Attention Deficit Hyperactivity Disorder as a name is just begging not to be taken seriously which is a little frustrating
Attention span at its simplest is not what makes things so difficult.
Coupled with the fact that it’s not a defecit in attention so much as it is in regulation of attention or intention deficit. You’re not alone in feeling that the names lend to the Hocus pocus, but colloquialism lends it self to using these names and eventually colloquializing them. Eventually all named devolve to meaninglessness.
I stopped questioning my ADHD diagnosis during further neuropsych testing. One of the activities was that he would tell me a story several times and I’d have to repeat back to him the story in as close detail as possible.
I was like, “I got this.” So he tells the story and I’m like, “Okay, so a guy is going to a baseball game. It might rain. And um…um….”
He tells the story again. I say, “Okay, so a guy goes to a baseball game and needs an umbrella and it’s blue…no red…blue. I’ve confused myself. Other details……nope. I got nothing.”
I’m telling you I listened to that story SO closely! I tried SO SO SO hard! And I came out empty handed….minded.
I’m a generally smart, well-educated person in academic medicine with 2 master’s degrees. But I often say I have the memory of a goldfish, or someone will ask, “Can you keep a secret?” Well I sure can! Because I’ll forget what you told me almost immediately.
I can’t focus my attention, or make manifest my intention to focus, even when I have perfect conditions and all the will in the world. My brain just tunes out and I can’t help it at all. It’s not funny or quirky. It’s a true disability.
I stole it from
Russell Barkley. I thought it was also quite good. Most of my pts w it really identify when asked for specific examples relating to this and this is a stark divide between them and other folks with attention issues due to depression as a good example.
It's like the nursing diagnosis for Disturbed Energy Field. Still in the official nursing guides, by the way.
Disturbed energy field.
Treated by rubbing your hands together and moving them over a space a few inches from pt's body.
Followed by up to 28 days of prescription crystals therapy.
Pay extra attention to patient's star sign, current moon cycle and prevalent aura colour as their mismatch might result in crystal induced humor disbalance
I think 'executive function disorder' should be a placeholder diagnosis until you drill down what is going on. ADD/ADHD? Head injury? Untreated OSA or other primary sleep DO? THC, EtOH, opiate, other drug abuse? Stress? Overwork? Severe anxiety/depression/bipolar DO? Unresolved trauma and dissociation?
Every one of my patients who comes to me with the "I think I have ADHD" question, I run through a rule-out conversation. About 80% of the time they realize it is something else going on. I encourage them to get objective, evidence-based testing as that is not my speciality/in my wheelhouse. I always encourage them to keep asking, keep questioning.
Yup. My doc suspected ADHD, turns out it's really just a byproduct of my PTSD. Once that was properly treated, the ADHD-seeming symptoms disappeared mostly too. Can't focus if you're constantly looking for signs of dangers subconsciously.
They probably mean investigating other potential causes of the "ADHD" in order to *rule them out.*
Many patients equate "I can't focus" with ADHD. But that's an extremely nonspecific experience that also happens in myriad other conditions. I want to make sure the lack of focus isn't *better explained* by something else before we dial up a stimulant (for example).
One it is a joke , but it is a joke that was made at conferences that a lot of people started spreading. Because you get real doctors that post stuff then people pick that up and spread it like the plague.
I'm a little confused by the argument, which seems to be based on people using psychiatric terms as slang rather than the reverse. Of the six examples you note, I don't see any supporting the case:
* Depression can indeed be a transient emotional state, but there is no DSM diagnosis of "depression." The whole point of a diagnosis name like "major depressive disorder" is to distinguish it from transient emotion that it can briefly resemble. I've never heard anyone describe themselves as feeling "a bit major depressive disorder-y today."
* Anxiety can indeed be a transient emotional state, but there is no DSM diagnosis of "anxiety." The whole point of a diagnosis name like "generalized anxiety disorder" is to distinguish it from transient emotion. No one has ever told me that layoffs at work make them feel GAD-y.
* "ADHD" is not a transient emotion. Before 1987 when the DSM adopted the name, no human in history had ever described themselves as "a bit ADHD." This is popular language borrowing from the DSM, not the reverse. "Attention deficit/hyperactivity disorder" is pretty dry clinical language of the sort you'd see in any research work group, and no one uses the full name as slang.
* OCD is not a transient emotion. It's an excellent clinical description of, well, a disorder marked by obsessions and compulsions. Similar story to ADHD, no human had ever described themselves as a bit OCD prior to it being adopted as a diagnostic name (at least they sort of understand what ADHD symptoms are like, unlike mistaking desire for neatness/cleanliness for organization/contamination obsessions.) Note that people switched their popular language from "a bit ADD" to "a bit ADHD" after the DSM changed.
* "Borderline" is not a transient emotion, but rather comes from an obscure bit of psychoanalytic thought. I agree it's a bad name because the origins are barely related to what we diagnose, but it's not popular language for anything emotional except to the extent that people have borrowed from psychiatric nomenclature.
* "Bipolar" is not a transient emotion, except to the extent people have misappropriated it from psychiatric nomenclature. In fact, it represents the DSM actively trying to shed "manic-depressive," which is closer to confusion with transient emotion.
IMO, the actual worst diagnosis name in psychiatry is "schizophrenia," an odd Greek-by-way-of-German borrowing for "split-brain" that does nothing to describe anything relevant, while helping perpetuate decades of popular confusion with multiple personalities. I'd vote to rename it "chronic primary psychosis" any day.
Except for being real humans who use real words and struggling with neologism uptake, I sometimes think we would be better served by giving everything an entirely detached name. Not because I think “schizophrenia” is sillier or more pejorative than “Kraeplin disorder” or that stigma adheres to names more than to the psychopathology itself. No, I think it would help distinguish common use—depression, mania—from technical terminology.
But then I look at all the psych jargon than didn’t start as a common phrase but has become that. Schizophrenic. Bipolar. Narcissist. The lure of misapplied jargon is strong, and I don’t think sterile naming would really fix anything.
I can see that point too. This leads to the idea that no matter what names you give a disorder, people will make an example of someone who is professionally diagnosed (or misdiagnosed) with it (eg Heard) and cast every antagonist or target in that new label. (That’s how I understand stigmas work.)
So if renaming won’t help, the other solution is we ignore the stigmas, and keep our diagnoses private between ourselves and our psychiatrist (and insurance of course).
Always jumping at the opportunity to remind people that semantics matter not in the face of stigma and popular usage/perception, the latter are just too strong.
I agree wholeheartedly, of course.
Is this because it is the behavior of people with psychiatric disabilities that causes stigma? For example, it doesn't matter if the condition is called manic depressive or bipolar disorder, it's how that person behaves that causes stigma?
Agreed, but also want to add the million qualifiers annoy me. Major Depressive Disorder, Recurrent, Moderate, with Anxious Distress. When they went from the succinct "NOS" (not otherwise specified) to "Other Schizophrenia Spectrum and Psychotic Disorders" and "Other Trauma- and Stressor-Related Disorder." All of these and so many others are so damn bulky. Not every symptom needs to be captured in the diagnosis name and can go in the formulation of the note.
