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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by marg on October 3, 1999, at 17:14:46
TO label or not to label>>>>>>>>>>>
I am in an ambnormal Psych class and we have a debate tommorow and would like some input about labeling for diagnosis I need to hear more for those who are against labeling and the reasons why.. I hope I would have your permisiion to use your opinion and rational in a debate... thank you
Posted by Sean on October 4, 1999, at 12:28:46
In reply to Labeling and diagnosis, posted by marg on October 3, 1999, at 17:14:46
> TO label or not to label>>>>>>>>>>>
>
> I am in an ambnormal Psych class and we have a debate tommorow and would like some input about labeling for diagnosis I need to hear more for those who are against labeling and the reasons why.. I hope I would have your permisiion to use your opinion and rational in a debate... thank youI'm neither "pro" or "con" to labeling. I see the
diagnostic system as part of a long heritage in
Western medicine which tends to look at differences
between things rather than similarities. This has
benefits and disadvantages.As for myself, I honestly don't care what my diagnosis
or label is. My subjective experience of depression
and mania is my own and though it has similarities
to others, it is integrated with the fabric of
my entire life and thus belongs only to me.Communicating with people at this board has really
shown me how different we all are, so two people
with the same diagnosis are going to react differently
to medications, have different triggers and life
stressors. And yet the final common physiological
pathway will be very similar: sleep disturbances
and intense shifts of mood. In a very strange way,
I feel more understood by people than anybody
else!Diagnoses are part of the science of Nosology and
thus change over time. And yet I think they serve
a valuable purpose in terms of dicussing particula
constellations of symptomoly. A schizophrenic person
is very different from a person with panic disorder,
and yet there are certain affinities between
them (as any person who has experienced derealization
during as massive panic attack can attest!)From a therapeutic standpoint, there may be some
value to a person classifying his or herself as
having some disorder called "X". This makes one's
experience seem like any other condition in medical
science.On the other hand, a person could harm him/herself by
identifying too closely with a "label". But my
intuition is that such a shallow definition of
the self is not likely to stand the test of time
and will be very temporary.ANother apsect of "labels" follows naturally from
pharmacological dissection. When certain drugs
work on one condition and not another, there seems
to be a reasonable basis for categorizing along
putative lines of one neurological system or
another.And in the "meta-meta" sense, we are talking about
language here. If we do not differentiate and label,
than how do we talk about something? I remember the
days before I learned how to distinguish the different
conifers in the Sierra Nevada mountains. Before I
learned about the differences, they were all just
"pine trees". Now I see Red Fir, Hemlocks, Ponderosa
Pines, Western Junipers, and many others. The
forest has become a very different experience for
me because I have learned to identify and "label"
the trees. The Linnean (latin binomial) system of
naming living things is also part of the
history of Western science, which despite its
shortcomings, is on the brink of really nailing
down some major diseases (like cancer). All the
New Age crtitiques of "allopathic medicine" will
sound very shrill within 10 years or so. There
is a value of understanding that labels give us.I guess I'm for labels that are accurate and not
gross, dehumanizing generalizations. I don't walk
around thinking of myself as a victim of condition
"X". No human can be reduced a few words. The
problem is with society's need to do this and
the stigma of mental illness. Nobody thinks about
"labels" when we talk about cancer types, diabetes,
or losing a limb in a car accident. All of these
are things that "happen" to a particular person
who is seen as an intact entity engulfed in a
painful experience. With mental illness, however,
there is this idea that no such intact person
exists within the illness, that they *are* the
illness.Oddly, I don't know anybody with a mental illness
who thinks of this way. And the contributions to
our collective humanity in the arts and sciences
by person having affective disorders should serve
as some sort of indicator of the underlying vitality
of the *individual* inside the "label".Sean.
Posted by Sean on October 4, 1999, at 18:36:03
In reply to Re: Labeling and diagnosis, posted by Sean on October 4, 1999, at 12:28:46
Wow, Sean, very eloquently put. I hope that marg credits you if she uses your post in her class discussion. I think I would only add that for a psychopathology class, it is important for those thinking of entering the mental health field to keep in mind that diagnoses are merely constructs, as Sean pointed out, to help us organize our thinking about problems and symptoms and how to address them. Too often, though, clinicians can get into the awful habit of conceptualizing entirely within the DSM IV envelope, and forget about the individual experience of the client. And, with insurance companies often calling the shots, there is a tendency to use labels that are "acceptable" to the managed care gatekeepers, which says nothing about the psychological needs of the client or patient. Keep in mind, too, and Sean has already addressed this point, that over time, concepts evolve because of a number of influences--research developments, technological capabiities, but also cultural trends. In short, I would say that it is fine to use diagnoses and labels, but to use them with caution and a grain of salt, ie don't get too caught up in them.
Posted by Noa on October 5, 1999, at 4:19:47
In reply to Re: Labeling and diagnosis, posted by Sean on October 4, 1999, at 18:36:03
BTW, that last post was from me. Don't know how that happened. Sorry, Sean.
Posted by saint james on October 6, 1999, at 1:24:43
In reply to Labeling and diagnosis, posted by marg on October 3, 1999, at 17:14:46
> TO label or not to label>>>>>>>>>>>
>
> I am in an ambnormal Psych class and we have a debate tommorow and would like some input about labeling for diagnosis I need to hear more for those who are against labeling and the reasons why.. I hope I would have your permisiion to use your opinion and rational in a debate... thank you
James here...The HMO will not pay w/o a "label". the doc's I have seen then to say the same thing, ie they try to use a general label to get to bills paid and to help them stay organized, but it is more important what they say, because no 2 people are alike nor do they often fit a DSM number exactly.
j
Posted by Bob on October 6, 1999, at 10:53:45
In reply to Re: Labeling and diagnosis, posted by saint james on October 6, 1999, at 1:24:43
> The HMO will not pay w/o a "label"...
