The Issue of Diagnosis
Jan. 6th, 2020 11:12 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ysabetwordsmithI spotted this today:
Why Do We Need A Diagnosis to See Mental Disorders As Real?
We don't. A mental problem is frequently obvious from the inside, though some people don't recognize or try to deny theirs. A diagnosis is needed to make other people see a mental problem as something they are obliged to address.
The issue with this is that it abdicates responsibility and compassion for bystanders, agency and trust for sufferers. If you have a problem, you don't matter. No matter how bad it is -- you could literally be dying of it, that happens a lot -- nothing will be done unless you can convince someone who matters that it's a problem and gain their permission to have it addressed. You don't matter; your problem doesn't matter; only the important people matter. If they say you don't have a problem, you will be treated as if you don't. If they say you have a problem, even if you are perfectly healthy, you will be treated as if you do. The facts are irrelevant; only the power matters.
Except that's all bullshit. Extremely few mental problems have a scientific diagnosis, the way a heart attack or an infection can be measured with objective tests. The vast majority of them are just descriptions of symptoms, many of which appear across multiple diagnoses, and the assessment of whether something is "bad enough" to "count" is highly subjective. It's all about convincing someone that your suffering is worthy of attention. If you belong to a disadvantaged group, the important people are unlikely to believe you or care even if you are indeed dying right in front of them. Conversely if they see an advantage to describing you as sick, they will do so regardless of the truth, no matter how obvious it is. This is an issue regarding prescription drugs in particular, since corporations wish to sell them. Sometimes they're useful, other times not, and they can be very destructive. People who want help can't get it; people who want to be left alone are dragged into "care" and forcibly violated in mind and body. The system is a mess.
Look at the things that have gone in and out of the diagnostic manuals over the decades. Homosexuality used to be considered a mental illness. Now grief is, if you dare to show it more than briefly. So. Much. Bullshit.
Mental problems are real. They can be illnesses or injuries. They can be small or large. They can be fixable or not. We need to understand them and deal with them, preferably when they are small and fixable, not leave them entirely up to experts who have a lot of conflicting interests and are minimally available anyhow. The current system is not serving people well. People made it; people can change it if they choose to do so. Or they can walk away and try some other solution instead.
In the UK and the US, lifetime prevalence rates are estimated to be roughly 1 in 6 and rising. What explains these rates and what ought we to do about them?
Basically, modern life is a shitty environment for human beings. Humans are social, but families are fragmenting and a more mobile population struggles to maintain meaningful ties. Most humans need stability, but job security is long gone and the social safety net is in ribbons. School is typically designed to meet the desires of powerful adults, not the developmental needs of children, which makes it harder to grow up at all. The planet is overheating with dire results, so everyone absolutely has concrete reasons for feeling existential dread. This is not a recipe for healthy, happy people. And "it is no great sign of health to be well adjusted to a profoundly sick society."
"The fact that we require people to be labeled with a disorder to be worthy of care is an indictment of our collective moral community"
No shit. If someone says they're hurting, don't blow them off. Do something about it. And don't be a dick while you're at it.
To stop the rising rates of mental disorders, don’t just ask what’s wrong with people who have one. Ask what’s wrong with our world and what we need to change about ourselves.
So let's get on that.
* Advocate for mental health access if you wish, but don't expect powerful people to respond readily. They benefit from the mess we have now, and they aren't paying attention to the drawbacks. Expect that you will have to do the work yourself.
* Make your environment as healthy as you can with the resources available to you. Connect with it. Build your resilience. Strengthen your support network. Take good care of yourself. These will help you weather the rough spots.
* A quiet room and/or a sunny window ease stress and lift spirits. You can establish these at home, at work, or any other space you control; and encourage people to make them elsewhere by pointing out the advantages or offering to help.
* When you encounter a problem:
- Identify your thoughts and feelings. Are you safe? Are you grieving? Are you looping?
- Search for possible causes.
- Brainstorm solutions.
- Try to solve it yourself.
If that doesn't work:
- Research more about the problem.
- Talk to friends or other confidants.
- Try some new solutions.
If you run out of ideas, consider whether expert help is available, affordable, and likely to be both safe and effective. Sometimes it's very useful, other times useless or downright harmful. If they refuse to help, which is common -- mental care is rarely available until problems get truly dire -- then try to find other people with similar complaints and help each other. For some things this may even be more effective, such as trying to live with a brain that works very differently than the usual. People with typical brains aren't very good at solving atypical challenges, but other atypical people have probably been there before and may know just what to do.
* Don't give up your agency. It's your body, your brain, your mind, your life; you can figure out how to cope with it one way or another.
