The Mills book is in my library. While we no doubt don’t fully agree clinically I think we’re on the same wavelength basically and I sense you have a similar commitment to the work that I had.

“When a mental health client goes to the ER or to see his doctor with acute anxiety or GAD (generalized anxiety disorder), he is usuually given some antianxiety medication and possibly some counseling.”

This is where we differ. No doubt some ER Docs would respond this way, but many others less competent do not. There in lies the rub. The DSM is an interperative tool and there are unfortunately many who do the interpretations that are bringing their own problems to the table. Also the people I worked extensively with were usually brought to the ER’s via 911 and so looked at differently.

Mike’s brevity in these parts is legendary.

Billy,
I have a big problem with this and mentioned it my 9/24, 11:15am post. Diagnoses made at the time of admission when most patients are at their worst are not to be counted on and seldom modified once made despite conflicting evidence. That it is used to form a statistical basis for pathology in my opinion gives a false picture of what is really going on.

Also please forgive the typos in my last post, I should have proofread it, but I’m rushing to finish up because I have a good book to read.

What historical data do you have that substantiates your allegation?”

First case in point check out the history of the diagnosis of homosexuality. In the original iterations of first the ICD and then the DSM I & 2 is was classified as a personality disorder.
Came DSM III and it was removed as a disorder. While I think that was a good thing why did it take until the late 1970′s to make the change. If you look at the history of the various DSM iterations you will find that things got put in or out based the power and standing of certain members of the overall community. Who got put on committees was decided by politics and popularity, not necessarily by rigid scientific standards.

Secondly is what I call the “diagnoses de jour syndrome.” Certain diagnoses are popular at given times and get used much more than others at those times. When I was in training in the late 70′s the popular diagnosis was Borderline Personality Disorder and mental institutions were putting this label on many a patient. About when I retired in the early 2000′s the people I was getting from Psych all seemed to be diagnosed with “Bi-Polar Disorder” and much fewer “Borderlines” were to be seen. The spike in diagnoses of autism (throughout as you know its wide spectrum) has almost caught up with ADHD. I feel very strongly that ADHD diagnoses and to a lesser degree autism diagnoses are very problemmatic. They are based primarily on children in the school system and many come about because of teacher initiated reports. My biggest problem with that is the rise in medication being used.

Now I must admit that ADHD concerns me personally because if they were making that diagnoses when I was in Elementary School they would have pinned it on me and if that was today tried to medicate me.. I was a self taught reader who was at a high school reading level in second grade, a college freshman in fourth grade and off the charts in sixth grade. School bored me stiff and because of it I tended to act out to alleviate the boredom. There were no gifted public schools available and my parents couldn’t afford a private school. Our entire Public School system is stultifying in most places and I can only imagine how many kids get labelled and drugged to make it seem as if they’re the problem, when the system is.

You also can never underestimate the impact psychopharmaceutical programs have on the profession and consequently on people who create the DSM. I’ve worked with private mental hospitals where the drug companies and their various clinical studies run the show. The drug companies fund the research and that’s where the money is. The researchers get well-known appear at conventions and get appointed to DSM review boards and voila.

http://www.palace.net/llama/psych/bpd.html

Check out this webpage alone for a good sense of where the diagnostic criteria for Borderline are. My money is with Marsha Linehan, I’ve read her stuff and seen the positive effect of DBT treatment on patients in both an in and outpatient settings. If I were starting out training today it would be in DBT/CBT. I think it makes a lot of sense and can be a really effective tool. I also appreciate the proactive methodology.

As you seem to know this a topic where you literally need to write books to explain a personal viewpoint. I’m retired and more interested in politics and sociology so I’m not writing any books, but I hope this helps you to st least make your own assessment of where I’m coming from.

My problem though is that the DSM and its’ diagnostic standards are political in the sense of the internal politics of psychology. Although the DSM is purported to maintain rigorous scientific standards its history is hardly that and more one of caving in to interest groups and psycho-pharmeceutical firms. So to me their diagnostic standards were at times less than helpful.

