One of the criticisms antipsychiatry folks like to make of psychiatry is its lack of objective diagnostic criteria. In other words, there’s no blood test that says you have bipolar disorder or schizophrenia.
And this is true. While today we do have blood tests for biological markers indicative of mental illness diagnosis, there is no hard and fast test that can diagnose a psychiatric disorder (except Huntington’s, for which we have discovered a gene).
The fact of the matter is no matter what is written in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or what blood we draw or which scans we do nothing diagnoses a person properly except a trained psychiatric professional.
But that doesn’t mean there’s nothing objective or meaningful about it.
Objective Diagnostic Criteria and Psychiatric Illness
In fact, using the diagnostic criteria from the DSM or even from a clinician’s clinical experience allows two experienced clinicians to arrive at the same diagnosis for a patient. (Is this always true? No, of course not. But there are second opinions in all of medicine so this is hardly rare.)
Psychiatric Diagnosis and Treatment
However, even if two clinicians were to arrive at slightly different conclusions, for example, one says unipolar depressive and the other says bipolar not otherwise specified, I would argue that it hardly matters as alleviating suffering is the goal and the diagnosis is only a way of getting to that end.
As Dr. Joseph Pierre has brilliantly said,
. . . clinicians do not in general fret over what does or does not constitute a disease. . . . If, for example, a patient’s arm is broken in a car accident, a doctor doesn’t lose sleep pondering whether this represents ‘broken bone disorder’ or simply an expected response to an environmental stressor—the bone is set and the arm is casted . . . mental disorder or not, clinicians working in ‘mental health’ see it as their calling to try to improve the lives of whomever walks through their office door seeking help.
Similarly, it is objective as to whether a person is suffering or not and thus it is obvious the person needs help regardless as to what the ultimate diagnosis is.
Do Psychiatric Diagnoses Matter?
Yes, of course psychiatric diagnoses matter as they direct treatment, however, just because there is no hard and fast test governing that diagnosis doesn’t make it any less valid nor does it mean that psychiatry doesn’t have a place in its healing.
Tylenol or ibuprofen works great for headaches, but did u take a test for the cause of your headache. Or how about the 55% of people who suffer from migraine headaches or cluster headaches and require prescription medications to attenuate their symptoms, any tests for that? Often times neurologists or internists will order tests to rule out deleterious causes of headaches. In close to 75% of people with headaches these objective anatomical tests will be negative. Even in such things as IBS or chronic pancreatitis or hundreds of functional disorders the medical profession resorts to a set of criteria to narrow the diagnosis.With the exception of Delusional disorder all psychiatric disorders require a loss or decrease in function. If people would recognize this they could breathe easier. It’s all about function or should I say dysfunction.
I don’t think that there aren’t objective diagnostic criteria for mental illness, but that we still don’t know enough about mental illness to find them. It’s taken medical science a long time to move from “disease is a punishment from the gods” to “dead bodies are unclean” to our understanding of viral and bacterial infections, mechanical malfunctions of internal organs and chemical imbalances. The genes that they are connecting to certain disorders weren’t even discovered until fairly recently and there may be objective criteria in them, or maybe it will be in the blood or in the electrical impulses in the brain or who knows?
Anyone who says that psychiatric disorders don’t exist because we can’t find them on an x-ray is using the same old idea that if I can’t see it, it doesn’t exist, even if I don’t know where to look or what to look for. The fact that it hasn’t been discovered yet, proves nothing.
Hi Bonnie,
I think those are excellent points. I, too, believe that there _are_ objective tests of psychiatric disorders but we jut haven’t zero’d in on them yet. I wrote about a blood test for schizophrenia which I derided as not being good enough to really be considered a scientific test – but what it does show is that we’re moving in that direction and at some point we will narrow it down to the point where it does make sense.
“Anyone who says that psychiatric disorders don’t exist because we can’t find them on an x-ray is using the same old idea that if I can’t see it, it doesn’t exist, even if I don’t know where to look or what to look for. The fact that it hasn’t been discovered yet, proves nothing.”
I just wanted to repeat that. Excellent.
– Natasha Tracy
Psychiatry is not alone in “lack of objective diagnostic criteria”. Neurology too has a number of diagnoses similarly made via clinical examination, observations and/or discussions of symptomology and yet to the suffering patient the illness certainly exists.
Yes, it does matter having “Objective Diagnostic Criteria” as one could better research and treat the specifics of the illness. Until such time as definitive, objective and quantitative diagnostic measures can be established these illnesses will continue to be treated with the same old “Trial and Error Approach to Wellness” so prevalent in psychiatry these many years.
