November 20, 2012

Temper Tantrums In The DSM

damien_omen.jpglet me guess

From BoingBoing, only slightly more valid than any of the journals I read:

The American Psychiatric Association is set to add "disruptive mood dysregulation disorder" to the Diagnostic Statistical Manual (DSM), the bible of psychiatric disorders. A kid has "DMDD" if she or he has "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation... at least three times a week."

Easy, everybody, if you're enraged about the wussification of America you can assume you watch too much TV and like Blue Pills.

1.  Diagnosis is not the same as disease.  This just coordinates the language, "from now on we're going to call this this."  "Then why is it called a disorder?"  Ah, you must have no insurance or the best insurance.  Healthcare policy is set by Medicaid/Medicare, you Blue Cross suckers are merely collateral damage.

In Medicaid America, i.e. America, if you come through the door and I ask you all the questions and I determine there is absolutely nothing wrong with you, two things will happen at the exact same time: 1. You will punch me.  2. I won't get paid, can't get paid for no diagnosis, no matter how hard I work.

Can't order any tests without a diagnosis code, either.

Someone stupid will ask me this: "then why doesn't Medicaid just offer a billing code for "need three evaluations, but likely no diagnosis?"  Because if Fox News got wind that Obama was paying for black people to get "no diagnosis" they'd blow up an abortion clinic.  Paying for "temper tantrums" is just the right amount of enraging, TV and internet enraging, no violence will occur.  "Isn't this why we need universal healthcare?"  Well, lieutenant, pronounced like I'm a British naval commander, if we had a system of healthcare in which doctors were paid the exact same regardless of diagnosis or severity, then there'd be little attention paid to "correct" diagnosis, all of our epidemiological data would be totally invalid, and the number one drug in America would be Xanax.  "Wait, isn't that the situation now?"  Huh, nailed it.

2.  "Is this is an attempt at preventing the erroneous diagnosis of "pediatric bipolar disorder?"  No. Come on, stop it.  Not to go full Popper, but how can diagnoses be "wrong" while simultaneously "not exist?"  You guys have to decide whether you're materialists or idealists, then we can cross blades.

In other words, regardless of what you call it, assuming the MD thinks it is "a problem fit for a pill," will the pills offered be any different in either diagnosis?  I'm closing my eyes, don't tell me which diagnosis it is... I'm sensing  something, a presence.... is it Concerta?  Concerta, is that you?  And.... Depakote?  Are you here too?

3.  "DMDD is "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation."  I'd like someone to explain what behavior  is "grossly out of proportion" for a situation characterized by physical/sexual abuse, parental drug abuse, and visibly swarming roaches, every day, while you sleep, while you eat....

"But not all kids are raised in poverty."  True, many are raised by nannies who alive in poverty.  So what kind of temper tantrum is out of proportion for a situation characterized by marital infidelity/swinging, overparenting, spoiling them materially and depriving them emotionally?  "I love my kid, I got him a Wii."  You should get them some weed, they'll get it eventually.

"So then it's not really a disorder, it's just caused a response to the social environment?"  Isn't that what a psychiatric disorder is?  "No, a real disease."  Like diabetes?

4.  It's all very simple, you have it mostly right but the direction of the force vector is wrong.  In order to create a living wage, the system deploys its social services through the least offensive department, healthcare.  e.g. people are furious about Social Security, but not as furious about Medicare.  As long as it can pretend it's about "health" or "compassion" or "disability" it doesn't have to worry about politics or race or "need".

But in order for this to work, the doctor has to get paid.  Not much, but paid.  If he is to get paid, the patient must have insurance, i.e Medicaid.  In order to get Medicaid, the patient must be temporarily disabled, for which he needs to have a diagnosis, so he must see a doctor, who will need to get paid, so the patient needs to have Medicaid.  Ouroboros.  The system has won.