From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Medical denial is it really a problem?
Date: 8 May 1999 20:38:03 GMT

In <37343B56.61144E1D@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>And after going through the difficulties of getting a correct
>diagnosis for a REAL mental illness, I can tell you that real mental
>illnesses are not diagnosed by ruling out everything else, then saying
>"all the whiners and crackpots get a mental diagnosis."


   I'm sure it gives you comfort to think there are such things as
"real" mental illnesses.  As opposed, I suppose, to those which are
just "all in your head" --the psychosomatic or fake mental illnesses.

   What you call "real mental illnesses" are indeed often diagnosed in
whole or in part by ruling out "everything else" (or at least,
everything else the doctor thinks is reasonable).  In the case of the
"real" mental illness called "somatization disorder" one gets the
doctor's opinion as to whether the symptoms (which must be of several
years duration, and caused the patient to take medicine or see a
physician) are caused by any physical problem (as if the doctor has any
way of really knowing), and if not, then saying that the people who
complain of 12 or 14 (12 for males, 14 for females) of the symptoms on
a somewhat subjective list (and a pretty subjective number) have
"somatization disorder."

Here is the list from DSM-III (now outdated, but just as illustrative
for purposes of this discussion).  Compare with DSM-IV, which I don't
have at hand at home.  Here is the DSM-III list:

Sickly a good part of the patient's life
Difficulty swallowing
Loss of voice
Deafness
Double vision
Blurred vision
blindness
Fainting
Trouble walking
Paralysis or muscle weakness
Urinary retension or difficulty urinating
Abdominal pain
Nausea
Vomiting (other than pregnacy)
bloating (gassy)
Intolerance of a variety of foods (illness results)
Diarrhea

After opportunity for sexual intercourse, and for a major portion of
life:  sexual indifference, pain from intercourse, lack of pleasure
during intercourse

Pain in back, joints, extremities, genital area (other than coital)
pain on urination, other pain (except headaches)

Shortness of breath, palpitations, chest pain, dizziness

Female reprudctive:Painful mentruation, irregularity, excessive
bleeding, vomiting in pregnancy sufficient to cause hospitalization.



   Most of this sounds like the symptoms of aspartame poisoning to me.
Or mercury amalgam poisoning.  Though a patient convinced they had the
last would probably get the diagnosis of Hypochondriasis.

   In the grab-bag of somatiform disorders there are goodies like
"psychogenic pain disorder."  That's where you have a pain that the
doctor doesn't recognize as being from a pathology, and which you
appear to get some benefit from (not difficult in our society).

   Those who believe in the "reality" of mental illnesses are invited
to take a look through different editions of the DSM over the years.
Homosexuality, up until December 1973, was a "real" mental illness.
After that, by virtue of a vote of the Board of Trustees of the
American Psychiatric Association (!), it became an unreal mental
illness, which is to say, not one.  Was it real before Dec, 1973, but
not after? Was it real afterwards, but is now not recognized?  I will
leave such difficult philosophical questions to Bret, who appears to
have The Answers.