Imagine you have something like leukemia.
In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).
Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.
Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.
“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”
So if you don’t have medical tests, you have nothing to go on.
Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.
And that’s just the low level analysis.
Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).
- The presence of a hypomanic or major depressive episode.
- If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
- Significant stress or impairment in social, occupational, or other important areas of functioning.\
How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.
So we now approach medication.
In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…
How does a psychiatrist pick a drug for bipolar II?
He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.
This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).
But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.
That’s a lot of meds.
Now what do I do when something goes bad like it has recently?
All of those drugs are working to keep my bipolar in check.
So how do you figure out which one is failing to help? Or how do you switch out one med for another?
It’s not easy. On the patient or the psychiatrist.
This becomes extremely frustrating.
And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?
These are all hard questions.
And I don’t know the answers.