Sunday, January 29, 2006

"A taxonomy of people."

NYT: A new diagnostic manual, written by psychoanalysts.
Unlike most psychiatrists, psychoanalysts focus their efforts on understanding the meaning and the psychological roots of mental suffering, rather than on diagnosing mental disorders and treating them with drugs or less intensive methods of talk therapy.

The new guidebook, unveiled Saturday at the annual meeting of the American Psychoanalytic Association, is modeled on the standard diagnostic manual in its format and its title, the Psychodynamic Diagnostic Manual. But it emphasizes the importance of individual personality patterns, like masochistic, dependent or depressive types, which are found in many people but which qualify as full-blown disorders only at the extremes...

"We wanted to say to therapists: find out and discover the nature of the internal experience before you pigeonhole a person based on symptoms only," Dr. Greenspan said.

...The new guidebook, some experts said, is partly intended to reassert the value of psychoanalytic thinking before it is lost for good. "Psychoanalysts have recognized that they are getting more and more outside the mainstream," said Dr. Drew Westen, a professor of psychiatry and psychology at Emory University in Atlanta. "And this project is an attempt to say, Wait, there is something that this tradition really has to offer."
"Whether the world's psychotherapists, or the public, will find the new manual helpful remains to be seen. But few experts doubt that there is an appetite for a guidebook that adds to the D.S.M..

"'Honestly,' Dr. McWilliams said, 'most of the people who come in for therapy do so for a kind of sickness of the soul, or for some interpersonal disaster. It's very artificial to chop them up into these
(DSM) symptom syndromes.'"

At the Medscape discussion board, psychiatrists are debating: is there a place for analysis in the treatment of mental disorders? One says,"We are all like the Sufi story of the 7 blind professors and the elephant. We do know there is an elephant, but the whole is so much more than the sum of the parts. Many years ago a psychologist friend of mine said: We shall stumble in the dark into progress..."


Blogger Dr. Deborah Serani said...

Absolutely. I do it all the time in my practice. As a psychoanalyst, I think the world harkens to Freud when analysis comes up. But the field is so different as is the training. Freud wouldn't recognize psychoanalysis today at all, but he would be pleased with the seeds he sowed.

8:41 AM  
Blogger Joel said...

I find therapy helpful when the therapist listens and advises, instructs me on simple reframing. When a therapist attempts to construct reasons for the evolution of my personality that does not include appreciation of the physiological bases of my illness, I am not helped.

I went to talk therapists for nearly twenty years before I went on meds and meds put down the floor I needed to execute change.

2:35 PM  
Blogger Raine said...

I was in therapy and misdiagnosed for about 3 years. they were treating me for unipolar depression ( severe) and after having had ETC fail and all the drugs fail and having been on nothing for a year they finally recognized I was bi-polar. while the therapy did nothing whatsoever to "cure" the bi-polar , it did give me some very valuable tools for dealing with it. I am sure that without having had that therapy I would be in much worse shape today

2:47 PM  
Anonymous Cheryl Fuller, Ph.D. said...

Many years ago, my clinical supervisor told me that we practice what we believe. It all works best when therapist and patient share the same belief. I am delighted about the new manual.

4:33 PM  
Blogger Donna said...

I know they still teach it, Shrinkette. It's big at my school, even as we all complain that it's outdated (which it really isn't).

6:50 PM  
Blogger Joel said...

Raine: your experience and mine are similar. Except I did not have ECT. I did not mean to say that talk therapy was entirely worthless. What I meant to say was that in the context of my illness, it wasn't enough.

I am also leary of psychoanalysis because it has given us some of the most bigoted and controlling aspects of modern psychological therapy. Consider, for example, the concept of "hysteria". It suggests that emotional mental illness is a woman-thing. Among the consequences:

* Women were often subjected to restrictive therapy such as the "rest cure".

* The danger signs for male depression were not recognized because of the focus on women.

* Depressives were often subjected to post-traumatic stress by psychoanalysts intent on finding the incest in their family.

I would rather be a pill consumer than the subject of another's myth.

10:19 PM  
Blogger Fallen Angels said...

I agree with all of that Joel, but I would say that isn't modern psychoanalysis. Modern psychoanalysis has grown and changed, just as every other type of therapy, medicine (the practice of and the pills) and basically every other thing in the world you can list. Some has changed for the better, some for the worse.


6:49 AM  
Blogger Joel said...

Fallen: you occassionally run into the pscyhoanalytic know-it-all who wants to get between you and your psychiatrist. There are more than a few who will not see patients on medication. Some of these treat phobias and post-traumatc stress disorder, so their insistance that you do not use medications for anxiety is understandable. But when they ask that bipolars, depressives, and schizophrenics to do so, they are no help at all.

Modern psychoanalysis still has its elements who operate on these principles and I dare say that they do no good. Others, however, work with psychiatrists. Go to them.

Another thought the pills versus personhood issue: I resent being told that I am not being treated as a person when the medical model is applied. On the contrary, I have found that the meds have helped me find myself better. Psychoanalysis asks that I undergo years of expensive therapy before I might find an answer to my illness. The medical model offers a proven and effective means of treating the symptoms of my disease.

Often psychoanalysis leads to bizarre conclusions such as the "myth of mental illness". I know of one schizoaffective who periodically goes through stages when he decides that his apparent condition does not exist or that he must enjoy his manias even though they lead him to endanger himself and others.

When psychoanalysts of this stripe talk about a culture of control by psychiatrists, I think one of their concepts fits the picture: projection.

shrinkette: sorry for yapping. I feel passionate about this subject.

9:47 AM  
Blogger Fallen Angels said...

I think the same can be said of every single field of work out there though Joel. Some lawyers are criminals themselves, some MD's are quacks, some therapists are too...but not all. Actually, more aren't then are. I however have been lucky in the mental health area. When my psychopharm needs went beyond that of an anti-depressant, my GP said find a pdoc, I'll T uses whatever approach best meets the current pdoc works closely with my T. My T also supports use of meds...she agrees that it's near impossible to do much in therapy if you can't get beyond hopelessness...and it's really hard to learn coping skills for anxiety if you are having panic attacks daily. Like I said, in that area I have been lucky. I have heard horror stories from people, but I'm not willing to discount an entire area of psychology because *some* aren't good at it or approach it in a way I don't agree with...if I did that in every area of my life, there wouldn't be much of anything left.


12:52 PM  

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