So milk them for all they're worth, I say.
They also come in quite handy for us Yanks when facing a situation covered by the Americans with Disabilities Act.
Personally, I was soooooooooo glad to get a label for what was wrong with me. Once the reality of it really sank in -- that my disorder includes a fault in the "hardware" as much as in the "software" -- I had a hard time coping with that. But now that I'm comfortable with it, it allows me to fall back into my culturally-conditioned Cartesian duality and say that it isn't my mind (which my mind thinks it should have *some* control over), but it started with and is prolonged by a malfunctioning body. I spent 20 years and more without a label, and the only thing I had to blame was myself. Giving my disorder a name other than "Bob" has helped me to detach myself from a lot of blame, guilt, shame, self-loathing, etc.
At times, I might even be going overboard on it. The shame, the stigma associated with "mental illnesses" puts me in a rage for what I've been through and for what others who've shared their own stories have been through. I have a number of close gay (male & female) friends, and they taught me a lot about "coming out", and that's what it feels like to me. Forget about "don't ask, don't tell". It's part of me, it affects how I behave, how I work, how I interact with others. I'm not going to parade it around, but I'm not going to hide it either. And if anyone is crass enough to pull some of that stigma sh*t openly on me, then'll I'll just have to paraphrase Winston Churchill:
"Yes, I am depressed. And you, (sir/madam), are stupid. When my meds kick in, I will no longer be depressed ... but you will still be stupid."
Cheers,
Bob BSEd, MA, MA, ABD, MDD, PD
Posted by Sean on October 6, 1999, at 12:00:50
In reply to Re: Labeling and diagnosis, posted by Bob on October 6, 1999, at 10:53:45
> > The HMO will not pay w/o a "label"...
>
> So milk them for all they're worth, I say.
>
> They also come in quite handy for us Yanks when facing a situation covered by the Americans with Disabilities Act.
>
> Personally, I was soooooooooo glad to get a label for what was wrong with me. Once the reality of it really sank in -- that my disorder includes a fault in the "hardware" as much as in the "software" -- I had a hard time coping with that. But now that I'm comfortable with it, it allows me to fall back into my culturally-conditioned Cartesian duality and say that it isn't my mind (which my mind thinks it should have *some* control over), but it started with and is prolonged by a malfunctioning body. I spent 20 years and more without a label, and the only thing I had to blame was myself. Giving my disorder a name other than "Bob" has helped me to detach myself from a lot of blame, guilt, shame, self-loathing, etc.
>
> At times, I might even be going overboard on it. The shame, the stigma associated with "mental illnesses" puts me in a rage for what I've been through and for what others who've shared their own stories have been through. I have a number of close gay (male & female) friends, and they taught me a lot about "coming out", and that's what it feels like to me. Forget about "don't ask, don't tell". It's part of me, it affects how I behave, how I work, how I interact with others. I'm not going to parade it around, but I'm not going to hide it either. And if anyone is crass enough to pull some of that stigma sh*t openly on me, then'll I'll just have to paraphrase Winston Churchill:
>
> "Yes, I am depressed. And you, (sir/madam), are stupid. When my meds kick in, I will no longer be depressed ... but you will still be stupid."
>
> Cheers,
> Bob BSEd, MA, MA, ABD, MDD, PD
I will also quote Churchill:"If you put reboxetine in my tea I would drink
it..."Sean, BPD, GAD, PMS(?), hee hee.
Posted by Noa on October 6, 1999, at 21:51:48
In reply to Re: Labeling and diagnosis, posted by Sean on October 6, 1999, at 12:00:50
Cool, Bob and Sean. "in your face" mental disorders.
Noa, DDNOS
Posted by Bob on October 6, 1999, at 23:18:58
In reply to Re: Labeling and diagnosis, posted by Noa on October 6, 1999, at 21:51:48
> Cool, Bob and Sean. "in your face" mental disorders.
>
> Noa, DDNOSTo paraphraze another Brit,
"Noa (DDNOS) wears her war wound like a crown ..."
=^)
('course, the next line, for me, would be "He sometimes thinks he's Jesus" ... delusional, martyr complex, y'know ... gotta add that to my pedigree....)
Posted by dj on October 6, 1999, at 23:43:11
In reply to Re: Labeling and diagnosis, posted by Bob on October 6, 1999, at 23:18:58
So, Bob, where's my acryonmn translator -- got a bit of software for that?
> >
> > Noa, DDNOS
>
> To paraphraze another Brit,
>
> "Noa (DDNOS) wears her war wound like a crown ..."
Posted by Bob on October 7, 1999, at 9:24:18
In reply to Re: Labeling and diagnosis, posted by dj on October 6, 1999, at 23:43:11
> So, Bob, where's my acryonmn translator -- got a bit of software for that?
Well, um, I don't quite know. Lessee ... I'm sure that there is some US Federal form that requires DSM-IV information, which means (since its the Feds) that it has to be stated as an acronym, so there is probably a guidebook available for download somewhere on the web as a 22MB PDF appendix to a 15kB PDF form. That'd prolly work.
Or, some clever programmer type out there in Babbleland could write us up a nice little program that takes an acronym as input and generates its translation by randomly choosing words beginning with the acronym's initials from some readily available word processor or spell checker dictionary.
Bob
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