This is a very interesting lecture, but above all a very, very important one. I urge everyone to listen to what S.Nassir Ghaemi, MD and professor in psychiatri at Tufts University, has to say about the science - or in most cases the lack of
science - when the psychiatric community is diagnosing people with different mental illnesses.
Of course, there a many psychiatrists and other clinicians who just like Dr. Ghaemi have raised critic and even disbelieve in the ways their profession are
I think that we as lay people are more unaware of the problems and controvercies in these matters than the psychiatric community.
Doctor Ghaemi offers some pretty heavy critic on what validators the "Diagnostic and Statistical
Manual of Mental Disorders" (DSM) are using when differentiate between, for example, bipolar disorder and unipolar depression. Are they really two different disorders or should we look at them as belonging to a "bipolar -spectrum?"
The DSM - currently
in its fifth edition - is the handbook, or "The Bible", that clinicians all over the world use to decide what kind of mental disorder a person is suffering from (in Europe we also have the ICD diagnostic tool).
Doctor Ghaemi makes the claim that most
of the nearly 400 diagnosis found in DSM 5, are not so much grounded in biology and science, as in political, economical and societal criteria.
Doctor Ghaemi asks a lot of "why"-questions and "says who?" He says for instance:
"Bipolar disorder as we talk about it (today) is not the same as manic-depressive disorder."
Historically,the diagnosis "manic-depressive" meant manic or depressive. Today, "bipolar disorder" means manic and depressive. Why
is the small change from "OR" to "AND" so important?
For one thing, it means that 40% of bipolar patients are initally misdiagnosed with unipolar depression. So, what if a person who do not fit the modern criteria for "manic episodes" still is bipolar
and not unipolar or major depressive?
What about a person who is diagnosed with major depressive disorder (MDD) experience three months of depression and then two days of high energy, rapid speech, raising thoughts and hyperactivity, and then falls
back in to a depressvie state that last for months?
Maybe those two days are symptoms of hypomania or mania? Is the patient suffering from MDD or bipolar disorder (BD)? Maybe they are not two different disorders?
Perhaps we should look at them
as belonging to a "bipolar-spectrum?" But according to DSM 5, those two days of hyperactivity, rapid speech etc, are not relevant. A psychiatrist should not pay attention to those two days, beause we think that a manic episode has to last at least four days
or longer to fulfill the criteria of a manic episode (4 days for hypomania and 7 days for mania).
So, perhaps we should go back and reexamine the older view of "manic" OR "depressive?"
Professor Ghaemi also makes some interesting observations
and thoughts about medication. He says he do not like, for instance, the label "mood stabilizer" ( lithium, valproat, lamotrigin and others ).
His experience is that his patients make wrong assumptions when he tells them that he is going to give
them a "mood stabilizer." Because the patient are afraid that the mood stablizing part means that it will take away his or hers feelings. Turn him or her into an emotional zombie.
But if he instead of using the term "mood stablizing" about lithium,
says to the patient;"I am going to give you a second messenger modifier to prevent your mood episodes" ( i.e the extreme changes in mood ) ,then the patient gets another understanding about what kind of effect the mediciation will have on his or her emotional
Also, Ghaemi means, the term "second messenger modifier" is a more scientific description of what the biological effects the medication has on the brain.
So listen carefully, with an open mind, and at the same time, a critical mind, on
Dr Ghaemi´s lecture. All the best to you and take care! / Janne
För svenska besökare, och som ännu inte har läst, finns symptomen och kriterierna för bipolär sjukdom, typ I och typ II, beskrivna i texten "Vad
är Bipolär sj?", och de är hämtade från DSM-5.
Ha det fint! / Janne