Ship of Fools: Mental Health Assessment

Thread: Mental Health Assessment Board: Oblivion / Ship of Fools.

To visit this thread, use this URL:
http://forum.ship-of-fools.com/cgi-bin/ultimatebb.cgi?ubb=get_topic;f=70;t=027726

Posted by lilBuddha (# 14333) on :

Watching a vid about narcissism, I heard the statement that the answer to the question 'Are you a narcissist' was a good predictor of the results of more intensive evaluation. There was a link to a test included.
So I took it. Twice. Being honest both times, I scored a 2 and a 32. "Normal" is 12-15, over 20 is narcissist.
So, we are beginning to see sexuality as more difficult to quantify than previously thought, but what of mental health?
IME, I do not see the same fluidity in diagnoses. Nor treatment.
Why?

Posted by que sais-je (# 17185) on :

I got 7. That can't be right. I'm wonderful, ask anyone (except my wife of course).

Posted by Mere Nick (# 11827) on :

Are you sure it wasn't really a test for split personality disorder?

Posted by balaam (# 4543) on :

I did the test but won't post the result as I can't see how that would help discussion.

Erm...

...what are we discussing?

Posted by Evangeline (# 7002) on :

I'm no expert but I don't believe an online quizz is the summation of current thought on mental healht and diagnosis of disorers. It is my understanding that mental health issues are extremely difficult to quantify and hence to diagnose. Medicine has a tendency to want black and white definitions, eg if your blood sugar is above 10 you're diabetic and mental health wants the same certainty and quantifiability but I suspect the experts know that's far from possible at the moment.

Posted by Moo (# 107) on :

I suspect that an individual's score is partly a function of age. I am eighty years old, and my score was 4. I want the people I like and respect to like and respect me, but I don't spend a lot of time worrying about what strangers may think. As far as leadership and ambition are concerned, I really have no interest.

I think that I would have had a higher score thirty or fifty years ago; however I'm sure I was never a narcissist.

Moo

Posted by lilBuddha (# 14333) on :

quote:
Originally posted by Evangeline:
I'm no expert but I don't believe an online quizz is the summation of current thought on mental healht and diagnosis of disorers.

No, but unlike the quizes which often appear in the Circus, this one is supposed to be an indication

quote:
Originally posted by Evangeline:

It is my understanding that mental health issues are extremely difficult to quantify and hence to diagnose. Medicine has a tendency to want black and white definitions, eg if your blood sugar is above 10 you're diabetic and mental health wants the same certainty and quantifiability but I suspect the experts know that's far from possible at the moment.

Well, yes and no, IME anyway. When asked, most will agree with your statement. But in practice, from what I can observe, many seem to forget this.

quote:
Originally posted by Moo:
I suspect that an individual's score is partly a function of age.

They do ask your age and it appeared I could achieve a slightly different result by changing the age.

Posted by Macrina (# 8807) on :

I am a mental health nurse. I have developed an extremely healthy suspicion of both the DSM IV and the ICD-10 during the course of my seven or so years in the field. It seems to be all about fitting the person to the box rather than a box to a person (even though I still have problems with the latter it at least starts the right end). There is a huge tension between the medical/pharmacological treatment of mental illness and the idea that services should be person centred and individualised.

I honestly believe that mental health "assessment" is hightly subjective and open to bias. People are also very often given a label of 'personality factors' when in reality they are hurting and processing traumatic and difficult experiences (albeit often in some unhelpful ways). The lack of space for compassion in crowded and overstretched services is the thing that makes me seriously question continuing in my profession at times.

Fundamentally, mental health diagnoses seem to be given with access to services in mind i.e you can't be admitted under crisis without a diagnosis to accompany the legal paperwork, you can't access certain follow up and support services without a certain established level of severity to your symptoms and accompanying diagnosis. There is also an unhealthy link between senior psychiatrists, the DSM and the pharmacological companies and that I think is what continues to perpetuate the problems we see in the system.

Posted by Eutychus (# 3081) on :

quote:
Originally posted by lilBuddha:

quote:
Originally posted by Evangeline:
I'm no expert but I don't believe an online quizz is the summation of current thought on mental healht and diagnosis of disorers.
No, but unlike the quizes which often appear in the Circus, this one is supposed to be an indication

"for personal use only", as it says in the disclaimer at the bottom. This is a dumbed-down version of a more stringent test and has about the same value as a Circus quiz.

I'm very sceptical about whether anything can be measured in the social sciences, but I've learned that there's a big difference between using this and other psychometric tests as they were originally intended to be used and how they are very often popularly implemented.

Posted by lilBuddha (# 14333) on :

quote:
Originally posted by Macrina:
It seems to be all about fitting the person to the box rather than a box to a person

This is my perception. But I would broaden it to say, for some, there is no box.

quote:
Originally posted by Macrina:

There is a huge tension between the medical/pharmacological treatment of mental illness and the idea that services should be person centred and individualised.

The thicker the money, the thinner the ethics. And drugs have a result, even if they are not the perfect solution.

Posted by lilBuddha (# 14333) on :

quote:
Originally posted by Eutychus:
"for personal use only", as it says in the disclaimer at the bottom. This is a dumbed-down version of a more stringent test and has about the same value as a Circus quiz.

