It was suggested in an article in The Gleaner of March 2, that the presence of "more specialist studies and increased knowledge" in modern societies may cause one to wonder whether these specialists are 'looking out' to justify their area of study. I am sure there are a number of persons who may hold a similar opinion for various reasons. However, these opinions may arise from a limited understanding of the system within which specialists operate, as well as the various maladies they are trained to manage.

The strict application of a personality disorder, such as borderline personality, to a nation or a society might be a bit of a reach. I agree with what others have said that these acts are by a minority of individuals and hence cannot be extrapolated on to an entire nation. What would be more accurate would be to say that there are a number of personality-disordered individuals, most significantly antisocial personalities in our society that have earned us the reputation we now have.

Controversy

The diagnosis of a personality disorder has been around since the beginning of the 19th century and like other areas in mental health has been associated with controversy. In modern societies these disorders have been managed resulting in improvement to many of our brothers and sisters and the protection of society. The diagnosis of these personality disorders should be reserved until the individual is in early adulthood and has "enduring inner experiences and behaviour that deviate from the expectations of that individual's culture". The environment and social circumstances that we all live in have changed over the years and this fact is a likely contributor to increased prevalence of some of these disorders.

In modern societies, another factor motivating referral to specialists and multiple investigations is the increasing number of medical malpractice suits. Professionals are unwilling to jeopardise their careers through possible errors of commission or omission. Hence, to cover themselves they may choose to refer persons to sub-specialists or order investigations and procedures that may prove to be unnecessary. This helps to drive up the cost of health care and professional insurance. There will always be stories of persons being diagnosed with disorders and these diagnoses being ignored with a resultant positive outcome.

No referrals

However, there are even more instances where persons are never referred for help and they grow into maladjusted, socially deviant individuals.

The author in his commentary, indicated that the parents of the child thought to have ADHD by the teacher, worked with their child. Many parents have no idea of what 'working' with their child may entail and intervention by a specialist may help them learn the skills necessary to improve the child's behaviour.

I would venture to suggest that Jamaica has been blessed to have medical and other specialists whose abilities are on par or exceed those of specialists found in high-income societies. The clinical acumen of many of our Jamaican medical specialists is superior to that of other countries and this prevents a rush to a 'quick diagnosis' and unwarranted investigations. It is often the lack of resources needed in these specialised areas that does the greater harm than any labelling of individuals.

I am, etc.,

CLAYTON A. SEWELL

Consultant Psychiatrist