Second, most Psychiatric Facilities (inpatient)rely on a diagnoses of the patient that is usually made “in extremis” and upon admission. These diagnoses are rarely updated as the patient progresses and the true nature of their symptoms becomes more apparent. The patient too becomes their diagnoses, since the institution has named it and that slows the process of therapeutic intervention.(i.e. I’m bi-polar, so what can you do?) Diagnoses are really shorthand so one MH professional can consult with or discuss a patient, without long explanations. The problem is the devil in the details that get missed often when using such shorthand. A diagnoses should be a fluid thing, updated and refined as more information about the patient becomes available.

Finally, to me one of the biggest unseen problems is that many Psychiatrists, the ones needed to prescribe psychopharmacology have not been trained as therapists. They view the patient strictly in psychopharmalogical terms and have little interest in either the therapy, or the negative sociological effect of the medication prescribed. (i.e. Giving a woman who brokedown after her husband left her for another, medication that causes her to gain 40 pounds, compounding the woman’s problems and her chances of resolving them) Psychiatrists too are often very influenced by the Detail personnel of Drug companies and many times literally bribed by them to prescribe their medication. It is also common knowledge in the field that a good number of Psychiatrists themselves have severe neurotic problems that go untreated and thus project things onto their patients. I have personally dealt with many like that and interviewed many, many more for positions with my programs. With many it was just astounding as to just the surface problems they exhibited.

All this said, I’m not against therapy or psychopharmacology, I just think they need to be looked at with a more jaundiced eye and that their pronouncements should not be taken at face value.

All I have to say is “Midnight Run”. Just replace Charles Grodin with a really annoying wife character.

that was great. But aren’t you forgetting the Defiant Ones? Now that actually would make a good reality TV show. A husband and wife chained together trying to escape the law. They might re-title it the Nagging One.

http://www.forbes.com/2009/08/13/top-celebrities-50-business-entertainment-oprah_slide_8.html

Ah, fame and stardom.

Look at the great state of Iowa and Dr. Phil. He was running from creditors when he came to Texas. At that time no UJEA, now its a piece of cake. Thanks GeoI.

The other problem is in this consumer driven culture people go to Therapists to help them cope better while they want to retain the same neuroses that brought them to therapy. I came to realize that it wasn’t about how good a therapist you were, it was about the patient’s commitment to change. Those committed to change got what they needed out of it, like myself. Those expecting a “cure” from the therapist without their own effort, just kept going for years and years. Since the latter was far in the majority I decided to stop practicing because I didn’t want to take peoples money under false pretenses.

But psychotherapy may not be all it is cracked up to be either:

http://blogdredd.blogspot.com/2009/05/100-yrs-of-psycho-therapy-take-cover.html

The book by Trevanian is even better. He also wrote one called “Shibumi”. About ninjas. Very nice. A little dated now, but also a fun read.

As far as Dr. Phil goes he was obviously a fraud when he first appeared on Oprah. Rather than psychology, he spouts his version of “common wisdom” which is usually to “toughen up and stop feeling bad.” That Oprah was taken in by him does her little credit. His history as a psychotherapist, as supplied by JT’s link is much less than exemplary. As a real Psychotherapist my feeling is that his work is a joke to begin with and his show is based on exploiting the need of the type of people that I referenced in the first paragraph of this post.

It is admissible, because only the police or other representatives of the government need read you your rights, and then only when you’re in custody. In any case, as the article indicates, they will not be prosecuted solely on the basis of their statement on t.v., but also on the basis of their possession of stolen goods. Their statement on t.v. must have given the police cause to investigate for evidence of stolen goods.

not being a lawyer I am curious.

Anyway as stupid as they are they should not have been allowed to reproduce. to paraphrase Justice Holms – “these 2 imbeciles are too many to raise children”

The video will not always stay in the evidence room, it is headed for that show about stupid criminals.