It is the Narcissistic Personality Inventory, 'the most widely used measure of narcissism in social psychological research'
To be fair, the site does say this:

quote:
A diagnosis for narcissistic personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

However, one question how narcissistic are you? Scale from 1 to 11 is seen as a good indication.

quote:
Originally posted by Eutychus:

I'm very sceptical about whether anything can be measured in the social sciences,

I would append this with easily, but this is my point.

Posted by chive (# 208) on :

quote:
Originally posted by Macrina:
I am a mental health nurse. I have developed an extremely healthy suspicion of both the DSM IV and the ICD-10 during the course of my seven or so years in the field. It seems to be all about fitting the person to the box rather than a box to a person (even though I still have problems with the latter it at least starts the right end). There is a huge tension between the medical/pharmacological treatment of mental illness and the idea that services should be person centred and individualised.

I honestly believe that mental health "assessment" is hightly subjective and open to bias. People are also very often given a label of 'personality factors' when in reality they are hurting and processing traumatic and difficult experiences (albeit often in some unhelpful ways). The lack of space for compassion in crowded and overstretched services is the thing that makes me seriously question continuing in my profession at times.

Fundamentally, mental health diagnoses seem to be given with access to services in mind i.e you can't be admitted under crisis without a diagnosis to accompany the legal paperwork, you can't access certain follow up and support services without a certain established level of severity to your symptoms and accompanying diagnosis. There is also an unhealthy link between senior psychiatrists, the DSM and the pharmacological companies and that I think is what continues to perpetuate the problems we see in the system.

You are absolutely right. Mental health diagnoses are absolutely subjective. I've seen about half a dozen psychiatrists in my time and each has given a different diagnosis when I give them the same symptoms. I have also found that if you get on with a psychiatrist they tend to give you a less stigmatising diagnosis then if you don't (eg. PTSD/BPD).

Mental health services seem to want to fit you in a nice little box that fits with the
cluster that either gets rid of you from services or gets more money to treat.

It's bullshit of course which is why it pays to become an expert in your own mental health to navigate through the system (as long as you're not too stroppy because that clearly means you're borderline). I may be a bit cynical.

Posted by Karl: Liberal Backslider (# 76) on :

2. What worries me is that being able to give the opposite answers (i.e. the high scoring ones) is exactly the sort of thing that job adverts tend to require ("you will be a born leader, you will have a proven track record of influencing people, you will have exceptional talent in your field" etc. etc. ad nauseam)

Posted by itsarumdo (# 18174) on :

It's all about allocating funds, filling posts, etc in a way that is justified by whatever administrative protocol is running the show. Cart is before the horse AND it tells the cart driver how to drive it.

Posted by Macrina (# 8807) on :

Just as a further thought, this is my profession and what I rely on to make a living but I do think that people put far too much stock in expert mental health professionals. I've often heard 'I'm not trained to deal with that' when faced with distress and human pain. The bare facts of it is you don't need training to be compassionate and meet someone on a human level.

As a nurse I've sometimes said exactly the right thing and helped someone. I've also said exactly the wrong thing (not deliberately but simply because sometimes there isn't a right thing or because I'm human too and make mistakes) and had my head bitten off. But no one trained me to understand that the person in front me is a person and has validity that is intrinsic and a story that needs to be heard.

Posted by Eutychus (# 3081) on :

quote:
Originally posted by lilBuddha:
It is the Narcissistic Personality Inventory, 'the most widely used measure of narcissism in social psychological research'

No it's not. It's based upon the NPI.

I'm not a fan of questionnaires, but I have realised there's a difference between doing a quick online version and having a test properly administered by a professional trained in the use of the questionnaire, who knows the difference between an ipsative and a Likert-type test and what you can and cannot reliably do with the results, and has signed up to a code of ethics.

quote:

quote:
Originally posted by Eutychus:
I'm very sceptical about whether anything can be measured in the social sciences,
I would append this with easily, but this is my point.

Again, you have my sympathies, but any kind of institutional care is faced with the need for some sort of assessment of how its care should be delivered, and the nature of Western society is that this will involve some form of supposedly objective reporting, such as a test score. One hopes that on average, it's slightly less bad than just the vague impression of one practioner.

[ 13. August 2014, 08:53: Message edited by: Eutychus ]

Posted by Barnabas62 (# 9110) on :

I had a lot of reservations about value of the test for measuring narcissism. Tried to do it honestly. Scored 2.

A narcissist who wanted to use the results to impress could pretty easily score nil, simply by going for the obviously humble answers. I've met folks in faith communities who strike me as narcissists and are proud of being humble.

A lot of these kinds of test don't work if you are more interested in creating an impression than genuine personal exploration. The desire to create an impression is a pretty good test of narcissistic tendencies.

Wonder what the late ken would have had to say about this one? I suspect the demolition job would have made his Myers Briggs critiques look vanilla.

[ 13. August 2014, 09:42: Message edited by: Barnabas62 ]

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by Barnabas62:
I had a lot of reservations about value of the test for measuring narcissism. Tried to do it honestly. Scored 2.

A narcissist who wanted to use the results to impress could pretty easily score nil, simply by going for the obviously humble answers. I've met folks in faith communities who strike me as narcissists and are proud of being humble.

But aren't they so proud of being humble! I find their humility is overwhelming.

I also scored 2. I don't know how anyone over 50, outside showbiz and politics (which is no more than a branch of showbiz), can get a score in double figures.

