Francis king
Well-Known Member
Identified correctly by Francis King, 2... just like the professionals...
today I have been reading a book called, madness explained, by richard bentall, penguin 2004... he's a reputable psychologist/psychiatrist in the UK...
he states in this book that this lack of certainty in diagnosis is based on several factors- the most importance of which is... we diagnose purely by chance... we jump to conclusions based on our "expert opinions". When a psych diagnoses a patient, he does not "test" them. He does not read brain scans or ask you to sort cards... there is usually no questionnaire to fill in, no exam to sit. He looks at you, listens to you, asks you questions which he feels are relevant, ignores what he doesn't feel is relevant, and jumps to a certain conclusion so he can prescribe something which might work.
Bentall says another factor in this "lack of certainty" is often centered on the accuracy of the scales we use to determine symptoms. In the beginning, schizophrenia was a designation given to ppl who probably suffered not just from schizophrenia, but from encephalitis lethargica or autism, or mania... today, the same thing applies- what one psych sees as schizophrenia another thinks is a bi-polar, or a histrionic attention seeker...
psychiatrists cannot quite decide what the features of the specific disorders are- which suggests that instead of looking for a label and then deciding on treatment we should forget labels and instead focus on symptoms, and treat the most troubling symptoms first...
bentall reckons that globally, psychs cannot decide who has what... in 1974, kappa measures computed for six studies - adapted from R.L. Spitzer and J.L. Fliess (1974)" a reanalysis of the reliability of psychiatric diagnosis" (BJ PSYCH, (123) pp341-7) found inter-rater reliability of the various diagnostic subscales to be only .38. A kappa of 1 would be spot on, perfect agreement, and 0 would indicate agreement at chance level (p>0.05)... to get .38 then means that the results you get from scales are even worse than chance... statistically, they are completely irrelevant...
ian brockington from Birmingham university applied the various definitions of schizophrenia to a number of patients (1992). Using these different scales ... american criteria- 163 patients had schizophrenia, but using the icd definition, of these 163 only 65 had schizophrenia. this number fell to 55 when schneiders first rank symptoms scale was used, when the RDC was used this number of patients became 28, and when DSM was used, this number fell to... 19...
162, or 19 schizophrenics? It depends who you ask.
Studies before and since these all find similiar results- that we cannot agree what mental illness is, and even when we do, different people have different criteria as to what it is, even if it is. The usual agreement or concordance of diagnoses is 0.38. Worse than just guessing...
Ten people then, with the same diagnoses would then be perceived and diagnosed and labelled by ten psychiatrists with ten seperate conditions and they would only agree three times between three of them them about 3 patients.
This begs the question- if these mental illness are in fact, illnesses, then why do they appear so different to so many different professionals?
In dermatology, there are, say... 35 different types of skin lesion. Of these, 5 have two forms each (for example). Of these 40 lesions, 15 are malignant and potentially fatal. We have looked at 3 million lesions, and we know what a basal cell carcinoma looks like. We can differentiate between a basal cell carcinoma and a squamous cell carcinoma quite easily. One might kill you, one will not. If in a dermatology clinic we only got this right .38 of the time, then out of a hundred people all of them but one would be dead, and he would be dying...
This kind of inaccuracy would not be tolerated in general medicine, so why should we tolerate it in psychiatric medicine?
In reality, there's probably only four mental health problems- 1) being hyper, 2) being on a downer, 3) being deluded, and 4) being a person not liked by other people, aka, having a personality disorder... Of each of these four, some ppl will be at the mild end, and some at the severe end of the spectrum, and some in the middle.
In my line of work I often come across ppl who have had several different mental health diagnoses over a period of years. Each new consultant can feasibly give you another one, your treatment is changed accordingly, and a person has schizophrenia one year, bi-polar disorder the next, the year after the diagnosis can change again and suddenly- you're just a benefits scrounger with nothing much wrong with you. You don't have any say in these decisions. The models we use mean... we don't just deal with the symptoms, dampen down the mania, lift up the depressive, level out the deluded one... that would be far too simple...
of course, we have scales and assessment tools with good validity... it's just that nobody knows what they are... even well known scales like "becks depression inventory", "hare's psychopathy scale", are flawed, and do not measure what they say they measure... we, the professionals, say we do not use scales because we think that "people are beyond boxes", but in truth, we don't use them as they are rubbish, and we know it...
