đ§ Listen to Sarah read this installment of Cured.
Onscreen is the Drop the Diagnosis! conference via Zoom. Itâs run by a British organization Iâve never heard of that vows to challenge the culture of psychiatric diagnosis. Two men and two women sit on a stage. I take notes but can barely keep up.
One of the men says, âTreating in terms of diagnoses isnât working. Rates of mental illness are increasing, as are suicide rates in some cases. We need an alternate system.â
They talk about transdiagnostic approaches to mental health problems. The transdiagnostic approach conceptualizes mental dysfunction along a continuum and targets the processes common to the diagnoses we now use: perception, thought, language, attention, learning, memory, emotion, and sensation. Instead of labeling a patient with major depressive disorder or generalized anxiety disorder or PTSD or anorexia, the focus is on the underlying process present in all these disorders. It acknowledges and embraces the myriad causes that contribute to mental and emotional distress and stresses their complexity and the unique ways they manifest in each person.
Onscreen, the moderator asks a question I miss because Iâm too busy taking notes. One of the panelists answers, âIatrogenic harm.â
I google it, butchering the spelling (itragenic?), but Google Scholar suggests the right word. Iatrogenic harm refers to the damage caused inadvertently in the process of treatment, whether by the careless use of diagnostic labels, misdiagnosis, overdiagnosis, over-medication, withdrawal from medications, abuse, etc. Iatrogenic illness typically refers to the adverse effects caused by physical medical treatments, but it can be applied to the side effects of psychiatric treatment, too.
It will be years before I read the academic psychologist Lucy Foulkesâ excellent book Losing Our Minds: The Challenge of Defining Mental Illness, in which she encapsulates what we actually know about mental illness and distress. She writes that the causes include âa bundle of hundreds of layers of explanationâsome biological and some environmentalâand those layers all interact with each other.â The biological layers include our brains and DNA, but thatâs a tiny part of it. Primarily, mental illness is the result of myriad factors: our personalities and psychologies, our past experiences, the societies we grew up in, our friends and family. She goes on: â[Y]ou may be better off just accepting that it all played a role: the factors that led to your disorder are as many and varied as we are.â But if a simplistic medical model dictates treatment, weâre lost.
Most importantly, Foulkes writes how mental illness builds based on compound interestâbut not the good kind. The longer one suffers from it, the worse it gets. Itâs âa suite of interrelated, mutually enhancing symptoms and difficulties that, once established, might even be said to cause itself.â
A woman on the panel recommends that all patients work with their clinicians to establish an exit strategyâa term Iâve never heardâonce theyâve received a diagnosis and been prescribed medication. An exit strategy is a plan for when the patient is better, including how to titrate off medication.
When the patient is better? How theyâll titrate off medication?
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