Sunday, July 02, 2023

Why Informal Psychiatric Diagnosis Is Important

If you don't get it clear that these are behaviors that other people find difficult, you run the risk of evading the issues in one more clever way.

Diagnoses can be worked around. They aren't immutable, they aren't death sentences. Sometimes they not only aren't permanent, they aren't even long lived. People avoid them because they would rather just dismiss what is infuriating others as "just being high-energy," or "their own fault, really," or "I just don't take bullshit from people;" These combine neatly with the other most common form or rationalisation, hiding behind political or cultural groupings, e.g. "Someone needs to stand up for women* in these situations." Uhh, you are standing up for the irrational preference of one woman, you, against the other six people in the group, two of whom are women.

If someone accuses me of some sort of diagnostic category I don't feel the least obligation to accept it as true (unless it is someone I have reason to believe has exceptional insight). They are likely a fool and a show-off. But I am very curious about what they are seeing that makes them say that, because that may be quite useful to me for my own self-understanding.  They're calling me OCD.  I thought I was pretty sloppy on that job myself. What do they mean by OCD? What did they see or hear that gave them that idea?

I have a friend who works for the state Supreme Court, and one of his tasks is examining all the cases submitted for review - some of which are pretty nutcase, frankly - and determining whether there is a real case underneath all the detritus, an idea that the court might put out on the rquest wire that they think there's something for them to decide abou a particular RSA, asking the attorneys in the state to be on the lookout for a sane version of the challenge.

I think many people find such observations about themselves intrusive. I can see that. But frankly, there are people who find everything intrusive, and those are usually the most brittle and blaming. I also freely admit that I am far on the other end of that scale, finding very little intrusive. I could point to decades of working with psychiatric patients who would make very intrusive and insulting statements - or intrusive and what they thought were complimentary statements - and say that toughened my skin. You can hear some pretty alarming theories about why you are the way you are, mostly involving your imagined love of controlling others or perverse sexuality. The amount of projection that goes into these is usually obvious, so you shrug it off. But actually,** I think I was this way when I was a teenager. Ask away!  Any attention is good attention!  

It can be easy to see who doesn't want anyone asking too many questions sometimes. They might have to give up their precious explanation for why they are as wonderful as they are. I'm pretty rough on examining my own motives; it's possible that's why I don't mind forcing yours out into the sunlight.

Not that I'd tell you. Not unless I have any of twenty good reasons...

* or Christians, or nurses, or pick a category.

** There's that Asperger word in explanation again.

5 comments:

Grim said...

Have you considered that the whole approach might be flawed?

Assistant Village Idiot said...

Do you mean that categories should be avoided? Or that the framing of psychology is inherently flawed?

As for what I have considered, I spent forty years under attack of why my/our/their ideas were wrong. I have considered a great deal. I may not be easy to persuade.

Assistant Village Idiot said...

For the overall questions, I recommend the retired British psychiatrist Theodore Dalrymple. He writes in many places and has written many books, though many of them are about culture and morality rather than psychiatry. He is no stranger to the abuses and has been scathing about them, and I think examined quite thoughtfully how much of the damage is from use rather than abuse, of which his most recent in City Journal is just a short example. https://www.city-journal.org/article/psychiatrys-bad-reasons . CJ is where I usually find him, and are an easy browse. https://www.city-journal.org/person/theodore-dalrymple.

He was a prison psychiatrist and inner-city outpatient psychiatrist in Birmingham, so there is little he has not seen.

Assistant Village Idiot said...

Freud set us back a hundred years, and a lot of the crap that is still out there now pretends it doesn't spring frm that fountain, but it does. It is still a mess. But the medical people - and I heard all the moaning for years about that hated people with their "medical model" - has put things on a much firmer basis. Perhaps I feel comfortable because I can now navigate it without much difficulty.

I came from an unusual corner, acute emergency psych, where we gradually burned the unevidenced fools out. It was medical doctors just shrugging off all the claims and rumors that others were bringing to the table saying "You can believe what you like, but it's my call and we're doing this." We could not afford to do otherwise. We had no room, we had laws severely limiting the amount of time we would be allowed, and people got hurt or died if we got it wrong. It focuses the mind, and I admit we developed considerable disdain for the rest of the situation. So we are not so far apart. But there are things that are now known pretty solidly, and people with wackadoo explanations get laughed out of the room. We know that the basic diagnostic manual is pretty good but always politicised, that some concepts are better if you hold them lightly, and always look for the question "Who sez?"

There is just so many players still in the game who can screw things up. A policeman who has this theory about what is "really happening with these people." How do you stop his influence? The local ER doc who takes it personally that we don't accept his diagnosis. Yet though all this I can still listen to initial report on someone I have never met, reasch a diagnostic conclusion in a couple of minutes, and have it hold up. It is perhaps like wine tasters: most who claim to do it aren't very good, but there is a core of people who independently keep coming up with the same answers. I knew which community doctors I respected in my system

james said...

WRT physics, I assume you're thinking of string theory and some of the stuff resulting. In the particle physics community, there are a lot of people who have been drumming their fingers waiting for the string theorists to come up with something testable, and others who've been putting tighter and tighter restrictions on what kind of supersymmetry we can have (a "hoped-for" result of string theory).

It is relatively straightforward to churn out papers with an add-on to some esoteric model to explain some new or ill-understood result, but it is quite hard to take one of those incompletely tested models and try applying it to _all_ the things it is supposed to explain. Everybody knows this, and so everybody ignores the churn.

If you're thinking about plasma physics, or solid-state, or nuclear--I'm not sure what you're referring to.