Not from my experience, Renzo. But please can you elucidate?

The only thing we can measure or assess are the patient responses to questions. The patient has all the answers, and the physician-patient relationship is a key component of treatment indication and response.

I recommend you to read my thesis project on quality of life and schizophrenia, the focus is the patient subjective experience in how he/she valorates his/her life. There are a lot of factors that can influence this and one of them are drugs, which are said to be neurotrophics in some cases (maybe we can corroborate this).

Quality of life is not really what I'm looking at but convincing justification for an array of psychiatric illnesses outside of physician conviction.

What questions are asked of patients, Javier, and how are the responses categorised? I've dealt with a number of schizophrenics who enjoy high quality of life due in large to their own efforts: one of whom runs a charity.

For evaluating other kinds of illness i recommend you first to review the PANSS scale, I think it is very comprehensive in general psychopathology, I would find it difficult to ask something else from a psychiatric point of view.

For quality of life we use likert scales (but you could use a qualitative interview for your research), specifically the WHOQOL BREF (it has a longer counterpart of 100 questions). It evaluates several domains, including: biological-physical, psychological, social relationships and environmental issues. Some questions are really straightforward, like for example: " How would you rate your quality of life? ", the patient/control can answer normal, good, very good, or poor, very poor (5 items); other questions can be very personal or deep, for example:"To what extent do you feel your life to be meaningful?"

I hope this can help you a bit on your quest, the link is for the WHO-QOLBREF is: http://www.who.int/mental_health/media/en/76.pdf

Javier, I do thank you of course but again my remit is the actuality of illness. I will of course look at your work but having worked in the field myself I grew somewhat wary of diagnosis and treatments. I found mentoring a much more successful technigue than drugs and whatever else is presently available and theories that encapsulate professional hubris. May I offer you in thanks:

The Elephant in the Room. Not my work, mine is under 'An Unusual Power', but by independent researches into psychothropic drugs.

I found this on Hello Poetry-a poetry website. Why is this not primary evidence and not top-down, biased research simply confirming professional presumptions and prejudices?

idk

medications

I stopped writing.

Not because I fell out of love with it...

My emotions just seemed to disappear.

I started a new medication.

The doctor said it would help my panic disorder, and it did.

I took that pill, like my mother talks to God (every morning).

When I went back to the doctor she said we had to up the dosage because apparently having 2 panic attacks a week still isn't okay.

I told her that when I woke up this morning I got out of bed without crying, but she didn't consider that as much of a victory as I did.

When I was put on a higher dosage, my emotions shut down.

After a few weeks I stopped crying, my OCD got better, my panic attacks were gone, and I could even go into the student union of my college campus without my heart trying to win a race against my thoughts.

I could breathe.

But, I also stopped having fun.

I felt like a stranger in my own body.

My emotions found the exit on the plane and jumped, never to be found again.

Since when did being able to breathe require me to feel like this?

Dear Stanley, though I do not aggree with your conclusions about psychiatry as such, I do think that your question holds some merit, and that phenomenological enquiry into patients' experience often has not been sufficiently attended to in treatment of patients with severe psychopathology. I can suggest the following excellent book which deals with the topic: "Psychotherapy of Schizophrenia - Treatment of Choice" by classic super-shrinks Bertram Karon and Gary VandenBos.

Best

Ole André

Ole, psychiatry constructs its ideas largely on observation, surely? It is then surely anecdotal? In my time working in the field I never once saw a psychiatrist pay any genuine attention to the views of the patient-largely because of surely self-serving ideas of mental illness, that is sufferers experience cognition difficulties as against the superior minds (sic) and logic (sic) of psychiatrists. May I suggest you read John Percival's astonishing work of the early 19th century in which he displays deep insights into psychiatric conditions-having been a patient in a private madhouse.

Ole,

An old work of mine I've just included on RG.

Preprint AN UNUSUAL POWER: THE CULTURAL CONSTRUCTION OF MADNESS

It is my observation as a psychiatric nurse that in the past many psychiatrists did not consider the views of the patient, family or staff caring for them. A good psychiatrists will attempt to listen to what patients and the team are saying regarding symptoms and symptom management. After all, for doctors in any field to continue to push ahead doing whatever they think is best for a patient is very paternalistic and patronizing. Acting this way ensures patient non-adherence and breakdown of the therapeutic relationship.

Doctors have very little time to spend with patients today. Nurses, direct care staff, and families are the ones that are with patients the most and can give the most insight into their behaviors and symptoms.

