Why we need the courage to see mental illness again in your social overall context
Depression is sometimes referred to as common disease. According to the widespread guidelines of the American Psychiatric Association, the diagnosis can be carried out in the presence of at least five types of symptoms on a longest period of time. But what makes a diagnosis with the people? Why psychology and psychiatry should be more than just checklists, the psychology student Nina Frohn explains in the following article. The essay was also the best submission to a writing competition in my science theory lecture in 2019. With recommendations from Stephan Schleim.
Risks create reflection needs
Today, of a specialist or psychologist the diagnosis "depression" To get exhibited, has not much with the common what was practiced for a long time in the Freudian Age. Only occasionally the patient is asked to put on a couch and let his life story, preferably with the early childhood memories, review.
Nowadays, it becomes depreciated whether the patient fulfills a certain number of symptoms listed in the internationally used DSM-5 (Diagnostic and Statistical Manual of Mental Disorder). If this minimum number, namely FUNF is nine, fills and cause these symptoms to make a suffering from the person concerned (and / or barriers to the person concerned in his life), the patient is considered depressed.
Although phases of mental imbalances, for example, do not end in suicide in their majority, we pray the lives of millions of people with present diagnostic procedures. The way we operate diagnostics has immense impact on the self-mortal of our society and the success of interventions. She is decisively crucial for whether humans are supported or misunderstood whether they understand themselves as chronically ill or action.
Therefore, critical looks on our diagnostic system are worth twice and it must be asked: What if the present type of mental illnesses diagnose the complaints does not always relieve, but partially causes and even worsen it?
The subjectivity of the diagnosis "depression"
Maybe it was the doubts about traditional psychoanalysis, as well as the harsh criticism of his representatives, which paved the way for a contrast program, which is lived today in the gear practice. In general, clinical diagnosis makes sense, they make it easier to communicate between professionals and can help to give those affected a meaning framework for their own suffering. However, these diagnoses should not be reflected in the affected persons after classification. Above all against the background that the theoretical foundation of depression still stands on shaky dockings.
Among the FUF, for the iing of depression required symptoms, MaBab DSM-5 must necessarily arise one of the two main symptoms: depressive mood or loss of interest and joy.1 If this is not the case, then it is the definition according to no depression. For the diagnosis is the root cause The symptoms insignificant, it depends only on your prasence or absence. This also makes it minor whether the symptoms arise in the midst of a heavy life crisis or without external, recognizable reason. In both cases, the person is depressed as depressed, diagnosed with a psychological disruption.
Except for the compelling presence of one of the two main symptoms, it is also insignificant for the diagnosis, which of the incident seven symptoms occur as long as it is a total of funf. Thus, two people with one and the same illness could be diagnosed, although they may only share a single, shared symptom.2 It was said that the symptom-based definition of depression does not have to match what a depression really is. It is the excessive understanding of those skilled in the art, as the disease state of depression is manifested to the outside, ie through the visible symptoms,.
The definition criteria of depression do not behave as well as other medical diagnoses. So we can be pretty sure in the diagnosis of a leg break that a leg break is really exactly that, namely the break of a bone in the leg. The depression is present, however, what the decision makers have made such a symptom list. This does not want to do it, but to some extent subjectively.
The DSM-5 relies on the creation of such a symptom list on quantitative data as well as on expert assessments. But this also means: were other data to consulted or had other experts in the DSM-5 advisory, we had a major definition of depression today with rough probability today. This was driven that some people who apply according to today’s standard as a psychic government were classified under other conditions as healthy.
For the actual substance of depression, as well as other mental diseases, there are still debates between scientists.3 It is by no means removing what the depression is in the true sense and where she comes from. In order to take into account these scientific uncertainties, our diagnostic system must be proceeded to continuing.
This makes the current symptom listing to a current interpretation Depression that does not have absolute truth content in the objective sense. This was not different at times of the early psychoanalysis. The explanatory model, which Sigmund Freud and his successors created, was the lens by which every admission of the human psyche was rated. Since she was not scientifically reviewed, as it simply did not say anything she could refute, Freud’s theories did not remain falsifiable. For the credo of science, which wins new knowledge from observable and repeatable facts, this was not portable.
Above all, psychological science was attributable to review and transparency, which is reflected in current trends to neuroscience. In this manner, the clearly symptom-based diagnostic scheme fits well into the picture: either patient A shows funf symptoms and is considered depressed, or just four and slides just over. This allows a clearer dividing line, which also facilitates the health insurance companies to assign therapy factories and approve cash benefits. Apart from the legitimate question on the medicalization of normal, human insignificance, we stob up at least two problems in this procedure.
