Hoop Jumping 470 (Medical Psychology)

Today is Monday and I find myself holed-up reading about the the mind numbing rules for diagnosis as laid out in the DSM-IV (The Diagnostic and Statistical Manual of Psychiatric Diseases, 4th Edition).

Frequent readers of this blog will recall that I have previously accused my Medical Psychology class as being the equivalent of academic masturbation. (You can read it here if you missed it the first time.) Perhaps I was too kind. Masturbation at least feels good. This class has become the absolute bane of my existence. Allow me to (rant) explain.

While I am not ready to join Tom Cruise, John Travolta, Kirsty Ally or any other delusional religious moron in calling for the boycott of the entire psychiatric branch of medicine, I do loathe the course work that we are forced to undertake in its name. If we were simply learning about the various afflictions of the mind, recognizing them, and theories on their respective treatments it would not be too bad. This is not the case. We are forced to undergo what equates to an exercise in taxonomy. The rules to "label" a patient with a particular numbered diagnosis read like corporate tax code:

"In order to meet the criteria for the diagnosis of blah blah blah, the patient must have had 4 of the following 9 symptoms from column A, and at least 2 of the 5 from column B. Furthermore, must never had had any previous diagnosis of any overriding disorder which preempts this diagnosis. Oh yeah, by the way, the symptoms must be present for at least xxx but no longer than xxx. If ,and only if, the aforementioned criteria are met then hop on one foot, point a thumb east and enter this number on your diagnosis sheet."

Sweet mother of tap-dancing Christ! This would be an almost noble (albeit tedious) pursuit were it not for the intentional ambiguity and rampant overlap. I asked the professor in class what, other than a curious taxonomic diversion, was the point in all this hair-splitting. The answer I received, suffice it to say was less than satisfactory, although, in her defense I suppose the question could have been interpreted as rude and an insult to her life's work.(my bad)

Todays particular brand of Vince tourture (oh yeah it is ALL about me, that gets me a diagnosis of 301.81 if you're playing along at home for Narcissistic Personality Disorder) involved being critiqued on how well we 'pretended' to interview a 'pretend' patient who 'acted' like she had a substance abuse problem.This was the first hour of hell, without so much as a milk and cookie break or nap time, we were forced to watch a video of a (I presume) a real psychiatrist interviewing a (again I'm guessing here) real patient with some "depression issues". We were then charged with the task of flipping around in our little DSM IV books and finding numbered diagnoses to label her with. 296.33 was her winning label: Major Depressive Disorder, Recurrent, Moderate in severity with no psychosis. Really! No shit. Thats how I spent 2 hours of my afternoon in medical school. I miss and long for the days of old when I was being bled on, puked on, and spit at. (and no I am NOT talking about the delivery room! ) I miss the ER. Even when I was having my life threatened by some of the kindly denizens of Philadelphia, or being assailed with various bodily fluids, I at least knew why I was doing whatever it was I was doing. This mindless hoop-jumping is enough to drive me to drink some scotch and forget all this! (291.1 - Alcohol-Induced Persisting Amnestic Disorder)

Whatever Psychiatrists earn in a year it's not enough! Not only do they spend all day dealing with, well let's face it, crazy people; they are forced to play this ridiculous square-peg, round-hole diagnosis game with silly little rules. If other physicians had to do this, the whole practice of medicine would grind to a halt.