* When someone else has a problem, listen and validate. That alone will put you ahead of most responses. Offer help, but don't pester. Even if you can't fix anything, which is sometimes true, you can still be there with them. Many support methods work for online friends too.
* Work to reduce violence at school and other places.
* Know emotional first aid. Have a self-soothing kit available for life's inevitable upsets. Promote emotional first aid for adults. This is every bit as necessary as having a physical first aid kit and knowing how to use it so a scratch doesn't cost you a finger.
* You may need to do emotional triage in an emergency.
* Be prepared to cope with stressful situations and emotional drop. Avoid compassion fatigue. Shit happens.
* Anyone can go nonverbal under enough stress, and there are ways to get through it.
* Know how to let go of things. Everyone needs to sometimes, especially shame.
If you don't like the way things are, change them. Reach out and make something happen. Humans are equipped with forebrains and thumbs for a reason. Use them.
Why Do We Need A Diagnosis to See Mental Disorders As Real?
We don't. A mental problem is frequently obvious from the inside, though some people don't recognize or try to deny theirs. A diagnosis is needed to make other people see a mental problem as something they are obliged to address.
The issue with this is that it abdicates responsibility and compassion for bystanders, agency and trust for sufferers. If you have a problem, you don't matter. No matter how bad it is -- you could literally be dying of it, that happens a lot -- nothing will be done unless you can convince someone who matters that it's a problem and gain their permission to have it addressed. You don't matter; your problem doesn't matter; only the important people matter. If they say you don't have a problem, you will be treated as if you don't. If they say you have a problem, even if you are perfectly healthy, you will be treated as if you do. The facts are irrelevant; only the power matters.
Except that's all bullshit. Extremely few mental problems have a scientific diagnosis, the way a heart attack or an infection can be measured with objective tests. The vast majority of them are just descriptions of symptoms, many of which appear across multiple diagnoses, and the assessment of whether something is "bad enough" to "count" is highly subjective. It's all about convincing someone that your suffering is worthy of attention. If you belong to a disadvantaged group, the important people are unlikely to believe you or care even if you are indeed dying right in front of them. Conversely if they see an advantage to describing you as sick, they will do so regardless of the truth, no matter how obvious it is. This is an issue regarding prescription drugs in particular, since corporations wish to sell them. Sometimes they're useful, other times not, and they can be very destructive. People who want help can't get it; people who want to be left alone are dragged into "care" and forcibly violated in mind and body. The system is a mess.
Look at the things that have gone in and out of the diagnostic manuals over the decades. Homosexuality used to be considered a mental illness. Now grief is, if you dare to show it more than briefly. So. Much. Bullshit.
Mental problems are real. They can be illnesses or injuries. They can be small or large. They can be fixable or not. We need to understand them and deal with them, preferably when they are small and fixable, not leave them entirely up to experts who have a lot of conflicting interests and are minimally available anyhow. The current system is not serving people well. People made it; people can change it if they choose to do so. Or they can walk away and try some other solution instead.
In the UK and the US, lifetime prevalence rates are estimated to be roughly 1 in 6 and rising. What explains these rates and what ought we to do about them?
Basically, modern life is a shitty environment for human beings. Humans are social, but families are fragmenting and a more mobile population struggles to maintain meaningful ties. Most humans need stability, but job security is long gone and the social safety net is in ribbons. School is typically designed to meet the desires of powerful adults, not the developmental needs of children, which makes it harder to grow up at all. The planet is overheating with dire results, so everyone absolutely has concrete reasons for feeling existential dread. This is not a recipe for healthy, happy people. And "it is no great sign of health to be well adjusted to a profoundly sick society."
"The fact that we require people to be labeled with a disorder to be worthy of care is an indictment of our collective moral community"
No shit. If someone says they're hurting, don't blow them off. Do something about it. And don't be a dick while you're at it.
To stop the rising rates of mental disorders, don’t just ask what’s wrong with people who have one. Ask what’s wrong with our world and what we need to change about ourselves.
So let's get on that.
* Advocate for mental health access if you wish, but don't expect powerful people to respond readily. They benefit from the mess we have now, and they aren't paying attention to the drawbacks. Expect that you will have to do the work yourself.
* Make your environment as healthy as you can with the resources available to you. Connect with it. Build your resilience. Strengthen your support network. Take good care of yourself. These will help you weather the rough spots.
* A quiet room and/or a sunny window ease stress and lift spirits. You can establish these at home, at work, or any other space you control; and encourage people to make them elsewhere by pointing out the advantages or offering to help.