Posted by Caissa (# 16710) on :

I scored a 10. Who knew that I was Bo Derek. [Yipee]

Posted by LeRoc (# 3216) on :

Some of the questions seem to measure the difference between your self-image and reality. So, if you answer "I'm a good leader", "I have a great body" or "I'm an extraordinary person", I suspect this adds to your narcissism score.

But what if you happen to be an extraordinary person, a good leader with a great body and just wanted to answer honestly? Did anyone think of that?? [Biased]

Posted by la vie en rouge (# 10688) on :

The questions that relate to body image were the ones I found most problematic.

I answered in the positive, because ISTM that liking one’s own body is part of healthy self-esteem. Doesn’t necessarily mean I think I have the most gorgeous body around anywhere, just that I’m happy with the one I’ve got.

Posted by sabine (# 3861) on :

As a social worker (and even without my credentials), I wouldn't take the results of an either/or, multiple choice test seriously...even as an indication, even for personal use.

Seriously, relatively few things in life can be reduced to such a format.

sabine

Posted by leo (# 1458) on :

Pity they can't spell 'extrovert'

Posted by Sister Influenza (# 15557) on :

I work as a counsellor and did the test, like others I am not a fan of DSM-IV diagnoses. These tests need to be taken with a pinch of salt because narcissistic personality disorder can present in different ways.

In my work I have come across people who are narcissistic but do not present as people with overinflated opinions of themselves or displaying a extreme sense of entitlement. They have usually experienced trauma in early life and shut everything out so it is only them, so life becomes all about them, their issues.

This type of narcissist uses people as objects to serve their needs and protect the traumatised self inside rather than facing the pain. The job of protection takes up so much of them that not only can they not let anyone in, they cannot give out so relationships become about taking. It's their sense of victimhood that drives the entitlement to attention rather than superiority,unfortunately this can lead to manipulative and abusive behaviours to get this attention or when others don't co-operate.

A type of superiority can present itself as totally good me/ totally bad world,so people close to a narcissist get forced into making up for the wrongs done by focusing solely on their needs.

Posted by Ad Orientem (# 17574) on :

I scored 4 points. 3 points for power and 1 for vanity. [Hot and Hormonal]

Anyway, there where some questions which I could have said yes to both options and others where neither of them really applied to me. I quite like doing these tests just for the sake of it though I don't really place much value in them.

Posted by itsarumdo (# 18174) on :

4, but that's definitely an underestimate, because otherwise I wouldn't be telling you my score [Big Grin]

Oh - and I'm an Aquarius

[ 13. August 2014, 18:07: Message edited by: itsarumdo ]

Posted by Curiosity killed ... (# 11770) on :

I've got a lot more cynical about mental health assessment recently. The student I work with most at the moment has a specific diagnosis and when he was asking me why certain things were in place I explained that they were dependent on his statement of special educational needs and diagnosis. He is 14 and I want him independent and taking responsibility for himself. At which point he said he didn't know why he had that diagnosis because he refused to engage in any tests. Now the answer to that particular question is that it's all on his mother's say so and descriptions and an observation. (That bit I didn't tell him.) Personally I agree with the student and think that this particular label and diagnosis is inaccurate, but it's going to take a whole lot of changing and a whole lot of co-operation from said student - who is in this situation because he refused to co-operate in the first place!

And that was all about a box to put him into so he could access other services and support.

Posted by Penny S (# 14768) on :

4, 2 for authority and 2 for exploitation - and I can't see how they worked out the latter. The first was because of the pair of exercising authority and being happy to follow orders, I decided to go with liking authority because I am really, really resistant to following orders. Polite requests, fine. Obviously necessary instructions, OK. Orders, no, no, no.

I think I could equally feel terrified at the idea of ruling the world and feel that if I did it would be better. (Provided that everyone did what I suggested...)

I really can't work out what the exploitative things were. I can manipulate, but I don't like it so I don't do it. I do depend on others to do things - who doesn't? That's only exploitation if they don't want to, and I don't respect and reward them for it.

[ 14. August 2014, 09:43: Message edited by: Penny S ]

Posted by North East Quine (# 13049) on :

Originally posted by Sioni sais:

quote:
I also scored 2. I don't know how anyone over 50, outside showbiz and politics (which is no more than a branch of showbiz), can get a score in double figures.

I got 13.

Like la vie en rouge I found the body image ones odd. I scored highly on vanity, but I think if I was actually vain, I'd score low, because I wouldn't be happy being a fat, middle aged woman who hasn't been to the hairdresser in months.

[ 14. August 2014, 10:17: Message edited by: North East Quine ]

Posted by Caissa (# 16710) on :

If we abolish the DSM and ICD with what should we replace them to develop diagnostic criteria?

Posted by sabine (# 3861) on :

Here is a link to a witty "anti-DSM"

All of the categories are what the author calls "cagey optimism."

Among many I like is this: * VIRTUOSO INTEGRATION. Consistently walking your talk; effectively translating your ideals into the specific actions; creating results that are congruous with your intentions; being free of hypocrisy.

sabine

Posted by Caissa (# 16710) on :

Cute yet hardly helps with the necessary diagnosis of psychiatric disorders.

Posted by chive (# 208) on :

quote:
Originally posted by Caissa:
If we abolish the DSM and ICD with what should we replace them to develop diagnostic criteria?