The first problem: Interactions between diagnosis and patient
In all of the straightforwardness and transparency, which has the diagnostics to offer, the question begins to change why something should change. Taking mental diseases do not even take seriously or worse to treat patients like simulants, simply not tolerable and no option of 21. Century.
In this regard, clear diagnoses and recognition for depression as a serious illness are worthwhile. But in closer inspection, the practice seems to be a serious mental disorder in the case of fumf criteria that could have the most diverse causes, as if the complexity of the human psyche was not really taken into account.
The first problem we are stobing that diagnoses can have strong consequences for those affected. They often urge both the perception of the outside and inwards, because we are standing in an interaction with our Auenwelt. A person who preserves the diagnosis of depressive is often treated differently by the Augenwelt as someone who is officially considered healthy.
Starting with the more obvious forms of changed manners such as stigmatization, social exclusion and bullying, often subtle changes are often sufficient to influence the self-image of the person concerned.
This can be the family, which in the presence of the person concerned no potentially difficult topics more responsive, from concern, it could cause the person to upload, or colleagues and supervisors who remove the affected areas of responsibility to contribute to relief. Even the general picture, which is still anchored in our society in the idea of mentally ill people, so tend to perceive them as weak, unfortunate and labil, can quickly transfer themselves to those affected.
Ian Hacking wrote this phanomena in his article in 2005 "Childs of People: Moving Targets". He discussed how disease concepts and diagnoses interact with people who are provided with them. He threw the question of whether there is a certain way to be someone before there is the diagnosis that specifies exactly this kind of being someone. Although something cryptically printed, this can be roughly translated: There were no depressive people before it’s diagnosis "depression" gave.
Although this thesis dared goods, given a long history of chronic depression, long before today’s DSM-5 definition, it stimulates thought. Even if there has always been the state of depression, melancholy or even chronic depression and probably also, we also create a new reality with a new definition. It would be possible that the diagnosis contributes to the fact that the person concerned learns to interpret itself in the sense of diagnosis, which is out of it and, if necessary, let them limit them?
If so, this was equal to a self-defensive prophecy. This is a prediction that causes your exploitation itself.4 This means that we use the depression itself to breathe only life, straight because we diagnose them.
Now one could rightly argue that patients only visit a psychologist or physician, if they have been suffering from certain symptoms for a long time and preceded by the official diagnosis. This is nothing to oppose, because as mentioned as mentioned are symptoms and complaints that demonstrate today’s definition of depression, has always been through our human history.
The point that is intended to reflect here for thought is that a lightweight excess diagnostics could lead to the affected person start to perceive in the same light, as it implies medical diagnostics. From the perspective of our present society, this means to look at yourself as ill and treatment for treatment, instructed on psychotherapy and in many cases on psychotropic.
This creates a number of people who are provided with a label to preserve the bill of objectivity and uniqueness in psychological diagnostics. The consequences for self-effort and foreign perception are understood.
An important antithesis
But what about the relief to get a tangible diagnosis for his suffering? After all, it ensures that the person concerned can be attributed to date for undefinencable suffering a clearly defined clinical picture. The fact that there is a name for its own symptoms, a statistical diagnostic manual, even treatment methods, was allowed to contribute to rearance in many cases.
It may also be that the individual is no longer guilty or responsible for his symptoms. Just as little as one can accuse a patient with a legs, no longer to run marathon, one can not be charged to a depressive that he recently came so powerful.
It should not be represented with this essay that no diagnoses should be ied from now on in psychology. As described, the diagnosis can often help to provide the patient a meaning framework for his suffering. Even more belongings and employers were easier to better classify the behavior of the person concerned through a medical diagnosis.
From this perspective, the responsibility for their own illness is released and protects the person concerned with statements such as: "Now do not say so and is not always so damn depressed!" These benefits must be weighed with the risk of imprinting people who prefect a combination of symptoms have the stamp of depressed diseases. In addition to the launches that this practice has a negative impact on the self-mortal language of those affected, we also stob up a second problem.
The second problem: social dead ends advised out of focus
The second sticking point of symptom-based diagnoses is that they anchor the disease in particular in the individual itself. This means that the diagnosis of depression does not always have the responsibility from the Affected is taken, as described above, but they are just about on shift.
