{"id":36319,"date":"2013-05-12T12:19:52","date_gmt":"2013-05-12T16:19:52","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=36319"},"modified":"2013-05-12T12:19:52","modified_gmt":"2013-05-12T16:19:52","slug":"said-it-again","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/05\/12\/said-it-again\/","title":{"rendered":"said it again…"},"content":{"rendered":"\n
I had a patient long ago who was struggling to find a way to describe her Mom and why she was so conflicted about her – being both devoted to and oppressed by their relationship. She said, "She’s just crazy-making<\/font><\/strong><\/em>!" That phrase stuck with me and was probably the nidus for a later old saying<\/em> I made up: "Never accept an invitation to go crazy<\/font><\/strong><\/em>" – which I both jokingly and seriously claim to be the only solid rule for living: <\/div>\n
\n
NIMH vs DSM 5: No one wins, patients lose<\/a>
Saving Normal: Psychology Today<\/font><\/strong>
by Allen Frances, M.D.
May 10, 2013<\/div>\n
<\/p>\n

The flat out rejection of DSM 5 by National Institute of Mental Health is a sad moment for mental health and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country. DSM 5 certainly deserves rejecting. It offers a reckless hodgepodge of new diagnoses that will misidentify normals and subject them to unnecessary treatment and stigma.<\/p>\n

The NIMH director may have hammered the nail in the DSM 5 coffin when he so harshly criticized its lack of validity. But the NIMH statement went very far overboard with its implied promise that it would soon find a better way of sorting, understanding<\/span>, and treating mental disorders. The media and internet are now alive with celebrations of this NiMH ‘kill shot’. There are chortlings that DSM 5 is dead on arrival and will perhaps take psychiatry<\/span> down along with it.<\/p>\n

This is misleading and dangerous stuff that is bad for the patients both institutions are meant to serve. NIMH has gone wrong now in the very same way that DSM 5 has gone wrong in the past – making impossible to keep promises. The new NIMH research agenda is necessary and highly desirable- it makes sense to target simpler symptoms rather than complex DSM syndromes, especially since so far we have come up empty. And the new plan will further, and be furthered, by the big, new Obama investment in brain<\/span> research. But the likely payoff is being wildly oversold. There is no easy solution to what is in fact an almost impossibly complex research problem…<\/div>\n

<\/strong><\/sup><\/div>\n<\/blockquote>\n

One thing that attracted me to psychiatry from the call of hard science and the allure of answering the really big questions about the universe was the satisfaction of answering the little ones. Putting the why on her conflict with her Mom [why "crazy-making<\/font><\/strong><\/em>"] took some work, but it allowed her to stop being crazy-made<\/font><\/strong><\/em> – and the ripple effect on the rest of her life was more than worth the effort. <\/div>\n

What Dr. Frances is talking about is, in my mind, the false dichotomy of this DSM-5\/RDoC debate. The DSM-5 process and the RDoC hype both flounder in the same way, trying to knock the ball out of the park<\/em>. What we needed from the DSM-5  was to just get on base<\/em>. We need a cleaner, more accurate, clinical diagnostic system and we didn’t get it. They were so busy swinging for the fences<\/em> that they didn’t make the simple changes that could’ve made a big [and helpful] difference. <\/p>\n

This isn’t a fight between Freud and Kraepelin, or a war between Insel’s NIMH and Kupfer’s and Regier’s DSM-5, or psychiatry and psychology. It’s only about so many people clogging up what ought to be a serious process of defining illnesses in a way that aids the ill and the people trying to help. That’s all it is: <\/div>\n
\n
<\/p>\n
So what is a patient or potential patient or parent<\/span> to make of the confusing struggle between NIMH and DSM5 debacle? My advice is to ignore it. Don’t lose faith<\/span> in psychiatry, but don’t accept psychiatric diagnosis or treatment on faith- particularly if it is given after a brief visit with someone who barely knows you. Be informed. Ask lots of questions. Expect reasonable answers. If you don’t get them, seek second, third, even fourth opinions until you do.<\/div>\n

<\/p>\n

A psychiatric diagnosis is a milestone in a person’s life. Done well, an accurate diagnosis is the beginning of increased self understanding and a launch to effective treatment and a better future. Done poorly it can be a lingering disaster. Getting it right deserves the kind of care and patience exercised in choosing a spouse or a house. Remember that psychiatry is neither all good or all bad. Like most of medicine, it all depends on how well it is done.<\/div>\n

<\/strong><\/sup><\/div>\n<\/blockquote>\n

And in case we didn’t hear him, Dr. Frances just said it again: The Inmates Seem To Have Taken Over The Asylum<\/a>…<\/div>\n","protected":false},"excerpt":{"rendered":"

I had a patient long ago who was struggling to find a way to describe her Mom and why she was so conflicted about her – being both devoted to and oppressed by their relationship. She said, "She’s just crazy-making!" That phrase stuck with me and was probably the nidus for a later old saying […]<\/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-36319","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36319","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=36319"}],"version-history":[{"count":3,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36319\/revisions"}],"predecessor-version":[{"id":42781,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36319\/revisions\/42781"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=36319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=36319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=36319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}