Major And Minor Psychoneurotics

There is no requirement at all for a parody. Reality is quite bizarre enough.

In 1905 Bluler ( I think it was Bluler )came up with the term schizophrenia. He grouped the paranoid, common, hebephrenic and catatonic forms together, not because he thought they had a common aetiology, but because the prognosis was poor in each case. A mere 101 years later a conference of the great and the good suggest the name “dopamine dysregulation disorder”. The fact that there is NO evidence to suggest a dopamine imbalance causes psychosis seems to have escaped them. 102 years later we are no closer to picking the bones out of it all.

Meanwhile, at its inception in 1952 the DSM ran to 100 pages. The DSM IV-TR ( 2000 ) managed to fill 943. Perhaps we should run a MentalNurse sweepstake on the length of the DSM V.

It all puts me in mind of another A.A Milne character - Pooh. I know who the Dopey Dwarves are in this saga.

Fortunately, none of this classification seems to worry Joe Public. Back in the 1960’s when my mum was admitted to our local asylum things were much simpler…. “She’s had a nervous breakdown” we were told. Nowadays the comprehensive diagnosis is even simpler, the word “nervous” has been removed and when referring to any type of psychiatric episode people can simply say “She’s had a breakdown” (no doubt this will soon to be shortened to “br8kdn”). Most friends and family are happy to accept that response and nod in understanding… “oh dear, a breakdown, what a shame”.

It always tickles me to think of a similar response being used to cover all physical problems. So that were someone admitted to a general hospital whether it be due to a fracture, heart attack, cancer, childbirth or infectious disease you could simply say “Oh, they’ve had a physical breakdown” and friends and neighbours, rather than asking for all the gory details, would nod in sympathy and say “oh dear, a breakdown, oh that is bad news”.

And before you all start hammering your keyboards, I’m not suggesting for a minute that this diagnosis is used by any nurse in the country… (not even OSB)… but it is still widely used among the public.

I’ve never understood what the term “nervous breakdown” means I have also heard “mental breakdown”.

Even as a student nurse I have no idea!

I have heard it used, but I would suppose by people who use it as a generic term for mentally unwell/unstable/whatever? I don’t know!

And that joke about the psychotic and neurotic really did have no humour in it whatsoever! That is an achievement in itself!

I have recently qualified as a mental health nurse and find it fascinating that the nurse training programmes (at least the course I was placed on) attempt to steer clear of all ‘professional’ words linked to diagnosis and symptoms. The most guidance we had in regard to the DSM was to tell us it existed, that Doctors are preoccupied with it and that if we felt like reading through it at our leisure we could! Jargon used to describe symptoms was also linked to the ‘old school’ ways of working. The rational for this ethos being that this ‘jargon’ leads to lazy stereotyping and damaging ‘labelling’ of people with mental health problems. Students are encouraged to describe a persons individual experiences rather than lumping them together as ‘delusions’ or ‘hallucinations’etc.

Whilst this may infact be a valid point and a move for the better it does not help the poor first (or even third) year student who arrives at their placement and during handover is immediately transported into a world of foreign language and spends most of their learning experience trying to work out what is going on!

“Old school ways of working” ????. Hello Kamaka.

Quite simply diagnoses ( and symptomatology ) should be a very effective method of communicating information. Previously, Mo has eloquently described how the patient body can find a diagnosis strangely comforting. It`s the same trendy academics, whose practice incorporates very limited engagement with the diagnosed, who claim to feel vicariously offended by labelling. To add insult to injury they then criticise coal face practitioners for poor communication and continuity of care.

There is DSM V Prelude Project going on. I`m nominating Mo for chairMAN and Joe Public for the committee. We might get it down to a sensible, student friendly size.

Can we put “mad as a fraggle” and “going off it” into the DSM V as approved psychiatric jargon?

Thinking about it, this may be a sign of the times, but I tend to associate personality disorders with certain Big Brother contestants rather than dwarves.

Psychopathic PD - George Galloway

Borderline PD - Shahbaz

Histrionic PD - Nikki

Mental nurse I completely agree, a mixture of laziness and also of tutors who have not been in the actual work place for some fifteen years so probably have their own insecurities about being able to teach students the most up to date ‘jargon’! In response to you ‘old school boy’ it seems that you have some query about ‘old school ways of working’ so to clarify: on the course I have just completed the ‘old school’ would be people who are mainly ‘resistive to change’, student and newly qualified phobic and those who work to strict routines. These strict routines include horror stories about using the same bath water for ten patients and using the same razor to shave all the males! Of course in reality the tutors are brain washing the students to ‘go forth and promote change’ which includes the use of paperwork, flow charts, assessments that are ‘measurable’ (giving people a number or a colour to indicate their level of distress or risk) and ignoring the basics such as helping people to manage daily tasks and doing ‘normal’ things such as taking the dog for a walk! Of course these ‘normal’ activities cannot be used to show the ‘meeting of targets’ but in my short time as staff nurse they seem invaluable to the recovery of the individual, which is of course the reason people train to nurse in the first place - to help not to bring everything down to a paper and pen exercise! Sorry, enough ranting as you can see I am a little disillusioned with my nurse training!

I disagree with your comments kamaka. The tutors at my uni are very up to date. It is their job. They have more time to research and find out what is up to date. More so than many of the ward based nurses. Many of my tutors also visit the wards to find out first hand what is going on as well as asking the students what they find on placement.

I would never say we are “brain-washed”, our tutors frequently ask us if we agree and invite us to challenge us on any points we do not understand or agree with.

We are also taught the latest “jargon” but again, in a realistic fashion.

Recently one of my many classes was on being non-judgmental. We were taught the theory and had a health debate about the difficulties in applying it to practice.

We were also taught about the DSM, but also that it is not the be all and end all. The decision on whether we want to see the diagnosis, or the patient, being down to us.

Perhaps I am lucky and have better tutors overall?

Having just last week finished my training, I feel the need to add to this debate. Firstly in three years of training not once did any tutor mention the DSM. Thankfully I had gained some knowledge of it during my access course.In fact in my management placement I got told off by the ward manager for paying more attention to signs and symptoms of mental illness than diagnosis or DSM classification. So I decided to look back through client files. I found at least 3 ‘labels’ per client. So late in my training I started to have a crisis of confidence and question the fundemental teachings of the course. The truth is the theory we are taught doesn’t always relate to what goes on in practice!