Criticism of Auberen’s life and society practices and cultural developments have no place in diagnostics. A diagnosis can create relief and acceptance. Likewise, however, it can be blind for ill factors of society, which require an urgent change.
This opposes at a time in a decalation textualization of depression. Responsibility for what the diagnosis causes and maintaining, is fully localized in the individual, because external circumstances find no consideration. However, this is wrong, because symptoms rarely occur in the airplier room, often there is a blame.
An impressive example of this is the vacuum of the woman, which has long been attributed to its place in the household for a long time instead of looking for himself. At that time, many women suffered from depression in the sense of the symptoms of today’s DSM-5. That’s how she slept too much or too little, fell worthless or no joy felt.
Once these symptoms were now considered as isolated as we do it in today’s practice, so you could ask yourself the question of what, the hell, with these women aged 20 to 60 is not true. In the trend of growing neurofursing, perhaps even once again certain misconnissions in the brain was supposed before the Muhe made to look at the life of these women in more detail: meaning-emptied activities determined their everyday life, they could not use their talents, inclinations and skills , Yet they learned recognition for their daily life.
Today, in the backlog, it probably held nobody for a good idea to diagnose these women a mental disorder. From today’s perspective on then conditions, it is probably clear to all that the circumstances have to be put to the pillory, not the women themselves. It was fatal when those housewives are quiet and quietly with the disease depression had identified instead of going to the strain for better living conditions.
But just like us this from today’s point of view, we will run a risk of falling back into the same trap. Just because it is normal for us today, to be reachable 24 hours a day and better recognize with consumption than with interpersonal mellow, so this is far from a healthy lifestyle. In the backlog, we are always smarter, we condemn at that time for their untenable ways, but live themselves day in a world where future generations (should it create this, to inhabit our planets) the head will be shaky.
Instead of having symptoms on a checklist and give the affected person to the feelings, he was sick in the objective sense, it must again give a healthy understanding of how the human organism interacts with his outdoor world. Instead of looking for billions of biomarkers and lost circuits in the brain in neurological research, which probably continues to wait, one could tackle the construction sites in the short term, which pretty sure might face the outbreak of depression. A good start would be to take considerable factors in the immediate environment of the patient in a possible diagnosis before it is pathologized.
A pladoy for more society criticism and reset in diagnostics
These criticisms should not convey that the discriminating, personal or social aspects can not be made in a disclosed therapy. Also, the potential sacrificial mode of the psychic suffering can often be successfully dissolved in therapy.
With the symptom-based diagnosis, we ame that certain behaviors and feeling expression of the underlying disease, depression, are. But what if z.B. Propulsion and dismissal Therefore, one of his own life is empty and inexcended by meaning-resistant activities? While this may be depression after that of experts, however, assign them to a cause. This cause is specifically tolerose and thus not for years to depend on psychotropharmaca with side effects, then appears as the better alternative.
Instead of surprising the rising number of depressive people from year to year, it would be appropriate to check the company who produced this increase. After being stained for years, it is more serious to take psychic diseases, it is now our task closely, how, when and why We certify mental dysfunctions.
At the game is the risk of self-awareness of the person concerned on the "sick people" to reduce when a sick system is the actual rusk. This is intended to question the authenticity of depression in any way. It is genuine, as well as a leg break, because the affected traces obviously a suffering prere that can range to self-tuning.
The definition criteria, on the other hand, which should depict the depression, have no authenticity in the same sense. They changed steadily, while the underlying clinical picture remained largely stable. A practice that the Prasence of these criteria is the only measuring instrument of one socially related Disease makes, loses the focus of her eyes.
It is not obvious that there is probably far less diagnoses, costs for therapies and suffering, our world would be a place of personal development, freedom and meaning. Conversely, the question arises on how to have in times of social media delusion, high-faster further mentalities and the consequences of capitalism not earlier or later at least one, two or just five the necessary symptoms of depression.
Just because it seems like a utopia that a society consists of purely fertilized and happy people, this may not lead to civil untunity. It is our duty that benefits not least our own health, uncovering abuses and to put cultural developments over and over again on the prud. For example, a framework could one day become a community that does not accept depression as a salon-proof continuous state. Because we all have earned a good life.
Nina Frohn studies psychology in the final year at the Dutch University of Groningen. Their interests focus mainly on personal development, theoretical-philosophical questions on mental diseases, as well as key elements of psychotherapy. Nina Frohn plans for their future, both even as a therapist tantig, as well as to teach and research at the same time at a university or college.
This article also appears in the blog "People pictures" from Stephan Schleim.