NB – careful, very rough old draft below to be updated!
Also, NB I am not discussing here those response-able who really do a profound examination based on excluding from an exhaustive differential diagnoses multidisciplinary list!
Also, before proceed; my paradigm´s psychological part is influenced by William Glasser Control Theory and his expression of verbalization of dysfunctions and both = not brand/imprint stamping, patients preventing changes! A verbalization concerns actions and adjective and subject are “stamping” and there by “semantics” prevents changes https://www.wglasserinternational.org/ and George Kelly, 1955 who have somewhat different critics (discuss elsewhere) of simple diagnosis and have completely other solutions not recognized in todays “running” health care, as e.g. different versions of DSM often is used. Even health care services can earn money to carry out “DSM stamping” of individuals.
In sum; diagnoses are mostly actually hypothesis (which many do not realize and believe – or not even that – they do not “have” absolute knowledge- or?), in other words, we should talk about diagnose hypothesis, which can be used for planning of individualized tailored actions – including group educations of patients as resources (see http://biopsychosocialmedicine.com/news/how-to-deal-with-not-absolut-knowledge-which-no-one-of-us-have-access-to/ , http://culturalmedicine.se/health-in-complex-world/hela-not-just-for-medicine-consideration/ and an example from cancer – http://biopsychosocialmedicine.com/projects/rd-international-projects-2/placebo-rd/the-cancer-patient-as-an-educated-resource-an-coworker-in-own-rehab/) .
Also, a hypothesis, which is associated with actions in real world and not “being”, can result in a treatment plan and also be modified and tested during process of the intervention (if any). Patients ARE not the problem, but their behavior – perhaps internalized and “anchored” in early part of their life – may be, e.g. psychological and/or physiological depressed but they are “depressing” (Glasser´s verbalizing of depression), that is a symptom behavior and behviors can be change – or? An easy understandable example from cardiovascular medicine is hypertension. A patient with hypertension does not “got” or “is” it, but (mostly) they acquired it through lifestyle behaviors. Here can relevant education and social processes play a constructive role given we work much more for prevention – the more effective problem solver in general, the more we can also learn to foresee and predict problems. Although, we cannot always foresee and be prepared but developing a humble and reasonable “cool” problem-solver attitude, we can use general strategy tools (see below) when we run into not expected problems.
Most psychological and psychiatric behaviors are also developed from grow up conditions and we can learn to deal with such problem my own means, using e.g. “man the problem solver”- or “man as the scientist” approach see e.g. http://culturalmedicine.se/integration-of-diet-inflammation-brain-functioning-and-sociopolitical-processes/hela-not-just-for-medicine-consideration/
A clinician who does not realize s/he does not base her/his work an absolute knowledge, and also (consciously or not – is appraised as) behave in Besserwisser terms (based own thinking on Confirmation Bias, see https://culturalmedicine.se/svensk-del/confirmation-bias-och/ and http://biopsychosocialmedicine.com/projects/rd-international-projects-2/placebo-nocebo-considerations/a-huge-problem-for-health-care-confirmation-bias-placebo-nocebo-vs-reductionistic-medicine/ is for everybody contra productive, also for her/himself. A personal catastrophe also if s/he really want to do good things, which I will believe most clinicians will!
In a dual-situation probably much happens which is not known outside at the same time that the consequences of the dual-situation can result in severe “trace” never coming “into the light”. At the same time we must work hard during education to secure best possible the ethics of Hippocrates Oath … https://pubmed.ncbi.nlm.nih.gov/29786117/ – or?
But the Oath is not used in Sweden since 1887 https://lakartidningen.se/wp-content/uploads/OldPdfFiles/2001/23409.pdf Not needed?
Perhaps an impossible question above in the title to argue about – who will accept to be the one who does meaningless diagnosis – or work based on learned attitudes about diagnosis not treatable or removeable? That is, the questions is not possible for those responsible for many present diagnoses which (some of us regards as a) based on to much lack of knowledge and/or too simple diagnosis base or weak diagnostic instrument. Many patients get simplified diagnostic “stamps”, where some will enter a perhaps even more complex suffering situation. The patient may over time adjust (limbic operational conditioning?) to meet the expectation criteria of a (Besserwisser? Confirmation Bias? based) diagnoses which lack serious diagnostic work. And some may be more or less forced into adjustment – to meet expectations of the clinician.
As the title above says, more and more scientist and clinicians dare to consider what many of us gradually have becoming aware of, diagnoses based on lack of knowledge and also ecological validation, may not only be meaningless ones but also more and more hazardously and even dangerous consequences for those targeted!
First, I quote the argument at https://news.liverpool.ac.uk/2019/07/08/study-finds-psychiatric-diagnosis-to-be-scientifically-meaningless/
Then refer with a link to one of the example of critics on the critic = https://www.technologynetworks.com/neuroscience/articles/are-psychiatric-diagnoses-scientifically-meaningless-as-claimed-326910?utm_campaign=NEWSLETTER_TN_Neuroscience&utm_source=hs_email&utm_medium=email&utm_content=79339353&_hsenc=p2ANqtz-8Oqjivsq3TcQROD50kZI6izy7_nvjHFvOIciwotj5NKEhjPEkUlvdxjTla3-zLmvDb8zFMl09YVrdUU7js-3B5Jfe7LI2yEPB57j7IwA1q3b0zUME&_hsmi=79339353
Below a brief quotation part from the first link above
“A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.
The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related disorders’.
Diagnostic manuals such as the DSM were created to provide a common diagnostic language for mental health professionals and attempt to provide a definitive list of mental health problems, including their symptoms.
The main findings of the research were:
- Psychiatric diagnoses all use different decision-making rules
- There is a huge amount of overlap in symptoms between diagnoses
- Almost all diagnoses mask the role of trauma and adverse events
- Diagnoses tell us little about the individual patient and what treatment they need
The authors conclude that diagnostic labelling represents ‘a disingenuous categorical system’.
Lead researcher Dr Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”
Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”
The full study, entitled ‘Heterogeneity in psychiatric diagnostic classification’, can be found here. https://doi.org/10.1016/j.psychres.2019.07.005”
Below I discuss
(a) alternatives to the above criticized diagnosis situation,
(b) also if this (title) can be extended to most life style medicine diagnosis including diagnosis as a platform for interventions and
(c) lastly discuss the main critics (in lines with the title)
(a) Alternative to the above criticized diagnosis situation -> How can we then do?
Already George Kelly show in the 1930-ties (Personal Construct Theory vol 1 and 2, 1955) the way I think no one really understood. I will try to write some of how I understood his thinking as well as how some very few, including me, have further try to refine – something he was very strongly encouraged during his last years!
Text is coming …
(b) Is the above argument applicable on life style medicine as well as todays diagnosis as a meaningful platform for interventions and its outcome validation
(d) What about the critics in first link – is it useful to achieve a substantial change?
Text coming …