Psychiatry is a science that is continuing to evolve. Responses to questions are not the only thing we can measure in regards to treating or diagnosing mental illness. Technology is advancing and it enables us to use MRIs to view brain activity, we can map DNA to see responsiveness to anti depressants, and identifying biomarkers of certain diseases and many other advances to come.

Renee, is Psychiatry really a science? Does it, apart from psychiatry claiming it is, meet scientific demands-that is the demands of objective verification? Does it meet other less rigorous criterion only?

Let me provide an example.

A young client of mine suffers recurring bouts of low self-esteem, of pointlessness and ennui. This he considers depression.

Not knowing what to do he eventually went to his GP. When he told me of his actions, I presented him with a likely outcome.

The GP would know little of mental illness/health, but simply believe what he/she is told within the profession as a whole. There is no 'competition of view or argument about the nature of this apparent illness nor how it should be treated. There is just one way! The medical way!

I told my client that without either his request or agreement he would soon receive notice from mental health services to attend their facilities. This duly occurred, much to his concern. There, had he attended, tests (of a certain kind-that is searching for confirmation of already-held viewpoints) would be conducted. He would by then be a fully-fledged mental health patient and statistic. The result would be he'd be given a drug regime to follow. now labelled, packaged-a product in effect.

The drugs would make him initially feel good. All drugs do that, including heroin. After a time, also because of the drugs, he'd stop feeling good. He'd be given more drugs, which may themselves have a number of psychologically damaging consequences. None of these factors would be reflected in the- or- any psychiatrist's reports. The psychiatrist's reports would reflect anecdotal information, which is certainly not scientific.

My client did not do any of the above, but told his GP, etc, not to bother. They effectively were, under or within their paternalistic medical role, attempting to control him. Now, recognising his mood swings had actual courses, feelings that his life was going no where, etc, he can more effectively deal with them.

There were and are a range of possible interpretations of my client's feelings, none of which required the medicalisation of his moods, thoughts and feelings. I predict that if he had chosen the route offered to him by the medical profession, he would, by now, actually be mentally ill.

I want to add to the above before I forget.

The GP would have made notes on the above young man. He might have put 'Depression', 'Anxiety' or even 'Personality Disorder.' Each diagnosis, really unqualified and poorly understood guesses, would have been subjective. But once such comments are written down, as they are written down by a physician, would assume the attributes of science. These would have been passed to a mental health worker, doctor or nurse, who would make similar guesses. Thereby, an illness is constructed.

Thank you for your thoughts and opinions. It would be unfortunate if this were to really happen and I am sure it does on a daily basis as we are in a crisis of provider shortage. General practitioners do their best to handle symptoms of depression, anxiety and other mental disorders but it is not their specialty.

Medication is not always the first choice for treatment for some mental illness. Again, unfortunately,most patients want a quick fix and expect to walk out of the doctor's office with a prescription in hand. Patients that sufferer from depression don't often want to hear that therapy, exercise, nutrition and living drug and substance free will help relieve their symptoms of depression, even though scientific evidence has proven otherwise.

Seeking treatment for mental illness does not make one mentally ill. Just like seeking treatment for high blood sugar does not make one diabetic. The science of psychiatry is a real science, but it is much more complicated than others in that it involves internal and external factors.

The brain itself is a complex and not fully understood organ. People often fear what they don't understand. This is why for centuries people have feared the mentally ill and treatment for illness that involves the mind.

It does not sound like your client's GP was trying to control him, he went to him asking for help. He was offered the only help he knew how to offer, based on his scientific knowledge.

Renee, I understand your response but this kind of practice is commoner than you imagine. The episode, one of many, demonstrates how notions of mental illness are immediately pursued without other considerations. There are a number of possibilities that could have been considered, not just mental health. Other possibilities, life, ennui, could advisedly be considered before knee-jerk diagnosis.

All human behaviour in this fashion is reduced to mental health, an approach that can be extremely harmful-especially once drugs are employed.

The control motif occurs through the imposition of an ideology (psychiatry) or perspective on clients and fitting them into preconceived patterns. Power, Renee, is involved.

What I have detailed here is fantasy, one that begins with GPs and continues. It permeates mental health. At no point was the youth asked his opinion, his judgement was not sort, but an alternative reality imposed based on anecdotal evidence, not real evidence. They could have discussed any of it with the youth, but chose not to. He was on his way to becoming another statistic. Both the GP and mental health workers could/would have written persuasive case studies based on that anecdotal evidence, which would have had nothing to do with either the client or his life.

Renee, I don't regard psychiatry as a science. Because of its unwillingness to gather information/evidence in a scientific manner, its top-down approach, its cleaving to dogma, and its abysmal history (Cultural Construction of Madness), it cannot be regarded as such.