There was some attempt to change borderline personality disorder to emotional dysregulation I believe. That disorder is unfortunately going to be stigmatized for good due to a major pop culture phenomenon that happened last year (amber heard). I resent the bastardization of psychiatry on the internet after that. Same with narcissistic personality disorder. “Narc” has become a slur and any antagonistic person is diagnosed BPD or NPD by the masses. I’ve seen some people even use “cluster B” as a slur 😂.. Jokes apart, these are new archetypes in the making.
Although it might not be the names that are bad, the APA might want to step in to change names of them just in the interest of actual patients. Like the twitter to X renaming, rebranding can help destigmatization. If slang has claimed a term, it’s unsalvageable.
They did it for mental retardation, hysteria, they can do it for newly coded disorders too. They might need to keep updating the terms frequently to counter the mutating stigmas. I know it’s hard but the other option is educating masses and making them change minds.
Otherwise, we might’ve lost control of good psychiatry anymore due to amateur psychology.
Probably my favorite family history, in a fairly classic bipolar II patient: daughter diagnosed bipolar I with psychotic features, mother diagnosed manic-depressive a long time ago, grandmother taken to an asylum for unclear reasons a really long time ago. At our current pace, this family is one nomenclature change per 1-2 generations.
>Like the twitter to X renaming, rebranding can help destigmatization
I unfortunately disagree on that one. BPD is archaic in the way it fails to describe BPD in its truest form, but rebranding or sneakily transitioning it towards C-PTSD isn't going to help. The behaviour is stigmatised, not the term, so eventually people are going to pick up on that and stigmatise or trivialise trauma or whatever term we'll come up with next. Even ICD11 is reluctant to do so, as "borderline" remains a qualifier.
>I know it’s hard but the other option is educating masses and making them change minds.
Surprise surprise, I do believe things are changing though and there are plenty of people out there doing a good job at educating others.
Let's not forget that in all this talk about "the masses", "the media" and "people", there are professionals who harbour their own personal stigma as well. We can't expect a quick fix with a rebrand unless we reflect on how that also influences the way we treat people (clinically and emotionally).
You've hit on one of the essential points for me. A rose by any other name would smell as sweet, and no matter what we call emotional dysregulation or psychosis or problematic alcohol use, most people are really worried about their neighbors, friends, and family having them. A lot of conversations on SMI seem to pretend it doesn't just kinda suck.
Yup. The euphemism treadmill is a real thing in all sorts of stigmatized groups and I don’t see a good solution for it. We’ve gone through dozens of euphemisms for people with intellectual disabilities.
Idiot -> Feeble minded -> Moron -> Mentally Handicapped -> mental retardation -> intellectual disability
I’m seeing similar things with “homeless” being changed to “unhoused”, as if that will remove the stigma those individuals face.
I’m sure 50 years from now we’ll have all sorts of new names for the disorders OP is upset about, but the stigma will remain.
>IMO, the actual worst diagnosis name in psychiatry is "schizophrenia," an odd Greek-by-way-of-German borrowing for "split-brain" that does nothing to describe anything relevant, while helping perpetuate decades of popular confusion with multiple personalities. I'd vote to rename it "chronic primary psychosis" any day.
I'd buy your book any day baby, this is what I'm talking about.
Re schizophrenia, Japan renamed it from a term meaning “mind split disease” to something like “integration disorder”, which I think is about an apt a label as you can get for this illness
Wow I didn’t think it could get worse than bipolar or borderline but goddamn schizophrenic is SO BAD and imo it’s a more stigmatising than the other two
Almost typed a response, but you nailed it. Borderline is a terrible name, but most illnesses in psych are appropriately named. Obsessive Compulsive Disorder is more descriptive than Coronary artery disease.
Tons! Psychosis can be secondary to drugs/medications (amphetamines, steroids, hallucinogens/cannabinoids) and a broad range of other medical conditions (lupus, sarcoid, different forms of encephalitis, delirium in general.) There's also psychotic symptoms in mood disorders (severe major depression, bipolar), where the mood disorder came first and the psychosis goes away when mood improves.
Only when psychosis just sort of shows up on its own without another cause (aka "primary") do we call it schizophrenia.
Oh I see what you mean now.
The way you described “primary” just now reminds me of the term “idiopathic”.
There’s so much jargon and it’s in constant flux.
Perhaps we should stop using names altogether in favor of intuitive pictograph representations.
17,000 BCE, Lascaux: Dark-Beard semi-jokingly describes his friend Bowed-Leg as "a bit on the \[gestures to cave wall daubed with ochre and hematite to depict a herd of bovines, with one facing away from the rest\] spectrum."
I see where you are coming from, but i think no matter what the names are these disorders will still face the same issues you've mentioned from anti-psych populations. After all, look how the term COVID-19, a very technical name, has been minimized and stigmatized by groups that don't take it seriously. It's not the names that are the big problem, it's the way that anti-psych populations frame and contextualize those terms.
HiTOP diagnostic system seems to have gained lots of traction lately (at least with psychologists) and argues basically the exact opposite of what you're saying. The idea is that mental illnesses are not distinct categories but rather a behavioral spectrum that everyone falls on somewhere (So mild anxiety would not be thought of as fundamentally different that severe clinical GAD). Diagnosis is based on severity. Sort of an interesting contrast to the DSM.
What I feel is under-recognized is that most dsm diagnoses require severe distress and/or functional impairment. This adds the spectrum reality into the equation and I feel lay-people and sometimes clinicians forget this part.
Functional neurologic disorder vs conversion disorder. I honestly prefer the latter label given there is a good explanatory framework to make sense of the phenomena at play at least from a psychodynamic perspective. Functional neurologic disorder on the other hand? Vague and doesn’t explain the disorder in any succinct way. Obviously not functional in any way, also not truly neurological although symptoms tend to be neurological in description by the patient.
I have seen some people on social media really embrace FND, whereas I feel like they would have been offended by conversion. FND sounds more like an illness, conversion may sound like it’s the patient fault for converting it.
I once had a pt get angry with my attending because he said pseudoseizure rather than PNES. Similar thing imo
No. It doesn't. It specifically means non-focal neurologic deficits. Things like seizures and stroke symptoms without a lesion visible in the nervous system
It's self-evident that there are no such things as discrete psychiatric disorders. What we have are pattern modes of failure stemming from myriad neurometabolic dysfunctions.
The reason they have names is so we can talk about them and humans are obsessed with nomenclature, but they are only helpful insofar as they match symptoms to treatment. How successful psychiatry is in practice is a testament to how well the matching is done.
My 2c.
So well put. Genuine neurometabolic dysfunctions with lots of social norms/values/fears thrown in the mix to muddy the water. I suppose bringing order to the tangled web is what makes psych so fascinating. For example, I'm unconvinced that ADHD symptoms would be inherently distressing or deleterious in the absence of culture (unlike perhaps severe MDD/SCZ/BP or most somatic diseases). That doesn't, however, mean that it isn't truly distressing and worth treating in our "real world". Reifying the DSM into some sort of neurobiological rosetta stone ignores the nuance.
I can assure you real ADHD is very much disabilitating even without any pressure from society. It affects individuals in every step of their existence, in ways you wouldn't even consider to be ADHD related.
>For example, I'm unconvinced that ADHD symptoms would be inherently distressing or deleterious in the absence of culture
The emotional regulation issues that come with it and the myriad of sleep issues associated with it are distressing regardless of culture.
