So, I'm a sucker for hearing about the news with the DSM-V, and the NYT just had an article on it: 's'here .

I guess it's my whole skeptical-critic coming out, but I like knowing that they're debating the very existence of some of the things I'm using to define myself.

Fills you with confidence, no? :P

It's sort-of right up there with this one: 50% of YA w/ PsychDisorders Like, when 50% of your population is 'disorderd,' doesn't the disorder become..."Being Human"?

Thanks for the articles Wynne. This is a hot topic.

But here's my rant.

I'm not a fan of the DSM nor are many folks who study neurosceince.

The DSM wouldn't have the weight it does without the insurance companies using it as a rule book to qualify claimants for reimbursement. Furthermore, the pharmaceutical companies use it to exploit the psychiatric community and keep the bucks rolling in.( Questioning Meds)

And as the mental health establishment continues to "pathologize" problems in living, it tends to distort our self-perceptions ("I am OCD" vs. "I have OCD").

I suggest that the system might work much better if folks were able to self use their health insurance entitlements for psychotherapy without a medical referral. This is how the Canadian system works; unfortunately most plans provide less than average U.S.-level compensation. (However, you often need a diagnosis for a disability plan i.e. where the insurance covers your salary if you're off work.)

It is incorrect to view the DSM as the final word because new research means it's constantly evolving. The problem is that this research can be driven by third party interests. In my view, we need a whole new paradigm, a complete revamping of our approach to mental disorders, one that is genuinely holistic.

Shrinklady

Many thanks for the correction and rant, Shrinklady. It's true that "defining myself" by the things on the DSM is probably a very bad idea.

I suppose that right now I'm going back and forth in much the same way insurance companies might: if there's a problem, it's a problem, let's name it. If it's not a problem, why go? Pathologizing at least acknowledges the "problem" part of the equation, though I'll admit with pathologizing comes stigma walkin' arm in arm.

...I mean this in the best way. Whatever that way might be.

Could you also explain when you've the time what a "holistic" approach would look like?

Hi Wynne, yeah, many of us fall prey to defining ourselves by outside sources. It doesn't help when the medical establishment inadvertently encourages it by silent acceptance.

Increasingly, problems in living are being defined as disorders. This stems in part from people's need to get their help covered by their insurance (e.g. couples counseling). But the drawback is, as you mentioned, we are slowing becoming a nation (here and in the USA, UK etc.) of "the disordered".

I understand the dilema. It gets dicey trying to identify when a problem should be called pathologcial. For instance, if I have trouble speaking in front of groups, can that usefully be called pathological? Well yes it can, when it becomes debilitating. But then where do we draw the line? That's a totally subject experience. I guess this is what the DSM tries to do, quantify subjective experiences.

It seems to me that if the client says it's a problem, then it's a problem. When a client is describing symptoms to a therapist they're being subjective in any case and that's often all we have to go on when making an diagnostic assessment.

In the present system I do see the point in naming it especially for folks who blame or question themselves. I know I felt much better knowing I was suffing from "dysthymia" when I got that diagnosis years ago. I got a break from the crazy-making that was going on in my head.

Yet, if I was to really look at it, the root of my problem was that I didn't feel justified in getting help period i.e. without a diagnosis. That was a more important aspect of the main problem. If we had a system that recognized a person's right to get help on their word alone, then I wouldn't have needed that diagnosis. I mean, who would go to therapy if they didn't need something? I remember trying to get help for years previous to that diagnosis but I didn't really have the words to describe why I felt I needed help. (Now fortunately neuroscience can help explain this.)

Today I go to therapy without a diagnosis (I was self-referred) and I still get to claim it on my insurance (for a whopping four sessions!).

As for the question of "why go", well, that's kinda why I created this site i.e. to help folks understand that therapy's a way to achieve balance in mind, body, spirit...and along the way my allergies get better, I've seen little sign of the IBS that I suffered for years, and I seem less prone to migraine headaches. In other words my overall health improved, which hopefully should interest insurance companies.

Sorry Wynne if this post seems tangential. I think I get a little lost trying to get my ideas down on paper these days.

