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Why Previous Psychiatric Models Are Wrong

This post follows on from my previous one about psychiatry and hypnotherapy. It was sparked by this article in Scientific American:

https://www.scientificamerican.com/article/roots-of-mental-illness/?fbclid=IwAR0nl_zVFgV0UaSZbv13e1ka-7o0Gcoib5TBX5vTfgslQOxS4SqbymfSAKY

To summarise what it says: the DSM (Diagnostic and Statistical Manual) is published by the American Psychiatric Association and currently in its 5th edition (hence DSM-5). This is the reference manual on psychiatric disorders for clinicians. With every edition it has been getting larger, and splitting disorders into smaller and smaller categories.

However, US government funding of psychiatric research has thankfully switched to a more biological-based model where brain imaging is linked to different disorders, as opposed to just studying collections of symptoms. What has been becoming ever clearer is that, on the contrary, psychological illnesses tend to overlap with each other and if people have any condition, they are likely to be vulnerable to have others as well. Just as importantly, the previous categories are being shown to be as misleading as Freudian theory.


The article quotes researcher Theodore D Satterthwaite, who has been involved in some of these studies. I looked at one of the studies, linked below, and it included a couple of interesting images:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070480/bin/41467_2018_5317_Fig3_HTML.jpg

This first one shows the four dimensions of mood, psychosis, externalising behaviour and fear. Let's translate the middle two into something more user-friendly: I would call them thoughts and sensations which other people can't confirm (such as hallucinations) and behaviours which other people find problematic (such as outbursts of anger). In fact, let's rearrange them. We have:

1. Internal sensations based around mood (such as depression)

2. Fear (with the accompanying increase in heart rate and the usual symptoms of the fight/flight (sympathetic dominant) response

3. Thoughts which other people can't confirm (such as hallucinations)

4. Behaviours which others find hard to tolerate (such as outbursts of anger).


A moment's thought makes it clear that it's perfectly possible to have symptoms in all four areas. Secondly, the first two involve internal states and sensations, although of course they will affect posture and breathing and voice tone and so on. The other two dimensions have a more external quality, experiences which do not coincide with the experiences of generally-agreed reality, and behaviours which make the external environment more unpleasant for other people as well as for the people with the conditions. This is in every respect a much more useful and non-stigmatising way to look at mental disorders.


It also fits well with the practice of hypnotherapy. Many clients present with fear and anxiety, and it is often necessary to help reduce them before working on the causes, even if that is not the main issue they want to change. This may be combined with a mood disorder, as in the case of anxious depression. In more extreme cases we have symptoms such as paranoia and hallucinations, and in my experience the severity of these is directly linked to the client's level of fear and anxiety. Finally, problematic behaviours are the bread and butter of hypnotherapy, as are the improvement of mood. Obviously that does not mean that we can get the most amazing results in every case, but it does mean that we can often make a great deal of difference, and it is well worth trying.


What this new dawn in psychiatric research reminds me of is the sequencing of the human genome. There was an expectation that once the mapping had been done, we would have huge insights into human health. However, when it was done, at great expense, much of the DNA turned out to be apparent 'junk'. In the same way, what the research is showing is that genetic factors do exist, but they involve slight effects from many different genes.


What delights me is that the previous diagnostic categories have been shown to be a sham. When a psychiatrist can sit in judgment over a patient, stroke their chin and give them a label, but no cure, and the diagnostic bible is directly linked to the billing codes for American insurance companies, something is very wrong. Manic depression became reclassified as bipolar disorder and then split into numerous subcategories. ADD (attention deficit disorder) became reclassified as part of ADHD (attention deficit hyperactivity disorder) even though it may not involve any hyperactivity whatsoever. Grief lasting more than six months was added to the DSM-V as a mental disorder. Fortunately, it appears that the era of these word games and money-generating labels is drawing to a close, although no doubt other ways will be found to distort the treatment of mental health for commercial benefit.

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