* When you encounter a problem:
- Identify your thoughts and feelings. Are you safe? Are you grieving? Are you looping?
- Search for possible causes.
- Brainstorm solutions.
- Try to solve it yourself.
If that doesn't work:
- Research more about the problem.
- Talk to friends or other confidants.
- Try some new solutions.
If you run out of ideas, consider whether expert help is available, affordable, and likely to be both safe and effective. Sometimes it's very useful, other times useless or downright harmful. If they refuse to help, which is common -- mental care is rarely available until problems get truly dire -- then try to find other people with similar complaints and help each other. For some things this may even be more effective, such as trying to live with a brain that works very differently than the usual. People with typical brains aren't very good at solving atypical challenges, but other atypical people have probably been there before and may know just what to do.
* Don't give up your agency. It's your body, your brain, your mind, your life; you can figure out how to cope with it one way or another.
* When someone else has a problem, listen and validate. That alone will put you ahead of most responses. Offer help, but don't pester. Even if you can't fix anything, which is sometimes true, you can still be there with them. Many support methods work for online friends too.
* Work to reduce violence at school and other places.
* Know emotional first aid. Have a self-soothing kit available for life's inevitable upsets. Promote emotional first aid for adults. This is every bit as necessary as having a physical first aid kit and knowing how to use it so a scratch doesn't cost you a finger.
* You may need to do emotional triage in an emergency.
* Be prepared to cope with stressful situations and emotional drop. Avoid compassion fatigue. Shit happens.
* Anyone can go nonverbal under enough stress, and there are ways to get through it.
* Know how to let go of things. Everyone needs to sometimes, especially shame.
If you don't like the way things are, change them. Reach out and make something happen. Humans are equipped with forebrains and thumbs for a reason. Use them.
(no subject)
Date: 2020-01-07 02:18 pm (UTC)(no subject)
Date: 2020-01-07 02:28 pm (UTC)Go you!
Date: 2020-01-07 06:04 pm (UTC)However, it's also the sort of thing the article was talking about in terms of what we need to change in order to have a healthier society. People need access to care without a wealth filter, because right now, a lot of folks who want care can't get it.
Well ...
Date: 2020-01-07 05:58 pm (UTC)I just worry about the people who cannot get what they need because those who control the supply refuse to believe them, or because the price is unaffordable. I also worry about quid pro quo abuses, because a very common way that doctors molest people is to hold health care hostage to enduring sexual or other abuse.
(no subject)
Date: 2020-01-07 02:38 pm (UTC)This may also affect perception of pets: many Americans are very lonely and keep companion animals who are treated as surrogate children, to the great confusion of people from other cultures who are used to primarily working pets. That would seem odd to someone who grew up poor, but with a functional community (why spend so much to be friends with a hamster, when you can talk to a neighbo?).
Yes ...
Date: 2020-01-07 06:00 pm (UTC)(no subject)
Date: 2020-01-07 06:40 pm (UTC)And better a surrogate child pet than a badly treated pet or a badly looked after child. Not to mention those who can handle pets but not children, or can't have children. Companionship of an animal can be vital.
(no subject)
Date: 2020-01-07 02:56 pm (UTC)I tried for /years/ to get care only to be told basically that I "wasn't sick enough" since I wasn't actively suicidal but I was also too complex a case for most of the basic supports available to me (your local clergy person is a pretty good first stop for everyday stuff but they are not typically equipped to deal with the complex fallout of childhood abuse in an adult.)
Oh. And. "It's not real of it's not in the DSM".
So much of our care system is currently predicated on having a diagnosis that if what's ailing you isn't in the DSM, you're pretty much fucked. Especially if you also don't have insurance or another way to access care. And they keep slashing funding for what safety net systems there /are/ so that people who legitimately need care can't get it until they are basically dying.
*takes a deep breath*
Sorry, I have a bit of a soapbox about this.
(no subject)
Date: 2020-01-07 04:47 pm (UTC)People are also desperate for excuses for their behavior.
This leads to people latching on to mental illnesses and diagnosing themselves with conditions they don't have, muddying the waters and leading to people who actually suffer from, eg, depression, being disregarded because of all the fakers that people have more experience with.
Professionals see a lot of different people with and without the various problems and can tell the difference. Trying to follow the list of symptoms in the DSM is almost pointless without that experience.
Thoughts
Date: 2020-01-07 06:08 pm (UTC)Some are, some aren't.
>> People are also desperate for excuses for their behavior. <<
If they're having significant behavior problems, and trying to excuse it, then something is wrong somewhere. That may not fit any of the official frameworks in the handbook -- which is a problem a lot of people have. If you can't show the expert a problem he recognizes then he won't agree you have a problem, so you can't get any help.
