Thursday, October 18, 2007

The DSM sucks

Here's a neat read from ShrinkTalk.Net

There are two sides here:

1. You're angry that you didn't get published. I'm sorry that it didn't work out for, I understand, but bringing up the bird journal just gives fuel to the opposition. That anger kind of "dequalified" point #2

2. The DSM is basically a piece of crap.

And it is, that book is the reason that I went into computing instead of psychology. 10 minutes and a little searching and all you're left with is "Man this is screwed up and useless, I can have two depressed people with totally different depressions"

The DSM is basically crap, but it's really just a small piece of the puzzle. B/c let's face it, most of North American medicine is crap. To follow up Amber's comment, I'm living in Canada (Edmonton) and I think that Canadian doctors over-prescribe (the American system is just a giant mess I don't want to touch).

But ironically, I think that the problem doesn't stem from the doctors, it stems from human nature (the pool from which we select doctors). Human nature is to desire the quick fix and the nature of the world is to favor the "gradual change": people want to wake up 20 lbs lighter, they don't want to lose weight; they want to "become" happy rather than "discover" happy. Like all classic dual-edged swords the "quick-fix" is both a source of success and failure.

So when it comes to medicine and health, people think the same way: "quick fix". We have pill for this a procedure for that and everything is fine. Human nature has reduced the concept of human health to a giant book of problems with an associated "lookup" for solutions. And it's done this under the very concept that such a "solution-lookup system" could feasibly exist and could feasibly be managed / maintained by doctors.

I can't be done. Sure it could theoretically be done, but it can't actually be done. At some point (as with all things) you have to cut your losses and work on your strengths.

Now sure, I'd love to yell at the doctors for believing that they could index all of humanity's problems, but hell We The People are basically yelling for it. We, the human race are just a bunch of "quick-fixers", that's our nature, heck that's our strength. Of course, at some point, we too have to cut our losses.

And this is where "modern medecine" has failed us, b/c our current medical scheme is highly focused on quick fixes. People (doctors) feel important when they are solving problems. "Processing" patients makes you feel good, it makes you feel like you're saving lives and making a difference. Of course, the problem with that logic is pretty clear: isn't the best news usually just no news at all? Wouldn't it be better to just have less people needing to visit the hospital?

Of course it would, but we (typical north americans) haven't built our system or our lives this way. We don't build for longevity, we don't "grow", we leap damnit! And that's why we're in trouble, we build bad foundations and then band-aid them up.

Think foundations:
  1. Diet
  2. Sleep
  3. Activity
  4. Mood

These things affect basically everything. Heck, these are the fundamental cycles of life, we eat, sleep, move around a bunch and act happy/sad about the whole deal.

So when you come in complaining about a headache, what does the doc ask you? He asks for descriptions or prior history, he's mostly trying to figure out what strength of pill to prescribe. But what he should be asking you is the above 4 questions. What he's fundamentally trying to do is return all of these to healthy norms.

Yeah, it doesn't always work, yeah some things are bigger, but unless we're trying to "normalize" these 4 factors, then how do we know what's causing the problem? How do we know what we're actually fixing? If your jaw hurts and you have a headache what's the problem? Unless I can ascertain that you've been sleeping well, eating well, treated your body well and were mentally positive, then how can I possibly evaluate the cause of your situation? Both of these issues could be caused by any of the above problems, face it, you could be having a headache b/c you aren't sleeping quite enough, but the doc probably just assumes that it's b/c of the jaw pain.

Yes to argue semantics I can't actually evaluate the exact cause of every ailment that you may have. But the least that the medical profession could enforce would be to throw out the most salient factors of variability. Anyone with a long-term ailment should be keeping diet/sleep/activity journals with a daily thought blurb. The goal, front and centre, should be normalizing these behaviours so that we can actually pick out the abnormality.

But we don't do this b/c it isn't quick. People, let alone doctors, don't want to keep these complicated journals and track their own progress, they don't want to get better, they want to be made better. So that's what the doctors deliver.

Deep-down, it angers me to no end that some of the smartest people around (doctors) can't actually behave like the smart people they are and learn to correctly guide the populace instead of buying into their weakness. But that's the fundamental problem, we don't just need doctors to pull out rotting teeth or replace broken hips or prescribe one-step solutions, we need doctors that can guide the patient on all levels but that's not what's happening.

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