I haven't answered your question about the "holistic" approach. It's a very good question. I may need a bit more time to get that one together.

Shrinklady

quote:

It seems to me that if the client says it's a problem, then it's a problem. When a client is describing symptoms to a therapist they're being subjective in any case and that's often all we have to go on when making an diagnostic assessment.

In the present system I do see the point in naming it especially for folks who blame or question themselves.

I really appreciate your response, ShrinkLady, and I don't mean to be difficult. It's just that... self-reporting self-doubters, like me, get all worried (not that I wasn't already!) when folks are like, "well, don't pathologize, it's not really a -problem-." I'm like, "...it's not?" Well, then I shouldn't be here! Half the time I wanna say "I'm fine! no problems here!" to begin with, so I seem to look at the pathology/non-pathology argument from a slightly different angle.

I do hear the balance argument, and I imagine that has to do with the 'holistic approach' you're talking about. I'd like very much to hear more. Thanks again!

Oh I'm not finding what you're saying difficult Wynne. I'm actually not always sure what you mean so I'm may be digressing a bit. It's nice to chat about this stuff anyway. It's also a little hard to talk about these concepts without defining them so I'm not sure we're talking about the same thing. Some folks have written entire books on these subjects so I'm not doing justice to them in the least.

When I say that a client will say, it's a problem, I really mean it. Most people know they have a problem. There's something not right and they sense that. That should be sufficient reason for obtaining health care. We'd all benefit if that were the case.

But there's no blood test to show pathology like a bacterial infection. There's no clear cut way of telling when a problem becomes pathological. Hence we depend on health professionals using the DSM to state it or to label it. Unfortuantely due to the way the system is organized, only then does it become real to some folks. It becomes something apart from them much as a virus is an invasion in the body. But if they were properly supported they'd see it was real for them anyway and that there is no shame in having it, that the brain adapted that way in response to dire circumstances.

You asked about the holistic approach that I subscribe to. Well, it's an evolving theory and it's based on what neuroscience is telling us. I can't describe it fully as it would take a book.

When I started to do body psychotherapy it became increasingly clear that the brain is very adaptable. It will change--and not always in the best way for the future--in a way to permit optimal survival for the moment. These adaptations take place in the womb, in the early years and through trauma. Problem is, these adaptations don't turn off when the environment changes so the individual is stuck with these patterns unless life events or therapy help the individual to rewire the brain. However, the patterns aren't always useful for a more congenial environment. In other words, if the circumstances were such that the brain needed to make large adaptations then the individual is gonna have a harder time getting rid of these old patterns and or laying down new ones that are more useful for the long run.

The best way I can understand many psychological problems is through the ( human nervous system and regulation. The brain might need to calm down (as with anxieties and some forms of addictions) or it might need to be stimulated (as in ADHD and some forms of depression and/or some addictions). We see this with brain imaging studies.

Many of our problems in living and pathologies are related to these patterns in the brain. The brain doesn't have a cut off point when a problem in living becomes a pathology so you can imagine how hard it is for us to determine it.

There's a lot more to this especially how physical illness and the mind body connection fits in and even more so energy and spirituality.

Shrinklady

Wow Shrinklady, that is one of the best, yet simplist explanations of neuroplasticity I have ever read in such synopotic form. Not to change the tone of this thread, but I MARVEL at the brains adaptibilty. It is absolutley fascinating.
JM

quote:

It will change--and not always in the best way for the future--in a way to permit optimal survival for the moment. These adaptations take place in the womb, in the early years and through trauma. Problem is, these adaptations don't turn off when the environment changes so the individual is stuck with these patterns unless life events or therapy help the individual to rewire the brain. However, the patterns aren't always useful for a more congenial environment.

Shrinklady, I felt like screaming "that's it" when I read this. One of the real keys to my healing has been my therapist's showing me that far from something being "wrong" with me that needed to be fixed, it was "development gone awry." That I reacted exactly how I needed to then to survive, but that those reactions don't function as well now. They need to be changed to live more fully in the present. That shift in thinking just brought the whole possibility of healing so much closer. I hadn't done anything wrong, but I do need to learn now to do something different.

