We had a good lively discussion about diagnoses. That was fun. I think I should make it clearer that I do believe there is mental illness. People ares still doing lots of work to determine what schizophrenia is, and there are always new theories, but it isn't clear. What is interesting is that there doesn't seem to be as many as there were before. I think many people who once had that dx are now seen as bipolar.
A real clinical endogenous depression seems to be one of the worst things anyone can endure. The treatments range wildly from therapy to pharmacology to shock treatments to brain surgery, and combinations of all of those. It is often very resistant to any treatment. Often people with depression are helped by medication so they can get going again, often they just feel weird or get fat.
Really, since I am not a psychiatrist, I only use the DSM IV diagnoses to fit into the insurance companies schema. What I really think is that there is one basic psychological problem, and that is the inability to regulate one's emotional responses. The people I see get too high or too low, too anxious or too lethargic. They react with too much anger, or they get frightened too quickly. In some ways, their emotions, and the behavior connected to them goes out of whack.
There are basically five causes of these dysfunctional reactions: loss, loneliness, stress, conflict, and some kind of physical problem. The physical problem can be that something is wrong with the brain, or the nerves, or that someone is reacting to chronic pain, or a terrible disease or a disfiguring accident.
Loss is anything from losing your wallet to the death of a child. It can include the loss of a job, or lots of money or a relationship, or even your ideals.
Loneliness includes isolation, rejection, and the lack of social skills and connections.
Conflict, to me means being in a situation in which you feel that you have to find a way to defend yourself against an opposing force. This can be in families, with a significant other, in abusive situation, on jobs, in bad neighborhoods or in wars.
Stress, is anything from the deadline at work to the trauma of waiting for a sexual abuser to creep into your room at night.
All of these causes create emotional reactions. It is when the reactions continue, and cannot be contained, and then seep over into the rest of someone's life that they become a problem.
Emotions are crucial for out survival. They are what guide us through life. Anxiety warns of danger, sadness helps us slow down and regroup, happiness is what keeps us going, anger defends us. disgust keeps us away from bad things, love and lust keep the species going. It is when these emotions last too long and get too intense, and when we feel that they are out of control and overwhelm us that they need to be treated as a problem.
Often the reactions include addictions or compulsions. These are attempts to control emotions that can work successfully for a while, but then probe to create more problems than they solve. Addictions can include anything from alcohol, to weed, to work, to yoga, to exercise to sex, to TV, to relationships. If it interferes with you getting to work and being happy, then it's an addiction.
That is the framework I work from. That is how I diagnose people and their problems. My intent is to help them get their emotions back under their control so they can get their jobs done and be happy.
If you don't like that framework feel free to comment, maybe I can learn something. Just don't get out of control.
2 comments:
ok... not a bad post there doc. good point.. and point taken. btw.. i am the anon poster on the dx post, just didn't have time to sign on at the time. (angry much? yes , yes i am.) anyhow... you mentioned A LOT of situations that people deal with, and the results that can come from such.. loss, abuse,chronic pain, depression, chronic illness, isolation, loneliness, the list goes on. well.. over time, i have experienced, and lived with just about every one of the things you listed, and more. and i have suffered the consequences. i don't claim to " be my diagnoses" ... but i cannot help but live with the results of them. i've lost two babies... each unexpectedly and suddenly, a brother/suddenly, both parents,among other family members... those being the closest obviously. also, i have been suffering with chronic back pain and migraines for over thirteen years.... not only physically painful, but the limitations on the quality of life is actually quite depressing.
i won't try to explain these types of things any further, but of course i do require many medications for both the physical, and the mental problems, on a daily basis. i have attempted to go on my own without anti depressants... always landing myself in an awful depressive state, and or in a psyche ward for being suicidal. i will say that losing my babies...left me with PTSD, and the chronic pain adds to the depression. but really, since i lost my last child in 1996... i have totally isolated myself, as no one i knew, not even my mother, or my closest friends, knew what to say or do... other than leave me and my husband alone in our pain. i lost ALL trust and faith in people at that point. i haven't had a friend since. not a real one anyways. not someone i would hang out with , go anywhere with etc. ten years. it's been only me, my husband, and my now 13 year old daughter. i of course chat a bit with my daughters friends mothers or fathers when i have to... but nothing "deep". lonely? sure. depressing? sure it is. but that's my life. it's actually a lot of peoples' life. it's just that a lot of people don't see it. a lot of people don't want to see it.
don't take this the wrong way... no one.. ok.. it's just my own way of thinking. but the shooter at the college the other day. cho. the quiet guy. the guy who wrote a question mark for his name. the guy who never spoke to anyone. yes... he was young. and surrounded by young people. people who did attempt to get to know him etc. but ... i honestly understand his side of this. what he wrote in class... how he wiggled his way out of the counseling session when his professor saw the signs in his writing and sent him there... I AM NOT APPROVING OF HIS ACTIONS. not at all. what i am saying... is i know the rage inside of him. i know that a human mind can only hold so much when it doesn't have an outlet....no matter how much it writes....a person has to speak. honestly. and that is where the docs come in. they have got to be trustworthy. they have got to be honest. they have got to be real. they cannot be judgmental. they cannot make one feel guilty for being ill, or thinking "differently" than others. don't let a patient feel that you fear them even if you do. don't let a patient feel that you dislike them even if you do. if someone does not trust or feel comfortable with their doc... be it a psychiatrist...or a therapist... bad things will happen...to them, or someone else. it may be as "simple" as isolating for ten or twenty years... or it may be cutting or burning themselves, it may lead to suicide.... or it may turn into a mass murder... it could lead to the murder of their dr. or their family. only the sick know how the sick think. if the dr's want to know how to treat the sick... how to REALLY help them. they just have to REALLY care. not be critical. or negative. or judgmental, ... they have to be doctors. just DOCTORS. just CARE.
i don't know. i'm just a gal who has had way to much pain and loss, and isn't willing to let anymore in. i have what i have, and when it's gone, it's just gone i guess. maybe you can help the next me..before they get ten years into it.
thanks
One thing is for sure, therapist, you do make people think. I agree with most of what you say, but I have not been in the shoes of those that don't. I have said it before--but I think it's worth repeating, your job is HUGE. I thank you and all that do your job for being there, but I would never be able to handle such responsibility. Thank you for such great posts, and thank you to those that comment, all of you make me think.
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