ABCs of Child Psychiatry

Real info about children's mental health

What If We All Got Mentally Ill Sometimes?

There are milder forms of illness that affect all organs of the body, so why should the brain be any different? Denying the existence of psychiatric symptoms is not the answer to reduce unnecessary medications. Read More

Ideally...

This was a very thoughtful post, and in concept I completely agree. It's not an easy admission for me to make, as I have cheered on Dr. Frances' efforts to "save normal" as well, and your two perspectives appear contradictory.

I believe your views can be reconciled. Our whole field grapples uncomfortably with categorical, as opposed to dimensional, diagnosis. Dr. Frances wants to limit the damage of these categories by reining them in, while you foresee a future that doesn't rely on ham-handed labels, and where we don't treat using only blunt instruments. I hope to live in the world you describe ASAP, and I'd like to think I do my part to help it emerge. Meanwhile, we currently live in a world where your pulled hamstring (mild to moderate depression, say) is treated not with ibuprofen for a week or two, but with systemic steroids for several years. Is it any wonder that critics seek to minimize the diagnosis of hamstring pulls, or to reserve the diagnosis for very severe cases?

Of course you're right: the consequences of diagnosis shouldn't logically determine the diagnosis itself. Rein in the treatments and the disability status — whatever we decide are the real problems. If we all recognized that emotional problems admit of degrees, and that many are minor, stigma would be reduced. The thing is, larger society already knows this. Minor anxiety and slight depression are self-treated just like your pulled hamstring, or handled by non-psychiatrists who shun diagnoses completely. In contrast, we psychiatrists are usually consulted for relatively big deals. If psychiatry is to move in the direction you suggest, we need to think less categorically, and more in terms of promoting lifestyle changes akin to the first-line treatment for mild hypertension, obesity, and many other medical conditions. Having one's emotional condition rise to the level of "psychiatric" need be no big deal — but it currently is, and we made it that way. Our efforts since DSM-III in 1980 to gain legitimacy by sounding "medical" have largely backfired. Even internal medicine and general surgery don't define themselves by the severity of what they treat.

This article makes me wonder, what is the purpose of psychiatry?

This article makes me wonder, what is the purpose of psychiatry? If it is to provide people with the emotional equivalent of a pulled hamstring with prescription drugs, why doesn't it just come out and admit that? I think Dr. Frances' point is, providing someone who has no medical diagnosis with a medical diagnosis is a lie, and this lie has become so (profitably) massive that it has undermined the credibility of psychiatry. If more of the same is somehow going to correct the massive social problems over-diagnosing and over-prescribing continue to cause, perhaps psychiatry should come up with a bunch of "non-diagnosis" diagnoses. The author's argument that diagnosing and treating more people who are less ill will combat provider fatigue and contribute to the number of new providers strikes me as especially bizarre. Reminds me of the time I, as an undergrad, walked in on a group of professors complaining bitterly about their students. The idea that everyone is "mentally ill" at some time in their lives, whatever that is supposed to mean, does nothing to alleviate the "stigma" someone with a more serious diagnosis experiences. From their psychiatrists too, apparently.

This is the the sort of

This is the the sort of reasoning from mds which causes me to avoid them for everything. If I can't treat something myself with herbs, diet, ande exercise, then death is the better option than falling into the hands of mds.

This is a great idea. Also,

This is a great idea. Also, in response to the people warning of an overload on the health care system if the definition was broadened, people suffering from mild mental illness or injury don't actually always need to go to a doctor or health professional to be diagnosed and treated. They can still fall under the diagnosis under new criteria and treat themselves, as they already do, eg for cuts and scrapes, colds, mild depression, pms etc. Once the new definition has been made it can spread among the population and just be recognised and understood, without the need for everyone to visit a doctor.

Misdiagnosis and Rating Scales

Children "diagnosed" on the basis of rating scales produced from checklists compiled by teachers (note the internet sites which reveal that 40% to 45% of Teachers admit to bullying pupils) and by parents (no emotional psychological abuse in the homes!) Children effectively "diagnosed by the unqualified,uninformed, ignorant and abusive. And the Psychiatrists have no case to answer because someone else filled in the checklist - and they just did the sums.

Children zoning out in class is not due to "disorder" (unless biological disorder). Gifted exceptionally intelligent talented children are essentially "special needs" as defined by the Education Acts and need to be taught in a way that suits them. They zone out when under-stimulated and under challenged. Numerous gifted children are wrongly placed into remedial classes and or are misdiagnosed with ADD, ADHD, ODD, Bi-Polar, ASD, etc. (there is no biological basis for any of these "disorders" which stigmatize and destroy life - defamations - and medication is legalised poisoning)

Believe it or not some children zone out because they are emotionally psychologically abused /bullied and are unable and or unwilling to explain.

Believe it or not some children zone out because they are over tired, physically unwell, food intolerant, clothes material intolerant, noise, light, etc. intolerant

Some children hate school - after all it is designed for the 40%, the mode average - the other 60% which include our brightest, our most talented, our most evolved those with different ways of looking at the world, etc. are too diverse - it is just easier to teach the usuals - and sacrifice the brilliant.

Unfortunately 'usual' is misinterpreted to mean 'normal' and those who are not 'usual' are wrongly believed to be 'abnormal' - and so stigmatizing disorders get slapped on them.

There was an industrial revolution which changed the world. Here's hoping that there will be a psychological revolution - the floodgates to defamation charges should open up any day now - throw out all the labellers, the stigmatizers, the defamers, the poisoners, the destroyers of lives and start afresh with a compassionate view

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David Rettew, M.D., is a child psychiatrist at the University of Vermont and author of Child Temperament: New Thinking about the Boundary between Traits and Illness.

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