More Redemption in the Mines of Madness

[usuakari]

Dear LJ, for my birthday I actually to got to break free from the psychiatric ward I've been spending time in for the past month. Freedom included discussing more mentally ill people living in the community in the morning, and then hooning around parts of the Derwent Valley in the afternoon pumping people full of antipsychotics. Sounds like fun,

Comments

[usuakari]

I've always thought the border between "sane, but with some problems" and "mentally ill" is far too grey and woolly for comfort. Even if you try to put other layers on it, such as "Is the person able to function in their day to day life or are their mental problems massively disrupting it?", it's still far from clear-cut

IMHO, it's very, very thin. It's actually quite easy to see the porous border between what we'd classically regard as 'normal', 'neurotic', and 'psychotic' issues and how one can become the other, and vice versa. Especially if you look at the same thing on a different day, or use different tools to assess a given issue.

As a partial aside, the Global Assessment of Functioning (Axis 5 on the current DSM IV TR) is an interesting attempt to quantify the ability of someone to function in the real world. It can be mildly hilarious to see in use - almost as much fun as doing a Mini-Mental State Examination on someone with dementia, which often produces weird results. My favourite on the MMSE is the surprisingly large array of people who cram the numbers 1-12 in the upper right quadrant of a blank circle when asked to write them in as if they were writing the hours on a clock face.

However, while the border may seem pretty visible and (sometimes) open to traffic in both directions in a clinical setting, getting rid of or changing a diagnosis definitely seesm to be a challenge in the outside world. I was pleasantly surprised to see a consultant psychiatrist reining in his registrar this morning. The patient we were talking to was describing some really excellent conspiracy theories (with very little in the way of coroborating evidence able to be uncovered), driving rapidly in the direction of delusions of reference and was generally pretty weird. However the consultant suggested that the patient was only a smidge over 18, and had admitted to using rather a lot of marijuana recently. Their mind and diagnosis were still in doubt as a result of both, and he wasn't in any great rush to saddle them with a specific diagnosis because of this. One expert who's well aware of the issues surrounding attaching a particular word and possible trajectory to a person.