We're all mental these days

[Gob]

IN RADICAL changes to the way mental health conditions are diagnosed, what was once considered an unruly child's temper tantrum could soon be labelled ''disruptive mood dysregulation disorder''.

If a widow's grief lasts longer than a fortnight then she might be diagnosed with ''major depressive disorder''. When the mother in a bitter custody battle tries to turn a child against the father, it might create ''parental alienation disorder''.

These are among new conditions proposed for the fifth edition of the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is due to be finalised next year.

The proposed changes have caused an international outcry. The Association for Psychological Science, the American Counselling Association, the British Psychological Society and leading psychiatrists are calling for the draft of the new edition to be subject to independent scientific review.

They fear it is so inclusive it risks mislabelling millions of healthy people as mentally ill, potentially leading to increased stigma and medication.

Doctors in Australia are also concerned, some arguing the revised manual - which has been produced by the American Psychiatric Association since 1952 and is used globally by psychiatrists and psychologists to diagnose mental disorders - is turning unhappiness into a disease.

''It's such a narrow and limited view of human experience to want to reduce every bit of suffering to medical diagnosis,'' University of Adelaide psychiatry professor Jon Jureidini said.

''Whenever you promote a new mental illness or a new medical way of understanding people's suffering, the impact of that is almost always going to be increased prescribing.''

The controversy over the new manual reflects division within the mental health community over a global rise in the use of drugs such as antidepressants, stimulants and antipsychotics.

The inclusion of conditions such as attention deficit hyperactivity disorder and autism in previous editions of the manual is believed to have contributed to increased prescribing.

The changes in the new manual would mean children only have to display six of 13 possible symptoms for a diagnosis of ADHD, compared with six out of nine in the previous manual.

New ADHD symptoms that have been added to the manual include acting without thinking, being often impatient, being uncomfortable doing things slowly and systematically, and finding it difficult to resist temptation.

Under the new edition's criteria, the diagnosis threshold for some existing disorders is also being lowered so that grief over the death of a loved one can qualify as a major depressive illness.

However, the authors have defended the move, saying the previous criteria potentially prevent people who need treatment from receiving help.

''A broad range of evidence … shows that there are little to no systematic differences between individuals who develop a major depression in response to bereavement and in response to other severe stressors, such as being physically assaulted and raped,'' Kenneth Kendler, a member of the DSM-5 mood disorders group, said in a statement.

Read more: http://www.smh.com.au/national/health/d ... z1fWllfUzu

[Lord Jim]

I've said it before, and I'll say it again...

There is a school of "thought" within the mental health industry that is hell bent to try and figure out someway to have "being a little boy" categorized as a mental condition....

[dales]

The DSM is written for ins. companies to aid them in paying out premiums.

It is also a good starting point for a therapist to work with until s/he gets more familiar with the patient's symptoms.

[Sean]

It's amazing how many disorders I had as a kid. Of course back then they came under a single heading... Acting the twat!

[Gob]

What you mean "back then"?

[Daisy]

New ADHD symptoms that have been added to the manual include acting without thinking, being often impatient, being uncomfortable doing things slowly and systematically, and finding it difficult to resist temptation

Isn't this just called being a child?

[Scooter]

I would have said it's called being human.

[Gob]

A constant bugbear of ours in my team is the parents who think now that, now their kid is on anti-psychotic medication, they suddenly should become a little angel.

I've had them phone up and ask for meds to be increased as; "She's leaving her clothes on the bedroom floor," and "He doesn't want to get up to go to school in the mornings", usually followed by, "what are you going to do about it?"

I've developed a polite routine about; "not wanting to interfere in normal family life, and leaving the parents to parent." They don't accept it though.

[Andrew D]

The article seems rather hyperbolic about the actual proposals. "If a widow's grief lasts longer than a fortnight then she might be diagnosed with 'major depressive disorder'." Well, she might be diagnosed with "Major Depressive Disorder, Single Episode". In which case, she would be offered a brief course of medical treatment.

But she would have to be having a "Major Depressive Episode":

A. Five (or more) of the following criteria have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gain

4. Insomnia or hypersomnia nearly every day

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (Language regarding “impairment” may change for consistency with DSM-IV conventions)

C. The episode is not due to the direct physiological effects of a substance or antidepressant intervention (e.g., a drug of abuse, a medication, or other treatment). Note: A full hypomanic or manic episode emerging during antidepressant treatment (medication, ECT, etc) and persisting beyond the physiological effect of that treatment is sufficient evidence for a hypomanic or manic episode diagnosis. However, caution is indicated so that one or two symptoms (particuarly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic or manic episode.

