{"id":23707,"date":"2012-05-24T21:55:26","date_gmt":"2012-05-25T01:55:26","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=23707"},"modified":"2012-05-25T09:16:41","modified_gmt":"2012-05-25T13:16:41","slug":"legitimacy","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/05\/24\/legitimacy\/","title":{"rendered":"legitimacy…"},"content":{"rendered":"\n

We hear a lot about Validity<\/font><\/em> and Reliability<\/font><\/em> when we read about diagnosis. What is less often discussed is Legitimacy<\/font><\/em>, though that seems the most important thing on the table at times. Is the illness a legitimate<\/font><\/em> illness? Is it being treated with a legitimate<\/font><\/em> treatment? Is psychiatry even a legitimate<\/font><\/em> medical specialty? This must be a difficult topic, because I’ve followed those opening sentences with four whole posts, erased them, then started over. I had made my own decisions about these things before I started training, having come from Internal Medicine. As a medical practitioner, I’d seen mental illness up close and personal, become interested, and decided that treating it was how I wanted to spend my life. I didn’t myself question the legitimacy <\/font><\/em>of mental illness or if psychiatry was a legitimate <\/font><\/em>medical specialty, but training in the 1970s, I sure heard a lot about that topic – from all sides.<\/p>\n

So for a tongue twister, the questions of legitimacy<\/font><\/em> are legitimately legitimate<\/font><\/em>. I met that in my own training. I was an analytic patient as part of my analytic training, and had "good" university insurance. One could also legitimately <\/font><\/em>take the cost of treatment off of income tax as an educational expense. Some of my classmates did both. I didn’t think that was legitimate<\/font><\/em>. There were plenty of people in the mental health field that worked the system that way, taking part-time jobs with "good" insurance to pay for their own therapy – legitimate<\/font><\/em>? The point is that medical insurance was used to pay for treatments that were in the range of choice, not medical necessity. And that avenue was only available to people who could choose jobs with that kind of insurance. Those examples abounded everywhere.<\/p>\n

And it wasn’t just psychoanalysis or psychotherapy where the presence or absence of "good" insurance determined treatment. It was true in hospital treatment as well – long expensive hospital stays for milieu therapy were primarily available to sick members of rich families. It’s not that such treatments weren’t effective. It’s that it was not something insurance companies could or should have to deal with – way too arbitrary. The decisions about treatment were made by individual practitioners based on expert<\/em> opinion – not based on an objective set of mutually validated parameters. It wasn’t even necessarily chicanery. A long stay hospitalization in a good milieu treatment unit is an effective treatment for certain show-stopping personality disorders, sometimes miraculous. But it’s not guaranteed and cost-effective? Forget about it. It’s legitimate <\/font><\/em>illness, legitimate <\/font><\/em>treatment, but is it a legitimate <\/font><\/em>use of the health care dollar? In the area of addiction treatment, for motivated alcoholic patients, the "28 days" in a treatment center is a good way to start a recovery program. But is it necessary? Is it cost effective? What do you mean by "motivated?" Is it legitimate<\/font><\/em>?<\/p>\n

All of those questions swirled around in the period leading up to the 1980 DSM Revolution. What was legitimate <\/font><\/em>illness? What was legitimate <\/font><\/em>treatment? What was legitimate <\/font><\/em>psychiatric practice? These were front and center issues in those years when psychiatry was trying to negotiate its way out of its disparate origins in sanatoriums and analytic consultation rooms. Throw in the rise of other mental health disciplines, managed care, the "sixties," the introduction of biological treatments, and you’ve literally got a devil’s cauldron – one that’s still boiling. It’s hard to talk about psychiatric diagnosis and its history as if the only issues are Validity<\/font><\/em> and Reliability<\/font><\/em>, and it’s impossible to understand many of the current conflicts without reminding ourselves that Legitimacy<\/font><\/em> has been a major parameter in the equation – sometimes the most important variable. And nobody in mental health is opinion-free [including me]. It’s impossible to ponder what’s happening right now without adding legitimacy<\/font><\/em> to the mix. I think it’s why I don’t believe what Dr. Lieberman was saying in that last post, or what the DSM-5 people are saying, because they’re leaving out too much – and legitimacy <\/font><\/em>is one of the things being left out…<\/div>\n","protected":false},"excerpt":{"rendered":"

We hear a lot about Validity and Reliability when we read about diagnosis. What is less often discussed is Legitimacy, though that seems the most important thing on the table at times. Is the illness a legitimate illness? Is it being treated with a legitimate treatment? Is psychiatry even a legitimate medical specialty? This must […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-23707","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/23707","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=23707"}],"version-history":[{"count":8,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/23707\/revisions"}],"predecessor-version":[{"id":23735,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/23707\/revisions\/23735"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=23707"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=23707"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=23707"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}