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com
Diagnoses are made with pharmaceutical drugs in mind. If they want to try you on a different drug they change the diagnosis so insurance will pay for it. DSM diagnoses are just so the psychiatrists get paid!
Natasha,
I hope that you know that when I said I was always compelled to write in response to your thoughts and opinions I meant that you inspire me and bring out my own desire to express myself. It was a sincere compliment. I respect and relate to your perspective on the topics you write about and experience the effects of being an ultra- rapid cycle bipolar much like you do. After reading the beginning of your book last night, I found that we had a very similar mother/daughter experience. When my mother was dying, I was the one who took care of her. I wasn’t motivated by love, but did it because it was an obligation and for the fact that I feel compassion for anyone who is helpless and in need. When she died, I was released from all of the obligation it took being her daughter. I did not cry or feel like I lost something. She did not have the capacity to love or show affection, so there was really nothing of value to lose. Sad, but true.
Basically, the diagnosis drives the treatment. I think we all agree on that. As stated earlier, the frustrating thing is finding the treatment that works for the individual. Unfortunately this is not a one size fits all kind of thing. There may be other factors as well. When I stopped using alcohol and illicit drugs my bipolar was stabilized. The key is to never give up hope on finding the answer.
I’ve heard there have been genetic links to bipolar disorder (not necessarily always). Well, whether we can find it in the blood or on a scan or in some other tangible test, we know mental illness exists. What’s been frustrating for me is the dx seems to change with the wind,depending on the doc or therapist, And bipolar seems to be overused as the label when there’s a problem. It’s hard to figure, I know, as so many “symptoms” overlap with mental illnesses.
I just wish I could find drugs to work. A few have helped a little, not much. My bipolar is such that I was in a depressive state most of my life, yet very agitated, hyper (and yes, bitchy) at the same time. Green tea and white tea have helped and I have since learned it’s been documented to help with depression sometimes. But watch out if you are bipolar, because the caffeine (even in the decaf there is some caffeine) can send you spinning. I am still trying to find my happy balance as far as how much tea and how much time between cups and as far as calming teas and herbs I can do with it that unfortunately aren’t’ doing a lot to calm me yet. But a few cups of white tea (or decaf green tea) a day do help more than any of the dozens of drugs I’ve been on.
Hi Rachel,
A constantly changing diagnosis is certainly frustrating. For a while depression had its day and then borderline personality disorder and bipolar disorder. Unfortunately diagnosis are, at least in some part, fashionable. It all depends what education is focusing on at the time (I suspect). But as we learn more, our ability to diagnose does get better although I know that doesn’t seem all that comforting to someone caught in the middle.
I too have the main symptom of depression. This is common in bipolar II. Might I suggest you read this article (in two parts) https://natashatracy.com/bipolar-disorder/bipolar-depression-treatments-dont-know-1/
https://natashatracy.com/bipolar-disorder/bipolar-depression-treatments-don%e2%80%99t-know-2/
You might find a treatment there you don’t know about.
– Natasha Tracy
Tea is great!
Why do I feel compelled to respond to almost everything you write. Lucky for you, I don’t always respond, but I do in my mind. When I first came across the The Mindfulness something anti-psychiarty organization I researched it like crazy finding nothing but b.s. based on b.s. Have to put it that way because I couldn’t believe that they actually existed but also seemed to rule internet sites when you looked up anything even against them. Freaky and cult-like. In my mind I began a campaign to destroy any false credibility they had someone managed to establish. It was a good plan and I was passionate about it but I felt alone in my pursuit. Justied my lack of follow-through anyway. I do that a lot. Get so enthusiatic about an idea or project but soon my fire fades. Couldn’t be due to some kind of mood disorger or something, could it?
Thanks for reminding that our extreme ambition about issues that matter to us, can, and have for me at times, been a fringe benefit of be Bipolar.
Laurie
Hi Laurie,
Well, I can’t say why you’re compelled to comment but as a writer, I shall simply take that as a compliment.
I had pretty much the same reaction as you when I came across my first antipsychiatry group. I researched and I was appalled at what they said and did.
However, while I try to discredit the notions behind these groups I don’t like to single out groups in particular because that would just bring about a war between me and a group of people and I have to time or energy for such things. I just hope that people who are on the fence find my work and find it compelling. Those who stringently believe in antipsychiatry are going to believe regardless as to what I, or anyone else, has to say on the matter.
So I believe there is fighting with a hope of making a difference and fighting for fighting’s sake. Of course, everyone has their own take on which is which, but that’s mine.
– Natasha Tracy