Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Joel Paris
Overdiagnosis In Psychiatry: How Modern Psychiatry Lost Its Way While Creating A Diagnosis For Almost All Of Life's Misfortunes, By Joel Paris. In undergoing this life, lots of people always aim to do and also get the very best. New knowledge, encounter, lesson, and also everything that could improve the life will certainly be done. Nevertheless, lots of individuals in some cases really feel perplexed to obtain those points. Feeling the limited of encounter and also sources to be far better is among the lacks to own. Nonetheless, there is a very easy thing that can be done. This is what your instructor constantly manoeuvres you to do this. Yeah, reading is the solution. Reviewing an e-book as this Overdiagnosis In Psychiatry: How Modern Psychiatry Lost Its Way While Creating A Diagnosis For Almost All Of Life's Misfortunes, By Joel Paris and other recommendations could enrich your life top quality. Just how can it be?
Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Joel Paris
Free Ebook Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Joel Paris
Dr. Joel Paris's Overdiagnosis in Psychiatry takes a much-needed look at the dangerous epidemic of unnecessary or incorrect treatments. The last 30 years of psychiatry have seen the development of a system of classification aimed at establishing greater scientific credibility. Unfortunately, the current categories are based entirely on signs and symptoms rather than on causes, which remain unknown. This has inevitably made diagnosis imprecise and uncertain. The result is that well-meaning professionals can have problems separating psychopathology from normality, can be unduly influenced by diagnostic fads, and can ultimately wind up prescribing treatments that do more harm than good. Paris examines prominent examples of overused diagnoses including major depressive disorder, ADHD, bipolar-II disorder, autism spectrum disorders, and PTSD.
Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, by Joel Paris- Amazon Sales Rank: #1547357 in Books
- Published on: 2015-05-13
- Released on: 2015-05-13
- Original language: English
- Number of items: 1
- Dimensions: 5.40" h x .80" w x 8.10" l, .0 pounds
- Binding: Paperback
- 208 pages
Review "Dr. Paris is a psychiatrist who knows his onions and so can make you weep. He weeps at the failure to recognize strengths in people rather than weaknesses, and after reading his book we should all gain from one of its key sentences 'it would probably be better to define mental health, not as happiness, but as resilience in the face of adversity'." - Peter Tyrer, Professor of Community Psychiatry, Centre for Mental Health, Imperial College, London
"Most discussions of diagnosis focus on problems with missed diagnoses or misdiagnosis. Dr. Paris does the field a great favor by focusing on the problem of overdiagnosis, and showing how it is as great a problem as underdiagnosis." - Mark Zimmerman, Professor of Psychiatry and Human Behavior, Brown Medical School, Providence, RI "Too much medicine can be bad for your health- over-diagnosis and over-treatment are now serious public health problems. Dr Paris has provided an important pebble in the David vs Goliath battle to contain the medical-industrial complex." - Allen Frances, Professor Emeritus and former Chair Duke University and author of Saving Normal "Dr. Joel Paris has written a wonderfully provocative book that will irritate some readers and delight others. With opinions based on his many years working in the trenches, Dr. Paris points out the problems of overdiagnosis, misdiagnose, and diagnostic epidemics that have been fueled in part by overenthusiasm for the DSM. Written in an accessible style, this book is bound to become a classic in the field." - Donald W. Black, MD, Professor, Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA "Dr. Joel Paris's book is the one book you must read to understand why psychiatry, in the midst of the most optimistic period in its history, is stumbling badly due to its disregard of the most basic medical distinction of all, the distinction between normality and pathology." - Jerome C. Wakefield, PhD, DSW, Professor of Social Work, and Professor of Psychiatry (Professor of the Conceptual Foundations of Psychiatry), New York University, New York, NY"I would highly recommend this book for anyone interested in psychiatry and, in particular, concerned about the pathologizing of normality. " -- Brett C. Plyler, M.D., Doody'sAbout the Author Joel Paris was born in New York City, but has spent most of his life in Canada. Dr. Paris' research interest is in borderline personality disorder. Dr. Paris has 193 peer-reviewed articles, and is the author of 17 books and 40 book chapters. Dr. Paris is an educator who has has won awards for his teaching.