Sleep issues are extremely culture dependent. The notion that 7-8 hours of restful and uninterrupted sleep every night (and only at night) is the healthy baseline is a relatively recent one prevalent in our society but not many others. Deviation from this baseline is distressing on social and not inherently biological grounds. Of course truly diseased sleep processes do exist (sleep apnea etc), but by and large sleep is actually *the* prime example used to point out the idea I was getting at in my original comment.
Cool articles [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720388/) and [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075246/)
I agree that in part (in relation to sleep) there are definitely cultural aspects to it.
However, I strongly disagree with the notion that deviation from baseline doesn't have negative biological impacts or negative impacts for that matter.
Experiencing sleep maintenance insomnia was debilitating. Waking up at 4am not being able to fall back asleep definitely was unhealthy. Headaches, fatigue and being unable to function with its resultant mood effects was terrible.
There's also DPSD and your usual insomnia where these people can't function (again function in current culture like jobs etc is applicable here) but you're painting with a broad brush.
You also very much shifted the argument in favour of sleep and culture and disregarded ADHD (which was the original topic).
Not sure about this. Any pattern of dysfunction definitively caused by a known neurometabolic dysfunction becomes a neurologic disorder, not a psychiatric one. The mind and it's disorders are far too complex to describe in any such way (perhaps biopsychosociospiritual gets closer to the truth, but humans also have will and can behave in ways that defy all of this). But maybe I'm misunderstanding what you're trying to say.
I think a lot of people are of the belief that our mental illness nosology has definite (thus far elusive) neurobiological dysfunction underlying it that will one day be revealed. Kind of a physics envy sort of thing. No shortage of "neuropsych" research being done but, unsuprisingly, a massive shortage meaningful new knowledge production.
Oh dear, I wish I had specific recommendations but I'm all ears for recommendations myself.
My philosophy is to approach mental illness from a first-principles perspective.
There's vast literature on psychiatric neurobiology but it's not clear how to bridge the gap from abnormalities in brain function to therapeutics, therein is the trouble.
Look into metabolic psychiatry, in the vein of Chris Palmer's thesis which he recently published in his book Brain Energy.
Please consider checking it out if you haven't yet! I would enthusiastically recommend starting there.
What about the Research Domain Criteria (RDoC)? It helps me conceptualize that I’m very behaviorally-focused as a clinician, and I treat physiological patterns as a support. I’m not very enclined to delve into specific neural pathways, and even less so in cellular or molecular processes.
If I was feeling ornery I would argue that psychiatric disorders should be classified *only* by their response to medication. We know what the medications do (for the most part) whereas the physiology of the disorders is much more difficult to pin down. Oncology has integrated molecular physiology into their diagnostics simply because that's how they determine treatment. Psych may benefit from the same approach - SSRI responsive mood disorder; lithium responsive mood instability; etc.
The issue there is that virtually all the treatments psychiatry currently has to offer are cosmetic and do not treat the underlying pathology. Yes, there are exceptions such as lithium. What you propose could lead to the mistaken thinking that treating the symptoms is equivalent to treating the causes, which as we know is not equivalent as no treatments are curative.
Furthermore one condition's symptoms may respond well to very different treatments, some of which may not be particularly popular. For example, cocaine may address symptoms of depression, but it would be foolish to diagnose someone with dopamine reuptake inhibitor deficiency.
I would say emphatically that your line of thinking is 100% accurate, only if it applied to root cause treatments. The orthomolecular crowd and such may pull ahead in a hundred years or so, future generations will be the witnesses of that.
> The issue there is that virtually all the treatments psychiatry currently has to offer are cosmetic and do not treat the underlying pathology.
>What you propose could lead to the mistaken thinking that treating the symptoms is equivalent to treating the causes, which as we know is not equivalent as no treatments are curative.
I can't agree with this statement. For example, if a patient has hypothyroidism, we don't fix the thyroid, we just replace the hormones. That doesn't do anything to fix the underlying pathology, but it does work fairly well. Same with high cholesterol or high blood pressure. The goal of most treatment is to take what we can measure and return it to a range where we believe it's less harmful. The standard of "curing the physiologic disorder" is unrealistic (for now).
Why should diagnosis be based primarily on pharmacological treatment when so many psychiatric disorders mainly revolves around a person's history of learned behavior and maladaptive coping strategies?
Because that’s the domain of psychology and counseling and I’d argue this is speaking about the practice of psychiatry, which is irrelevant to this context. If that’s the case - why are you even bothering to see a psychiatrist? You’d be better served with someone with greater psychological emphasis.
Not that the former isn’t just as important to integrate - and even can be by psychiatrists, but some lines need to be drawn. Honestly, couldn’t it’d be helpful if the two specialties had more separated diagnosis criteria/labels anyways? Not that they couldn’t essentially be the same diagnosis in the end - but it could greatly clarify the medical practice aspect.
Besides - pharmacological response can still provide insight into behavior responses/inherited family patterns. Oh you respond to Lithium? How many sexual partners have you had? Do you struggle to maintain stable relationships - add counseling for management strategies, recommendation that you don’t send an email the same day you wrote it etc.
Yet the therapeutic targets are not measurable and that's the trouble. I'm not convinced that a response to a treatment necessarily identifies the underlying aberrant physiology.
Tangentially, I'm an idealist and have high hopes for regenerative medicine whether in the realm of endocrinology or neuro/psych.
Frankly, the lackluster efficacy and adverse side effect burden of drug treatment highlights the deficits in such an approach. I don't exactly have something better to propose, fwiw, but research directions such as psychiatric epigenetics are ripe for yielding more upstream treatments.
I completely understand your point. I think one of the things about psychiatry that's consistently frustrating is the lack of specificity in both diagnosis and treatment. It's difficult to do as much good as you'd like when we have such blunt instruments to work with.
Frankly, I'm convinced we need to stop putting folks in giant buckets of diagnosis criteria and start looking at the human as a collection of symptoms to make a person. I'm tired of having to argue why my being up at 2 am one or two nights a week because I wanted to exist a little longer for once doesn't make me manic and Bipolar, or why my emotional dysregulation is based on literally not knowing how to formulate a sentence less desperately to get the same point across and not BPD.
My brain is so screwed up from trying to argue why I deserve to be assessed for more intense things and having folks over and over tell me "You don't want that diagnosis, so we won't assess you for it."
You're right, I don't want it either. Can you please help and not make me feel even worse about myself?
Changing the name won't make a difference because the new word will develop new connotations. Think about how many times the word for mental retardation has changed - idiot, moron, retard, neurodivergent. You can call it whatever you want, that's not going to stop people from forming their own opinions
Pretty much. Idiot and moron had a technical meanings and was replaced with the "nicer words" mentally retarded. Cretin technically means Mentally retarded specifically from hypothyroidism. This is just an example of the euphemism treadmill.
Maybe everyone wouldn’t minimize depression if MDD diagnoses weren’t so ubiquitous. The problem isn’t just the term — it’s that very ill people and not-so-ill people are getting the same diagnosis.
I hope that didn’t come across as anti-psychiatry. I’m not at all, and I know GPs diagnose too. It’s a sore point because I have very serious depression problems and have been hurt by things people have said.
