Lourdes Salvador's Column
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The Wastebasket Diagnosis - Preventing Misdiagnosis and IntimidationThe Wastebasket Diagnosis - Preventing Misdiagnosis and Intimidation
by Lourdes Salvador
When the cause of a patient´s illness is not immediately obvious, a reference to a brilliant diagnostician is provided. The diagnostician´s sole focus is to brainstorm and uncover all the possible causes of symptoms and signs that don´t make instant sense to the general practitioner. The goal is to help the patient get well again.
The problem is that real medicine and insurance coverage don´t allow for the time or funding that investigative medicine requires and for which the world of television fruitfully provides. A physician like television´s Dr. Gregory House, M.D. is an extremely rare find. Yet, medicine needs a Dr. House in every hospital and clinic.
In the real world when a patient presents with symptoms that don´t fit neatly into a quick and obvious predetermined diagnostic protocol, dismissal with a wastebasket diagnosis is increasingly common.
A wastebasket diagnosis is a vague or fake medical or psychiatric diagnosis that cannot be proven to exist by any clinical test. Such a diagnosis is often faddish and broadly inclusive to the point of being scientifically useless.
At best, receiving such a diagnosis can be frustrating when one is not feeling well and seeking a real solution to return to living life at the fullest. At worst, the treatment is useless and misleading; and, it may even be harmful as it often delays proper and legitimate care.
There are many wastebasket diagnoses. Common wastebasket diagnoses include the effects of aging, depression, anxiety, somatization, stress, and most so-called mental illnesses such as oppositional defiant disorder and attention deficit hyperactivity disorder. These are sham illnesses for which bogus treatment or medication is given.
Mental illnesses are the most common wastebasket diagnoses. There are no objective, clinical tests which can reliably and consistently prove they exist; they are defined solely by their symptoms, not by any break down of the body. In some cases, detailed interviews, and clinician observance are used to make a diagnosis. In other cases, a busy doctor may simply make an assumption that a perplexing disease process is of mental origin.
While most patients are relieved to find out what is wrong with their health so that it can be treated and they can get on with life, these diagnoses rarely seem right.
Real diseases are diagnosed and treated on the basis of symptoms and objective tests. Wastebasket diagnoses are diagnosed on the sole basis of symptoms and cannot be proven to exist, either in the patient or as a disease entity.
A big red flag with wastebasket diagnoses of mental origin is that they just don´t ring true. Someone who is depressed or apathetic would know it, feel it. There would be clinical tests to prove it. Patient´s who object to the diagnosis are routinely said in be ´in denial´ and intimidated into ´compliance´. In a classic case of coercive persuasion, these diagnoses are typically forced upon the patient, treated, and evaluated without the patient's consent under the guise of being for their own good. Improvement is rare and unproven. With no clinical tests to provide evidence that any mental illness exists, there are no objective measures for improvement. Studies have shown that antidepressant medications are no more effective than a placebo pill.
The world of psychiatry is riddled with questionable practices and violations of human rights. It is not unheard of for doctors to have patients placed on a 72 hour psychiatric hold against their will when limited thinking interferes with the logical process of running medical tests to rule out all possible medical conditions. A 72 hour hold in a psychiatric hospital is extremely frightening, especially when one is not feeling well. Contact with family and friends is prohibited and emotions often run high, thus may be misinterpreted. Psychiatric medications may be forced on the patient altering their mental and functional capacity, therefore creating false conditions which allow for being held indefinitely.
Thomas Stephen Szasz, Professor Emeritus of Psychiatry at the State University of New York Health Science Center in Syracuse, New York, says "People who are said to "have" a mental illness can only have, at best, a "fake disease." Diagnoses of "mental illness" or "mental disorder" are passed off as "scientific categories", but they remain merely judgments to support certain uses of power by psychiatric authorities. A genuine disease must also be found on the autopsy table and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association."
These vague labels may be given to the patient for non-medical reasons or when something is evidently wrong and the doctor doesn't know what it is. They may also be given to placate a concerned patient in a form of dismissal.
The unfortunate part is that a wastebasket diagnosis delays proper diagnosis and treatment in all but the most strong, aware, and persistent patients. This leaves people vulnerable to high levels of reactionary stress, anxiety, and depression from the struggle to maintain and regain a quality of life while health continues to deteriorate. When one is led to believe that mental illnesses exist and are within their power to fix, it can lead to reactionary depression when health continues to decline despite doing everything right by the fake mental illness diagnosis.
