premature diagnostic problems

Premature Diagnostic... problems.

Sexual references henceforth.

Been a bit frantic here lately, Sarah is across the Nullabor and I and

the niece (who in this blog wants to go under the name of Ginger, I

kid you not), have been slaves of the cats.

However, I have been reading, in my spare time between talking to

heroin addicts and giving presentations on urine testing, about

borderline personality disorder (BPD). Borderline and bipolar

disorder, and where one relates to the other, and so on.

Bipolar, by the way, is BPAD, or bipolar affective disorder. Seasonal

affective disorder, where you get deeply depressed at certain times of

the year, is appropriately known as SAD. I think the DSM III used to

have a class of major affective disorders (bipolar, unipolar, etc.)

that rejoiced in the acronym MAD.

If you are an amateur when it comes to psychiatry (and I definitely

am) the DSM IV is a dangerous book. You can, if you are not careful,

end up using it as a "spotters guide to the mental illnesses". You see

someone and you check if they have five of the following symptoms from

this list, if the symptoms have been there for more than the minimum

required time and so on ... and pretty soon you can announce "Aha.

This person has Insert Disorder Here. Take these tablets. My work is

done."

I don't know if Premature Diagnostic Ejaculation is a recognised

psychiatric disorder, but it should be. You see it happen all the time

with interns in the ED. The hassled junior doctor goes into the room,

gets straight into it, squicks out a diagnosis after a few minutes and

leaves, satisfied, probably wrong and utterly unaware that this has

not been a mutually satisfying experience.

Obviously that's a simplification, and completely unlike most people's

experience of presenting to a doctor with mental distress, but it's

not entirely untrue. Medicine is an applied science, it works via

quantities and measurable things, and it works best if it is given

discrete, anatomized subjects to deal with. This person fits the

diagnostic criteria of such and such, the evidence suggests we treat

that with so and so, move on. It's easy, especially when the clinician

is pushed for time, or has to get the patient out of there quickly, or

never really feel comfortable with psych patients, to slip into

flowcharts, protocols, either-or judgements.

I should point out that even doctors know that every person is an

individual, and thus every brain and mind and mental illness is an

individual. But technology isn't about what is true, it's about what

works. Every cow is an individual, too, but the meat processor still

works. And so do mood stabilizers, and anti-psychotics, and (to a

lesser extent) anti-depressants.

But I can't helpo feeing that that is a problem with the use of the

DSM IV. It's meant to be a tool so that when doctor A says "this guy

has schizophrenia", then Dr B knows what she's talking about. But the

truth is that there is no rigid, crystalline barrier between normal

and abnormal, healthy and unwell, and that most people move back and

forth and in and out of the diagnostic criteria with little regard for

the intellectual convenience of the junior doctor.

Anyway, seeking to keep these brief and relatively more frequent. Next

post is actually about borderline personality disorder, and how it

affects someone close to you.

Thanks for listening,