But as I have also written that I find much of this utter bullshit and the fact that mental health is so overlooked and often run by nut jobs themselves it makes this quest an almost impossible one to find the trees for the forest for what is legitimate medical and psychological research and information.
We clearly need a nationalized health code that includes mental health as a part of the program. The idea that medicating someone to garner compliance and ease of control is clearly not working. The medicine is only good if used appropriately and within reason. But we love drugs in this country especially the ones Doctors give us.
Understanding mental health is complex and time consuming and therefore costly. I find that few Therapists actually ask questions as that would require them to listen and then to listen is to actually have to ironically analyze and collaborate with you and others to determine the best course of action for what ails you. Regular Physicians are on the drive through program so how would therapy be much different. At the end of a day to make it work in the current economic climate a Therapist would have to see at least 10 patients a day. Ten people with ten different ailments, emotional or otherwise that may require the same commitment and time, I don't think so. So you get the one size fits all diagnosis. "Depression" "Anxiety" "Bipolar' or whatever hot new trendy disorder is on the Big Pharm lists and Voila! you will fit that quite nicely thankyouverymuch NEXT!
Below is an article that is discussing the current model of Psychoanalysis and what it means to have a "personality disorder." Frankly I could save time by saying if you aren't like your therapist in any way shape or form you will have something wrong. We tend to identify ourselves in relation to others and if you think Therapists are any different then you have a personality disorder! But also it falls under the nemesis of insurance. Whatever is covered by a plan the higher the likelihood that will be the disorder your medical "code" will fall under. At times you are simply diagnosed by codes that can ensure the highest premium return. Shocking, I know.
Not to utterly condemn the field as I think it has a purpose but like their brothers in the Medical Industrial Complex they are utterly adrift in bullshit frankly and after awhile bullshit smells. But they could always get a low paid home health care worker to clean it.
Thinking Clearly About Personality Disorders
Jonathon Rosen
By BENEDICT CAREY
For years they have lived as orphans and outliers, a colony of misfit
characters on their own island: the bizarre one and the needy one, the
untrusting and the crooked, the grandiose and the cowardly.
Their customs and rituals are as captivating as any tribe’s, and at
least as mystifying. Every mental anthropologist who has visited their
world seems to walk away with a different story, a new model to explain
those strange behaviors.
This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.
Personality disorders occupy a troublesome niche in psychiatry.
The 10 recognized syndromes are fairly well represented on the
self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.
But when full-blown, the disorders are difficult to characterize and
treat, and doctors seldom do careful evaluations, missing or downplaying
behavior patterns that underlie problems like depression and anxiety in millions of people.
The new proposal — part of the psychiatric association’s effort of many
years to update its influential diagnostic manual — is intended to
clarify these diagnoses and better integrate them into clinical
practice, to extend and improve treatment. But the effort has run into
so much opposition that it will probably be relegated to the back of the
manual, if it’s allowed in at all.
Dr. David J. Kupfer,
a professor of psychiatry at the University of Pittsburgh and chairman
of the task force updating the manual, would not speculate on which way
the vote might go: “All I can say is that personality disorders were one
of the first things we tackled, but that doesn’t make it the easiest.”
The entire exercise has forced psychiatrists
to confront one of the field’s most elementary, yet still unresolved,
questions: What, exactly, is a personality problem?
Habits of Thought
It wasn’t supposed to be this difficult.
Personality problems aren’t exactly new or hidden. They play out in
Greek mythology, from Narcissus to the sadistic Ares. They percolate
through biblical stories of madmen, compulsives and charismatics. They
are writ large across the 20th century, with its rogues’ gallery of
vainglorious, murderous dictators.
Yet it turns out that producing precise, lasting definitions of extreme
behavior patterns is exhausting work. It took more than a decade of
observing patients before the German psychiatrist Emil Kraepelin could
draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.
Likewise, Freud spent years formulating his theories on the origins of
neurotic syndromes. And Freudian analysts were largely the ones who, in
the early decades of the last century, described people with the sort of
“confounded identities” that are now considered personality disorders.
Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.
