Sunday, June 11, 2006

This Post Is Unrated

While cruising around the blogosphere and generally surfing the net, I came across a web page that advertised testing for just about everything: IQ, personality, depression, anxiety, psychosis (do many people with psychotic disorders search for online tests for it?) as well as a few for medical issues such as obesity (see last post) and heart disease. That got me thinking: What do you get if you invent a rating scale? Aaron Beck has his famous scale as well as the Beck Institute for Cognitive Therapy and Research. Robert Hare has the ubiquitous Hare Psychopathy Checklist with its national training circuit as well as books and manuals. It seems to me that mental health has become something akin to the Tai Bo of medicine. Invent the right angle, sell it and you're pretty much set for life. The pharmaceutical industry gets a lot of heat for its profit margins and marketing efforts, and as a result drug companies have limited patents for their products. After twenty years, drugs go off-patent and generic forms are introduced. Perhaps therapeutic monitoring tools like psychological tests should also have time-limited copyrights.


Spiritual Emergency said...

... do many people with psychotic disorders search for online tests for it ...

I couldn't resist peeking at that one. I doubt that people go searching for such things during a state of "psychosis" but those around them might. Alternatively, the affected individual might go looking after the fact. I certainly did, although not until long after.

I think that "psychiatric services" are out of the reach for many people and those who can afford the cost of a computer and connection are using the net as a means of self-help. That means online tests, articles, support/discussion groups, even .

That got me thinking: What do you get if you invent a rating scale?

I suppose that depends on the marketing that is done and how useful the program might be. There are a number of scales, theories and models out there but popularity wanes. Tai bo will eventually go the way of other aerobic programs and Beck's scale will eventually be replaced by something new.

Perhaps therapeutic monitoring tools like psychological tests should also have time-limited copyrights.

Sounds reasonable to me. Of course, I also think some of them should be rewritten entirely.

Spiritual Emergency said...

Hmmm. I don't know what I did wrong with my link, everything showed up fine in the preview. The link belongs to the previous paragraph which had stated... support/discussion groups, even e-therapy. The link leads to an article on e-therapy.

Roy said...

The AMA has done something similar with the CPT manual (Current Procedural Terminology), which is updated annually, requiring each medical office to buy a new manual.

The APA also has the DSM (Diagnostic & Statistical Manual), the psychiatric equivalent of AMA's CPT. They don't update it near so often, but it still generates a good bit of income.

Coming soon: The Shrink Rap Blogopathy Rating Procedure ("the Burp"). All rights reserved

Spiritual Emergency said...

Coming soon: The Shrink Rap Blogopathy Rating Procedure ("the Burp").

Ahhh. Catch phrase: We put the "you" in BURP.

On the Same Page said...

I recall in NY, it being NY and all, home-grown proponents of one "issue" or another - chemical dependency, co-dependency, children of dependency, shame, grief, PTSD, victims of torture, and roads less traveled immediately come to mind - would emerge as an obscure workshop presenters at a conference. The issues were unique, the research tentative, the presenter approachable. But watching their predictabe "ascent" was disconcerting: book, less obscure conference presenations, 2nd book, main presenter at single-subject conferences, workbook, headlining travelling workshops, training of trainers, and finally the "attainment of authority." In most cases, the research remained tenative and terminal; "success" in this direction seems to discourage continuing research (with the notable exception of someone like Marsha Linnehan). Whether they are, indeed, "set for life," is unknown to me, because they also seem to become unapproachable (except through an agent). But true to the axiom of military generals, they certainly fade away.

Murky Thoughts said...

Those questionnaires quaintly called "diagnostic instruments" are copyrighted and expensive, aren't they? Like several dollars for one sheet of paper? Yep, I expect one could make quite a bit. But I imagine creating a winning instrument is not much more likely than winning a Nobel or American Idol, at least with regard to use by licensed practioners.

ClinkShrink said...

Great comments, one and all. I particularly like the BURP and the slogan. Personally, I was aiming for the BARS (Blog Addiction Rating Scale, slogan: "Can you pass the Bars Exam?").

I think of a psychological test as being analagous to any other medical diagnostic test or therapeutic monitoring device. If cigarettes can be found to be a medical device that is designed to deliver nicotine (the legal theory behind the tobacoo industry class action product liability claims), then I think psychological tests could warrant the same reasoning.

Then again, I'm not a lawyer and frankly will admit I don't know the difference between a patent and a copyright.

jw said...

My problem with all of the scales and tests bases on sleep disorders. If a patient has a severe enough sleep disorder the test will show all sorts of psychopathology, all of it garbage. AVI writes about this here:

Five years ago a friend who was sleeping about 3 hours per night saw a shrink who diagnosed him with several serious disorders: He'd been sleeping at this rate for more than a year. His family Dr. happened to ask about sleep. With Seroquel his sleep went up to a normal 7.5 hours per night and all of the symptoms went away: I know! Off use of Seroquel; it worked for him ...

None of the available tests will catch a sleep disorder caused psychosis. It's up to the shrink to ask about sleep and most do not; at least that is my experience.

For a goodly many patients a sleep disorder Dr. is the correct test & "medicine."

Roy said...

JW: On the contrary, sleep is one of the few psychiatric symptoms that we can attach an objective number to (#hours). I suspect that 90%+ of the time, psychiatrists will ask about sleep when evaluating someone for the first time.

Your point about how sleep deprivation can trigger all sorts of secondary symptoms is right on target.