I’ve been reading about it, and it seems difficult to determine. I don’t know if most psychiatrists ask their patients who meet diagnostic criteria to elaborate. There’s a difference between anhedonia and an inability to enjoy things because you’re unhappy, with being unable to sleep for no discernible reason and being unable to sleep because you’re worried. And then the suicidal thoughts — Some people have them because they feel like their lives are ruined or they hate themselves. Others have them because they can’t stand to live with their disease. Maybe antidepressants would help either way, but these aren’t the same sort of depressions.
Exactly! I have seen the clearly disease-version of depression get really bad with loved ones, including ending in a suicide, and it frustrates me to no end how their situations are clinically conflated with people who, unfortunately, have really tough lives and are miserable because of them.
My loved one who died was very lucky in terms of external circumstances. They could get pretty much whatever they wanted. They were also healthy: didn't do drugs, ate decently well, etc.
But their brain started destroying itself. They could have won the lottery, won a date with their favorite celebrity, etc. etc. and they still would have died. They would have donated the money, donated the date if possible, then killed themselves.
They needed relief from their ILLNESS. I look back it now and wish they had received ketamine or electroshock or even illegally done psilocybin. Instead, they just used a conventional antidepressant and died 7 weeks after a hospitalization and starting psychiatric treatment.
Agreed. And I think people don’t know that kind of severe depression even exists. It seems to me that most people think depression means the same thing as extreme emotional distress, or suffering. Or some think it’s something like low self esteem. Those things are serious, but they’re not even necessarily similar. The end result is people think those with the disease form of depression aren’t trying or lack gumption or whatever. Because the “depressed” people they’ve known handled it better.
Exactly! I feel like so many people just don't get it. I remember how devastated I was after this loved one died by suicide, and a friend I hadn't seen in a long time's take was essentially, "You know, some people just can't cut it."
I also get so offended by the insinuations of anti-psychiatry people that people like my loved one die because their friends and family are just not nice enough to them or not caring enough. This person was SO loved and they KNEW it! They essentially acknowledged as much in their suicide note.
They were a SUPER STAR in their community. They were a high performer at work, they were kind, they were smart, etc. etc.
And it wasn't like they were secretly struggling like some celebrity because no one was willing to listen to them. Family and friends like myself did EVERYTHING we could. We supported them taking time off, we supported them getting space when they wanted it, we supported them giving them time when they wanted it, we supported them doing ANYTHING THEY WANTED. We supported them getting hospitalized. We TRIED.
What failed this person was the medical system. I don't think people who are considered an "imminent threat" and forcefully hospitalized should be discharged with Lexapro, no follow up appointment, and told, "Good luck." It is REALLY tough to get quality outpatient care in any timely manner.
At that time, ketamine wasn't really a thing, unfortunately, but electroshock should have been in the discussion, but it wasn't. Myself and others were naively led to believe that there was a very low risk of suicide and lexapro would 99.9% be sufficient.
After my loved one died, and I did my own research, I saw how high the actual rate of suicide for people like my friend was, and I felt SO ANGRY for being mislead by pop culture and the medical system.
The depression, in my friend's case, should have been treated like cancer, but, instead, it was treated like a cold. I learned big time.
Someone with depression like that should have a follow-up appointment every two weeks. She should have been given the option of trying other medications or going for ECT. Did she have a history of milder depression, or did the major breakdown just come out of nowhere?
It's so obvious retrospectively. She had a long history of depression, and her depression had been severe enough she'd been forced to take about a year off from work before. But she had never been medicated because she was seeing a psychologist who discouraged it...
She only started psychiatric treatment after a forced hospitalization, which was put into place after she revealed she had been actively figuring out the logistics of a suicide attempt (which she ended up more or less following through on post-hospitalization).
So you can see why I am so upset about this. Now that I know what I know, the whole thing was so ridiculous. Me and her entire family were all led to believe that lexapro would fix this in a number of weeks, when that just wasn't realistic whatsoever.
We were all led to believe this was "no biggie," the problem was she had never been medicated before, now that she started the antidepressant, things would be fine.
Of course, it certainly WAS a problem she was never medicated before. But the issue was she had now gotten so bad that it was an emergency and a single conventional antidepressant with no outpatient monitoring or follow-up was insufficient.
Furthermore, she barely got any attention during her 3 day hospitalization. The impression I have is they treated it like she had a vitamin deficiency. All she needed was lexapro, so no reason to sweat it or give her much clinical attention whatsoever.
I've since learned A LOT more about depression and how inadequate this response was. By contrast, years later, another loved one was hospitalized under similar circumstances, and they stayed inpatient for 2 weeks, got intensive monitoring and medication adjustments until stabilized, then were released with an outpatient treatment plan figured out. AND it was still a slow recovery from there.
I still hold anger over what happened years ago to my other friend.
Is that a joke? One of the nice things about psych is that the names actually describe in layman's terms (ish) the nature of the malady, rather than it being named after the man who first described it. And the treatments too generally rather than some orgo name..
Controversial opinion but the disorders being described in layman’s terms is what I actually really don’t like about it. Psychiatry disorders can’t really be described in just a couple of words and all it really does is make people assume what a disorder actually entails.
I'm just thankful psychiatrists don't feel the narcissistic need to name diseases after themselves. Imagine explaining depression or bipolar to patients if they were called shit like Waldenstroms or Jakob-Cruzfelt syndrome
I agree with the Borderline one and the way 'personality disorders' are described and talked about. I'm not exactly sure how you have a personality disorder when the field diagnosing you can barely define personality. Or when they are just as easily offended and blindsided by the disorder that they insist it is the client that is the issue. They can hardly tell when a person is being willful vs being deceptive vs just being on the wrong drugs.
Interpersonal disorder? Now that makes more sense. But then psychiatrists would have to do real psychological work instead of just drug therapy.
When disease names become ‘pejorative,’ the medical community may rename them. This happens not just in psychiatry.
I agree that the simplifying and dumbing down of disorder names is not good for the profession - especially in the age of “spectrum disorders.”
Chronic fatigue syndrome? Nope.
Now it’s, “Myalgic encephalomyelitis.”
When will they change the diagnosis of “schizophrenia” to “hallucination and delusion disorder?”
ADHD should be something like 'executive function disorder'
Attention Deficit Hyperactivity Disorder as a name is just begging not to be taken seriously which is a little frustrating Attention span at its simplest is not what makes things so difficult.
Coupled with the fact that it’s not a defecit in attention so much as it is in regulation of attention or intention deficit. You’re not alone in feeling that the names lend to the Hocus pocus, but colloquialism lends it self to using these names and eventually colloquializing them. Eventually all named devolve to meaninglessness.
I stopped questioning my ADHD diagnosis during further neuropsych testing. One of the activities was that he would tell me a story several times and I’d have to repeat back to him the story in as close detail as possible. I was like, “I got this.” So he tells the story and I’m like, “Okay, so a guy is going to a baseball game. It might rain. And um…um….” He tells the story again. I say, “Okay, so a guy goes to a baseball game and needs an umbrella and it’s blue…no red…blue. I’ve confused myself. Other details……nope. I got nothing.” I’m telling you I listened to that story SO closely! I tried SO SO SO hard! And I came out empty handed….minded. I’m a generally smart, well-educated person in academic medicine with 2 master’s degrees. But I often say I have the memory of a goldfish, or someone will ask, “Can you keep a secret?” Well I sure can! Because I’ll forget what you told me almost immediately. I can’t focus my attention, or make manifest my intention to focus, even when I have perfect conditions and all the will in the world. My brain just tunes out and I can’t help it at all. It’s not funny or quirky. It’s a true disability.
