Psy even getting bombed on DIT

[majestic red]

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Yeah, if you're memorizing it. Human psych development, how we learn, etc. and how we are what we are is interesting to most human beings.

My point was that most of these models for the "stages of psychological development" are largely arbitrarily decided upon with no real scientific basis and little practical applicability. At least at my institution, we were taught to embrace evidence-based medicine, and our Psych department takes a very neurobehavioral approach to psychiatric disease. Most of my residents and attendings were similarly frustrated that such archaic notions as Freud's id/ego/superego were still being tested board and in-service exams.

As interesting as "how we are what we are" is, I don't think we have any good answers yet. The models that we've been taught are more philosophy than science, and I don't think they have any place outside a history or philosophy textbook.

 

[Psai]

Just search over diagnosis and _______ and arrive at the same conclusion about any field.

The over diagnosis of Bipolar is a well known problem. Depression and other disorders have elements of under and over diagnosis.

I can assure you, a psychiatrist's office is full of people with serious problems. No one has time to go finding perfectly healthy people to label them somethingorother in the DSM--for what purpose?

Your conception of what the DSM is to a psychiatrist is completely imaginary. Your thoughts on the matter lack the rigor or creativity or originality to be worthy any more of my time. But I just couldn't let a google search for your loaded buzz words sit unchecked.

When I was going through psych, I found myself overlapping with many of those diagnoses and personality disorders. I don't know if it's just me and that I should be locked up but it seemed like other people I talked to also came to similar realizations. I'm not doubting that it's probably my superficial understanding of the field.

 

[FIREitUP]

When I was going through psych, I found myself overlapping with many of those diagnoses and personality disorders. I don't know if it's just me and that I should be locked up but it seemed like other people I talked to also came to similar realizations. I'm not doubting that it's probably my superficial understanding of the field.

many individuals with personality disorders do not fit one discrete disorder, instead they may have traits from several. that may be why they are so hard to discern from each other.

 

[PL198]

When I was going through psych, I found myself overlapping with many of those diagnoses and personality disorders. I don't know if it's just me and that I should be locked up but it seemed like other people I talked to also came to similar realizations. I'm not doubting that it's probably my superficial understanding of the field.

Exactly. Observe any person for an hour and they will show for 5+ mental disorders.

 

[Nasrudin]

Exactly. Observe any person for an hour and they will show for 5+ mental disorders.

This is anything but exact. Unless you're posting from the psych ward. Which would at least elucidate your foggy notions about psychiatric diagnoses and the frequency of mental illness in your environment.

 

[PL198]

This is anything but exact. Unless you're posting from the psych ward. Which would at least elucidate your foggy notions about psychiatric diagnoses and the frequency of mental illness in your environment.

Yeah, that must be it. Sounds like you should be in one, seeing as you want to jump on anyone's back that disagrees with you. But hey, you've got all the right answers, always.

 

[Nasrudin]

Yeah, that must be it. Sounds like you should be in one, seeing as you want to jump on anyone's back that disagrees with you. But hey, you've got all the right answers, always.

I was obviously joking.

What separates me from you is not right answers but an appreciation for my own ignorance. Not all ignorance is equal. Some is wise. Some foolish.

 

[DermViser]

Exactly. Observe any person for an hour and they will show for 5+ mental disorders.

The key here, which you keep missing (why, I don't know) is functional impairment to where it interferes with their life or job.

 

[PL198]

The key here, which you keep missing (why, I don't know) is functional impairment to where it interferes with their life or job.

I'm not missing anything. Everything has some sort of functional impairment on someone's life. Let's take the hoarding example. There's no arbitrary guideline for how much impairment is justifiable for that diagnosis to be plausible. If I keep an extra 10 things on my desk that's still going to be disorganized and impair productivity in some ways. I have no idea when you can say something is an actually a true impairment or not. If I have a ton of shoes, so I can't find the ones I want to wear at a certain time among my pile of other shoes, that's certainly a detriment to my productivity. Yet it's not really hoarding until someone says it is.

 

[Psai]

I'm not missing anything. Everything has some sort of functional impairment on someone's life. Let's take the hoarding example. There's no arbitrary guideline for how much impairment is justifiable for that diagnosis to be plausible. If I keep an extra 10 things on my desk that's still going to be disorganized and impair productivity in some ways. I have no idea when you can say something is an actually a true impairment or not. If I have a ton of shoes, so I can't find the ones I want to wear at a certain time among my pile of other shoes, that's certainly a detriment to my productivity. Yet it's not really hoarding until someone says it is.

There are things that are a somewhat difficult to define but you know it when you see it.

