I couldn’t possibly write this week’s AotW without mention of the first public consultation on the DSM-V, which was unveiled today.  The American Psychiatric Association has put its proposals on existing and new mental disorders up at www.dsm5.org, for the delectation of professionals and the public at large.  Comments are invited.

I’ve had a rudimentary gander through the pages on BPD and bipolar II.  The latter seems largely unchanged, though the section on personality disorders has a distinctly new feel.  I noted with interest that they want to change the term ‘borderline personality disorder’ to ‘borderline type’.  What the fuck does that even mean?  As one of my Twitter followers said, the borderline type of what exactly?  (It’s the borderline type of personality, I think, which makes the new designation no different from the old one as far as I can see).  I know there have been many calls to change the name of BPD (I don’t share the hatred of the name myself, though I agree that the disorder is unfairly stigmatised), but why change it to something so meaningless, that still incorporates the supposedly offensive word?  I can’t see any sense in it, I’m afraid.

One thing that is, I think, a positive move, is the APA’s decision to introduce rating scales to assess the severity of traits in the personality disorders (though assessing ‘severity’ as a more general concept still seems rather vague).  As far as I can see, the present methods of establishing just how bad someone’s PD is are nebulous and arbitary.  If the new ratings are adopted as the current draft of the tome suggests, it will, I think, force psychiatrists to take certain cases more seriously than they presently do.  Maybe I’m being ridiculously idealistic in supposing this, but I do think that whatever happens, this is a positive development.  Of course, some of the ‘traits’ discussed are pretty negative in tone, and I suppose the danger exists for a clinician to be biased against a particular patient.  It is my hope that most are more professional than this…

Anyway, onto other stuff I came across this week.

In light of a recent news story in which a man in a long-term coma was shown to be able to communicate with scientists using a brain scanner, the Independent has run an article asking just how much we know about the human brain.  My immeadiate reaction was that we know sod all really, but there is a surprising amount of information detailed in this fascinating article.  Of course, what is known is infintessimal relative to what is unknown, but nevertheless the material presented here sheds light on this intriguing subject.

The Big Question: What Do We Know About the Human Brain and the Way it Functions?

The following is quite an old article from Psychiatric Times, apparently dating back to 1996.  To that end, the material therein is probably quite outdated, but it does address a question that has bothered me for some time (yes, my life is that sad) – in what way is psychopathy distinct from anti-social personality disorder?  My understanding had been that as things stand, ASPD was the new name for psychopathy – yet in popular terms at least, the two aren’t equated much; a psycho- or sociopath is seen as someone so much more than someone with ASPD.  This article discusses the distinction and confusion surrounding the diagnoses.

Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion

Here we have yet another article on the therapeutic relationship.  Not one of my favourite topics, or anything *whistles innocently*

This is also from Psychiatric Times, which is fast becoming one of my most-visited websites.  There isn’t anything especially revelatory in it, but nevertheless it intelligently discusses therapuetic boundaries, issues of transference and countertransference, and why the unilateralness of the relationship is an inherently good thing (even though it doesn’t damn well feel it most of the time, from this side of the couch anyway), but doesn’t stop the therapist caring for the client, nor sharing an intimate relationship with him/her.

I can think of a certain someone that would do well to read this and similar articles.

Boundaries and Benefits of Psychotherapy

Finally, something vaguely amusing (or so it was to me).  Last night, in a rage at C, A Googled “fucking incompetent therapist”.  This turned up the highly reliable and unbiased (!) site of Stop Bad Therapy, in which you can take a test to see whether or not your therapist really is as shite as you think he or she is.

I answered ‘yes’ to 13 out of 40 questions.  Apparently:

If you answered ‘yes’ to ten or more questions, you need to carefully question your therapist about the relevance of your therapy. If the outcome of this discussion fails to reassure you, decisive action is warranted. Rather than walk away from this therapist, or even trot, consider sprinting from therapy as rapidly as you can. Any therapist who elicits this many ‘yes’ responses is likely incompetent. He is probably doing you much more harm than good.

To be clear, I am not taking this remotely seriously.  But I thought it was entertaining

Evaluate Your Therapy

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Your comments on all or any of these articles are most welcome.