AG

I'd like to see a brain scan of a DID system when different people are 'out'. i'm wondering what the changes in the brainwould be, especially if it's a male in a female body.

Antoni

Antoni

That would be really amazing to see. I have to believe the scan would look different depending on which person is out.

AG

You captured my interest on that too Antoni. Whether DID specifically or even DDNOS. Might be interesting to see how the brain patterns are affected when that happens.

quote:

One of the real keys to my healing has been my therapist's showing me that far from something being "wrong" with me that needed to be fixed, it was "development gone awry." That I reacted exactly how I needed to then to survive, but that those reactions don't function as well now. They need to be changed to live more fully in the present.

AG - How long did it take for that to sink into your head? My T tells me this, but I haven't been able to wrap my head around it. I'm still in the stage where I have to "blame" someone. It may be me at fault or a caregiver, but I just haven't bought into the realization that it just "is." And, that I can do something to change it.

ShrinkLady

Thanks so much for your explanations. The whole idea of being able to rewire the brain after so many years of repeating the same patterns is just so incredible to me. It not only makes me think that changing my thought patterns will help me, but that changing my patterns will also help how I parent my own children. The more I learn about the influences of the parenting I received, the more guilty I feel about my parenting of my children. I can now see that it is never too late to change that and therefore help them change.

PL

PL,
Quite some time if I remember correctly. One of my T's virtues is his ability to repeat the same facts more times than a human being should possibly be willing to.

What really helped me with this though is a lot of the reading that I did on Attachment theory. (I don't know if I ever mentioned this but one of the ways I avoided my emotions was to overcompensate with my intellect. Show me a new problem, I find a book on it. Keep the left brain happy, so the right can do what it needs to, that's what I say!) When my T realized that I had an attachment problem, I knew very little about it and I asked him to recommend a book about it. Took him a little while, but he recommended Parenting from the Inside Out which discussed attachment research from the perspective of how to parent. There was a lot of neurobiology tucked into the book (such that it was easy to skip if you wanted to). It was really fascinating that the neurobiological research about how we develop and just what the attachment mechanism is and how it affects us, explained so much of my behavior. But one thing the author was really clear about and hit again and again, was the possibility of change, that the plasticity of the brain was such that you could change, even long implanted, deep behaviors. It really gave me a lot of hope.

The more I learned about attachment and development the more sense it made to me. I would also highly recommend A General Theory of Love. This book was written by three psychiatrists and brought together the findings of neurobiology and their experience in therapy and what worked. And really well written, its a good read. It resonated so deeply with me and my experience that I recommended it to the my T, who really loved it. There's a very dog-eared, note-stuffed copy of the book on his desk now. It so resonated with our work together that we discussed it on and off for around six sessions and it still occasionally comes up. Reading that was what reconciled me to my need to be dependent on my T for awhile. But that was because I needed to go back and get something I really needed which reinforced the "development gone awry" theme.

I will tell you that it was a long hard struggle and on the way it felt like I was NEVER going to believe this or sometimes even understand it. It could be confusing or chaotic beyond belief. If you read some of my older posts, you'll see that I regulary threatened to quit therapy. But it crept in little by little until one day without realizing how you got there, you find yourself in a different place, a large grassy meadow with many beckoning hills.

AG

@PL

I share your feelings about parenting. Sometimes the more I learn about how many effects of my childhood are still with me, I start to think I will never be a good parent. Maybe it is time for me to get a copy of Parenting from the Inside Out so I can start to understand a little more rather than just by scared.

Incognito,
I highly recommend it, the author gave a lot of advice about how to give your children a secure attachment even if you didn't have one. I remember reading it and consistently thinking I wish I had read it when my kids were younger.

But to encourage both of you, attachment research has proved that your ability to reflect on yourself is a much stronger indicator of how you'll do as an attachment figure. The fact that you're both in therapy indicates a good and/or developing capacity for that. So you're doing a better job than you think you are. But I understand the fear, I've wrestled with it for a long time. And my children are old enough that I've had to deal with some things that I know I'm at least partially responsible for. But you cope, and that teaches you and your children that you can face whatever it is.

AG