12 September 2013

The Dehumanizing of Patients

When the first discussion took place in June 2012 and then when the Diagnostic and Statistical Manual (DSM5) was published in December 2012, I have been reading what has been published by other writers and psychiatrists and psychologists have been saying or writing. Finally, an author that I am able to understand and more importantly agree with has written a blog about topics covered in DSM. Much of the discussion on mental health really dehumanizes patients and throws medications at patients when this may not be the best.

I would ask that you read his blog for you own understanding, as I am biased and pleased that he sees his patients as humans and how they respond to positives given to them rather than just a diagnosis and another medication to solve the problem. Medications may be necessary for some mental health issues, but the wholesale prescribing of medications will only lead to dependence on medications and not a treatment, which will help the patient manage their lives in a positive way.

Because of the way Dr. Dan Peters describes things, much of the following will be quoted. “The questions that eat at me during my day as a psychologist and at night as a person searching for answers are:

#1. Is it possible to accurately identify mental health “issues,” “illness,” or “disorders?” versus extreme ranges within the sphere of the human condition?
#2. Even if it is possible to identify these conditions, does it determine the course of “treatment” or “intervention?”
#3. If so, is there a “treatment” for every identified “condition?”
#4. Does it mean there is a treatment that works?
#5. Do you need a diagnosis to get help?

Without going into detail about some of the changes in the newest edition of the DSM, some diagnostic categories have been added and some diagnosis “thresholds” have been lowered. This means that you need fewer symptoms to “meet diagnostic criteria.” Here are some examples of concerns with the new DSM-5:

#1. Temper tantrums will now be diagnosed as Disruptive Mood Dysregulation Disorder
#2. Normal forgetting will now be diagnosed as Minor Neurocognitive Disorder
#3. Gluttony will be diagnosed as Binge Eating Disorder
#4. Grief will be diagnosed as Major Depression
#5. First time substance users and college partiers will get a diagnosis of Substance Use Disorder
#6. Everyday Worry will be diagnosed as Generalized Anxiety Disorder”

The following is important and very meaningful. “And what’s the number one treatment for all of these diagnoses? Medication. In my 20+ years of working with children, adolescent, adults, and families, I have found some simple and profound truths. First, if you talk to people about what is wrong with them and causally assign diagnostic labels to explain them, they feel badly about themselves and it plays into their low self-esteem, self-confidence, and self-worth. Next, if you help them to better understand their strengths and weaknesses, and help them to develop tools to cope with life, all of the aforementioned increases. Lastly, if you focus on their strengths, rather than their “deficits,” “disorders,” and “illness,” they become aware of neglected and unknown aspects of themselves that they can and do use to navigate life and meeting their goals.” Bold is my emphasis.

I ask that all mental health and medical providers, educators, administrators, adults, and parents think critically when making or accepting a diagnosis.
Ask yourself:

#1. What is the purpose of making or accepting a diagnosis?
#2. Does it fit my or my client’s experience?
#3. How will I explain the diagnosis to my client?
#4. What does this diagnosis mean to me (client)?
#5. Will this diagnosis help my client (help me) achieve my goals?
#6. Does the diagnosis explain a normal human emotion or condition?
#7. What are all the possible helpful interventions? Can medication wait?
#8. What is right with my client? What is right with me (client)?

Those of us in the field of mental health and medicine have a minimal obligation to do no harm. Further than that, we have an obligation to improve the life conditions of our clients. Our current mental health and insurance system makes this very hard, but nothing in life that is worth anything is easy.”

I am very thankful he included “do no harm” in the above paragraph and from the tenor of his blog, I understand him to mean just that. Many of his colleagues may not care when they find it easier to pass out pills. Don't misunderstand me, some mental health issues do require medications, but as Dr. Peters points out, medication does not solve all problems or should it be the end-all for all mental health issues.

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