So the diagnosis of a "Major Depressive Episode" must include:

• Symptom (1) plus at least four of symptoms (3)-(9);
  
  Symptom (2) plus at least four of symptoms (3)-(9); or
  
  Symptom (1) plus symptom (2) plus at least three of symptoms (3)-(9).

(And the other criteria for "Major Depressive Disorder" must also be met.)

Why would offering someone a brief course of medical treatment in those circumstances be unreasonable?

[loCAtek]

The issue is: And then what?


Dope up her feelings, but the void left by her deceased spouse is still there.

What did he fulfill, that she can't cope without?

So, she copes with meds ...and then what?

[Lord Jim]

"what are you going to do about it?"

How about this:

"well ma'am I wouldn't have thought to do anything about it but since you've called I do see the problem. So as soon as I get off the phone I'll contact Child Services and see what can be done about placing your child in a foster home environment with people who aren't complete clueless morons."

[Scooter]

The issue is: And then what?

Dope up her feelings, but the void left by her deceased spouse is still there.

What did he fulfill, that she can't cope without?

So, she copes with meds ...and then what?

"Treatment" doesn't necessarily mean (just) meds. Treatment for major depressive disorder also includes talk therapy, referral to appropriate support groups, etc. to assist in coping with the void left by the deceased spouse.

[The Hen]

It also involves taking positive steps for yourself.

That part can be the hardest for most depressives to handle.

[Andrew D]

Medication for single-episode major-depressive disorder is not just "here, take these; and when they're gone, you're done". It involves careful monitoring with, usually, a tapering-off of the medication(s) so that the patient gradually returns to coping with her situation unassisted by medication.

It also involves taking positive steps for yourself.

That part can be the hardest for most depressives to handle.

True. And if one is so shattered that one cannot even recognize oneself, wouldn't a brief course of medication designed to assist in the reintregration which is a necessary prerequisite for taking positive steps for one's reintegrated self be a good thing?

[BoSoxGal]

Profound grief demands to be experienced and grief is ultimately never-ending; it merely changes over time and becomes far more tolerable.

The individual experiencing grief that triggers a major depressive episode (BTDT) becomes so stuck in the 'darkness visible' (as brother Styron described depression) that s/he cannot get out of bed in the morning - or night - and thus cannot begin the healthy process of working through the stages of grief to the new life beyond the trauma.

Meds are merely the first step out of the darkness; the CBT or grief counseling is what will take the individual back to life entirely.

But after one has experienced major depression, life is never quite the same again.

I'm not sure I would have wanted to live my whole life without knowing darkness visible; everything else is that much sweeter.

[Andrew D]

Meds are merely the first step out of the darkness; the CBT or grief counseling is what will take the individual back to life entirely.

I am not convinced that "grief counseling" is necessary to bring "the individual back to life entirely." In my observation, many people come back to life -- a changed life, of course, but still life -- without any "counseling" beyond that which concerned loved ones provide simply by being there, listening, and (rarely and sensitively) offering whatever advice they may have.

Either way, though, some people need medication simply to make that "first step out of the darkness". And if one cannot make the first step, then the subsequent steps are not really in the picture.

[The Hen]

True that the first step is needed. However, if drugs don't work, then a different approach should be considered to get them over that first step.

Doing nothing is usually not a productive solution.

Drugs, CBT, counselling, exercise, whatever it takes.

Though it must be recognised that some people will not want to take that first step.

They are happy with their issues. In those cases, there isn't much you can do for them apart from wishing them well.

[Andrew D]

True that the first step is needed. However, if drugs don't work, then a different approach should be considered to get them over that first step.

Doing nothing is usually not a productive solution.

Drugs, CBT, counselling, exercise, whatever it takes.

I agree, Hen. Sometimes, though, the only external thing that can help is time. People process grief, trauma, etc., in their own ways. It is very difficult to tell from the outside whether a person's individual processing has stalled, has failed, or is simply not yet complete.

Medication is no panacea. But when administered correctly -- i.e., by a careful and caring professional -- it can do a great deal of good. And sometimes it does enough good so that the afflicted person can deal with everything else on her own: In some instances, the only necessary intervention is medication to help someone get through that first step. Or to be able to take it in the first place.