Why do we need diagnostic criteria? Many of those in the DSM and ICD are bollocks anyway. Most are completely subjective and as I mentioned above every psychiatrist seems to interpret diagnostic criteria differently.

I no longer really believe in diagnosis. I think it is stigmatising, it pigeon holes people and it is largely irrelevant. Instead what is important is relieving distress. If a specific intervention relieves distress then that should be undertaken irrelevant to what label the person is given.

The DSM seems to have been created to allow doctors to claim payment from insurance companies. Fuck that as a form of diagnosis.

Posted by Caissa (# 16710) on :

So how does one treat what one cannot diagnose?

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by chive:

quote:
Originally posted by Caissa:
If we abolish the DSM and ICD with what should we replace them to develop diagnostic criteria?
Why do we need diagnostic criteria? Many of those in the DSM and ICD are bollocks anyway. Most are completely subjective and as I mentioned above every psychiatrist seems to interpret diagnostic criteria differently.

I no longer really believe in diagnosis. I think it is stigmatising, it pigeon holes people and it is largely irrelevant. Instead what is important is relieving distress. If a specific intervention relieves distress then that should be undertaken irrelevant to what label the person is given.

The DSM seems to have been created to allow doctors to claim payment from insurance companies. Fuck that as a form of diagnosis.

That's a very interesting comment, and I largely agree with you. I worked with clients over quite long periods of time, and giving them a diagnostic label seemed less and less useful, as I became more experienced. And I also noticed that the psychiatrists would change their mind quite frequently about a diagnosis.

I remember trainees who would frantically search through books looking for something useful about borderline clients, or whatever, when in fact, they have all they need in front of them - that person, who is with them, or maybe not with them. But this is a more existential/phenomenological approach, of course.

Posted by lilBuddha (# 14333) on :

It isn't that I do not agree, but that approach ignores a fundamental part of human psychology. We need to catagorise. It is innate, it helps us function. Yes, treating the individual is better. And it can be done, but it is more difficult. Not only from a nature POV, but from a systematic one as well.
So Dr. Quetzalcoatl, You say your patient has pernicious internetus addictivitus? How do we know? And, therefore, why should we pay?

Posted by chive (# 208) on :

quote:
Originally posted by Caissa:
So how does one treat what one cannot diagnose?

The idea of treating diagnoses is pernicious. It is people that should be treated. It is their distress that should be relieved. Putting a label on someone doesn't make them more intact as a person.

Posted by Caissa (# 16710) on :

Of course we treat the individual and we treat them for a specific "illness". I would hate to be treated for diabetes if I had cancer.

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by lilBuddha:
It isn't that I do not agree, but that approach ignores a fundamental part of human psychology. We need to catagorise. It is innate, it helps us function. Yes, treating the individual is better. And it can be done, but it is more difficult. Not only from a nature POV, but from a systematic one as well.
So Dr. Quetzalcoatl, You say your patient has pernicious internetus addictivitus? How do we know? And, therefore, why should we pay?

Patient? Good grief, how 19th century.

There is no should pay, but you will - dearly.

Posted by chive (# 208) on :

quote:
Originally posted by Caissa:
Of course we treat the individual and we treat them for a specific "illness". I would hate to be treated for diabetes if I had cancer.

In my experience psychiatric diagnoses are not as clear as other medical ones. Your hba1c will tell you about diabetes. A scan should pick up on cancer. Psychiatry is based on a subjective decision based on a history and observing behaviour which I'm sure you'll agree is a completely different kettle of cheesecake.

I'll give you an example from my own situation (I know anecdote does not equal data and I'm aware of what I'm revealing about myself but I have no issue with that). I have been under psychiatric care for a decade now and my history,behaviour and symptoms have not changed markedly in this time.

Psychiatrist #1 - depression
Psychiatrist #2 - ptsd
Psychiatrist #3 (wanker) - definitely not PTSD, being gay was apparently my diagnosis. Something that I did complain about
Psychiatrist #4 - psychosis
Psychiatrist #5 - borderline personality disorder
Psychiatrist #6 - ptsd and generalised anxiety disorder
Psychiatrist #7 - no diagnosis given just told she was discharging me from secondary services so I could be on someone else's budget.

So there you go. I haven't changed
My madness hasn't changed. My experience hasn't changed beyond becoming more cynical about psychiatry. And fundamentally my treatment hasn't really changed.

Do you really think diagnosis is so fundamental now?

Posted by Doublethink (# 1984) on :

quote:
Originally posted by chive:

quote:
Originally posted by Caissa:
Of course we treat the individual and we treat them for a specific "illness". I would hate to be treated for diabetes if I had cancer.
In my experience psychiatric diagnoses are not as clear as other medical ones. Your hba1c will tell you about diabetes. A scan should pick up on cancer. Psychiatry is based on a subjective decision based on a history and observing behaviour which I'm sure you'll agree is a completely different kettle of cheesecake.

I'll give you an example from my own situation (I know anecdote does not equal data and I'm aware of what I'm revealing about myself but I have no issue with that). I have been under psychiatric care for a decade now and my history,behaviour and symptoms have not changed markedly in this time.

Psychiatrist #1 - depression
Psychiatrist #2 - ptsd
Psychiatrist #3 (wanker) - definitely not PTSD, being gay was apparently my diagnosis. Something that I did complain about
Psychiatrist #4 - psychosis
Psychiatrist #5 - borderline personality disorder
Psychiatrist #6 - ptsd and generalised anxiety disorder
Psychiatrist #7 - no diagnosis given just told she was discharging me from secondary services so I could be on someone else's budget.