“These therapists saw people coming into treatment who looked well
put-together on the surface but on the couch became very disorganized,
very impaired,” said Mark F. Lenzenweger, a professor of psychology
at the State University of New York at Binghamton. “They had problems
that were neither psychotic nor neurotic. They represented something
else altogether.”
Several prototypes soon began to emerge. “A pedantic sense of order is
typical of the compulsive character,” wrote the Freudian analyst Wilhelm
Reich in his 1933 book, “Character Analysis,”
a groundbreaking text. “In both big and small things, he lives his life
according to a preconceived, irrevocable pattern.”
Others coalesced too, most recognizable as extreme forms of everyday
types: the narcissist, with his fragile, grandiose self-approval; the
dependent, with her smothering clinginess; the histrionic, always in the
thick of some drama, desperate to be the center of attention.
In the late 1970s, Ted Millon,
scientific director of the Institute for Advanced Studies in
Personology and Psychopathology, pulled together the bulk of the work on
personality disorders, most of it descriptive, and turned it into a set
of 10 standardized types for the American Psychiatric Association’s
third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.
These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder.
Borderline is characterized by an extreme neediness and urges to harm
oneself, often including thoughts of suicide. Many who seek help for
depression also turn out to have borderline patterns, making their mood
problems resistant to the usual therapies, like antidepressant drugs.
Today there are several approaches that can relieve borderline symptoms
and one that, in numerous studies, has reduced hospitalizations and
helped aid recovery: dialectical behavior therapy.
This progress notwithstanding, many in the field began to argue that the
diagnostic catalog needed a rewrite. For one thing, some of the
categories overlapped, and troubled people often got two or more
personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a
catchall label meaning little more than “this person has problems”
became the most common of the diagnoses.
It’s a murky area, and in recent years many therapists didn’t have the
time or training to evaluate personality on top of everything else. The
assessment interviews can last hours, and treatments for most of the
disorders involve longer-term, specialized talk therapy.
Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.
“The diagnoses simply weren’t being used very much, and there was a real
need to make the whole system much more accessible,” Dr. Lenzenweger
said.
Resisting Simplification
It was easier said than done.
The most central, memorable, and knowable element of any person — personality — still defies any consensus.
A team of experts appointed by the psychiatric association has worked
for more than five years to find some unifying system of diagnosis for
personality problems.
The panel proposed a system based in part on a failure to “develop a
coherent sense of self or identity.” Not good enough, some psychiatric
theorists said.
Later, the experts tied elements of the disorders to distortions in basic traits.
For example, the team’s final proposal for narcissistic personality
disorder involved rating a person on four traits, including
“manipulativeness,” “histrionism,” and “callousness.” The current
definition includes nine possible elements.
The proposed diagnostic system would be simpler, as well as “responsive
to the array of diverse and sometimes contradictory suggestions made by
other” personality disorders experts, wrote Dr. Andrew Skodol, a
psychiatrist at the University of Arizona and chairman of the group
proposing the new system, in a paper published last spring.
But since then the outcry against the proposed changes has only grown louder.
Some experts argued that throwing out existing definitions was premature
and reckless. Others insisted that the diagnoses could not be
simplified so much. And some complained that the effort to anchor the
disorders in traits had not gone far enough.
“You simply don’t have adequate coverage of personality disorders with just a few traits,” said Thomas Widiger, a professor of psychology at the University of Kentucky.
Dr. Widiger compares the process of reaching a consensus on personality
to the parable of the six blind men from Hindustan, each touching
different parts of the elephant. “Everyone’s working independently, and
each has their perspective, their own theory,” he said. “It’s a mess.”
“It’s embarrassing to see where we’re at. We’ve been caught up in
digression after digression, and nobody can agree,” Dr. Millon said.
“It’s time to go back to the beginning, to Darwin, and build a logical
structure based on universal principles of evolution.”
At least for now, then, the misfits will remain in their colony, part of
mainstream psychiatry but still in the back country.
And if a unified theory can be devised to explain them, most agree that
it will be some time in the making — perhaps requiring the efforts of an
obsessive-compulsive narcissist with some political skills.
No comments:
Post a Comment