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Wednesday, April 23. 2014

Psychodynamic Formulation


My friend Debbie Cabaniss et al got around to writing this book before I got around to it: Psychodynamic Formulation.


I have written about Psychiatric diagnosis often here, and I re-post my pieces each year. It is a complicated topic, because Psychiatric complaints originate from all sorts of sources and usually multiple sources, and an exhaustive psychodynamic formulation is not always relevant to minor life problems.


When it is relevant, a serious formulation is a difficult thing to do unless one just casually links history to current complaints. That's not a real formulation.


The current fad in Psychiatry is the DSM, which a robot could do. In many situations a DSM "diagnosis" is nothing more than a list of complaints useful only for an insurance claim and has nothing to do with understanding an individual person.

Posted by Dr. Joy Bliss in Our Essays, Psychology, and Dr. Bliss at 14:41 | Comments (2) | Trackbacks (0)

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DSM is a great way to quickly "diagnose" a lot of people, which in turn generates a lot of income as all those people go away having paid for their consults and pills (for all those conditions of course there's a remedy, over half of them no doubt placebos).

It's a disservice to people with real problems, but a great way to quickly make money off of hypochondriacs you'd otherwise have to spend a lot of time talking out of the idea that they have some serious condition.
Just point at a page in the DSM, prescribe them a placebo, and a few weeks later they've talked themselves into being cured, only to be back a few weeks after that with a new complaint for you to "treat".
#1 J.T. Wenting on 2014-04-24 00:45 (Reply)
QUOTE:
a serious formulation is a difficult thing to do unless one just casually links history to current complaints. That's not a real formulation.


What is a 'serious formulation', then? What's 'real'?

Humans are patternable across dozens of domains or categories, and in that respect your 'robot' is indeed serious and real in categorizing deviant behavior directly into these consistent psychological channels.

Personally I've found three disordered persons in my life, whose thefts, lies, and general narcissistic, antisocial, and/or avoidant detachment from reality in pursuit of their own chronic dishonesty, self-aggrandizement, and sheer unaccountability uncannily and exactly fit the DSM categorization.

Personally I don't care if the DSM exists as a benchmark or not. What I care about - and you should too - is if I can use a finer gradation to grasp and comprehend persistent odd, bad, damaging, or even criminal behavior than simply calling these people fraudulent lying thieves.

I'd also refer you to the late great M Scott Peck, whose work in broadening functional psychology into real life included a vast spiritual and Christian reference, including redemption and restoration, the 'born again' component of the soul that is no different in religion than it is the therapist's couch. Clearly, we need that higher power whether we identify it as the Unknowable G-d or the perfect principle.

You may prefer fraudulent, lying thieves in your serious, real formulation, but that's more a manifestation of your rigidity than it is a useful determinant of the deviant and the harmful. To each his own, if you please.
#2 Ten on 2014-04-24 07:16 (Reply)

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