26 Dec Misdiagnosis, Over-Diagnosis, and the Potential Problem of Mistreatment in Mental Healthcare
Robert – Misdiagnosis
In June of 2006, Robert and Carol lost their 32-year-old daughter to what was believed to be an accidental overdose of the drugs she had been abusing for 15 years. They had done everything they believed they could for their daughter, including several expensive rounds of in-patient drug rehabilitation, but nothing had worked. Robert’s last words to his daughter had been, “If you leave our home today, you will never be allowed to come back.” One week later, the couple learned of their daughter’s death.
Both Robert and Carol experienced understandable grief at the loss of a loved one, but their circumstances were particularly traumatic. No parent should have to experience the death of a child, especially by suicide. Because Robert believed his last words to his daughter had been unloving, he experienced more than just a father’s grief; he also experienced the feeling that he had caused his daughter to take her life.
Robert began to experience depression, which can sometimes occur in someone who has experienced a loss but which is usually temporary, and he also began to have difficulty concentrating. His symptoms grew progressively worse and were further complicated by periods of irritability, confused thinking and chronic pain for which doctors could find no physiological basis. Robert’s symptoms began to create enough dysfunction that he chose to take early retirement. He was treated solely by his longtime general practitioner and given several different psychiatric medications including an antidepressant, an antianxiety and a benzodiazepine. Robert did not attend or receive psychological counseling or therapy.
Seven years after the death of his daughter, Robert’s grief had not lessoned. His depression was no less severe, and in fact, in many ways it had worsened. He was no longer leaving the house for any other reason than to take his wife to and from work and to make occasional visits to the doctor or to the pharmacy. He found that he was no longer able to read as he had once enjoyed doing, and was easily distracted while listening to his wife. His physical ailments had increased, with pain in his back, neck, head, and down his right leg and foot, even while his doctor had only diagnosed him with high blood pressure.
Robert was experiencing complicated grief, but had not been adequately diagnosed or treated.
Kelli – Over-Diagnosis
In March of 2013, CNN reported on the story of Kelli Montgomery, director of the MISS Foundation for Grieving Families in Austin, Texas, who’d experienced the stillbirth of a child and was astonished that, in her grief, her doctors were solely recommending antidepressants and sleeping pills. Instead, Montgomery chose exercise, yoga and meditation to move through her grief and become healthy and whole again.
Lindsey – Mistreatment
At 16-years-old, Lindsey was placed in voluntary treatment for suicidal ideation. Her parents had Lindsey placed in the child and adolescent wing of an in-patient treatment facility with the expectation that she would receive psychiatric evaluation and some form of therapy. On the evening Lindsey was brought into treatment, an in-take questionnaire was completed by Lindsey and a psychiatric nurse. The questionnaire was then turned over to the psychiatrist on duty, who passed it on to the next two psychiatrists to come into the hospital and perform rounds in the child and adolescent wing. Lindsey, however, was not seen or evaluated by an attending psychiatrist during her brief stay at the hospital, and was released 48 hours after arriving.
At the time Lindsey was released, the psychiatrist on duty reviewed Lindsey’s chart and wrote down two diagnoses: Oppositional Defiant Disorder (ODD) and Post-Traumatic Stress Disorder (PTSD). Lindsey’s parents were troubled by the brevity of her stay and the seeming incongruity of ODD as a diagnosis for their daughter.
After questioning their daughter and interviewing the staff, the family came to the conclusion that too little time had been spent observing their daughter, speaking to or evaluating her in a clinical environment, or discussing their daughter’s history and behavior with the family for such diagnoses to have been made. The family was troubled because the recommendation had been made for Lindsey to receive immediate and regular out-patient therapy, which they fully intended to follow through with, but now that these diagnoses had been established for their daughter, would a therapist believe them, and furthermore, would another doctor attempt to prescribe their daughter with medications based on these diagnoses? The family knew that sometimes, psychiatric pharmaceuticals could have dangerous side effects, especially in children and adolescents.
In the case of Lindsey, best mental health practice dictates that a psychiatrist or other clinical mental health professional would spend time speaking to and evaluating her in the clinical setting, and would also, if possible, speak to the family to gain a history and insight into Lindsey’s behavior at home. All of this would occur before diagnoses or further treatment recommendations were made for a patient. Especially where a child or adolescent exhibits suicidal thoughts or behavior, it is critical that mental health professionals take the utmost care and precaution to examine every piece of the puzzle and bring to the family an assessment made in due care and caution.
On the subject of the difficulty of easily demarcating the subtleties of insanity from sanity, Allen Frances, professor emeritus of Duke University and former chairperson of the American Psychological Association’s Diagnostic and Statistical Manual-IV Task Force, reminded the world of a quote by Isaac Newton: “I can calculate the motions of the heavens, but not the madness of men.” Frances went on to write, “We can’t [today] do a very precise job of this either, but we can certainly do a lot better than we are now.” For individuals experiencing grief, the mental health establishment and the healthcare profession at large can be in agreement that patients such as Kelli Montgomery, parents like Robert and Carol, and the family of a teen like Lindsey can all benefit from care, caution and quality human-centered healthcare. Putting patients’ lives before pharmaceutical company profits while approaching people and families as the experts of their own lives is not too much to ask the healthcare industry. No one of us is impervious to human struggles, be they physical, emotional, or psychological. When we find ourselves inevitably hurting, it is in the best interest of all of us to have good doctors with good practices on our side.
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