So there you go. I haven't changed
My madness hasn't changed. My experience hasn't changed beyond becoming more cynical about psychiatry. And fundamentally my treatment hasn't really changed.

Do you really think diagnosis is so fundamental now?

I think there is a conversation to be had about differential diagnosis but leaving that aside, what that list appears to tell me is that:

You have suffered severe trauma in your life, some of it probably early on
You often feel distressed and miserable
You can find it hard to trust people
You are valuable and worthwhile human being, but there are times when you find that hard or impossible to believe
You find it difficult to change your mood once you are distressed
You are hypervigilant to threat
You have intrusive re-experiencing symptoms; intrusive memories, flashbacks or nightmares or some combination of these
Sometimes, probably when most distressed, you have internally generated perceptions others do not
You deserve better support than you are getting

All a diagnosis is good for is to condense your story, to predict what is likely to happen in the future and to predict what treatments might help - that's all. Beyond that, those offering a service need to understand you as an individual, how these things manifest uniquely for you in your life, and what things specifically help you - not what worked for someone else who happens to share a diagnosis or symptom pattern.

Posted by chive (# 208) on :

quote:
Originally posted by Doublethink:
All a diagnosis is good for is to condense your story, to predict what is likely to happen in the future and to predict what treatments might help - that's all. Beyond that, those offering a service need to understand you as an individual, how these things manifest uniquely for you in your life, and what things specifically help you - not what worked for someone else who happens to share a diagnosis or symptom pattern.

That's exactly my point. Diagnosis is fairly pointless, attempting to alleviate someone's unique distress is worthwhile. But that doesn't fit with tick box culture.

(I also forgot to mention an occupational health Dr who decided I was bipolar on no grounds whatsoever.)

Posted by Doublethink (# 1984) on :

It does make a functional difference for some treatments and diagnoses though - for example - non-directive counselling can help mild anxiety and depression but is likely to make ptsd worse.

Methylfenidate (Concerta) can make a massive difference for people with adult ADHD, it will make most other mental health problems worse.

It is not the be all and end all, but it is important.

Posted by Lamb Chopped (# 5528) on :

Now I'm curious. Why would non-directive counseling make PTSD worse? (I have PTSD, so am interested--and I could make a guess, but won't)

Posted by luvanddaisies (# 5761) on :

quote:
Originally posted by chive:

quote:
Originally posted by Doublethink:
All a diagnosis is good for is to condense your story, to predict what is likely to happen in the future and to predict what treatments might help - that's all. Beyond that, those offering a service need to understand you as an individual, how these things manifest uniquely for you in your life, and what things specifically help you - not what worked for someone else who happens to share a diagnosis or symptom pattern.
That's exactly my point. Diagnosis is fairly pointless, attempting to alleviate someone's unique distress is worthwhile. But that doesn't fit with tick box culture.

(I also forgot to mention an occupational health Dr who decided I was bipolar on no grounds whatsoever.)

I wonder whether it varies from person to person how useful a diagnosis is. What I mean is someone like you, Chive, is (from the evidence of your posting here) articulate and able to communicate well. You create coherent arguments, present a case, re-present it in a different way or with different wording if it needs clarified. You're able to call upon language, upon metaphor, simile, anecdotes... You are clearly someone who is academically able, and someone who can research, read articles or accounts, and draw what is relevant from them, also taking into account whether you're reading something from a Sunday newspaper or a scientific journal.

I guess you probably have days where you might not really be so hot at some or any of that (my brain packs its suitcases and fucks off I know not where, leaving in its place a heap of soggy cotton-wool sans even cress-seeds when I'm depressed), but you certainly appear to have those skills and that aptitude, so I guess if you don't arrive at someone's desk with a label, you're able to go some way towards explaining where you're at and making yourself understood.

For someone who's just not that good at verbal or written communication, who'd never really want to research something, and wouldn't necessarily have the skills to do so or to read critically and apply what they've read to their own situation, it might be more beneficial to their treatment teams to be able to have a category as a starting point or frame of reference - it might maybe take longer for them to say what they want to or to put a point across, or to ask effectively for help - especially if they're having a crisis or are depressed so aren't functioning at their best. If they arrive at someone's desk unlabelled, it might be more difficult for them to explain where they're at and make themself understood, taking up much more time that could be spent helping them and maybe being frustrating and distressing if they're trying to fish for words or how to assemble them in order to put across an idea.
That's not to say that people who're not natural communicators should just be labelled and treated wholesale, but maybe it's something of a relief once you feel the pressure taken off to be able to describe stuff. Maybe.

All that said, it sounds a bit like sometimes some doctors see the label before they meet the person, but surely the ideal is that the label is there as a glance-at-notes, see what the ballpark looks like according to previous professionals, then see what the actual 3D real-life person is like, use notes to help, add stuff in to help next person.

Maybe also my view might be skewed by having always lived in the UK with the NHS, so labelling doesn't affect insurance companies paying for one's treatment as it's free at point of use. Maybe labels are more useful if healthcare is about money?

Posted by Timothy the Obscure (# 292) on :

I usually avoid the mental health threads (I'm a psychologist, I think about this stuff all day, I try to let it go at 5:00). However, just this once...

