Saturday, December 8, 2007

If We Know the Medical Cause, Then is it Still “Mental Illness”?

Yes and no.

I wish I could say that once medical causes of a person's brain condition are determined, or the symptoms are relieved with medical interventions, the problem is no longer, ever, referred to by the psychiatric diagnosis. It is not "mental" in the true sense of the word, but it is sometimes labeled as such for "convenience"--not to define it as a psychological or emotional problem.

But lines get blurred.

And unfortunately society still does not associate "mental" with non-psychological, completely MEDICAL, issues! Even newspapers and hospital literature confuse the issue by referring to brain disorders caused by medical conditions, such as schizophrenia, as "emotional and behavioral disorders" on par with maladaptive coping strategies, being a disobedient child, and being overly shy!

If we know the medical cause of one person's “Schizophrenia” then theoretically, it is not supposed to be called “Schizophrenia”.

But I've read research articles finding causes for certain schizophrenias running in families ("schizophrenia" is thought to be about a dozen different illnesses--not just one)... and am apalled they are still calling it "schizophrenia" rather than saying "Oh - their psychosis was actually found to be caused by a mitochondrial defect." or a defect in a particular gene, or a sensitivity to gluten. People tend to still call them “mental” even though they are physical! Perhaps because they still match the diagnostic criteria in the DSM-IV and psychiatrists diagnose according to that manual.

When a condition can be labeled with a specific medical, non-DSM-IV diagnosis, the doctors are NOT SUPPOSED TO call it “schizophrenia”. There is a “general medical condition” exclusion in the DSM-IV diagnostic criteria for the label “schizophrenia”.

BUT, they still get to call psychosis from a medical condition one of the "mental illness" labels. They can call it: “Psychotic Disorder Due to [insert name of General Medical Condition here]” because it is written up in the DSM-IV that way. It can still be called a “psychotic disorder” if the general medical condition has
· Prominent hallucinations or delusions.
· The psychosis is the direct physiological consequence of a general medical condition.
· It is not better accounted for by another mental disorder.
· The disturbance does not occur exclusively during the course of a delirium.

The DSM-IV has a disclaimer that just because they include a diagnostic label, it does NOT actually mean to imply that the condition meets legal or other non-medical criteria for what constitutes mental disease, mental disorder, or mental disability. It states that it is just for the convenience of communication.

However, it seems that once in the DSM-IV, medical doctors seem to wash their hands of treatment, leaving it up to the “mental health” professionals because, after all, the patient now has a “mental” diagnosis.

Then, there always is the catch-all NOS (Not Otherwise Specified). That is used when the “mental disorder” appears to fall within the larger category but does not meet the criteria of any specific disorder within that category. It is used when the unknown is even more unknown than usual.

My daughter had diagnoses like that. “Mood-Disorder NOS” and “Psychotic-Disorder NOS”. It just describes a set of symptoms and says, “We don’t have a clue as to what is causing them.” The sad thing is that even though they don’t have a clue, it is still lumped into the “mental” bucket.

What is quite bizarre is that as researchers study schizophrenia and find strong underlying biological causes for some cases, they are starting to say some “causes” for “schizophrenia” have been found instead of reclassifying those cases or creating new labels!

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Last Updated:
21 June 2010

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