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Anasazi23 said:Your questions are good and not uncommon. Religion can be a difficult area to deal with in psychiatry. What may be perfectly normal in one person's non-disordered beliefs may seem bizarre to us. To conservative Jews, for example, evangelical Baptist church sessions must seem awfully strange. This is just one example. I've had patients on the unit "witnessing" to the convex mirror since no one else would listen to their ramblings. One decent rule of thumb is to understand what is normal behavior for THAT patient, and act accordingly. If a normally very religious person escalates their behavior to the point that it interferes with their social functioning or that they cannot work or take care of themselves, it becomes a concern to the psychiatrist.
In the USA, you have every right to be bizarre, and even act bizarre, as long as it is not illegal or otherwise causing disturbance. Whether or not this is necessarily in the person's best mental health, however, is another matter. The DSM states that most disorders must cause clinically significant distress in the patient, or otherwise represent an change in function. The definition of bizarre, in turn, can be found with clinical experience. We all know bizarre folks, or people that are normal but may have a bizarre belief or habit. That doesn't necessarily make them delusional.
The DSM doesn't give in to popular opinion so much as it does scientific opinion. Although it may not always seem like it, the DSM is a diagnostic STATISTICAL manual. Except in cases such as homosexuality, there are supposed to be empirically validated constructs which are delineated for the disorders. Try reading "Research agenda for DSM V." It's interesting.
An example would be the proposed elimination of Borderline personality disorder from the DSM. I know how a borderline presents, and so does any other psychiatrist. When we say the term, we convey a lot of information without having to say a lot. There is a good chance this disorder will be eliminated from DSM V because women's groups feel it is degrading to what (is almost exclusively) a female pattern of neurotic and often intolerable behavior. The elimination of this particular disorder would likely come from political pressure and as you put it, popular (or not so popular) opinion.
The important thing to keep in mind is that with experience, you can get a feel for what the normal range of behaviors is for a patient, and when certain other symptoms arise either in that same patient or in another, your psychiatric bell goes off, alerting you to investigate further. Often this investigation in the form of the clinical interview and mental status, reveals deeper psychopathology that may have not been initially detected.
so essentially, the diagnosis rests in the doctors clinical opinion from experience and not on any conclusive tests?