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smithy

whats abnormal ? suggestions

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Could someone please suggest a good book that will offer perspective on how we decide upon what is abnormal.

I'm looking for a few books that offer an introductory insight into the philosophy of psychiatry/psychology.

I feel that i'd be more comfortable attaching labels to patients if I had some sort of moral appreciation to back up my decisions apposed to simply prescribing according to what a drug company has highlighted as a potential market e.g. pre menstrual dysphoric disorder (and rip of prozac)

Cheers

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RD Laing's 'The Divided Self' and 'Politics of Experience' are both classics that everyone should read. Though, often described as being 'anti-psychiatry,' this term is a misnomer.

I would also recommend any of David Healy's books on psychopharmacology, particularly 'Let Them Eat Prozac.' Healy shows how the pharmaceutical industry functions by 'medicalising distress.' His writings on the introduction of Xanax in the 1970's and the marketing of 5HT1a agonists are especially illuminating. It used to be the case that drug companies were run by people with chemistry PhD's, now it's people with MBA's.

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Dear Smith,

I wish there was a book that could tell what was normal/abnormal. In reality I have spoken to many Clinicians with over 20 years experience who were actively involved in training SPR's & have been academically involved, within my local region over this topic on and off for over 5-7 years now.

Modern Western Psychiatry derives its logic from Greco-Roman Logic. So a reading of Descartes & Cartesian Philosophy would be a starting point.

Then an abridged version of Kant & Kantian Logic is also recommended.

(German Phenomenologist)

One learns a lot from experience, so a look at various historical books on Psychiatry

Then the discourses of Bleuler,Scneider & other phenemenologists is also recommended.

Ofcourse the history of Psychoanalysis(Freud & Jung) has created this organic/functional divide & separated neurologists from Psychiatrists. I think some knowledge is essential.

Some knowledge of the Anti Psychiatry movement9RD Laing & Thomas szaz) would be useful

Irving Goffman's excellent essay ' On The Characteristics Of Total Institutions' highlights the social moorings of Community Psychiatry.

Some understanding of the Mental Health Law would be very helpful.

The Combined gist of it should then be married with your clinical experience(which is why as your experience changes your opinions change) & interpreted in a culturally sensitive manner & you will hopefully arrive at your destination.

Hope I did not add to your confusion.

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There's a good book called 'The Philosophy of Psychiatry' by Jennifer Radden (Oxford Univ. Press 2004) that has a section on 'circumscribing mental disorder' that deals with the limits and definitions of diorder and normaility.

I guess the most recent definitive text would be the 'Oxford Textbook of Philosophy and Psychiatry' published earlier this month. I'm still only in the opening chapters of it but its fairly comprehensive and well written.

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This is a fascinating topic, which is at the core of why we are consulted. If Joe Public or a doctor in another specialty says 'that's weird or crazy,' people take it with a pinch of salt, if we say that something is abnormal or mad, then people take it seriously and do not question us. It's a tremendous responsibilty that we shoulder.

I worked for an extremely eminent and distinguished psychiatrist who had quite a simple formula. It did away with the finer points of psychopathology. If you cannot understand what the patient is saying either in form or content, then that's abnormal!

I think empathy and understanding are important. Like the judge who sentences the criminal, we are far far removed from the patients that we deal with in terms of education, status, expectations, social circles. We must try and empathise more and see why this patient is presenting in this way.

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My first lesson in Psychiatry was by a very good consultant and that was TO KEEP IT SIMPLE and believe you me it is such a difiicult thing to do when trying to work out as to what is going on in your patient`s head.I feel that abnormality is easily appreciated if one could achieve the above.

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I treat people not because they are abnormal (who is normal?), but because they are in distress. Some need medication, others need direction, others therapy, etc, etc... I can't help everybody though.

If one treats people because they are abnormal and one seeks for everybody to be normal, we'll end up with a very boring world indeed!

OK, maybe I'm not normal either...

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Just to play devil's advocate to Oreta's post, but we do treat manic and hypomanic patients who are undistressed, but still have abnormal mental states. Are we treating the distress of their family, or the distress of society?  ;)

Clearly there is a need to recognise when patients have deviated from a state of health, as there is in any illness, but whether it is helpful to define it as abnormal is less clear. Mostly I would try to use non-judgemental terms like 'unwell' or 'ill' but that again implies that there is a clear concept of mental wellness.

Because of the wide ranging nature of psychiatric symptoms, and the way they impact on a patient's reality, it is more difficult to say where health/normality and illness/abnormality lie. All we have to guide us are the diagnostic criteria in ICD and DSM which enable us to say that a particular pattern of symptoms (or our objective interpretation of them) is recognised as an illness. These (in practical terms at least) define abnormality for us.

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Chris

I would agree with you that patients experiencing manic or hypomanic symptoms are undistressed during the episode. Infact, they enjoy being in that state especially if they have been depressed before.

But the same patients regret what they had been upto when they were high when these episodes remit. So in a sense we do treat because these patients are distressed if not immediately then later.

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Just to play devil's advocate to Oreta's post, but we do treat manic and hypomanic patients who are undistressed, but still have abnormal mental states. Are we treating the distress of their family, or the distress of society?  ;)

Indeed these are some of the questions that psychiatrists have been asking for quite some time. As LS says, sometimes we do treat because of the potential distress (particularly when we/they have previous experience). As to treating the individual, families or society... I guess we've all given treatment with any of those three in mind (and what about treating staff, your consultant, yourself...? we could go on).

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Maverick,

I fully agree with the empathy bit, but you can only empathise when you are very aware of the transference and countertransference & have proper support systems like supervision etc........

Chris & Oreta,

Let me introduce another view into the mix, the concept of 'pre-emption', driven primarily from the insurance companies. It looks wonderful in a cubicle in whitehall, but in the real world makes the practisioner anxious about potential litigation from the patient as well as the public(if there is a serious incident)

This government has used preemption as a cornerstone of its health care policy, be it sure starts or talks of increasing funds for activity centres and exercise parks,early intervention teams etc...

This preemption & its fear of litigation also has a role in doctors judging whats abnormal,atleast to a certain extent in my view.

carry the line of discussion as you have been, its very thought provoking.

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I don't think it's sufficient to go purely on distress as a means of deciding what is normal or abnormal though. I might be causing distress to my family or to society, and may be making decisions that I will later regret and be distressed about, but have no mental illness.

It is also not possible to predict at the time whether a particular patient will in the future be distressed by their actions while unwell. They may well sell their house as a result of being manic, but once recovered be happy with this decision. Also certain patients (eg in Alzheimer's) may never regain insight and thus will not in future be distressed by their decisions.

Therefore there must be something else beyond distress caused to ascertain whether a patient needs our input.

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