The NPI is used in social psychological research, not for clinical diagnosis (a clinical psychologist would probably use the MCMI-III--which has its own issues--or the SCID-II to diagnose a personality disorder).

DSM is indeed a crap diagnostic system, and ICD is only slightly better. As someone mentioned, their main purpose is to justify payment. Some very different diagnostic systems have been proposed, mostly by psychologists, but who listens to us? To mention only one example, how does it make sense for someone to have two or more personality disorders (assuming they only have one personality)? The DSM is in some ways worse than useless--it many cases it's a positive impediment to effective treatment, and it's definitely an impediment to good research. Still, there is a need for some kind of common language--the DSM was intended to fix the problem of every clinician and every psychiatric hospital having their own diagnostic system and being unable to communicate, which was pretty much the situation in the first half of the 20th century.

Nevertheless, most people overestimate the precision of medical diagnosis--it is not that much more reliable than mental health diagnosis if you take a hard look at the data.

The bottom line is that if you look at a client and just see a label, you're not going to be of much help. Diagnosis is only a very small part of assessment.

Posted by lilBuddha (# 14333) on :

quote:
Originally posted by luvanddaisies:
so labelling doesn't affect insurance companies paying for one's treatment as it's free at point of use. Maybe labels are more useful if healthcare is about money?

Healthcare is about money everywhere. The NHS is not driven by profit, which is the factor that make the American system behave very unethically.
The problem with the NHS is that it is government and government means there will be a system.
And systems will tend against adaptability. The positive in a system is that it can regulate excess and wild swings.
One of the biggest problems with government is that it selects and forms people who serve the system, not the public it is meant to serve.

quote:
Originally posted by quetzalcoatl:
Patient? Good grief, how 19th century.

I generally attempt to speak to people in deference to their comfort zone....

Posted by Curiosity killed ... (# 11770) on :

The UK does play the money game.

If you (general you) get the *right* diagnosis you can, currently†, register as disabled and become entitled to disability benefits. I have come across a couple of parents, a few outliers, playing the benefits game for children and putting pressure on schools to back up their claims that their child requires diagnosis and funding. It doesn't do the child much good either.

There was one family set up that had all sorts of wrinkles. They were caring for a nephew/cousin who genuinely had challenging behavioural difficulties, but put incredible pressure on the school to support claims that their daughter equally had disabilities. At the time it was worth a good £100 a week per disability when Income Support was around £40 a week per adult. Child benefits finish or are paid to the child when the child turns 16. The pressure on the school really increased when the boy was 15. After a few years of this situation the daughter definitely exhibited challenging behaviour. Her diagnosis came from an external private clinic, which also tends to up the cynicism levels.

I suspect I'm currently dealing with a misdiagnosis that attracts similar monies. I suspect this is actually a misdiagnosis rather than anything as cynical as above. However, I think that I'm going to be opening all of the above cans of worms trying to right this, if I'm right. And I wouldn't bother to do this if in the long term the diagnosis didn't come with a permanent label which looks as if it's going to be unhelpful and not attract the right sort of support or treatment. And the student involved is not happy that he has that label.

† benefits are changing - and it's abusers like this that are discrediting the majority who really don't claim what they are entitled to and struggle on not realising that they could ask for help.

Posted by Doublethink (# 1984) on :

quote:
Originally posted by Lamb Chopped:
Now I'm curious. Why would non-directive counseling make PTSD worse? (I have PTSD, so am interested--and I could make a guess, but won't)

Essentially, it will encourage the person to focus on the trauma - thereby increasing re-experiencing phenomena such as flashback and nightmares - without providing effective techniques to reintegrate the traumatic memories, or grounding techniques for use during flashback.

Treatments with good evidence bases, such as trauma-focused CBT and forms of EMDR and culturally mediated narrative approaches, have the person retell the trauma story repeatedly in a highly structured way in order to integrate the memory into episodic memory and break the cognitive avoidance cycle.

However, such treatments should only be undertaken if the person has enough social support and emotional resilience to cope with the distress involved in the process. They are more likely to work when the ptsd is in response to a single discrete trauma - e.g. a single rape rather than a whole childhood of abuse - and if you don't haven't a significant acquired disability as a result of the trauma - e.g. You didn't lose a leg in the car accident etc.

It is better to offer no treatment, rather than a treatment that will worsen the condition or (whilst being distressing and unpleasant for the person to undertake) will be unlikely to work. Unfortunately, that may mean having to advise against this type of talking treatment for people who are very ill.

[ 15. August 2014, 08:30: Message edited by: Doublethink ]

Posted by Doublethink (# 1984) on :

I should add that even if trauma focused treatment is not appropriate, there maybe other forms of supportive treatment - including both medication and coping strategy focused talking therapy - that will help people live with their symptoms.

[ 15. August 2014, 08:33: Message edited by: Doublethink ]

Posted by chive (# 208) on :

Doublethink,

Isn't it also true to say however that many studies have shown that the best indicator of the success of therapy is the relationship with the therapist as opposed to the type of therapy undertaken?

I think what you're saying may be true for some individuals but not for others. For example, I have undergone CBT more than once and on each occasion I have found it has made me worse. I experience it as reductive, patronising and deeply offensive. It is appropriate that I experience the emotions I feel, they are what someone who has been through what I have been through should feel. It is denying them or trying to ignore and sublimate them that cause the problems. Whistling a happy tune or turning the frown into a smile is not going to make me better.

