Monday, January 26, 2009

Another Trick Question


You are depressed. The DSM checklist reveals you have nine depression symptoms out of nine. Question: Is your condition diagnosable as a depressive episode?

Not necessarily. "Checklist psychiatry" tends to influence how we view ourselves, but beneath the symptom menu to every Axis I DSM entry we find other qualifying criteria, such as a time period (two weeks for a major depressive episode). Also, before a diagnosis can be made, other possible causes (such as bereavement or a general medical condition) need to be ruled out.

The most intriguing qualifier, though, concerns functionality. With regard to depression, the episode must be severe enough to cause "significant distress or impairment in social, occupational, or other important areas of functioning."

Virtually identical wording appears across the Axis I panoply of episodes and disorders, including mania, anxiety, and schizophrenia. The prominent exception is hypomania.

So, in theory, it is possible to walk into a psychiatrist's office looking like a DSM basket case and yet obtain a clean bill of health. In practice, this is unlikely to happen. But suppose, just suppose, that we could have depression and not be depressed, that we could have a panic attack and not panic. And so on and so on.

Wait! I know what you are about to say. But before you call me crazy, I ask you to indulge me for a moment or two. Just suppose ...

Imagine.

5 comments:

Paul said...

John,

Great post, and it reveals the problem of seeking care, and getting care.

If one already has a relationship with a Psychiatrist, then the docs clinical wisdom and objective view of our condition over a period of time will help in the right diagnosis.

But, what of those seeking treatment for the first time. Your "another trick question" is excellent in revealing how one probably misses opportunities for care ... when they do seek help.

Then there are the others, I think the majority, with Anasognosia who are not going to seek help.

Oh my, I guess this is what makes up the foundation, or building blocks, of our broken system of care ... both mental and physical.

Gina Pera said...

John wrote:
So, in theory, it is possible to walk into a psychiatrist's office looking like a DSM basket case and yet obtain a clean bill of health. In practice, this is unlikely to happen. But suppose, just suppose,
-------

Whaddya mean, in theory? LOL!

It happens all the time. Especially with ADHD....e.g. doc says: "Everybody forgets! My wife says I forget where we keep the ice cubes. But does that mean I have ADHD? Of course not. I'm a physician! Nah, you don't have ADHD. You're just a guy." :-)

Gina

John McManamy said...

Hey, Paul. Hey, Gina. This is the fun part about writing half a blog - you two can finish it for me. Seriously, I was going to write a longer piece to explain myself, then I decided to cut it short. Neither of these were the endings I would have put in, but - holy crap - this is really interesting. I need to be writing more half-blogs :)

Gina Pera said...

Or maybe I just missed the point!

(Does soup come with that half-blog?)

John McManamy said...

Hey, Gina. I brewed up a big pot of chili today.:)