We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
This is not surprising, but it is interesting. "Schizophrenia" really meant miscellaneous chronic psychosis. We have all always felt that the paranoid psychoses were a different animal. Time will tell whether this information will have any practical value.
Absolutely. We have not been allowed (DSM) to differentiate these last few decades, because the lines are indeed blurry, especially with so much substance abuse complicating the picture. Yet if you sit across the table from a lot of them, it is abundantly clear that there are observable variants that cluster.
Assistant Village Idiot
A major element in our current diagnostic mess is insurance. Doctors, families and patients end up fighting, allying, and sometimes conspiring to describe a set of symptoms in the way most likely to secure reimbursement from increasingly reluctant insurers. You say whatever is needed to get the care the patient needs. Also, people are individuals not diagnoses. But one could only do accurate research if the financial element were removed. A school district will not provide services to a bipolar kid at the same level as a diagnosed autistic kid, even if it is same kid with same symptoms. When same kid ages out of school services, their state government may not provide autism services to said high functioning but vulnerable person but will proved some lousy bipolar services. So diagnosis flip flops to pursue the help the person needs.
Nobody but the rich can afford to pay retail for the lifelong mental health care of someone with a chronic mental illness or developmental disorder. The state purports to cover it for the poor or those with SSI, etc. but in most states (my own) the "care" provided amounts to occasional 3 day mandatory holds and life on the streets.
The best advice one can give a person with a serious illness is to hide it, get a job with anybody who offers good health insurance, and hold on to it for grim death, being the best worker possible and faking good health, in hopes that one's employer won't fire one for using the insurance. Or to parents, to choose their own job based on insurance coverage for their kid. This doesn't always work. I know someone, a stellar performer, who was fired from a hedge fund because their KID was diagnosed, and fund was afraid this would raise their health insurance premiums.
The cost of mental health care, like all medical care, escalates (lawyers, insurance premiums, liability are a big factor) and research and development into decent psychiatric drugs falters (insurance, lawyers, liability), and hospitals for desperately ill people close (cost cutting by states and insurance companies: the money saved by closing state mental health hospitals was "supposed" to be earmarked for care in the community for the chronically ill, but such care rarely developed adequately (NIMBY by communities, governors wanting slush funds, popular denial of and fear of mental illness).
My point is, diagnosis takes place in a cultural, political and economic context. Doctors, social workers, families and patients are not greedy but often desperate to save a life, clear the mists of illusion, paranoia, desperate misery that keep a person isolated and unable to function. Most people will call an illness whatever it takes to get help. Parents learn to accept the most stigmatizing diagnosis if it gets their kid treatment. We are not talking about the neurotic worried well.
As to the schizophrenia stuff, I've seen people diagnosed "schizophrenic" who were the cultural stereotype of the paranoid knife wielder killing his mother. Also near catatonic people unable to function at all. Also manic bipolar patients in states of acute agitation and paranoia. Also obsessive people with autism who mutter to themselves. Also imaginative, withdrawn socially phobic geeks.
Diagnosis doesn't matter for drugs: the same elephant tranquilizers are used for everyone. They DO matter for therapy because people's thought processes and functioning vary so much.
The only things that really help patients now have nothing to do with diagnosis: some meds that don't have appalling side effects but modulate symptoms, a faithful doctor or social worker who will monitor and care for the person for the long haul, a patient and loving family that will sacrifice their own selfish desires to accommodate the needs and supervision of the former patient. We are essentially back in the Middle Ages, with popular stigma rife, virtually no long term care for the truly ill, and everything falling on the family. Better diagnosis wouldn't help this.