However, having non-directive therapy with someone who is prepared to be there with me, bear witness for me, experience my emotions with me and finally listen to what I need to say instead of trying to force me to say what they want me to say, has been an immensely healing process. It has taken a long time and a lot of trust to be developed before we got to that point but if thats what needs to happen thats what needs to happen.

As to EMDR, I am still unconvinced it is anything less than snake oil and have refused to have anything to do with it.

The one size fits all thinking about talking therapies seen within the NHS at the moment is fundamentally damaging. Alongside diagnoses they pigeonhole people and force them to fit into a structure that suits the provider not the individual which is just wrong. As I've said a few times now (and may be at risk of crusading) meeting the individual where they are and trying to alleviate their distress should be what should be happening. Anything else is a failure.

Posted by quetzalcoatl (# 16740) on :

Just echoing what Doublethink said - that for some people, therapy is not suitable, as it can restimulate stuff, which is too raw. Sometimes, it is best to let sleeping dogs lie.

I also agree with Chive, that CBT is unsuitable for some people. But then all styles of therapy are unsuitable for some. The aim is to match yourself up with a style (and a person) which benefits you. As Chive said again, I see the relationship as the healing force in most therapies, but of course, some clients find relating to be the problem, so I learned to leave some clients alone pretty much, as that was the only thing that was tolerable to them. In Patrick Casement's wise words, this is learning from the patient.

Posted by Doublethink (# 1984) on :

It is certainly true that no particular treatment will suit everyone.

I would say a good therapeutic relationship is necessary, but not sufficient for talking treatment of any kind to be effective.

I am not prepared to comment on what is the right treatment for you, as I don't know you and your history, and because it would be inappropriate to give medical advice.

Re EMDR, I seriously doubt eye movement has much to do with its effectiveness - but it does retain the core reintegration strategy of retelling the trauma.

Non-directive rogerian counselling can be helpful - just not for what I would understand to be trauma focussed therapy. This would be a different thing again from psychodynamic therapies - and we defintely have a dearth of these in the NHS.

Posted by Curiosity killed ... (# 11770) on :

Isn't part of the problem with CBT* that it's seen as a panacea for all things and applied by many different organisations and therapists who may or may not have bought into the therapy when they apply it?

* Cognitive Behaviour Therapy

Posted by quetzalcoatl (# 16740) on :

quote:
Originally posted by Curiosity killed ...:
Isn't part of the problem with CBT* that it's seen as a panacea for all things and applied by many different organisations and therapists who may or may not have bought into the therapy when they apply it?

* Cognitive Behaviour Therapy

Yes, agree. I think with the NHS it's seen as cheap and cheerful, isn't it, particularly cheap?

I suppose also it's usually quite short, and people disapprove quite strongly of long therapies, whereas I have mostly done that.

Posted by Curiosity killed ... (# 11770) on :

I've encountered CBT as a treatment for CFS/ME and those who used it reported variable success rates. At the time, and it may well have changed, therapists tended to fall into two camps: those with the opinion that CFS/ME is psychosocial and a false illness belief and the CBT should address that false illness belief and those who saw CBT as a way of helping someone cope with a long-term illness as they would cancer.

I suspect CBT applied as a quick panacea, often in groups, encounters similar difficulties. Although I suspect it works well in something like a pain clinic group helping people deal with chronic pain.

Posted by Doublethink (# 1984) on :

quote:
Originally posted by quetzalcoatl:

quote:
Originally posted by Curiosity killed ...:
Isn't part of the problem with CBT* that it's seen as a panacea for all things and applied by many different organisations and therapists who may or may not have bought into the therapy when they apply it?

* Cognitive Behaviour Therapy
Yes, agree. I think with the NHS it's seen as cheap and cheerful, isn't it, particularly cheap?

I suppose also it's usually quite short, and people disapprove quite strongly of long therapies, whereas I have mostly done that.

It depends what it is for really. Simple phobias can be treated very fast, mild depression, where that individual is suited to the approach, 6 to 12 weeks. Whereas, In some situations therapies lasting more than a year maybe offered (and not always CBT).

Most areas have stepped care approaches. So IAPT may offer assisted self-help or basic couselling for 6 weeks, or manualised CBT for 12 weeks. Whereas locality mental health teams may offer 16 or 26 week CBT treatments, of other talking and arts therapies. Then tertiary services may offer something different again, but exact provision will vary by location.

Obviously, most people don't end up in secondary and tertiary services.

Posted by itsarumdo (# 18174) on :

I work in the private sector and see the fallout from all this - so with a relatively small client throughput it's hard to really know how well served the people coming to the NHS are - maybe it does serve well. The general message I get is that CBT helps with relatively small stuff and where there is no underlying material from childhood or previous PTSD issues. Beyond that it acts as a sticking plaster and the pressure then builds up. Similarly with the latest fad - mindfulness - great as long as what is being connected to with the improved mindfulness skills is not overwhelming. Dissociation may be dysfunctional, but it has a purpose.

On which note, the health services and psychological model base in general do not in my experience cater well for dissociation on the scale that it is rife in society and considering the amount of somatisation that occurs as a result of it. The DSM system hides the fact that there is plenty of argument as to what mental illness is, and how best to treat it (or not). What the DSM does is provide a basis for making decisions in a large organisation that has to classify people so the organisation can function efficiently.

