Posted on 13-08-2013
Filed Under (ED Treatment) by admin

Psychiatric disorders such as bipolar disorder, major depressive disorder, and schizophrenia are as much the result of disease processes as are somatic diseases such as pituitary adenoma or tuberculosis. As such, they deserve the same diagnostic strategies and consideration of appropriate somatic treatments (e.g., medication). Most of these psychiatric diseases affect a patient’s sexual functioning.

In the initial diagnostic stage of treatment, the disease perspective alerts the clinician to exhaust empirical medical data provided by the presenting problem and gathered in the patient’s history. A recent physical examination is necessary for any disorder that may have somatic roots. Dr. M.’s knowledge of Sally’s behavior was grounded in a careful history taking, which indicated that a major mental illness had afflicted the patient’s mother. While certainly the illness could have affected the mother-daughter relationship in many ways (e.g., making the mother less emotionally available), Sally’s bipolar disorder might also have genetic components.

The disease perspective correspondingly alerts the clinician not to rush prematurely to establish an etiology rooted in a “meaningful explanation” of the problem. For example, it would be facile to attribute Sally’s behavior to some fault in the marriage or to personality factors such as inappropriate dependence on male approval. Indeed, almost all depressed individuals attribute their depression to life situations, in an understandable attempt to develop a rationale for the way they feel. It is much easier to say “I am depressed because of the way my life has gone recently” than to say “While things have not been perfect, all in all everything has been going as it usually does. It is just that my depressed mood has a life of its own. My neurotransmitters must not be working properly.” The former is an attempt at a meaningful explanation (to be examined in the life story perspective), while the latter is a (rarely heard) appreciation of the depression from the disease perspective.

The disease perspective is, as would be expected, the main perspective of schools of medicine and nursing. These graduate programs stress the need to observe carefully and exhaustively the various somatic phenomena in a person’s complaint as well as the medical history that he or she provides. Medical graduate programs teach their future clinicians how to conduct a review of organ systems and mental status examinations. Personal and family medical histories yield information about past diseases, surgeries, and medications.

Graduate schools of psychology and social work often do not share this emphasis. In these disciplines, the circumstances of intrapsychic, interpersonal, and social environment are valued highly and therefore often described in minute detail. Attention may be paid to personal and family medical and psychiatric histories. There is less likely to be a recording of the complete regimen of medications with accurate dosage. And conducting a mental status examination—with its attention to factors such the patient’s appearance, neurovegetative symptoms, manner of speech, thought processes—is usually an indication that the psychologist or social worker has been trained in a medical or residential facility.

Whereas medical and nursing students may overlook the psychological and relational factors in the patient’s disease, social science students, especially with the advent of social constructionism, may overlook the role of the body and the body’s diseases in the etiology of the problem. The disease perspective, then, is the familiar territory of the physician, nurse, and medical clinician. It is the terra incognita of the psychologist, social worker, and counselor, unless efforts are made to learn more of this “body” of knowledge. Thus, the role of the disease perspective should be supported and nurtured by the psychologist, social worker, and counselor by developing relationships with medical practitioners, including psychiatrists, who can supplement their psychological skills with medical knowledge of the body and its diseases.

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