>>Professionals see a lot of different people with and without the various problems and can tell the difference. Trying to follow the list of symptoms in the DSM is almost pointless without that experience.<<
This is sometimes true. But given how many people go from one doctor to another collecting scads of different diagnoses for the same complaint, I'm not highly convinced of the accuracy.
(no subject)
Date: 2020-01-07 06:37 pm (UTC)People who want help can't get it; people who want to be left alone are dragged into "care" and forcibly violated in mind and body. The system is a mess. I won't reblog those helpline posts you see on tumblr because most of those helplines will violate someone's agency by sending police to investigate a suspected suicidal person if they believe they can prevent a suicide; the Samaritans is the one always listed for the UK but Mind UK is never listed and that's the only mental health charity I really trust on this.
I'm enjoying your posts on the subject, like the one about acknowledging people are depressed for various reasons that can't be medicated (lack of feeling safe was an example). I think there's a long way to go on tackling mental health.
Thoughts
Date: 2020-01-07 06:49 pm (UTC)*bow, flourish* Happy to be of service.
>> It's something I think about it. The "you don't have x unless a dr says so" rubs me up the wrong way since as you point out there's no direct blood test for something like anxiety or depression, etc.<<
I feel that anyone should be able to walk in and say, "I have a problem with X and I need to reach improvement Y. What options can you offer me for accomplishing Y?" and get some help with Problem X. If X happens to fit a standard problem framework, great, there should be a standard list of solutions to match. But if not, they should at least have a menu of things that tend to help that symptom or symptoms, and perhaps in the process a more recognizable pattern will emerge. As it stands, the answer is prevailingly no diagnosis, no help.
Another problem is that doctors often lie about diagnostics to get help for patients who don't fit anything. They'll pick the "closest" match or something vague enough to cover everything, so the person can hopefully get something useful. That makes the scatter a lot worse.
>>I won't reblog those helpline posts you see on tumblr because most of those helplines will violate someone's agency by sending police to investigate a suspected suicidal person if they believe they can prevent a suicide<<
I agree. Sending police to handle health problems is abusive and dangerous at best, lethal at worst. Merging emergency services drives people away from calling an ambulance or fire truck because they know police will or might be sent. That runs up the rate of avoidable injuries and deaths from untreated problems. >_< It's also vicious to the poor cops who have little or no training in this area; it's not what they signed up for.
>>I'm enjoying your posts on the subject, like the one about acknowledging people are depressed for various reasons that can't be medicated (lack of feeling safe was an example).<<
Thanks.
>> I think there's a long way to go on tackling mental health.<<
Painfully true. I can't fix the system, but I can arm people with information, which may help.
(no subject)
Date: 2020-01-07 08:47 pm (UTC)The definition of symptoms she learned obviously interacted poorly with her CPTSD, since she was already predisposed to dismiss all of her feelings as not worthy of any attention, but nonetheless.
Yes ...
Date: 2020-01-07 09:03 pm (UTC)Alas! That is becoming more and more common. >_<
I am annoyed that modern medicine has contrived to un-know things that have been known basically as long as humanity was human, and are now teaching that ignorance to people and harming them with it.
>>The definition of symptoms she learned obviously interacted poorly with her CPTSD, since she was already predisposed to dismiss all of her feelings as not worthy of any attention, but nonetheless.<<
Yyyyyeah. Not good.
Grief is the price we pay for love, and all humans experience it. Grief hurts like fuck and can absolutely wreck your life for days or weeks. That is normal. It should be treated with self-care and community support in most cases.
Extreme grief in the immediate aftermath may need expert care if the person flailing in agony is doing things which could hurt themselves (like drinking to unconsciousness) or others (like operating heavy machinery while crying too hard to see straight).
The normal course of grieving can also be disrupted by complications. It is absolutely a good idea to teach people about complicated grief so they can get additional support as soon as they feel a need. They get stuck in it and usually can't get past it without help. However, it's difficult to distinguish normal from complicated grief early on, and the handbook makes it harder instead of easier. To distinguish: normal grief typically begins to break up or show progress after 1-3 months, but an average loss takes about a year to mourn, while losing a spouse takes 7-8 years and survivors of child loss say you never get over that one you just learn to live with the pain. Complicated grief either doesn't change over time, or actively gets worse.
Americans have crappy grief skills on average. This is a place where education and community support will usually help more than medical interventions, except for rare people thrown into crisis by a loss. And muddling those things can do a great deal of harm all around.