tag:blogger.com,1999:blog-5087696456618083407.post8579956693740335654..comments2023-05-28T02:44:32.813-07:00Comments on EquilibriumMag: The Ethics of Psychiatric DiagnosisEquilibrium Magazine for Wellbeinghttp://www.blogger.com/profile/14000768854148387271noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-5087696456618083407.post-1022983241582991632013-02-16T04:23:07.765-08:002013-02-16T04:23:07.765-08:00Whilst medications are still the mainstay of psych...Whilst medications are still the mainstay of psychiatric treatment the implied scenario that it is the only service offered by medical professionals is misleading, offensive and unhelpful. NICE guidelines advocate the use of talking therapies as first line in the primary care treatment of mild to moderate depression/anxiety and as an adjunct in severe depression/anxiety. Of course this approach relies on the use of psychiatric diagnostic categories. However, physicians are not as restricted by such definitions as much as one might imagine. Diagnoses are not based on DSM/ICD10 criteria alone and a consideration of a given patient’s psychological and social context are a key part of any diagnosis. Certainly modern medical training in general focuses increasingly on the holistic consideration of a patient along with a partnership style approach. Have you never wondered why your GP asks you what you think might be the cause behind your complaint? Such questions become particularly pertinent when a patient complains of mental health issues.<br /><br />So, in summary, whilst I do not disagree in the slightest with the argument that we should be “concentrating on helping people live their lives better and fulfilling their potential” I do counter the unfounded allegation that the disease model of mental health difficulties retards this process. There is ample evidence that a significant proportion of people seeking help for mental health problems from the medical profession do benefit from the assistance that is provided. I agree that there HAS BEEN a trend towards medicalising normality but I have observed personally that this trend is already abating if not reversing. Physicians do their best to provide a “bespoke service” to “clients” but within the constraints of a relatively universal health care service and the breadth of medical issues any given non-specialist physician needs to be prepared to handle there are limitations as to just how individualised such services can be. What is needed is cooperation between the various health professionals, recognition that the current mental health care service is unsustainable in the light of the expense of training and employing psychological specialists and an end to the vitriol between physicians and psychologists which has its basis in outdated arguments of the 1960s (an era preceding a significant proportion of health service users as the vast majority of providers). Finally, I accept that the diagnostic classification approach is fundamentally flawed, I am yet to see a realistic attempt to replace it with a viable qualitative approach that will serve the needs of the NHS and social medicine commissioning. What is needed is the continued mixing of quantitative and qualitative approaches by people who are highly motivated towards the development of a health service that best serves patients’/clients’ needs rather than merely arguing in favour or against meaningless and unhelpful philosophical idealisms. <br /><br />Jarrod Franklin, BSc, PhD, final year medical student, University of Sheffield.doctorjabhttps://www.blogger.com/profile/01240903100302048632noreply@blogger.comtag:blogger.com,1999:blog-5087696456618083407.post-613522007448287732013-02-16T04:22:38.249-08:002013-02-16T04:22:38.249-08:00Training for medical students at the University of...Training for medical students at the University of Sheffield centres on biopsychosocial formulations of a patient and their disease. Note: in my training there has always been a specific avoidance of labelling patients as their disease – social labelling theory has, for the better, made its mark. This approach was particularly emphasised in the case of mental health problems (I personally despise the negativist term “mental illness”). It was made abundantly clear to me by our psychiatrist teachers that a diagnosis should not get in the way of a holistic understanding of the problems faced by people within the context of their psychology, social environment and their biology - these three components were given equal weighting.<br /><br />Unfortunately, health service funding relies on the classification of people by disease so as to establish population level efficacy and thus inform commissioning. A social health program is built on the foundation of public health principles – the NHS as an organisation treats the British public not each individual British person. I agree that a individualised narrative approach is preferable and I suggest that as much as possible, specialist services provide individualised therapy through the cooperation of psychiatrists with nurses, counsellors, psychologists, social workers and occupational therapists. I suppose such comprehensive and multidisciplinary services might not be the norm in the UK but I would argue in very strong terms that they should be and will continue to grow to become so. At any rate, for now a discursive approach to mental health does not assist health providers in achieving its ideal of just distribution of highly limited health resources. A diagnostic system does so, not well I accept but it gets us part the way there. The car is faulty but at least it runs.<br /><br />1/2<br />doctorjabhttps://www.blogger.com/profile/01240903100302048632noreply@blogger.com