I've seen the mental health system fail people really badly - both patients I've seen and friends. As a society although we don't have Bedlams any more to quite the same degree, we are far less tolerant now of marginally off-beat behaviour, and that leads to institutional abuse of people who otherwise would have gone through a difficult process and come out the other side. I think of a friend who committed suicide when depersonalised by the medication she was forced to take, and of an old lady who fainted due to emotional strain and was prescribed lifelong anti-epileptics. CBT for both these would have been pointless - they both needed somewhere genuinely caring to go to for a few weeks. The more chronic off-beat behaviour cases - people who will not come out the other side - can remain immune to the worst excesses of the system because by and large they are less compliant and push their legal rights to the limit. I have no idea how I would manage it all if I were in charge, but I'm convinced that there must be something better than the present system.

Posted by no prophet (# 15560) on :

CBT has been distilled into a technique, which makes QA (quality assurance) business analysis of 'received deliverables' possible, with 'risk' being well managed. In plain language, give a diagnosis, apply statistically justifed treatment with things you can measure and you can decide afted spending the agreed upon sum that the case is closed.

Without going too confusingly far, I have reviewed the data for a public insurer about what should and should not be funded. CBT is is distillation of easily taught techniques that may or may not meet the needs of!the patient, but it has better data sets than others both because of its effects and because it provides easily measured variables.

The 'general psychotherapeutic effect' which showed in the past that the therapy relationship was the most important thing has some truths, but is overstated. This is true for mildly troubled 'worried well', often young adult univ students versus psychiatric patients.

Posted by Lamb Chopped (# 5528) on :

I do know that the counselors where my husband worked for a while were all being heavily pushed to use CBT for a maximum of 10 visits ("short term, solutions-based, focused" I think were the buzzwords. Problem was, my husband's adult clients one and all had PTSD, as well as an average of 2 complicating issues (substance abuse, family abuse, joblessness, etc.) on top of it.

Never did manage to work out how to satisfy both the system and the needs of the clients.

Posted by itsarumdo (# 18174) on :

PTSD is endemic. Even in the UK the best estimate is 10-15% of the population have it to a clinically measurable degree. and about 0.5 % DID - the available NHS resources don't cater for more than 1% of that, probably a lot less that 1%. So most people muddle on without treatment. Sometimes they muddle on very well indeed, because they are under stress, and the symptoms only start to surface when life slows down.

Posted by no prophet (# 15560) on :

quote:
Originally posted by Lamb Chopped:
I do know that the counselors where my husband worked for a while were all being heavily pushed to use CBT for a maximum of 10 visits ("short term, solutions-based, focused" I think were the buzzwords. Problem was, my husband's adult clients one and all had PTSD, as well as an average of 2 complicating issues (substance abuse, family abuse, joblessness, etc.) on top of it.

Never did manage to work out how to satisfy both the system and the needs of the clients.

This is precisely the problem.

Posted by no prophet (# 15560) on :

quote:
Originally posted by Lamb Chopped:
I do know that the counselors where my husband worked for a while were all being heavily pushed to use CBT for a maximum of 10 visits ("short term, solutions-based, focused" I think were the buzzwords. Problem was, my husband's adult clients one and all had PTSD, as well as an average of 2 complicating issues (substance abuse, family abuse, joblessness, etc.) on top of it.

Never did manage to work out how to satisfy both the system and the needs of the clients.

This is precisely the problem.

Posted by mousethief (# 953) on :

Why is diagnosis important? Well at least in one case it can be vital. If someone with bipolar is given SSRIs, a common, well-tolerated, and effective* treatment for depression, it can send them into mania.

Also if you can determine someone has SAD, they can get light therapy, which works wonders. For garden-variety depression, not so much.

quote:
Originally posted by lilBuddha:

quote:
Originally posted by Evangeline:
I'm no expert but I don't believe an online quizz is the summation of current thought on mental healht and diagnosis of disorers.
No, but unlike the quizes which often appear in the Circus, this one is supposed to be an indication

Supposed by whom? Who designed it? Has it been tested or normed? How?

At the end of the day, an online quiz is an online quiz is an online quiz.

_______________
*severe depression; SSRIs have not been shown to be effective for mild depression.

Posted by JoannaP (# 4493) on :

quote:
Originally posted by Doublethink:
Most areas have stepped care approaches. So IAPT may offer assisted self-help or basic couselling for 6 weeks, or manualised CBT for 12 weeks. Whereas locality mental health teams may offer 16 or 26 week CBT treatments, of other talking and arts therapies. Then tertiary services may offer something different again, but exact provision will vary by location.

Obviously, most people don't end up in secondary and tertiary services.

IAPT has provided me with assisted self-help for 6 weeks (rather to my surprise, I found being in a a group helpful as it showed I was not alone), followed by personal, one-to-one CBT (I am not sure what you mean by manualised here) for a maximum of 20 weeks. I have nothing but praise for the service and wish something similar had been available for my first bout of depression.

Posted by Doublethink (# 1984) on :

Where the cut off is between IAPT and secondary care varies a bit by area. I am glad it worked for you [Smile]

It can be a very effective form of intervention, it works for a lot of people. Just not for everyone.

UBB.classic^TM 6.5.0