Psych Problems: the Categorical Wars

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Categorical Thinking Addresses Categories, Not The Specific Details

The media and the public are trying to tell us: get more precise, stop the casual use of ADHD meds. Many of us completely agree, others are stuck in simplistic, reductionistic thinking in the worst kind of blinders: scientific denial.

Let's see… Your overt symptoms meet criteria for depression, – here's an antidepressant. But what other symptoms and neurobiologic systems drive the power of the most obvious presentation? What are the multiple causes of the depression? Remember: If we don't know the cause we are primarily treating symptoms.

As the road sign says outside of Patagonia, Arizona:

Chose with care the rut you drive in,
You'll be in it the next 40 miles…

We're Living In Psychiatric Denial

The evolution of this current psych/med crisis parallels numerous bumps along the road with the development of science. We are taught to think reductionistically from the beginning of our careers, and to chase “no false claims.” Get that one diagnosis, then choose one med. Ouch.

The answer to this conundrum of cookie cutter denial is simple: accept complexity as the norm for psych diagnosis.

We will have to abandon the philosophy of Democritus and the concept of elementary particles. We should accept instead the concept of elementary symmetries. Quoted in E Maor: To infinity and beyond (Princeton 1991) from Werner Heisenberg

Skilled psychopharmacologists accept complexity everyday, yet complexity does require more thinking. On the other hand, outcomes are more predictable. And it's more fun if all of us [patients, family, media, and other docs] approach these new territories with similar maps, and more open minds.

The obverse: don't think, stay simple, remain stuck in platitudes, old meds, and anachronistic labels.

Multiple underlying, missed diagnoses can cause completely unpredictable outcomes because the wrong medication is delivered, or the wrong protocol of medication delivery [the wrong med came first].

The Fuss: Categorical Wars

We live in a minefield of categorical wars: I'm right, you are wrong. This kind of mentality is how managed care took over in the first place. If we can't agree, they will run the meetings. And, by the way, remember that they are the absolute worst folks at insisting on outdated labels, because those labels in the denial, deny claims. Categorical thinking is about reducing psych money – far more than any monetary challenge by pharmaceutical companies. Managed care repeatedly causes neglect of individuals in pain by using outdated label games.

My point here: we are all somewhat right and need to listen more to each other rather than pointing fingers and talking about belief, categorical, systems. Diagnosis must evolve through science, not belief in appearances. Traditional psychopharmacologists, as much as they love biology and science, often think the molecular and cellular guys are quacks. The function folk run down the traditional medical docs because they have seen traditional practitioners miss an obvious contributory bowel problem. Our best medical people disagree, leaving the public and media justifiably puzzled and apprehensive.

Let's Drop Categorical Thinking

Time to work together gang. The DSM-IV [diagnostic manual] isn't bad, isn't completely wrong, it needs biologic revision.

The next post answers one of the hottest current questions: why do kids get depressed on antidepressants. In a nutshell: categorical diagnostic thinking.

See you soon,



  1. Chuck Parker says:

    This comment, my friend, contains some important keys to the cognitive kingdom. So many do have pre-frontal cortical dysfunction, but don’t “test” as ADD, often because they are, 2. competitive the testing process, 4. have no remote history of AD”H”D. They focus well in the testing process itself.

    They struggle along and are missed so often.

    Racing thoughts? In 2006 “racing thoughts” is the bipolar default button everywhere, and, yes, may be a characteristic of bipolar, but it is not the standard for bipolar.

    Mood dysregulation is the standard we started with years ago, not cognitive abundance.

    Hard to keep this short, – will step off the soap box, and get this next post off ASAP on this very subject. Was I shouting?

    You are so right. ADD is a *cognitive spectrum,* so let’s do look at the other colors.

  2. A bit late oh this but…

    A question.

    Many of my very bright, creative clients self-identify as having ADD or ADHD.

    Yet, my experience of them is that they have very dendritic minds, to use a fav term from Kay Jamison, and racy thoughts.

    I’m thinking that there is a continuum of distractability — from barely to full blown ADD.

    Thoughts Maestro, LL

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