Thursday, August 16, 2012

Prognosis: Grave

Some of our readers would psychiatry to abolish diagnoses.  I would like us to abolish prognoses.  We don't know how patients will do.  We just don't. This is why.  


Anonymous said...

I liked her book. Here is a snippet from a Time rag article in 2007 , when it was published.,8599,1656592,00.html

Interviewer: You were put in a mental hospital against your will. What was that like?

Saks: It was horrifying. It's demeaning and debilitating to have choice taken away in general, to not be respected as an autonomous agent. To be put in a hospital is an extreme version of that. You're totally isolated from friends and family, and from your work. Freedom of locomotion is gone; freedom of choice is gone...It causes resentment and anger. I don't say that it's the case that nobody should be ever be hospitalized against their will, but I think that we should really study ways to help people seek the treatment that would be best for them. One of the things that forcibly hospitalizing people does is deter them from seeking help in the future.

rob lindeman said...

I read the post title and I thought you were making some philosophical comment about our "final common endpoint". Indeed the grave is our "prognosis", if you wish to prognosticate that far.

Yes, psychiatric prognoses ought to be abandoned. It is silly to make prognoses when we know nothing about the natural history of MI. It is worse to throw in the towel and tell the client he/she will be sick for the rest of his/her life.

Liz said...

she is amazing. now i want to read her book, to hear the rest of her story.

being manually restrained was possibly the single most traumatic event of my life-- i'm so glad i survived.

my prognosis, too, was grave. i am so thankful, now, to be working hard to live well, and i'm excited to begin graduate school in a couple of weeks.

thanks for posting this wonderful video.

Anonymous said...

Saks' book was amazing. I read it a number of years ago.

Diagnosis re prognosis....perhaps the difference is that diagnosis is a label of the patient, and progrnosis is a label of the outcome of the treatment. A bad prognosis gives the treater an easy way out. Then again, so does a bad diagnosis.

It's a stacked deck. Psychiatrists and other mental health providers would be better off recognizing it and working to change then railing against the details that honestly don't matter much.

Jane said...

That was a good point the above poster made (a bad prognosis gives the treater an easy way out if treatment fails). Prognoses don't just hurt patients. They hurt doctors too. They can serve as a way for doctors to make excuses for not doing their best to help the patient. That kind of thing hurts the whole profession. I've witnessed this kind of thing in hospice care. I've only seen hospice care twice in my life, but I noticed each time the care was horrible. The patient was not turned enough and had bed sores, not documenting how often they were giving morphine, etc. And I've wondered if it's because they felt the patients were going to die soon anyhow so they didn't have to give very good care.

Dinah said...

Rob, it's not that we know "nothing" about the natural course of psychiatric disorders, it's that there is individual variation. And prognosis is a term with nuance. The prognosis for stomach cancer is poor, 95% of those diagnosed will be dead in 5 years. And yet there are the other 5%. Do you know which children with strep throat will have sequelae? Which will develop PANDAS? Which children with Lyme disease will have an uneventful course of antibiotics and full recovery versus who will have a neurologic impairment?
Statistics are more useful in these settings then fortune-telling words, but what difference do the statistics make if you're one of the 3% who dies from the disease with the excellent prognosis.

Unknown said...

The first time I was hospitalized I had called and asked for help but ended up involuntary locked up for almost a month. I had been at the hospital a week earlier with auditory hallucinations saying that my psychiatrist was out of the country and couldn't be reached. They didn't evaluation my medication (I was jacked up on antidepressants and about to go into full blown mania but had not been diagnosed as bipolar up to then), just gave me a weeks prescription of 25 mg seroquel and sent me home.

The second time the psych ward doctors gave me a bleak diagnosis of bipolar 1 with psychosis and a bleaker prognosis and I remember asking them how could they be so sure of my future. It was really depressing. There was not one who offered any hope that I could lead a normal life. It turned out to be a self-fulling prophecy and I got extremely depressed after I got out and had been given what amounted to a professional death sentence after a successful professional career, in my mid 40s.

I was robbed of hope and the notion that anything I could do would make it possible to live a fulfilling, active and productive life.