 

[BobbyB]

There are things that are a somewhat difficult to define but you know it when you see it.

when you see the disorders in the clinics, you realize how dumb it was to entertain ever having that disorder

@PL198, impairment in the sense of losing your job or family relationships. are you unable to work because of hoarding? does your hoarding take so much time and effort that you have no friends and your family won't talk to you anymore? did you have to drop out of school because you were too busy hoarding?

don't worry. when you see these things in clinics, you will begin to understand where the line is. i laugh at my classmate and MS1 self for thinking we had these mental disorders.

 

[Anastomoses]

When I was going through psych, I found myself overlapping with many of those diagnoses and personality disorders. I don't know if it's just me and that I should be locked up but it seemed like other people I talked to also came to similar realizations. I'm not doubting that it's probably my superficial understanding of the field.

I had my thyroid levels checked during endocrine. I thought it was common knowledge that med students see zebras everywhere.

 

[PL198]

when you see the disorders in the clinics, you realize how dumb it was to entertain ever having that disorder

@PL198, impairment in the sense of losing your job or family relationships. are you unable to work because of hoarding? does your hoarding take so much time and effort that you have no friends and your family won't talk to you anymore? did you have to drop out of school because you were too busy hoarding?

don't worry. when you see these things in clinics, you will begin to understand where the line is. i laugh at my classmate and MS1 self for thinking we had these mental disorders.

This is what I mean though, like I pursue lifting incredibly hard to the point of where instead of going out on any given night, I won't if it interferes with training. Same thing for eating, drinking, etc. It's most definitely impaired relationships I've had. Yet I don't see that as a problem at all. It's a choice I'm ok with making. I'm not saying that it has been extremely detrimental to my life, however it certainly has its negatives( like anything). I just think that there's way too much ambiguity for what is considered acceptable and unacceptable. Isn't it possible someone just cares about amassing things more than anything else, and that there is nothing wrong with that? I don't see why we actively look to label these things as a disorder. It's like the whole concept of all suicide as being wrong. This is something I strongly disagree with. It's completely plausible for someone to be in a sound state of mind, and still exhibit the functions that we deem as "abnormal" or requiring diagnosis.

 

[evilbooyaa]

This is what I mean though, like I pursue lifting incredibly hard to the point of where instead of going out on any given night, I won't if it interferes with training. Same thing for eating, drinking, etc. It's most definitely impaired relationships I've had. Yet I don't see that as a problem at all. It's a choice I'm ok with making. I'm not saying that it has been extremely detrimental to my life, however it certainly has its negatives( like anything). I just think that there's way too much ambiguity for what is considered acceptable and unacceptable. Isn't it possible someone just cares about amassing things more than anything else, and that there is nothing wrong with that? I don't see why we actively look to label these things as a disorder. It's like the whole concept of all suicide as being wrong. This is something I strongly disagree with. It's completely plausible for someone to be in a sound state of mind, and still exhibit the functions that we deem as "abnormal" or requiring diagnosis.

Maybe you have hoarding (weights) disorder.

Lack of insight is commonly part of personality disorders (obsessive compulsive personality vs true OCD).

Wait, you don't think suicide is wrong (or at least the wrong choice for an individual)? You're gonna have to explain that one to me. Does that mean you don't feel all murder is wrong?

 

[PL198]

Maybe you have hoarding (weights) disorder.

Lack of insight is commonly part of personality disorders (obsessive compulsive personality vs true OCD).

Wait, you don't think suicide is wrong (or at least the wrong choice for an individual)? You're gonna have to explain that one to me. Does that mean you don't feel all murder is wrong?

Suicide isn't even close to the same. There are absolutely people that are completely rational and choose to suicide. We just tend to lump it as being wrong due to large amounts of people who suicide that have mental disorders and are not autonomous. Also, I'd never compare it to murder.... I have talked to my school's head ethicist about this specifically. Suicide isn't inherently wrong.

I'm just saying, I have friends who study continually, are brilliant students and honor every class to the point where it hurts their social interaction significantly. That's definitely impairment, yet I'm pretty sure we don't classify that as wrong. It seems pretty arbitrary and if something is acceptable, we don't classify extreme devotion as a problem, yet if something is "strange" we do.

 

[evilbooyaa]

Suicide isn't even close to the same. There are absolutely people that are completely rational and choose to suicide. We just tend to lump it as being wrong due to large amounts of people who suicide that have mental disorders and are not autonomous. Also, I'd never compare it to murder.... I have talked to my school's head ethicist about this specifically. Suicide isn't inherently wrong.

There are people that are completely rational that choose to kill themselves? This is news to me. I'm genuinely curious as to why you think this to be true. I've never heard of someone committing suicide that was not undergoing significant mental anguish (whether it was known to the outside world or not), ending with severe depression and eventually attempting suicide.

