Different diagnostic methods serve different goals:

Categorical systems (DSM) are essential in clinical work bec highlight crucial differential diagnoses.

Simple dimensional systems (eg RDoC) are for research.

Complex dimensional systems will be good for AI, not clinicians.

This long-Covid paper helps correct the most frequent/harmful mistake I've seen in my career- ie docs using psych diagnoses as a reflex default ('its all in your head') when can't nail a known cause for symptoms.

Uncertainty always beats false certainty!
thelancet.com/journals/lanmi…

Laws of Unintended Consequences:
1)Anything that can possibly be misused in DSM will certainly be misused.
2)Once DSM makes a mistake it takes on a life of its own
3)Most changes do more harm than good
4)DSM mistakes are usually unpredictable/never correctable
5)First Do No Harm!

We made big mistake in DSM-IV including #Aspergers as milder form of classic severe #autism

#DSM 5's #autism spectrum greatly compounded our error.

Lumping normal #Neurodiversity w most impairing neurological disorder causes harmful controversy/confusion
washingtonpost.com/national/healt…

I've known many leaders of different schools of #psychotherapy .

Striking how similar they are in personality & their work with patients.

Differences between therapies are more at level of jargon & theory than actual practice.

Past time to unify therapies/End competing splits.

I reread 'Saving Normal' to see if still current- pleased it is.

Only thing I'd add if writing now is malignant effect of seductive social media algorithms on mental health of girls/women.

Explains rapidly raised rates eating,anxiety,depressive disorders & suicide.

#BanTikTok

I was against including Antisocial Personality Disorder in DSM-III/wanted it excluded in DSM-IV.

Why? Describes almost all criminals/no treatment/confuses bad with mad/forensic abuse.

Lost both times based on historical precedent/grandfathering.

An excellent review of issues:

This is a precious history of the rise & fall of theory that #schizophenia can be understood & treated as a simple genetic disease.

Inside story colorfully told by Fuller Torrey- who knew all the players & understands the issues better than anyone else.
sciencedirect.com/science/articl…

Main thing we've learned from the history of psychiatry is that we learn nothing from it & keep making same mistakes:
1)Recurrent diagnostic fads
2)Neglecting the most impaired
3)Overreacting the least impaired
4)Funding too much 'cool' research & too little to really help people

JED FOUNDATION support for college mental health works:
•25% fewer suicide attempts
•13% less suicide planning
•10% less suicidal ideation
•improved anxiety/depression
•increased graduate rate

Investing in better mental health really helps our kids:
businesswire.com/news/home/2024…

JED FOUNDATION support for college mental health works:
•25% fewer suicide attempts
•13% less suicide planning
•10% less suicidal ideation
•improved anxiety/depression
•increased graduate rate

Investing in better mental health really helps our kids:
businesswire.com/news/home/2024…

3 painful lessons learned from 50 years psych experience:
1)Hidden unintended harms of any new psych diagnosis or treatment are often much greater than the more obvious hyped benefits.
2)Anything in DSM that can possibly be misused will certainly be misused.
3)First, do no harm!

Psych diagnoses that can be very useful when correctly used for the few become very harmful when carelessly misused for the many:
1)ADHD
2)Bipolar II
3)Autistic Disorder
4)Borderline PD
5)Major Depressive
6)Schizophrenia

Safe diagnosing takes time/care/knowlege/modesty/caution.

Things I recommend for people whose #anxiety & #depression haven't responded to #meds / #psychotherapy :
1) #exercise
2) #Nature
3) #pets
4)helping others
5)hobbies
6) #mindfulness
7)movies
8)dding more 'good minutes' to each day
9)reducing stress
10)family/friend support
11)stoicism

How to avoid Bipolar II overdiagnosis/overuse of antipsychotic meds:
1)Dont mistake return of normal mood for hypomania in people who've been depressed
2)Require frequent episodes of hypomania before switching away from unipolar diagnosis
3)Require hypomanic episodes last 4+ days

'There are only 2 ways to live your life- one is as though nothing is a miracle; the other is as though everything is a miracle.'
Albert Einstein

Conveying this neglected wisdom constitutes the spiritual side of psychotherapy.

Deepest truth re human nature:
We evolved from, & remain, pack animals.

When threatened, our basic tendency is to mindlessly follow the herd.

Democracy rare/precious/fleeting exception in human history.

Ours will survive only if supporters unite/form own herd to fight for it.

'An average human looks without seeing; listens without hearing; touches without feeling; eats without tasting; moves without physical awareness; inhales without smelling; & talks without thinking.'
Leonardo da Vinci

Part of therapy is helping people feel the wonder of life.

WE MUST INTEGRATE THE 50+ EXISTING PSYCHOTHERAPIES INTO 1 UNIFIED WHOLE!

CURRENT CHAOS WAS CAUSED BY NEEDLESS SCHISMS/RIGID SCHOOLS/FOUNDER NARCISSISM.

THERAPISTS SHOULD LEARN ALL USEFUL TECHNIQUES & FLEXIBLY DO WHAT EACH PATIENT NEEDS EACH MOMENT.

THIS CHANGE IS LONG OVERDUE.

Another important implication of Jasper's useful observation:
As patients get better in treatment, they are often the last to notice it (eg they tend to focus on the 50% of symptoms still present, not the 50% improvement).