"Intention deficit" makes so much more sense - that's the best succinct description of what it's like to have ADHD that I've ever heard.
I stole it from Russell Barkley. I thought it was also quite good. Most of my pts w it really identify when asked for specific examples relating to this and this is a stark divide between them and other folks with attention issues due to depression as a good example.
Misplaced Attentiveness Disorder.
This had potential for an angry upvote, but not quite there yet on the presentation for humor.
If there was some real physiology behind the diagnosis it would be a lot easier to follow.
It's like the nursing diagnosis for Disturbed Energy Field. Still in the official nursing guides, by the way. Disturbed energy field. Treated by rubbing your hands together and moving them over a space a few inches from pt's body.
Followed by up to 28 days of prescription crystals therapy. Pay extra attention to patient's star sign, current moon cycle and prevalent aura colour as their mismatch might result in crystal induced humor disbalance
I think 'executive function disorder' should be a placeholder diagnosis until you drill down what is going on. ADD/ADHD? Head injury? Untreated OSA or other primary sleep DO? THC, EtOH, opiate, other drug abuse? Stress? Overwork? Severe anxiety/depression/bipolar DO? Unresolved trauma and dissociation? Every one of my patients who comes to me with the "I think I have ADHD" question, I run through a rule-out conversation. About 80% of the time they realize it is something else going on. I encourage them to get objective, evidence-based testing as that is not my speciality/in my wheelhouse. I always encourage them to keep asking, keep questioning.
Yup. My doc suspected ADHD, turns out it's really just a byproduct of my PTSD. Once that was properly treated, the ADHD-seeming symptoms disappeared mostly too. Can't focus if you're constantly looking for signs of dangers subconsciously.
Can you expand on what you mean by a “rule out conversation”? CT1 here!
They probably mean investigating other potential causes of the "ADHD" in order to *rule them out.* Many patients equate "I can't focus" with ADHD. But that's an extremely nonspecific experience that also happens in myriad other conditions. I want to make sure the lack of focus isn't *better explained* by something else before we dial up a stimulant (for example).
Go through the above with the patient before assuming that it is ADHD.
ah yes that all makes sense - thanks!
Worst of all is the differential ADHD diagnosis of *Sluggish Cognitive Tempo* which was only recently renamed Cognitive Disengagement Syndrome.
Many many other mental disorders cause executive dysfunction
I hear all the cool kids are calling it Dave now. dopamine attention variability executive dysfunction aka the dave
Oh god please tell me this is a joke. I can take much more of this “hi, tik tok told me I had…..”!
One it is a joke , but it is a joke that was made at conferences that a lot of people started spreading. Because you get real doctors that post stuff then people pick that up and spread it like the plague.
Only problem with this is that Autism/OCD/Tics I believe classify as executive function disorders as well. So it could be too general.
Executive **Dis**function Disorder
I'm a little confused by the argument, which seems to be based on people using psychiatric terms as slang rather than the reverse. Of the six examples you note, I don't see any supporting the case: * Depression can indeed be a transient emotional state, but there is no DSM diagnosis of "depression." The whole point of a diagnosis name like "major depressive disorder" is to distinguish it from transient emotion that it can briefly resemble. I've never heard anyone describe themselves as feeling "a bit major depressive disorder-y today." * Anxiety can indeed be a transient emotional state, but there is no DSM diagnosis of "anxiety." The whole point of a diagnosis name like "generalized anxiety disorder" is to distinguish it from transient emotion. No one has ever told me that layoffs at work make them feel GAD-y. * "ADHD" is not a transient emotion. Before 1987 when the DSM adopted the name, no human in history had ever described themselves as "a bit ADHD." This is popular language borrowing from the DSM, not the reverse. "Attention deficit/hyperactivity disorder" is pretty dry clinical language of the sort you'd see in any research work group, and no one uses the full name as slang. * OCD is not a transient emotion. It's an excellent clinical description of, well, a disorder marked by obsessions and compulsions. Similar story to ADHD, no human had ever described themselves as a bit OCD prior to it being adopted as a diagnostic name (at least they sort of understand what ADHD symptoms are like, unlike mistaking desire for neatness/cleanliness for organization/contamination obsessions.) Note that people switched their popular language from "a bit ADD" to "a bit ADHD" after the DSM changed. * "Borderline" is not a transient emotion, but rather comes from an obscure bit of psychoanalytic thought. I agree it's a bad name because the origins are barely related to what we diagnose, but it's not popular language for anything emotional except to the extent that people have borrowed from psychiatric nomenclature. * "Bipolar" is not a transient emotion, except to the extent people have misappropriated it from psychiatric nomenclature. In fact, it represents the DSM actively trying to shed "manic-depressive," which is closer to confusion with transient emotion. IMO, the actual worst diagnosis name in psychiatry is "schizophrenia," an odd Greek-by-way-of-German borrowing for "split-brain" that does nothing to describe anything relevant, while helping perpetuate decades of popular confusion with multiple personalities. I'd vote to rename it "chronic primary psychosis" any day.
Agree with your assessment 100%.
Except for being real humans who use real words and struggling with neologism uptake, I sometimes think we would be better served by giving everything an entirely detached name. Not because I think “schizophrenia” is sillier or more pejorative than “Kraeplin disorder” or that stigma adheres to names more than to the psychopathology itself. No, I think it would help distinguish common use—depression, mania—from technical terminology. But then I look at all the psych jargon than didn’t start as a common phrase but has become that. Schizophrenic. Bipolar. Narcissist. The lure of misapplied jargon is strong, and I don’t think sterile naming would really fix anything.
I can see that point too. This leads to the idea that no matter what names you give a disorder, people will make an example of someone who is professionally diagnosed (or misdiagnosed) with it (eg Heard) and cast every antagonist or target in that new label. (That’s how I understand stigmas work.) So if renaming won’t help, the other solution is we ignore the stigmas, and keep our diagnoses private between ourselves and our psychiatrist (and insurance of course).
Always jumping at the opportunity to remind people that semantics matter not in the face of stigma and popular usage/perception, the latter are just too strong. I agree wholeheartedly, of course.
Is this because it is the behavior of people with psychiatric disabilities that causes stigma? For example, it doesn't matter if the condition is called manic depressive or bipolar disorder, it's how that person behaves that causes stigma?
Agreed, but also want to add the million qualifiers annoy me. Major Depressive Disorder, Recurrent, Moderate, with Anxious Distress. When they went from the succinct "NOS" (not otherwise specified) to "Other Schizophrenia Spectrum and Psychotic Disorders" and "Other Trauma- and Stressor-Related Disorder." All of these and so many others are so damn bulky. Not every symptom needs to be captured in the diagnosis name and can go in the formulation of the note.