today I have been reading a book called, madness explained, by richard bentall, penguin 2004... he's a reputable psychologist/psychiatrist in the UK...
he states in this book that this lack of certainty in diagnosis is based on several factors- the most importance of which is... we diagnose purely by chance... we jump to conclusions based on our "expert opinions". When a psych diagnoses a patient, he does not "test" them. He does not read brain scans or ask you to sort cards... there is usually no questionnaire to fill in, no exam to sit. He looks at you, listens to you, asks you questions which he feels are relevant, ignores what he doesn't feel is relevant, and jumps to a certain conclusion so he can prescribe something which might work.
Bentall says another factor in this "lack of certainty" is often centered on the accuracy of the scales we use to determine symptoms. In the beginning, schizophrenia was a designation given to ppl who probably suffered not just from schizophrenia, but from encephalitis lethargica or autism, or mania... today, the same thing applies- what one psych sees as schizophrenia another thinks is a bi-polar, or a histrionic attention seeker...
psychiatrists cannot quite decide what the features of the specific disorders are- which suggests that instead of looking for a label and then deciding on treatment we should forget labels and instead focus on symptoms, and treat the most troubling symptoms first...
bentall reckons that globally, psychs cannot decide who has what... in 1974, kappa measures computed for six studies - adapted from R.L. Spitzer and J.L. Fliess (1974)" a reanalysis of the reliability of psychiatric diagnosis" (BJ PSYCH, (123) pp341-7) found inter-rater reliability of the various diagnostic subscales to be only .38. A kappa of 1 would be spot on, perfect agreement, and 0 would indicate agreement at chance level (p>0.05)... to get .38 then means that the results you get from scales are even worse than chance... statistically, they are completely irrelevant...
ian brockington from Birmingham university applied the various definitions of schizophrenia to a number of patients (1992). Using these different scales ... american criteria- 163 patients had schizophrenia, but using the icd definition, of these 163 only 65 had schizophrenia. this number fell to 55 when schneiders first rank symptoms scale was used, when the RDC was used this number of patients became 28, and when DSM was used, this number fell to... 19...
162, or 19 schizophrenics? It depends who you ask.
Studies before and since these all find similiar results- that we cannot agree what mental illness is, and even when we do, different people have different criteria as to what it is, even if it is. The usual agreement or concordance of diagnoses is 0.38. Worse than just guessing...
Ten people then, with the same diagnoses would then be perceived and diagnosed and labelled by ten psychiatrists with ten seperate conditions and they would only agree three times between three of them them about 3 patients.
This begs the question- if these mental illness are in fact, illnesses, then why do they appear so different to so many different professionals?
In dermatology, there are, say... 35 different types of skin lesion. Of these, 5 have two forms each (for example). Of these 40 lesions, 15 are malignant and potentially fatal. We have looked at 3 million lesions, and we know what a basal cell carcinoma looks like. We can differentiate between a basal cell carcinoma and a squamous cell carcinoma quite easily. One might kill you, one will not. If in a dermatology clinic we only got this right .38 of the time, then out of a hundred people all of them but one would be dead, and he would be dying...
This kind of inaccuracy would not be tolerated in general medicine, so why should we tolerate it in psychiatric medicine?
In reality, there's probably only four mental health problems- 1) being hyper, 2) being on a downer, 3) being deluded, and 4) being a person not liked by other people, aka, having a personality disorder... Of each of these four, some ppl will be at the mild end, and some at the severe end of the spectrum, and some in the middle.
In my line of work I often come across ppl who have had several different mental health diagnoses over a period of years. Each new consultant can feasibly give you another one, your treatment is changed accordingly, and a person has schizophrenia one year, bi-polar disorder the next, the year after the diagnosis can change again and suddenly- you're just a benefits scrounger with nothing much wrong with you. You don't have any say in these decisions. The models we use mean... we don't just deal with the symptoms, dampen down the mania, lift up the depressive, level out the deluded one... that would be far too simple...
of course, we have scales and assessment tools with good validity... it's just that nobody knows what they are... even well known scales like "becks depression inventory", "hare's psychopathy scale", are flawed, and do not measure what they say they measure... we, the professionals, say we do not use scales because we think that "people are beyond boxes", but in truth, we don't use them as they are rubbish, and we know it...
