tag:blogger.com,1999:blog-1732132352927731247.post8195780342940938478..comments2024-03-16T00:27:31.848-07:00Comments on Hooked: Ethics, Medicine, and Pharma: Another County Heard From: NIMH Boss Takes Aim at DSM-5Howard Brodyhttp://www.blogger.com/profile/00599587504924835039noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-1732132352927731247.post-38949119606268078762013-05-15T13:42:14.646-07:002013-05-15T13:42:14.646-07:00Dear Dr. Brody:
I am a huge fan of this blog and...Dear Dr. Brody: <br /><br />I am a huge fan of this blog and a skeptic of many things in medicine and psychiatry -- and I am also a psychiatry resident. And I assure you that the DSM is both worthy of criticism and also an incredibly useful guide to diagnosis when used skillfully and humanely. <br /><br />The key assumption that you're making, and that nearly everyone makes, is that a diagnosis equals an indication for medications. Surely this is the epistemology that the drug companies themselves would promote. But it's far from true. And we've got great studies to show that things like psychoeducation -- simply sitting down to explain syndromes to patients and their families -- can in certain diseases be more efficacious than any pharmacology. Or in PTSD: sure there are classes of medications that are useful, but cognitive processing therapy (and other related psychotherapies) are much more effective. <br /><br />Another poor assumption is that a diagnosis that *might* be applied to a surprisingly large population should and will be. Again, psychiatry is different than other fields in that we only make certain diagnoses when they come to clinical attention, as if that says something about their severity. This might dissatisfy those of us who want a clear sense of what is pathological and what is not. But for those of us who want to intervene and support people in crisis, it makes perfect sense. For example, I have been taught by some of the smartest psychiatrists to make use of the V-codes. They're not discrete medico-psychiatric syndromes; they say things like "Educational problem" or "Partner relational problem." But often they say so much more about the person and their struggles. When I put down that diagnosis I am not saying that *everyone* with a partner relational problem is sick; I am not saying that there's some profitable treatment for it; I am just trying to understand and describe a person's crisis so as to focus on their recovery. Many of us are also keenly aware of the way that people use their illnesses to keep from getting better, and have many lines of thinking about these identities and conflicts that could help such folks where no other branch of medicine can even come close.<br /><br />My field is definitely full of conflicts of interest and problematic politics. And DSM5 may not be all that modern (the definition for major depression is a half-century old!). And many people practice psychiatry horribly, just like many practice primary care or GI surgery so. But there's a lot there that is useful and humane when the practice itself is.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-49525058716110896812013-05-15T11:27:52.797-07:002013-05-15T11:27:52.797-07:00This bullet tests was captured on video, and Anywa...This bullet tests was captured on video, and Anyway i posted <br />it along with this review. Typically a cell or a solar <br />solar panel can easily fail, and they'll prefer to be changed.<br /><br />Feel free to visit my website - <a href="http://detektywenigma.pl/" rel="nofollow">agencja detektywistyczna</a>Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-54391548470696006582013-05-15T04:03:33.079-07:002013-05-15T04:03:33.079-07:00here on this web site assembled a huge range of sm...here on this web site assembled a huge range of smart articles: [url=http://strojdomsam.ru/shkola-remonta/shkola-remonta-11-spalnya-v-stile-barbi-remont-spalni.html]сайт школы ремонта[/url].Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1732132352927731247.post-84391345505186474132013-05-15T02:54:47.696-07:002013-05-15T02:54:47.696-07:00Dub Turbo will give you the better that your
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