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6 of 6 people found the following review helpful. PLEASE READ THIS BOOK NOW! Mandatory reading for every modern practicing psychiatrist. By K. Garcia Dear Joel,I cannot thank you enough for writing this book. As a psychiatrist, the current system makes performing thoughtful, conscientious psychiatry nearly impossible. Your well-researched volume describes the dysfunctional situation quite well! The art of interacting with the patient and appreciating not just the verbal content, but the body language, what the patient attends to, how they interpret the interviewers open ended questions, their choice of words, and also what is not said.... has been lost. Instead, we are experiencing the misguided equivalent of transforming psychiatry into something akin to the Wong-Baker FACES® Pain Rating Scale: the overly happy face gets the mood stabilizer, the sad face gets the antidepressant, the odd face gets the antipsychotic, and the angry face gets the cocktail in a syringe.Some nuances of meaning for your consideration: Like another book from 2007 titled "Doing Psychiatry Wrong" by Rene Muller, the idea that the problem relates to 'biological psychiatry' should be clarified to appreciate that talk therapy is a biological intervention! Competent talk therapy for the appropriate patient is the most circuit-specific intervention within our psychotherapeutic armamentarium. The central issue is the faulty model of what it means to be human.I would say that overdiagnosis is not the issue. A accurate assessment with a reasonable response of clarity and support is what is required. Perhaps the root of stigma is not overdiagnosis, but that someone imagines there is really a line between sickness and health. Whether one is talking about the heart, lungs, kidneys, quadraceps...function is best described as part of a spectrum. If someone is building a bridge, one must engineer the supports to handle the load. The idea here is that supports which are too robust or insufficient would be problematic. LIkewise, thinking of a deaf person as disordered would get you quite a defensive response from that community. It is best to match the individual capacity to withstand stress to the tasks they can handle, while certainly intervening to prevent the declination of capacity while optimizing function where we can. A mental health assessment should be part of a yearly screening if psychiatry could accept nature taking it's course. All human beings fall on a spectrum with regards to their adaptive capacity and, in times of excessive stress, their baseline adaptive capacity may falter. If someone is sitting in front of a psychiatrist, they are either troubled about something or someone is troubled about them. There is likely an issue to be recognized and appropriately addressed, even if that requires listening and simple reassurance. It may not be a personality disorder, but perhaps personality disorder features. It may not be a morbid depression, but something may be triggering some anxiety and despondence. As with any complex system, the less one mettles with the systems build in balancing mechanisms the better. Sometimes a sympathetic and encouraging soul is all it takes to promote the individual's cognitive integration processes. The only thing wrong with that soul being a psychiatrist is if that psychiatrist feels compelled to relieve their own stress by insisting on a medications intervention when none is require just because they lack the time to care in the way that really matters. Something ingested effecting a person's brain chemistry which not necessary, it is an unnecessary risk. I see nothing wrong with labels or descriptors which accurately portray an individual's condition, even if they reflect something benign. It is not the label that is the problem as long as it derives from a well grounded model of human experience and triggers an appropriate intervention.Society is unrealistic in its expectations of the psychiatrist. It holds the psychiatrist accountable for not being able to predict the future or read minds, such as when someone attempts suicide when it is impossible to predict with certainty what will happen after the individual leaves that office. Yet, the psychiatrist must respect the individuals autonomy or self-determination, even when many patients are indulging in risky behavior. There is a bind here as many of our patients are not forthcoming, many misunderstand or distort their reports, while many others are misleading. The quality of the relationship, understanding of human nature, generally, and, more specifically, what motivates the individual specifically is our leverage. Yet, as long as a concrete token of our intervening, such as prescribing a pill, is the main legitimate indication of our conscientiousness, unnecessary medications will be prescribed.I was surprised at your arguments within the personality disorders chapter not discussing what I consider the central features which distinguish any affective disorder with a personality disorder; particularly bipolar disorder compared to borderline personality disorder. The basis of