Friday, 7 December 2012

Self-Diagnosis, Self-Treatment and Self-Monitoring


The following is an excerpt from an editorial I wrote for Medical Hypotheses, which is designed to assist people in treating themselves for psychiatric symptoms - but the principles are applicable to other phenomena such as pain: 

It may seem over-complicated, but the key point - most likely to be missed - is the self-monitoring phase: especially in the hours following the first dose of a new agent.

I have slightly edited the excerpt.


Self-awareness, phenomenology

The process by which self-diagnosis may be accomplished requires some elucidation. I have previously termed the sequence S-DTM – meaning Self-Diagnosis, Self-Treatment and Self–Monitoring. The aim is to introduce to self-management a helpful degree of thoroughness and formalization to make the process both safer and more effective than unstructured self-management.

The first step involves developing self-awareness of symptoms. The word ‘phenomenology’ refers to the process of introspection or inward-looking by which a person can become aware of their inner, subjective states – psychiatric symptoms are one of the body states which may be accessible to such introspection.


To self-diagnose by introspection requires a skill which may be unfamiliar. For example, it is possible to be anxious but unaware of the anxiety. To become aware of anxiety as a feeling, a person needs to be able to recognize their own state of mental angst, muscular tension, rapidly beating heart, sweatiness, ‘butterflies in the stomach’ and so on.

Furthermore, inner states must be identified in terms of a system of classification – because body sensations tend to be experienced as formless and undividedly ’holistic’ unless there is a systematic classification which can describe them. Without some such analytic scheme, it may not be possible for someone to be aware of, and to express even to themselves, much more than a simple dichotomy of feeling either ‘good’ or ‘bad’. Self-treatment, however, requires that different types of ‘feeling bad’ can be distinguished and identified.


In terms of ‘depression’ – the process begins with recognition of a depressed mood, in other words a negative or unpleasant mood state which could be characterized by some kind of unhappiness. Then there is a further introspective process by which the sufferer tries to identify some inner physical, bodily state which may be the main cause of this unhappiness. The assumption is that if this causal symptom can be alleviated or eliminated then the person may become happier.

Happiness is not necessarily entailed by removing the cause of unhappiness, but it is easier and more probable that a currently-unhappy person will become happy if they are relieved of unpleasant symptoms. For example, it is hard to be happy when suffering a headache and relief of the headache may therefore cause a person to become happy who would otherwise have remained miserable.


Having identified a particular aversive body state as a probable cause of depressed mood, this symptom is then made the focus for self-treatment; and the symptom is monitored for its response to treatment.

A treatment agent or mode is selected as being both safe and potentially able to alleviate the specific symptom, and a trial of this treatment is made.

So, if the symptom underlying depressed mood is identified as anxiety and unstable emotions then stabilizing drug is chosen (such as St John’s Wort or chlorpheniramine – see below); and the symptom is monitored to see whether it responds to this treatment.



1. Recognition of a depressed, unhappy, low mood.

2. Introspective self–diagnosis of the symptomatic and emotional cause of depressed mood: its core feelings.

3. Matching the symptoms and emotions to one of the four sub-types of ‘depression’.

4. Matching the sub-type of depression to the drug class which is most likely to alleviate those symptoms and emotions.

5. Researching the scientific literature on the effects, side effects and possible interactions of the drug class – and choose a (probably) safe first-line agent.



6. Begin trial of treatment.



7. Very careful monitoring for effects and side effects for the first 4 hours after taking the agent, and continued vigilance for several days. Keep a record.

8. If there immediate problems of side effects, or feeling worse after taking a drug, consider stopping immediately – or continue with vigilant self-monitoring.

9. If no benefit at all after a few days consider increasing dose or stopping and trying another agent.

10. If side effects are bad, or there is concern over dependence, or if unsure about whether or not the drug is having benefit, or if wanting to stop taking the drug; consider stopping the drug and self-monitoring the result of stopping – then consider restarting and monitor the results of restarting.

11. Go through the process for each new drug tried. Avoid known interactions between the drug stopped and a new one being started, and between multiple agents.



The Great and Powerful Oz said...

It's hard to analyse one's self when psychoactive drugs are involved. Particularly when they are not supposed to have any side effects and every doctor I've spoken has refused to set up any sort of testing protocols.

In my case, I react very badly to drugs in every family used to treat hypertension and some doctors ignore the serious symptoms to the point I spent a day in the ER, where the doctors were just as clueless.

So I live with high blood pressure, it's safer than taking drugs.

Yeah, I don't think much of the medical profession these days, the quality of care is abysmal. If it wasn't for the advances in technology, we would be seeing a rapidly increasing mortality rate.

Bruce Charlton said...

@GaPO - Hard as it is to analyse oneself - it is ever harder to analyse somebody else - and, as you say, most doctors don't even try to do this.

As for mortality rate - who knows? It may be increasing, and we would not know about it, because the whole field us rotten with corruption. Certainly, the amount of damage (from suffering up to death) caused by modern medicine is staggering, yet I know for sure that hardly any of this gets into the statistics.

danbk99 said...

I was always curious since discovering your blog, how much of Psychiatry and the Human Condition do you still endorse, now that your views on other subjects have changed so much?

Bruce Charlton said...

Re P and the HC - I would endorse the Psychiatry, but not the human condition stuff!