Psychiatric Diagnosis: Brain Function Changes our Perspectives

Diagnosis By Function, Beyond Labels

When I began training in psychiatry, back in 1969, much of the diagnostic psychiatric world evolved from affect thinking: depression and anxiety, euphoria, and emotionally based misperceptions of reality. In a word, we began with a Freudian,  affect driven, trauma driven set of patterns. The most important mind-markers for diagnosis in those days: dreams and fantasies – the unconscious.

Freudian thinking, and careful observations of behaviors were all we had until modern technology arrived.

Today reality makes the difference.

The Mind Beyond Cigars

Meeting Anna Freud

In fact, one of the highlights of my early training in Philadelphia was meeting Freud's daughter, Anna Freud, [the founder of child psychoanalysis] at the Philadelphia Association for Psychoanalysis after her interesting presentation on her book, Ego and the Mechanisms of Defense, hosted by the Association. [See her remarks on personal qualities of psychoanalysts, and you will understand more of my early interest.]

From Labels to Biomedical Function

Now functional brain science, SPECT, fMRI, qEEG, is changing the way we make brain and psychiatric diagnosis. With the understanding of brain function we inevitably change the way we think about the patient in the room… the way we actually make the diagnosis.

These are interesting contemporary comments by Harvard Professor John Ratey from a User's Guide to the Brain:

“The transition from trauma to biology has unfortunately failed to wean clinicians from  affect-centered diagnosis. If you are unhappy and decide to seek help, the main thrust of the diagnostic process begins with an inquiry into how you feel. From this initial information, diagnosis and treatment proceed, as a rule, by either sifting through your psyche for sources of guilt, anger, or unfulfilled longing, or by attempting to modify the affective symptoms pharmacologically, or both.”

And for an edgy bit more, read on:

“The entire approach here is, in my opinion, quite misguided. Many brain disorders, particularly those that produce deficits in perception and cognition, can turn the lives of patients into abject misery. Historically virtually all metal disorders were associated with character flaws…. leaving enough residual confusion to feel ashamed of psychological shortcomings.”

The world has changed considerably in these last few years. Ratey does a great job of discussing the science in layman's terms so that anyone can begin to see the profound impact of the new science on diagnosis and treatment.

Further Insights On Psychiatric Diagnosis

And Ratey is not alone. See this esteemed collection of Critical Thinkers who regularly report on the need for more informed, more biomedically based brain and body diagnosis: CoreSight Critical Thinkers.

cp
Dr Charles Parker
Connect & Subscribe To CorePsych News: This Link
Connect & Subscribe For YouTube Updates: This Link
Complimentary & New: 25 pg Special Report: Predictable Solutions For ADHD Medications

Related articles by Zemanta

• Psychiatric Diagnosis and DSM 5: Maps to Nowhere
• Using Brain Imaging to Target Psychotherapy
• Dopamine leaves its mark in brain scans
• Anna Freud
• The Interpretation of Dreams: The Complete and Definitive Text
• Low Message Sensation Health Promotion Videos Are Better Remembered and Activate Areas of the Brain Associated with Memory Encoding