I'm just saying, I have friends who study continually, are brilliant students and honor every class to the point where it hurts their social interaction significantly. That's definitely impairment, yet I'm pretty sure we don't classify that as wrong. It seems pretty arbitrary and if something is acceptable, we don't classify extreme devotion as a problem, yet if something is "strange" we do.

There's a spectrum here. If they have literally 0 human contact for the 1st 2 years of medical school because they are studying for classes, then yes, I would classify that as wrong. If they hang out in study groups or have a small group of friends they see occasionally, then that's fine.

There's a spectrum for almost every behavior. If you're too far on one side (say OCP, where everything has to be in its place) or the other (say hoarding, where there's just crap everywhere), then it's an issue.

 

[PL198]

There are people that are completely rational that choose to kill themselves? This is news to me. I'm genuinely curious as to why you think this to be true. I've never heard of someone committing suicide that was not undergoing significant mental anguish (whether it was known to the outside world or not), ending with severe depression and eventually attempting suicide.



There's a spectrum here. If they have literally 0 human contact for the 1st 2 years of medical school because they are studying for classes, then yes, I would classify that as wrong. If they hang out in study groups or have a small group of friends they see occasionally, then that's fine.

There's a spectrum for almost every behavior. If you're too far on one side (say OCP, where everything has to be in its place) or the other (say hoarding, where there's just crap everywhere), then it's an issue.

You don't think it's possible for someone to rationally not want to live anymore? It certainly is.

Regarding the spectrums, that's the problem though. There's no definition for where on those spectrums a problem begins(seeing as that's the whole point of a spectrum), so to me the system is pretty ineffective at actually addressing medical issues. All it does is allow more people to be grouped into conditions.

 

[evilbooyaa]

You don't think it's possible for someone to rationally not want to live anymore? It certainly is.

Not rationally. IMO it's always tied to depressive or psychotic symptoms. Please explain a situation that you would be in where suicide would be the rational choice (not talking about brain death/coma where you are unable to make the decision for yourself).

Regarding the spectrums, that's the problem though. There's no definition for where on those spectrums a problem begins(seeing as that's the whole point of a spectrum), so to me the system is pretty ineffective at actually addressing medical issues. All it does is allow more people to be grouped into conditions.

It's not perfect, but what's the other option? Blow up the whole system? Don't have any psychiatric diagnoses outside of depression/anxiety/psychosis?

 

[Wordead]

Not rationally. IMO it's always tied to depressive or psychotic symptoms. Please explain a situation that you would be in where suicide would be the rational choice (not talking about brain death/coma where you are unable to make the decision for yourself).

It's not perfect, but what's the other option? Blow up the whole system? Don't have any psychiatric diagnoses outside of depression/anxiety/psychosis?

I would prefer death if I lose multiple limbs or if I have any condition with cognitive impairment, and have made that clear to my entire family. It's absurd to say that suicidal ideation is always irrational.

You are right that its an imperfect system but there isn't any clear alternative. But psych is still a young field so who knows what develop in the future.

 

[PL198]

Not rationally. IMO it's always tied to depressive or psychotic symptoms. Please explain a situation that you would be in where suicide would be the rational choice (not talking about brain death/coma where you are unable to make the decision for yourself).




It's not perfect, but what's the other option? Blow up the whole system? Don't have any psychiatric diagnoses outside of depression/anxiety/psychosis?

I can think of tons. Someone has a looming diagnosis of Huntington's, doesn't want to live in pain, knows there is no treatment, etc. What wordead said. Someone decides they aren't content with the world they are living in, and would rather leave it. Someone is near their death and doesn't want to burden their family. Someone feels their actions justify death. All of these thoughts are possible to have while being completely rational. Google rational suicide. It's quite well accepted. I think you just have the negative connotation due to the typical suicide, however those certainly aren't the only kind. Someone surely has the right to take their own life. If someone refuses treatment due to a religious/cultural/spiritual belief and knows its the only thing that can save them, I'd say that's suicide as well. They just have their faith and are devout enough in it to give their life. I don't think that is irrational.

 

[evilbooyaa]

I would prefer death if I lose multiple limbs or if I have any condition with cognitive impairment, and have made that clear to my entire family. It's absurd to say that suicidal ideation is always irrational.

You are right that its an imperfect system but there isn't any clear alternative. But psych is still a young field so who knows what develop in the future.

But wouldn't either of those be sequellae of being depressed? If I lost multiple limbs, I'd be really depressed. I would likely consider suicide at that point, but it would only be because I was depressed. If people were able to work with me to try to get me out of my depression (and it worked) then I wouldn't commit suicide.