Sometimes family and friends, though well meaning, may push a wastebasket diagnosis as well. For the patient, it´s usually very clear whether depression or anxiety was an issue before an illness struck. For the family, it can be unclear that stress and anxiety is a reaction to failing health. The well meaning push loved ones provide may, therefore, further interfere with finding the true cause of illness and regaining health.
In an interesting twist, people with legal and financial agendas often try to dismiss real medical conditions as wastebasket diagnoses. This is common with diseases of environmental origin such as fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, mold illness, toxic injury, and even asthma and allergies. The difference is that these conditions all have abnormal, objective, clinical laboratory findings… something that wastebasket diagnoses such as mental illnesses lack entirely.
Patients can protect themselves by being informed, asking questions, and doing research. If a diagnosis doesn´t make sense, there´s probably a reason why that deserves further investigation and testing.
A doctor should always rule out all other possibilities before making a wastebasket diagnosis. A patient who presents with fatigue and is immediately diagnosed as "depressed" and prescribed an antidepressant without any testing should demand testing and seek an independent second opinion.
It never hurts to ask for clinical proof of a diagnosis and insist on testing to rule out other causes. Web MD asserts that a doctor should do a physical exam and ask for specific lab tests to determine whether the symptoms are related to a medical condition such as thyroid disease, cancer, adrenal disease, nervous system disorders, hormonal imbalances, anemia, multiple sclerosis, brain injury or tumor, stroke, reactions to medications, or heavy metal and other toxicities. Hypothyroidism, for example, is the most common disorder misdiagnosed as depression. Treating these illnesses eliminates the apparent anxiety or depression.
Some doctors may say that it´s most important to treat depression or anxiety first, before testing and treating for any other medical condition. This does nothing more than delay treatment and increase suffering, both of which may lead to social, relational, and financial problems.
If, for example, a patient has undiagnosed hypothyroidism and the doctor says to treat the depression first and will only look for other causes of the symptoms when the depression is controlled, s/he has set the patient up for failure because that hypothyroidism will not go away. As long as the symptoms are being blamed on depression, the patient will never get well. A patient may spend years of trying different antidepressants and talk therapy before realizing that emotions were never the problem. Unfortunately, many antidepressant drugs have been linked to addiction, suicide, and permanent chemical changes in the brain that cannot be reversed.
Yet if hypothyroidism is properly treated with thyroid hormone replacement therapy, the so-called depression and sluggishness almost immediately and magically disappear. The depressive symptoms are not caused by emotions or poorly defined and unproven chemical imbalances in the brain; they´re simply the result of insufficient thyroid hormone.
Depression is a fad of the 21st century. In fact, according the National Institute of Medicine, nearly 50% of adults suffer from a mental illness at some time in their life. When it gets to the point that more people have mental illness than not, logic stands to reason that the definition of mentally ill and normal needs serious revision.
Getting qualified, open-minded, appropriate medical care can be daunting in the face of insurance company limitations, cost cutting, inadequate physician time with patients, medical intimidation, and industry and political interference. Some recommendations include researching the possible cause of symptoms before making a medical appointment, asking for specific tests, bringing a spouse or friend to the appointment to increase credibility and dissuade medical intimidation tactics, and asking for objective and clinical proof of the doctor´s diagnosis.
If forcefully held for an unwarranted psychiatric evaluation, it´s best to remain calm, agreeable, confident, happy, and cooperative. This is not the time to fall prey to fear and buck the system even though you´ve been misunderstood. The best thing to do is to comply, except when regulations allow you to deny medication. Get out of there as quickly as possible and get back to finding real, qualified treatment for your health.
When in doubt, get another opinion. Some doctors consider "doctor hopping" to be a sign of malingering. But the reality is that if one can´t help, you should try another and another until the condition is properly diagnosed.
It´s a shame that it often takes years to receive a proper diagnosis and treatment, nevertheless it will happen a lot faster when one is educated, informed, asks questions, and stays alert to any warning signs.
For more articles on this topic, see: MCSA News.
Copyrighted 2011 Lourdes Salvador & MCS America
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