distinction, in my clinical experience, has to do with (1) the dynamic quality of the interaction between mood and the environment and, (2) the appreciation of the patient's worldview or source of meaning. When one appreciates the patient's worldview, one understands what motivates and disappoints them. This allows one to recognize the individual's triggers and to appreciate the relationship between environmental events and how it moderates their moods characteristically at a shorter time-course than if the individual were suffering from a primary mood issue. On the unit, when the borderline patients do not get their way, they act out. Often when they are enticed by someone of the opposite sex or suddenly wish to be discharged, their depressive symptoms resolve. Mood disorders are governed more by neuromodulatory processes that are not as responsive to the environment. Personality disorders represent limited strategies based on an impoverished model of how the world works. More adaptive Individuals are capable, at various times as the situation requires, of acting avoidant, antisocial, narcissistic, and the full gamut of strategies. (Strategy here not simply being some intellectual, declarative understanding, but their responsiveness to stressors derived from both conscious and unconscious processes.)Having worked in two major NYC Health & Hospital institutions the shocking trend is currently to label the majority of patients from the ER as schizoaffective disorder and then prescribe a combination of Risperdal and Depakote or their equivalent. Certainly this mindless indiscriminant treatment is expeditious and dangerous. It actually fosters a co-dependence between the institution and the patients, many of which suffer from some combination of personality disorder, some secondary affective disorder with comorbid substance use. The co-dependence results from the patients never having their true problem identified or resolved, while the institution believes it is acting as a benevolent caregiver for a chronically ill patient who could not be better helped! It is delusional, but a delusion that serves both entities as both parties essentially agree not to work towards change and the band plays on. Physicians have so much mandatory paperwork to respond to every quality assurance initiative that they cannot see the patient who is right in front of them. If the patient says they are hallucinating, then the psychiatrists writes down the patient is hallucinating. If the patient says they are paranoid, the psychiatrist writes down the patient is paranoid. It does not matter that the patient is sitting with his chair leaning backwards and speaking in a relaxed manner, describing all the details of their presentation motivated to convince the doctor of their psychosis (when there is none). So although you make an argument for standardization, I would counter that what is really needed is mastery. An expert can get to the answer in ways that depend on intuition. Certainly that intuition must be subsequently supported by additional data from observations and interactions. But I believe a relaxed, conversational style of interview which undermines the patient's performance and results in greater candor, while still focusing on essentials allows for collecting the highest quality data. Just consider how you or anyone would feel asked a bunch of standardized questions as opposed to having an open discussion about life with someone who appears concerned and genuinely interested with you as a person.In summary, I believe that the problem lies with the model being applied to the assessment and management of the human condition. I am in complete agreement with many of your points and believe you have done an outstanding job of documenting this disturbing trend. There are many contributing factors which are reinforcing these practices: psychiatrists lacking the training to perform competent interviews or to perform psychodynamic psychotherapy, the insistence on completeness without quality or understanding motivated excessively by medicolegal ends, the definition of treatment being the prescription of a pill or the quick fix, the lack of time available to care for patients secondary to a reduction of funding for psychiatry in general, the general depersonalization of medicine under misguided belief that the relationship does not matter, the misunderstanding of free will that leads to individuals diagnosed with a personality disorder to interpret this as saying that all their poor choices must be their fault, the system of secondary gain for certain diagnostic categories along with the standardized predictable DSM questions which allow certain patients to tailor their responses towards certain conclusions, and several more concerns.I'm hoping books like yours have an impact, but typically change is motivated by significant positive reinforcement (i.e. profit) or significant negative reinforcement (i.e. malpractice, loss of licensure). Currently, both of these are working strenuously against your books argument despite your moral and intellectual high ground.
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