I guess we're not seeing completely eye-to-eye on this issue. I believe that suicides are due to depression most of the time. The only example PL gave is the guy who refuses treatment due to religious belief (and I would imagine most people don't classify that as suicide).

That being said, I get where you guys are coming from. However, there is nothing I can imagine that would immediately make me 100% commit suicide. Maybe my mind just is not capable of imagining the worst things that can happen. If I get depressed due to something happening which would make me commit suicide, then I think that is a separate deal entirely.

 

[Wordead]

But wouldn't either of those be sequellae of being depressed? If I lost multiple limbs, I'd be really depressed. I would likely consider suicide at that point, but it would only be because I was depressed. If people were able to work with me to try to get me out of my depression (and it worked) then I wouldn't commit suicide.

I guess we're not seeing completely eye-to-eye on this issue. I believe that suicides are due to depression most of the time. The only example PL gave is the guy who refuses treatment due to religious belief (and I would imagine most people don't classify that as suicide).

That being said, I get where you guys are coming from. However, there is nothing I can imagine that would immediately make me 100% commit suicide. Maybe my mind just is not capable of imagining the worst things that can happen. If I get depressed due to something happening which would make me commit suicide, then I think that is a separate deal entirely.

But I'm making that decision now, while I'm not depressed. Doesn't that make it NOT a consequence of depression? I mean yeah, I would probably become depressed as well, but even if my depression were treated I would still want to commit suicide.

I know a lot of people can't understand suicide as a rational decision (especially as it's immoral in a lot of religions), but that is why the decision is left up the patient for most treatments, so why is this different?

 

[Nasrudin]

Leaving aside the suicide discussion to backtrack for a second:

PL, you don't have a mental illness for lifting like a nut. No psychiatrist would be interested in that label. If you presented yourself and stated that it was harming your life in your own subjective sense of it, then an outpatient psychiatrist might help you work through it.

It makes zero sense that you think that these mild obsessions are something addressed by psychiatry.

More like pseudo-psychiatric pop culture. Like saying I have OCD for over organizing my study area and the like in common parlance.

 

[PL198]

I agree it's not a problem, but what is your basis for making that conclusion? Mine is essentially that it's not an adverse behavior, or something the average person would consider weird. I feel like that's not a good criteria for deeming something an illness or not. I don't see why someone wanting to gather lots of items to the point where it interfered with their life is automatically an illness, but being serious about lifting(which also interferes) is acceptable. I'm not saying I'd ever want treatment as I don't think it's a problem, I'm just stating that it clearly does impede on parts of my life, thus I'd fit on that spectrum. I don't think they should be addressed by psychiatry, I'm just saying that we're continuing to branch out what mental illness really is. As we do that, more and more people that do activities that we deem relatively normal, show signs of being mentally ill. That is my problem with the idea of spectrums. In my opinion, it's going to end up with everyone being mentally ill.

 

[Nasrudin]

I agree it's not a problem, but what is your basis for making that conclusion? Mine is essentially that it's not an adverse behavior, or something the average person would consider weird. I feel like that's not a good criteria for deeming something an illness or not. I don't see why someone wanting to gather lots of items to the point where it interfered with their life is automatically an illness, but being serious about lifting(which also interferes) is acceptable. I'm not saying I'd ever want treatment as I don't think it's a problem, I'm just stating that it clearly does impede on parts of my life, thus I'd fit on that spectrum. I don't think they should be addressed by psychiatry, I'm just saying that we're continuing to branch out what mental illness really is. As we do that, more and more people that do activities that we deem relatively normal, show signs of being mentally ill. That is my problem with the idea of spectrums. In my opinion, it's going to end up with everyone being mentally ill.

Ok, well, how should we measure dysfunction of the consciousness then except as reported by a patient or by comparative assessment of functioning as determined by societal consensus and characterized by similarity of symptoms to other patients.

Many psychiatrists are for scrapping the DSM and it's methods. But, from my sense of it, whether by statistical similitude or by other narrative means, no one would be interested in capturing normal range, high functioning behavior as problematic or diseased.

Spectrums are for characterizing our understanding of behaviors that are similar and might vary only by severity. In a sense, they are better approximations of what we don't know currently.

This type of thing does not hold well in the medical mind. Fastidious and dependent on closed loops of discrete information, as it is. But it is the nature of where we are now currently.

You are welcome to dislike it. But I have seen no evidence for your feelings and premonitions about psychiatry seeking to capture normal people under a label of illness. We're quite busy enough trying to keep severely mentally ill people from falling through cracks in civil society and helping out where we can.

You have feelings and dislikes. But no information. This is why I'm not respecting the content of your posts on the issue--they're simply the muddled impressions of an uninvolved passerby.