Case Study

Under DSM-IV, a “diagnosis” of somatization disorder entailed a history of physical symptoms for which, despite thorough medical evaluation, no satisfactory physical etiology could be established. In DSM-5, this “diagnosis” was replaced by somatic symptom disorder. This is essentially similar to DSM-IV’s somatization disorder – with one critical difference. The newer “diagnosis” can be assigned even if there is an identifiable physical illness. The essential requirement for the new “diagnosis” – indeed the only requirement – is that the individual is excessively or disproportionately preoccupied with the symptoms. And who, one might ask, decides if a person’s preoccupation is excessive? A psychiatrist, of course, whose vast training in drugs and ECT equips him with the wisdom, empathy, and insight to make such judgments. As the eminent Dr. Biederman proclaimed in a public courtroom on February 26, 2009, a psychiatry professor is second only to God in status and ability! ...

One of the criticisms that I routinely make of psychiatry is that its primary agenda during initial evaluations is the assignment of a “diagnosis,” and that ongoing “treatment” consists of 15-minute “med checks,” during which drug regimens are changed and adjusted. The essence of my criticism is that this kind of approach inevitably oversimplifies human problems, and in practice does more harm than good. My contentions in this regard have from time to time been challenged. It has been said that my portrayal of psychiatry is a kind of misleading caricature, and that in reality, psychiatrists do, in fact, concern themselves with human issues over and above “diagnosis” and drugs. This debate will, of course, continue, but I recently read an article on Psychiatric Times that has some bearing on the matter. [Thanks to Nick Stuart for the link.] The title is Conduct Disorder, ADHD – or Something Else Altogether? The author is Steven Dilsaver, MD, and the piece is dated October 11, 2013. The article is a case study of the psychiatric “treatment” of an eight-year-old boy (John). ...

In DSM-IV, conversion disorder is described as distressful symptoms (or symptom) of voluntary motor or sensory function that “suggest” a neurological or other illness even though no actual pathology is present, and there is reason to believe that the problem is psychological in origin. It has sometimes been called hysterical blindness, hysterical paralysis, hysterical anesthesia, etc… This diagnosis is being retained in DSM-5 Prevalence estimates vary from 1 in 10,000 to 50 in 10,000. ...

Years ago I was director of a county mental health center in an Eastern state. Shortly after taking the position, I became concerned that clients were being involuntarily committed too readily and without exploration of other options. I issued an instruction that all such activity had to be approved by a middle manager before it could proceed. This measure aroused enormous resistance from the front-line staff. There was one client – let’s call him Charlie – who was committed to the State Hospital every year, usually in July. Every July, he would become “agitated,” would scream profanities at his elderly mother, and break things around the house. He carried a “diagnosis” of schizophrenia. ...

When we were young, most of us devoted a good deal of time and energy to squabbling with other children. To the dismay of our parents, we because adept in the use of impolite language, and kept our stock of insulting words and phrases up-to-date. As adults we are more socially sophisticated. We no longer call one another rude names – at least not openly. Tragically, however, many people go through their entire adult lives calling themselves names, which although not as vulgar as the insults of childhood, are considerably more destructive. ...

Elsewhere on this site, I have argued that depression is not an illness, but rather is an adaptive mechanism that encourages us to make changes in our habits or our circumstances. I have written about what I call the seven natural anti-depressants: good nutrition; fresh air; sunshine (in moderation); physical activity; purposeful activity; good relationships; and adequate and regular sleep. But the question has often been posed: Why does this adaptive mechanism apparently not work in some cases? Why is it that for some people the unpleasant feeling fails to act as a spur to make changes, and instead the person sinks further into despondency and inactivity? ...