{"id":23422,"date":"2012-05-17T16:39:02","date_gmt":"2012-05-17T20:39:02","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=23422"},"modified":"2012-05-17T16:39:02","modified_gmt":"2012-05-17T20:39:02","slug":"the-dreams-of-our-fathers-viii","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/05\/17\/the-dreams-of-our-fathers-viii\/","title":{"rendered":"the dreams of our fathers VIII…"},"content":{"rendered":"\n
So I’ll begin winding up this journey by starting over. The Psychiatric Department ay Washington University in St. Louis in the 1960s stood as the center of Bological Psychiatry in America. They thought psychoanalysis, a dominant paradigm at the time, had no place in psychiatry either as theoretical base or as political force in organized psychiatry. They particularly opposed the inclusion of the Neuroses in the 1968 DSM-II. Shortly after it was published they published an article [Establishment of Diagnostic Validity in Psychiatric Illness: Its Application to Schizophrenia<\/font><\/strong>] with these comments [quoted in full this time for a reason<\/font><\/strong>]:<\/div>\n
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One of the reasons that diagnostic classification has fallen into disrepute among some psychiatrists is that diagnostic schemes have been largely based upon a priori principles rather than upon systematic studies. Such systematic studies are necessary, although they may be based upon different approaches. We have found that the approach described here facilitates the development of a valid classification in psychiatry. This paper illustrates its usefulness in schizophrenia.
The Five Phases<\/font><\/strong><\/u>
1.Clinical Description
In general, the first step is to describe the clinical picture of the disorder. This may be a single striking clinical feature or a combination of clinical features thought to be associated with one another. Race, sex, age at onset, precipitating factors, and other items may be used to define the clinical picture more precisely. The clinical picture thus does not include only symptoms.
2. Laboratory Studies
Included among laboratory studies are chemical, physiological, radiological, and anatomical (biopsy and autopsy) findings. Certain psychological tests, when shown to be reliable and reproducible, may also be considered laboratory studies in this context. Laboratory findings are generally more reliable, precise, and reproducible than are clinical descriptions. When consistent with a defined clinical picture they permit a more refined classification. Without such a defined clinical picture, their value may be considerably reduced. Unfortunately, consistent and reliable laboratory findings have not yet been demonstrated in the more common psychiatric disorders.
3. Delimitation from Other Disorders
Since similar clinical features and laboratory findings may be seen in patients suffering from different disorders (e.g., cough and blood in the sputum in lobar pneumonia, bronchiectasis, and bronchogenic carcinoma), it is necessary to specify exclusion criteria so that patients with other illnesses are not included in the group to be studied. These criteria should also permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible.
4. Follow-Up Study
The purpose of the follow-up study is to determine whether or not the original patients are suffering from some other defined disorder that could account for the original clinical picture. If they are suffering from another such illness, this finding suggests that the original patients did not comprise a homogeneous group and that it is necessary to modify the diagnostic criteria. In the absence of known etiology or pathogenesis, which is true of the more common psychiatric disorders, marked differences in outcome, such as between complete recovery and chronic illness, suggest that the group is not homogeneous. This latter point is not as compelling in suggesting diagnostic heterogeneity as is the finding of a change in diagnosis. The same illness may have a variable prognosis, but until we know more about the fundamental nature of the common psychiatric illnesses marked differences in outcome should be regarded as a challenge to the validity of the original diagnosis.
5. Family Study
Most psychiatric illnesses have been shown to run in families, whether the investigations were designed to study hereditary or environmental causes. Independent of the question of etiology, therefore, the finding of an increased prevalence of the same disorder among the close relatives of the original patients strongly indicates that one is dealing with a valid entity. We hope it is apparent that<\/sup><\/div>\n<\/blockquote>\n
As we’ve seen, one on their residents, John Feighner, took it upon himself to construct a taxonomy for psychiatry with their help from the literature based on signs and symptoms which they published [Diagnostic Criteria for Use in Psychiatric Research<\/font><\/strong><\/u><\/a> – full text on-line<\/font><\/strong><\/u><\/a>]. It was a deceptive article requiring a close reading. In an early paragraph, they lodged their complaint about the current system:<\/div>\n
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In contrast to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-II), in which the diagnostic classification is based upon the "best clinical judgement and experience" of a committee and its consultants, this communication will present a diagnostic classification validated primarily by follow-up and family studies. The following criteria for establishing diagnostic validity in psychiatric illness have been described elsewhere and may be divided into five phase.<\/sup><\/div>\n<\/blockquote>\n
Then they included the section from their former paper verbatim<\/font><\/strong>, literally word-for-word. I’ve never seen that in a published paper. Next came the report of two unpublished studies showing high inter-rater reliability, that apparently used some other version of a diagnostic system and could only have antedated John Feighner’s compilation. Then came what are known as the Feighner Criteria. On the first several readings, I didn’t know that:<\/div>\n