I was surprised that Brown did not cite this article from “JAMA Psychiatry” May, 2014 that could have helped him understand something about half (or more) of servicemen: Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army. Results From the Army Study to Assess Risk and Resilience in Service members (Army STARRS)
http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1835338 The study found that almost half of soldiers had some mental disorder when they enlisted. The rates of disorders like attention deficit-hyperactivity disorder and intermittent explosive disorder (IED) in the study were similar in the new recruits as well. This finding in line with our practice experience in Japan that includes servicing a total population of 100,000 military personnel, dependents, and civilian workers. Most of these persons seemed to us to have similar problems before they entered the service, some got worse in the service. There is a clear path of employment, training, and for long-termers a pension plan, making the military both a good choice for these persons, and these persons a good choice for the military that recruiting is not likely to give up. However, ADD, ADHD, IED, etc are frequently associated with dysphoric mood states and recurrent brief, persistent, or major depression, in addition to drinking, drug abuse, risk taking behavior, and, along with the stresses of being in a war theater the risk of suicide can increase. The answer to all of this is that, because so many persons enter the military with mental health problems to begin with, any addition of the horror of war to this baseline will continue to make it very challenging to mitigate morbidity and mortality in this population. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ Social Media
https://www.facebook.com/douglas.berger.3954 https://twitter.com/Douglas_Berger1 https://www.linkedin.com/in/douglasbergerpsychiatristtokyo/ Blogs: https://www.youtube.com/channel/UCDj351WhGaBdU22UeV1NCCw https://douglasbergerpsychiatristtokyo.tumblr.com/ https://douglasbergerpsychiatristtokyoblog.wordpress.com/ http://douglasbergerpsychiatristtokyo.weebly.com/ Websites: DouglasBergerPsychiatristTokyo.com http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ Original article published, October 07, 2016 in The Psychiatric Times:
http://www.psychiatrictimes.com/blogs/couch-crisis/deconstructing-and-reconstructing-goldwater-rule#comment-509 Thank you, Ron, for your thorough reply that I largely agree with. First though, let’s be clear, your article was on psychiatric diagnosis in INDIVIDUALS not on the validity of the existence of psychiatric diagnoses in the population. You stated, “On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media.” You are also falling into a logic trap by noting that a SOME medical or neurological problems have no specific marker, i.e., migraine. This is because there are also many like stroke or brain tumor that DO have an objectively measurable parameter such as seeing infarction, hemorrhage, or mass on a brain scan. Unfortunately there is NO psychiatric condition that has an objectively measurable parameter in an INDIVIDUAL in spite of some persons in a POPULATION who fit diagnostic criteria showing various DIFFERENT and subtle brain abnormalities. Brain scans can be said to have near 100% validity in physically proving that the condition specified because scan results match physical findings on direct examination of the brain seen in surgery or autopsy. This is what is meant by “clearly definable and objectively measurable”. The first link you provide below by Aboraya states: “The authors encourage clinicians to use as many validity criteria as possible to improve the validity of their diagnosis.” They do not state or prove anywhere that a psychiatric diagnosis in an INDIVIDUAL is the same as having objective proof as in neurology (I would place Alzheimer’s in neurology not psychiatry for this discussion). The paper by Levy only discusses that pursuit eye movement findings are commonly found in POPLULATIONS of persons who fit criteria for schizophrenia (and in the CLINICALLY UNAFFECTED relatives of these persons). As they show in Fig 5 and in other places in the article, findings are trends in these groups with a standard error but they nowhere state that these tests can be used clinically as proof of diagnosis in an individual. It’s not the same as seeing a mass in one’s head CT which is clearly a mass: there is no trend or standard error, nearly all INDIVIDUAL cases are either yes or no. Coincidentally, I was also the lead author on a published study of eye-movements in schizophrenia: Berger D, Nezu S, Iga T, Hosaka T, Nakamura S: INFORMATION PROCESSING EFFECT ON SACCADIC REACTION TIME IN SCHIZOPHRENIA, Neuropsychiatry, Neuropsychology & Behavioral Neurology, (Journal Name Changed to: Cognitive and Behavioral Neurology) 3:2, 80-97;1990. Full paper here: https://www.japanpsychiatrist.com/Abstracts/Information_processing_effect_on_saccadic_reaction_time_in_schizophrenia.pdf We found a strong trend for differences between normals and those diagnosed with schizophrenia in the small group we studied, but there was overlap and there were outliers. Thus, it is just interesting research data, it is not useful clinically for individual diagnosis, nor does it prove the validity of schizophrenia. Now, evaluating public figures who are more likely to have personality issues, ADHD, mild forms of mood disorder etc. and not schizophrenia is even more problematic because there is less robust evidence of a consistent biologic finding in populations of these persons compared to schizophrenia, especially in personality disorders. So while we would agree on Goldwater, I think you need to take it to the next level of uncertainty when it comes to labeling individuals, examined or not. Psychiatric diagnoses are helpful in clinical treatment, but are unproven constructs and never more than concepts that guide us in what to do, and for mental health workers and institutions to bill medical insurance companies. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ ‘Why the “You” in an Afterlife Wouldn’t Really Be You’
https://www.scientificamerican.com/article/why-the-ldquo-you-rdquo-in-an-afterlife-wouldnt-really-be-you/ Shermer states that a copy of your memories is no different than your twin but twins never had the same memories to begin with. If one’s genes and connectomes could be exactly copied and functional then there would be two of “you”, both exactly the same at the moment of copy, the next instant on diverging biological life courses. While the engineering hurdle is enormous, it is not physically impossible. For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ In “One’s True Nature”, Stickleback fish were said to “tamp down individual personalities” and “conform” when they were placed under the same cover as opposed to individual cover in pursuit food located at the other end of the tank. Regardless of behavior when separated, it seems to be conjecture that these fish tamped-down their personalities when covered together when they may just as well have been exhibiting imitative behavior.
For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: http://douglasbergerpsychiatristtokyo.com/ http://douglas-berger-psychiatrist-tokyo-reviews.com/ http://about-douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo-info.com/ http://douglas-berger-psychiatrist-tokyo.com/ http://douglas-berger-psychiatrist-tokyo.com/ |
Author - Douglas BurgerBilingual Psychiatrist located in Tokyo. Archives
June 2018
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