Tuesday, December 19, 2017

Dangerous Diagnostic Dualism

Are people always or totally "sick" or "well" with whatever diagnosis they have received? 
I'm not suggesting that diagnosis has no place and should be abandoned, but asking readers to consider the following and decide for themselves if the totalistic / absolutistic / all-or-nothing and permanent & pervasive notions of diagnosis serve professionals and patients alike.
Of the thousands of ostensibly "healthy," "functional," "well-adapted" (adapted to what?) adults I've ever encountered, I've only ever met less than a half-dozen who displayed consistently & reliably alert, aware, mindful, conscious, capable and competent behavior without ever regressing to earlier, less competent and effective behaviors under stress. Which is not to say that most people are "asleep," "sensorily challenged," "mindless," "unconscious," "incapable," and/or incompetent." Just some of them. And mostly only *some* of the time. (Does everyone display their defense mechanisms at *all* times? Or do they tend to do so when they feel threatened and/or stressed?)
Is anything -- including a diagnosis -- really an either-or deal. Or is it a spectral deal? (Running from "totally" functional on one end to "totally" dysfunctional on the other on one spectrum... and from "totally" present and observable right now to "totally" not present and observable right now. Isn't it true that "under stress we may regress?")
Isn't the presence or absence of CPTSD, bipolar, some personality disorder like borderlinism -- or any other collection of traits that suggest one diagnosis or another -- the same thing? The DSM and ICD were orginally built on medical models of pathology. In medical models, one is either "sick" or "well." In the 1990s or so, noise began to emerge about exactly that during the evolution of the DSM IV. Hagop Akiskal et al led the charge for a spectral notion of the manic-depressive "bipolar" disorders that was widely resisted then, but largely accepted now.
Moreover -- and here's the Big Deal in all this -- isn't one "sick" or "well" at the moment they are diagnosed... but possibly "sicker" or "weller" at other times?
Is all-or-nothing, black-and-white, either/or, dualisticdichotomistic thinking (see Beck, Dyer, Ellis, Meichenbaum, Ruggiero and Young) so deeply conditionedsocialized and normalized into the human brain's, largely binary and ambiguity-intolerant default mode network by dint of the common cultural consensus trance that most of us are at least somewhat blind, deaf and senseless to what actually is (including CPTSD as a range of intensity of reaction to abuse)?

Resources & References

Akiskal, H.; Pinto, O.: The evolving bipolar spectrum, Prototypes I, II, III and IV. North American Journal of Clinical Psychiatry, Vol. 22, No. 3, 1999.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, New York: APA, 2000.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Dyer, W.: Your Erroneous Zones, New York: Avon Books, 1977, 1993.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Becker, I.: A Guide to Personal Happiness, North Hollywood, CA: Melvin Powers, 1982.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Meichenbaum, D.: Cognitive-Behavior Modification: An Integrative Approach, New York: Springer, 1977.

Ruggiero, V. R.: Beyond Feelings: A Guide to Critical Thinking, 4th Ed., Mountain View, CA: Mayfield Publishing, 1995.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

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