimately, treat it.

Rather than saying that's unique to psychiatry, however, I'd suggest that's important in all of medicine. Dr., er, Riviera is right in that we ought to treat suffering, not diseases. It should not matter so much that your pain is caused by the inflammation of your appendix secondary to distention and ischemia; it doesn't change the fact that someone should try to alleviate your pain. At the same time, though, treating the cause of pain, if possible, is crucial as well.

I think medicine has built up this culture of diagnoses, and that has extended to society as a whole. People become attached to their diagnoses, because "pain" or "nausea" is a vague feeling, but a "herniated disc" or "irritable bowel syndrome" is a tangible thing you can attribute it to. I'd also suggest that's a bug, rather than a feature, and that there are too many implications for diagnoses beyond guiding best treatment -- a problem that's particularly apparent when it comes to mental illnesses.

In any case, I'm grateful to everyone's input about this. My experiences with mental health prior to going into medicine were minimal at best, so my opinion is based purely on the experience from the professional side of things. It's interesting to hear what other people think about on the same topic from their own experiences. My thanks to you all for that.

That show looks hilarious. Fred Armison (the guy) did one of my favourite characters ever on SNL, but I can't find a link I'm allowed to play in Canada sadly.

Dr. Nick, thanks for the awesome response. I love it when people who know stuff about stuff talk about that stuff! I think I liked this part the most:

"...there is no way for me to know what a 'true positive' actually is.

I believe that it is better to think of mental illnesses as being analagous to other symptoms like pain, as opposed to specific diagnoses like appendicitis."

I LOVE Portlandia! It's just the right combo of WTF and "there's no way these people are serious"

Enough sitting on the sidelines, especially with such a provocative topic.

What if I were to say, as one practicing in the field, that one of the major misconceptions of psychiatry is that we have 'diagnoses'? Depression, schizophrenia, bipolar disorder, etc. are behavioral syndromes assumed to have common, underlying pathophysiologies. Recent research suggests that there are a multitude of potential causes and contributing etiologies. Biological, psychological, social, and spiritual factors all contribute to the development and presentation of mental illness. What constitutes a mental illness is also related to societal and cultural norms (hysteria, anyone?). It therefore makes it hard to have a 'false positive' or 'false negative,' as there is no way for me to know what a 'true positive' actually is.

I believe that it is better to think of mental illnesses as being analagous to other symptoms like pain, as opposed to specific diagnoses like appendicitis. Psychiatric treatments are also symptom based, as opposed to being specific to a particular etiology. When I see a patient who tells me that they are 'depressed' that actually has little meaning for me until I can understand what their experience is, and how it limits their functioning and quality of life.

What constitutes 'bad psychiatry,' anyway? Most people would probably think that drugs with terrible side effects, or restricting people's freedoms is bad psychiatry. Many drugs used to treat rheumatologic conditions are quite toxic to other body systems, but they are considered good and appropriate treatments for arthritis or scleroderma. Acetaminophen can cause liver failure, ibuprofen can cause kidney damage.

I'd suggest that 'bad psychiatry' be defined as a lack of willingness to understand people and meet them in their suffering. I can offer a number of useful tools that may (or may not) be helpful for any particular patient, but it is in collaborating with them that I can figure out how I can be useful. And sometimes, there are things that I can't fix or undo.

Science will always continue to change and reinvent the way that we think of illness and disease. Humours, vapors, ether, phlogiston, fenestration, phlebotomy, leeching, and lobotomies were all cutting edge science at one point and taken as being unalterable truths. Antibiotics were going to eliminate infectious diseases, not create resistant 'superbugs'. Thalidomide would (and does) reduce nausea. It seems that science is always limited by hubris.

I doubt that all mental illness will ever be explained by neurochemistry, and even if it is, the experience of suffering, not a deficiency in serotonin, is what drives patients to seek help. That's why I do what I do.

I agree with Jess' point that people see their emotions and thoughts as somehow more intrinsic to themselves, and the fear that a psychiatrist can change that with drugs, electricity, or therapy, is a threat to their very identity in a way that losing a leg isn't.

BTW, Paras, when are you coming back?