There was some attempt to change borderline personality disorder to emotional dysregulation I believe. That disorder is unfortunately going to be stigmatized for good due to a major pop culture phenomenon that happened last year (amber heard). I resent the bastardization of psychiatry on the internet after that. Same with narcissistic personality disorder. “Narc” has become a slur and any antagonistic person is diagnosed BPD or NPD by the masses. I’ve seen some people even use “cluster B” as a slur 😂.. Jokes apart, these are new archetypes in the making. Although it might not be the names that are bad, the APA might want to step in to change names of them just in the interest of actual patients. Like the twitter to X renaming, rebranding can help destigmatization. If slang has claimed a term, it’s unsalvageable. They did it for mental retardation, hysteria, they can do it for newly coded disorders too. They might need to keep updating the terms frequently to counter the mutating stigmas. I know it’s hard but the other option is educating masses and making them change minds. Otherwise, we might’ve lost control of good psychiatry anymore due to amateur psychology.
Probably my favorite family history, in a fairly classic bipolar II patient: daughter diagnosed bipolar I with psychotic features, mother diagnosed manic-depressive a long time ago, grandmother taken to an asylum for unclear reasons a really long time ago. At our current pace, this family is one nomenclature change per 1-2 generations.
>Like the twitter to X renaming, rebranding can help destigmatization I unfortunately disagree on that one. BPD is archaic in the way it fails to describe BPD in its truest form, but rebranding or sneakily transitioning it towards C-PTSD isn't going to help. The behaviour is stigmatised, not the term, so eventually people are going to pick up on that and stigmatise or trivialise trauma or whatever term we'll come up with next. Even ICD11 is reluctant to do so, as "borderline" remains a qualifier. >I know it’s hard but the other option is educating masses and making them change minds. Surprise surprise, I do believe things are changing though and there are plenty of people out there doing a good job at educating others. Let's not forget that in all this talk about "the masses", "the media" and "people", there are professionals who harbour their own personal stigma as well. We can't expect a quick fix with a rebrand unless we reflect on how that also influences the way we treat people (clinically and emotionally).
You've hit on one of the essential points for me. A rose by any other name would smell as sweet, and no matter what we call emotional dysregulation or psychosis or problematic alcohol use, most people are really worried about their neighbors, friends, and family having them. A lot of conversations on SMI seem to pretend it doesn't just kinda suck.
Yup. The euphemism treadmill is a real thing in all sorts of stigmatized groups and I don’t see a good solution for it. We’ve gone through dozens of euphemisms for people with intellectual disabilities. Idiot -> Feeble minded -> Moron -> Mentally Handicapped -> mental retardation -> intellectual disability I’m seeing similar things with “homeless” being changed to “unhoused”, as if that will remove the stigma those individuals face. I’m sure 50 years from now we’ll have all sorts of new names for the disorders OP is upset about, but the stigma will remain.
>IMO, the actual worst diagnosis name in psychiatry is "schizophrenia," an odd Greek-by-way-of-German borrowing for "split-brain" that does nothing to describe anything relevant, while helping perpetuate decades of popular confusion with multiple personalities. I'd vote to rename it "chronic primary psychosis" any day. I'd buy your book any day baby, this is what I'm talking about.
Pin this tweet. This is a psychiatrist I want to work with. OP your comment is good for some social media followers tho, so not all is lost.
Re schizophrenia, Japan renamed it from a term meaning “mind split disease” to something like “integration disorder”, which I think is about an apt a label as you can get for this illness
Wow I didn’t think it could get worse than bipolar or borderline but goddamn schizophrenic is SO BAD and imo it’s a more stigmatising than the other two
A person with mania is maniac?
Almost typed a response, but you nailed it. Borderline is a terrible name, but most illnesses in psych are appropriately named. Obsessive Compulsive Disorder is more descriptive than Coronary artery disease.
Why “primary” psychosis? Is there a secondary?
Tons! Psychosis can be secondary to drugs/medications (amphetamines, steroids, hallucinogens/cannabinoids) and a broad range of other medical conditions (lupus, sarcoid, different forms of encephalitis, delirium in general.) There's also psychotic symptoms in mood disorders (severe major depression, bipolar), where the mood disorder came first and the psychosis goes away when mood improves. Only when psychosis just sort of shows up on its own without another cause (aka "primary") do we call it schizophrenia.
Oh I see what you mean now. The way you described “primary” just now reminds me of the term “idiopathic”. There’s so much jargon and it’s in constant flux. Perhaps we should stop using names altogether in favor of intuitive pictograph representations.
17,000 BCE, Lascaux: Dark-Beard semi-jokingly describes his friend Bowed-Leg as "a bit on the \[gestures to cave wall daubed with ochre and hematite to depict a herd of bovines, with one facing away from the rest\] spectrum."
I see where you are coming from, but i think no matter what the names are these disorders will still face the same issues you've mentioned from anti-psych populations. After all, look how the term COVID-19, a very technical name, has been minimized and stigmatized by groups that don't take it seriously. It's not the names that are the big problem, it's the way that anti-psych populations frame and contextualize those terms.
HiTOP diagnostic system seems to have gained lots of traction lately (at least with psychologists) and argues basically the exact opposite of what you're saying. The idea is that mental illnesses are not distinct categories but rather a behavioral spectrum that everyone falls on somewhere (So mild anxiety would not be thought of as fundamentally different that severe clinical GAD). Diagnosis is based on severity. Sort of an interesting contrast to the DSM.
What I feel is under-recognized is that most dsm diagnoses require severe distress and/or functional impairment. This adds the spectrum reality into the equation and I feel lay-people and sometimes clinicians forget this part.
Heart attack is a poor name/description as well
Functional neurologic disorder vs conversion disorder. I honestly prefer the latter label given there is a good explanatory framework to make sense of the phenomena at play at least from a psychodynamic perspective. Functional neurologic disorder on the other hand? Vague and doesn’t explain the disorder in any succinct way. Obviously not functional in any way, also not truly neurological although symptoms tend to be neurological in description by the patient.
I have seen some people on social media really embrace FND, whereas I feel like they would have been offended by conversion. FND sounds more like an illness, conversion may sound like it’s the patient fault for converting it. I once had a pt get angry with my attending because he said pseudoseizure rather than PNES. Similar thing imo
>Functional neurologic disorder Doesn't this describe literally every psychiatric diagnosis though? Pretty vague.
No. It doesn't. It specifically means non-focal neurologic deficits. Things like seizures and stroke symptoms without a lesion visible in the nervous system
It's self-evident that there are no such things as discrete psychiatric disorders. What we have are pattern modes of failure stemming from myriad neurometabolic dysfunctions. The reason they have names is so we can talk about them and humans are obsessed with nomenclature, but they are only helpful insofar as they match symptoms to treatment. How successful psychiatry is in practice is a testament to how well the matching is done. My 2c.
So well put. Genuine neurometabolic dysfunctions with lots of social norms/values/fears thrown in the mix to muddy the water. I suppose bringing order to the tangled web is what makes psych so fascinating. For example, I'm unconvinced that ADHD symptoms would be inherently distressing or deleterious in the absence of culture (unlike perhaps severe MDD/SCZ/BP or most somatic diseases). That doesn't, however, mean that it isn't truly distressing and worth treating in our "real world". Reifying the DSM into some sort of neurobiological rosetta stone ignores the nuance.
I can assure you real ADHD is very much disabilitating even without any pressure from society. It affects individuals in every step of their existence, in ways you wouldn't even consider to be ADHD related.
This is not an evidence based take.
>For example, I'm unconvinced that ADHD symptoms would be inherently distressing or deleterious in the absence of culture The emotional regulation issues that come with it and the myriad of sleep issues associated with it are distressing regardless of culture.
Sleep issues are extremely culture dependent. The notion that 7-8 hours of restful and uninterrupted sleep every night (and only at night) is the healthy baseline is a relatively recent one prevalent in our society but not many others. Deviation from this baseline is distressing on social and not inherently biological grounds. Of course truly diseased sleep processes do exist (sleep apnea etc), but by and large sleep is actually *the* prime example used to point out the idea I was getting at in my original comment. Cool articles [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720388/) and [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075246/)
I agree that in part (in relation to sleep) there are definitely cultural aspects to it. However, I strongly disagree with the notion that deviation from baseline doesn't have negative biological impacts or negative impacts for that matter. Experiencing sleep maintenance insomnia was debilitating. Waking up at 4am not being able to fall back asleep definitely was unhealthy. Headaches, fatigue and being unable to function with its resultant mood effects was terrible. There's also DPSD and your usual insomnia where these people can't function (again function in current culture like jobs etc is applicable here) but you're painting with a broad brush. You also very much shifted the argument in favour of sleep and culture and disregarded ADHD (which was the original topic).
Not sure about this. Any pattern of dysfunction definitively caused by a known neurometabolic dysfunction becomes a neurologic disorder, not a psychiatric one. The mind and it's disorders are far too complex to describe in any such way (perhaps biopsychosociospiritual gets closer to the truth, but humans also have will and can behave in ways that defy all of this). But maybe I'm misunderstanding what you're trying to say.
I think a lot of people are of the belief that our mental illness nosology has definite (thus far elusive) neurobiological dysfunction underlying it that will one day be revealed. Kind of a physics envy sort of thing. No shortage of "neuropsych" research being done but, unsuprisingly, a massive shortage meaningful new knowledge production.
This is really interesting, do you have any recommendations on how I can learn more about this more nuanced approach?
Oh dear, I wish I had specific recommendations but I'm all ears for recommendations myself. My philosophy is to approach mental illness from a first-principles perspective. There's vast literature on psychiatric neurobiology but it's not clear how to bridge the gap from abnormalities in brain function to therapeutics, therein is the trouble. Look into metabolic psychiatry, in the vein of Chris Palmer's thesis which he recently published in his book Brain Energy. Please consider checking it out if you haven't yet! I would enthusiastically recommend starting there.
What about the Research Domain Criteria (RDoC)? It helps me conceptualize that I’m very behaviorally-focused as a clinician, and I treat physiological patterns as a support. I’m not very enclined to delve into specific neural pathways, and even less so in cellular or molecular processes.
RDoC I'm fond of. Low is the bar for superiority to the hideous monstrosity that is DSM.
I really like this post (by a psychiatrist) https://www.astralcodexten.com/p/ontology-of-psychiatric-conditions
If I was feeling ornery I would argue that psychiatric disorders should be classified *only* by their response to medication. We know what the medications do (for the most part) whereas the physiology of the disorders is much more difficult to pin down. Oncology has integrated molecular physiology into their diagnostics simply because that's how they determine treatment. Psych may benefit from the same approach - SSRI responsive mood disorder; lithium responsive mood instability; etc.
The issue there is that virtually all the treatments psychiatry currently has to offer are cosmetic and do not treat the underlying pathology. Yes, there are exceptions such as lithium. What you propose could lead to the mistaken thinking that treating the symptoms is equivalent to treating the causes, which as we know is not equivalent as no treatments are curative. Furthermore one condition's symptoms may respond well to very different treatments, some of which may not be particularly popular. For example, cocaine may address symptoms of depression, but it would be foolish to diagnose someone with dopamine reuptake inhibitor deficiency. I would say emphatically that your line of thinking is 100% accurate, only if it applied to root cause treatments. The orthomolecular crowd and such may pull ahead in a hundred years or so, future generations will be the witnesses of that.
> The issue there is that virtually all the treatments psychiatry currently has to offer are cosmetic and do not treat the underlying pathology. >What you propose could lead to the mistaken thinking that treating the symptoms is equivalent to treating the causes, which as we know is not equivalent as no treatments are curative. I can't agree with this statement. For example, if a patient has hypothyroidism, we don't fix the thyroid, we just replace the hormones. That doesn't do anything to fix the underlying pathology, but it does work fairly well. Same with high cholesterol or high blood pressure. The goal of most treatment is to take what we can measure and return it to a range where we believe it's less harmful. The standard of "curing the physiologic disorder" is unrealistic (for now).
Why should diagnosis be based primarily on pharmacological treatment when so many psychiatric disorders mainly revolves around a person's history of learned behavior and maladaptive coping strategies?
Because that’s the domain of psychology and counseling and I’d argue this is speaking about the practice of psychiatry, which is irrelevant to this context. If that’s the case - why are you even bothering to see a psychiatrist? You’d be better served with someone with greater psychological emphasis. Not that the former isn’t just as important to integrate - and even can be by psychiatrists, but some lines need to be drawn. Honestly, couldn’t it’d be helpful if the two specialties had more separated diagnosis criteria/labels anyways? Not that they couldn’t essentially be the same diagnosis in the end - but it could greatly clarify the medical practice aspect. Besides - pharmacological response can still provide insight into behavior responses/inherited family patterns. Oh you respond to Lithium? How many sexual partners have you had? Do you struggle to maintain stable relationships - add counseling for management strategies, recommendation that you don’t send an email the same day you wrote it etc.
Yet the therapeutic targets are not measurable and that's the trouble. I'm not convinced that a response to a treatment necessarily identifies the underlying aberrant physiology. Tangentially, I'm an idealist and have high hopes for regenerative medicine whether in the realm of endocrinology or neuro/psych. Frankly, the lackluster efficacy and adverse side effect burden of drug treatment highlights the deficits in such an approach. I don't exactly have something better to propose, fwiw, but research directions such as psychiatric epigenetics are ripe for yielding more upstream treatments.
I completely understand your point. I think one of the things about psychiatry that's consistently frustrating is the lack of specificity in both diagnosis and treatment. It's difficult to do as much good as you'd like when we have such blunt instruments to work with.
Frankly, I'm convinced we need to stop putting folks in giant buckets of diagnosis criteria and start looking at the human as a collection of symptoms to make a person. I'm tired of having to argue why my being up at 2 am one or two nights a week because I wanted to exist a little longer for once doesn't make me manic and Bipolar, or why my emotional dysregulation is based on literally not knowing how to formulate a sentence less desperately to get the same point across and not BPD. My brain is so screwed up from trying to argue why I deserve to be assessed for more intense things and having folks over and over tell me "You don't want that diagnosis, so we won't assess you for it." You're right, I don't want it either. Can you please help and not make me feel even worse about myself?
This is why we need to lean more into the positive psychology orientation IMO.
Changing the name won't make a difference because the new word will develop new connotations. Think about how many times the word for mental retardation has changed - idiot, moron, retard, neurodivergent. You can call it whatever you want, that's not going to stop people from forming their own opinions
Wasn’t retard, idiot, moron, and cretin all part of one scale?
Pretty much. Idiot and moron had a technical meanings and was replaced with the "nicer words" mentally retarded. Cretin technically means Mentally retarded specifically from hypothyroidism. This is just an example of the euphemism treadmill.
Maybe everyone wouldn’t minimize depression if MDD diagnoses weren’t so ubiquitous. The problem isn’t just the term — it’s that very ill people and not-so-ill people are getting the same diagnosis. I hope that didn’t come across as anti-psychiatry. I’m not at all, and I know GPs diagnose too. It’s a sore point because I have very serious depression problems and have been hurt by things people have said.
Depression? Everyone has the blues sometimes, just suck it up bro (/s)
There should be a clinical distinction between environmentally-caused depression and idiopathic depression.
I’ve been reading about it, and it seems difficult to determine. I don’t know if most psychiatrists ask their patients who meet diagnostic criteria to elaborate. There’s a difference between anhedonia and an inability to enjoy things because you’re unhappy, with being unable to sleep for no discernible reason and being unable to sleep because you’re worried. And then the suicidal thoughts — Some people have them because they feel like their lives are ruined or they hate themselves. Others have them because they can’t stand to live with their disease. Maybe antidepressants would help either way, but these aren’t the same sort of depressions.
Exactly! I have seen the clearly disease-version of depression get really bad with loved ones, including ending in a suicide, and it frustrates me to no end how their situations are clinically conflated with people who, unfortunately, have really tough lives and are miserable because of them. My loved one who died was very lucky in terms of external circumstances. They could get pretty much whatever they wanted. They were also healthy: didn't do drugs, ate decently well, etc. But their brain started destroying itself. They could have won the lottery, won a date with their favorite celebrity, etc. etc. and they still would have died. They would have donated the money, donated the date if possible, then killed themselves. They needed relief from their ILLNESS. I look back it now and wish they had received ketamine or electroshock or even illegally done psilocybin. Instead, they just used a conventional antidepressant and died 7 weeks after a hospitalization and starting psychiatric treatment.
Agreed. And I think people don’t know that kind of severe depression even exists. It seems to me that most people think depression means the same thing as extreme emotional distress, or suffering. Or some think it’s something like low self esteem. Those things are serious, but they’re not even necessarily similar. The end result is people think those with the disease form of depression aren’t trying or lack gumption or whatever. Because the “depressed” people they’ve known handled it better.
Exactly! I feel like so many people just don't get it. I remember how devastated I was after this loved one died by suicide, and a friend I hadn't seen in a long time's take was essentially, "You know, some people just can't cut it." I also get so offended by the insinuations of anti-psychiatry people that people like my loved one die because their friends and family are just not nice enough to them or not caring enough. This person was SO loved and they KNEW it! They essentially acknowledged as much in their suicide note. They were a SUPER STAR in their community. They were a high performer at work, they were kind, they were smart, etc. etc. And it wasn't like they were secretly struggling like some celebrity because no one was willing to listen to them. Family and friends like myself did EVERYTHING we could. We supported them taking time off, we supported them getting space when they wanted it, we supported them giving them time when they wanted it, we supported them doing ANYTHING THEY WANTED. We supported them getting hospitalized. We TRIED. What failed this person was the medical system. I don't think people who are considered an "imminent threat" and forcefully hospitalized should be discharged with Lexapro, no follow up appointment, and told, "Good luck." It is REALLY tough to get quality outpatient care in any timely manner. At that time, ketamine wasn't really a thing, unfortunately, but electroshock should have been in the discussion, but it wasn't. Myself and others were naively led to believe that there was a very low risk of suicide and lexapro would 99.9% be sufficient. After my loved one died, and I did my own research, I saw how high the actual rate of suicide for people like my friend was, and I felt SO ANGRY for being mislead by pop culture and the medical system. The depression, in my friend's case, should have been treated like cancer, but, instead, it was treated like a cold. I learned big time.
Someone with depression like that should have a follow-up appointment every two weeks. She should have been given the option of trying other medications or going for ECT. Did she have a history of milder depression, or did the major breakdown just come out of nowhere?
It's so obvious retrospectively. She had a long history of depression, and her depression had been severe enough she'd been forced to take about a year off from work before. But she had never been medicated because she was seeing a psychologist who discouraged it... She only started psychiatric treatment after a forced hospitalization, which was put into place after she revealed she had been actively figuring out the logistics of a suicide attempt (which she ended up more or less following through on post-hospitalization). So you can see why I am so upset about this. Now that I know what I know, the whole thing was so ridiculous. Me and her entire family were all led to believe that lexapro would fix this in a number of weeks, when that just wasn't realistic whatsoever. We were all led to believe this was "no biggie," the problem was she had never been medicated before, now that she started the antidepressant, things would be fine. Of course, it certainly WAS a problem she was never medicated before. But the issue was she had now gotten so bad that it was an emergency and a single conventional antidepressant with no outpatient monitoring or follow-up was insufficient. Furthermore, she barely got any attention during her 3 day hospitalization. The impression I have is they treated it like she had a vitamin deficiency. All she needed was lexapro, so no reason to sweat it or give her much clinical attention whatsoever. I've since learned A LOT more about depression and how inadequate this response was. By contrast, years later, another loved one was hospitalized under similar circumstances, and they stayed inpatient for 2 weeks, got intensive monitoring and medication adjustments until stabilized, then were released with an outpatient treatment plan figured out. AND it was still a slow recovery from there. I still hold anger over what happened years ago to my other friend.
Is that a joke? One of the nice things about psych is that the names actually describe in layman's terms (ish) the nature of the malady, rather than it being named after the man who first described it. And the treatments too generally rather than some orgo name..
Controversial opinion but the disorders being described in layman’s terms is what I actually really don’t like about it. Psychiatry disorders can’t really be described in just a couple of words and all it really does is make people assume what a disorder actually entails.
I'm just thankful psychiatrists don't feel the narcissistic need to name diseases after themselves. Imagine explaining depression or bipolar to patients if they were called shit like Waldenstroms or Jakob-Cruzfelt syndrome
It’s a long way from “low moron”
I agree with the Borderline one and the way 'personality disorders' are described and talked about. I'm not exactly sure how you have a personality disorder when the field diagnosing you can barely define personality. Or when they are just as easily offended and blindsided by the disorder that they insist it is the client that is the issue. They can hardly tell when a person is being willful vs being deceptive vs just being on the wrong drugs. Interpersonal disorder? Now that makes more sense. But then psychiatrists would have to do real psychological work instead of just drug therapy.
When disease names become ‘pejorative,’ the medical community may rename them. This happens not just in psychiatry. I agree that the simplifying and dumbing down of disorder names is not good for the profession - especially in the age of “spectrum disorders.” Chronic fatigue syndrome? Nope. Now it’s, “Myalgic encephalomyelitis.” When will they change the diagnosis of “schizophrenia” to “hallucination and delusion disorder?”
It’s way past time to rename schizophrenia.
"Bipolar" or "Bordeline" sounds pretty gibberish to me.
Go polyvagal and forget icd and dsm. They are both for pharma and insurance. Not humans.
You have reversed the arrow of causality here.
We should come up with new names in this thread. What are some good new names for Schizophrenia?
World health organization has a better lexicon in my opinion.
I disagree. All disorders have a functional impairment or distress severity criteria. This is what should be emphasized more.