6 ms·

Before the sceptics get in: 1. The purpose of DSM/ICD is often to justify financing treatment: > Chris Ferguson, a professor of psychology at Stetson Universi

Before the sceptics get in: 1. The purpose of DSM/ICD is often to justify financing treatment: > Chris Ferguson, a professor of psychology at Stetson University ... described the ICD as "the book of real diseases that you can get insurance payments for." 2. Treatment has to be mindful of the specific form of addiction: > "These are co-morbid conditions," he said. "If you just treat the depression and not gaming, the gaming is likely to come back." This suggests it's a unique condition, he said. 3. No we are not "medicializing everything": > But Ferguson argued that, if it is a disorder, it seems to be very rare. NB. Before criticizing modern psychiatry keep in mind: 1. mental health patients are extreme in their dysfunction, never common. 2. the operation of the brain (, nervous system, etc.) in its interaction with its environment is as liable to breaking as any other part of the body 3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s.

DanBC 9y ago
> Before criticizing modern psychiatry keep in mind: > 1. mental health patients are extreme in their dysfunction, never common. I agree with what you're saying, but the US does have a problem of over-testing, over-diagnosis, and over-treating illness. Not just mental ill health, but everything. In the US about 10% of children have ADHD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/ > Based on the Heath Resources and Services Administration's National Survey of Children's Health, the percentage of children aged 4–17 years diagnosed with ADHD increased from 7.8% in 2003 to 9.5% in 2007, representing a 21.8% increase in just 4 years (Centers for Disease Control and Prevention 2010). An estimates 3million US children take stimulant medication: > Experts estimate that approximately 60% of children with ADHD are treated with prescription stimulants (Center for Disease Control and Prevention 2005a); therefore, approximately three million children in this country take stimulants for problems with focusing. At the same time, many studies have revealed the numerous adverse effects associated with prescription stimulants when they are used inappropriately. These numbers are a bit worrying, especially if medication alone is being used, and it's not provided as a package of bio-psycho-social treatment.
- mjburgess 9y ago
  Ahh, sigh. I was writing with ADHD in mind actually. Up to 10% children really do have ADHD which is a delay in the development of the frontal lobe. Such a delay seems "somewhat common" amongst humans. More than half catch up, leaving upto 5% of adults with some form of ADHD. ADHD is serious. It is a severe impairment to planning, self-management, emotional regulation, etc. You are likely to be impoverished without substantial resources to rely on (family, etc.). > are a bit worrying > it's not provided as a package of bio-psycho-social treatment. ADHD researchers (serious neuroscientists & clinical psychiatrists) have for DECADES tried "biosocial blah blah". It has failed. ADHD is not a failure of child training (ie., parents "Raising Their Child Right!!!"). Overwhelmingly the effective treatment for ADHD is pharmocological. At this point comments like yours, along with the media hysteria, are doing real harm to children actually getting treatment. The problem we have with ADHD is significant under treatment and under diagnosis. It turns out all those "useless" people joked about in human history have not just been failures of character: in need of "social" intervention. They have had a physical impairment, a delay in their brain's development. Not Fixable by a good beating, or whatever the touchy-feely equivalent is. The suggestion that a child with a broken leg not receive crutches would be absolutely outrageous. Or a person with cancer not receive a daily pill treatment. The very same outrage should be felt here in the suggestion that people with ADHD not receive medication vital to their ability to even pay attention to their lessons (goals, etc.). Vital to their ability to socailize (ie., control their frustation in ways that doesnt alientate other children). And therefore vital to their future success. Yes there does need to be a fundamental reorganization to western education systems to, from the ground up, be aware of how wide-spread developmental issues are -- and to build in fundamental support structures. However this isnt a "treatment" for ADHD. There is no cure. This is just bracing the crutches. Overwelmingly the research over the last 30 years has shown the only significant impact on ADHD is pharmocological.
  - xena 9y ago
    Honestly I think about half the problem is that psychiatric illnesses don't make people bleed, so there's no way to universally tell something is wrong.
algesten 9y ago
> 3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s. But isn't modern clinical psychiatry marred by the same problems social or economic sciences are? Ultimately you are studying/interpreting human behaviour, which doesn't lend itself well to quantisation or categorising.
- mjburgess 9y ago
  The most reasonable thing to think about any mental health disorder is whatever the consensus in clinical psychiatry is. That is the point. It is so overwhelmingly well-researched, that even if its conclusions are wrong, no lay person is going to be in a position to have "an argument" that hasn't already been considered and researched and folded into the consensus. This isnt the case with social sciences, and it isnt the case with macroeconomic policy. Both of these are about groups of humans, not individual humans, and are fundamentally about behaviour in the face of cultural/economic/social changes. That kind of analysis is purely speculative and historically accidental in the way that giving people adderall and measuring their cognitive performance isn't. A man on the street may well have good reasons to speculate differently about the evolution of his society that those speculations produced in some university in a foreign country. A man on the street can have no good reason to act against the consensus of research-based medicine. To do so is to fly blindly into an area of profound research depth and consideration. We have a problem today of these domains being equivocated. About people believing they are experts because the "Experts" they see are really political speculators and commentators of macro-cultural changes. And so everyone thinks everything is speculation. This is profoundly not the case for, let's say, what the best treatment plan for bipolar disorder, adhd, autism, clincial depression, psychosis, etc. etc. etc. is. ...which has folded in lifetimes of research on the way the brain works, the way that drugs work, CBT, social therapies, counselling, etc. etc. etc. ... An opinion on what "should be done" about a family member with bipolar disorder may as well be an opinion about what should be done about their thyroid problem, carpal fracture, lymphoma, etc.
  - xapata 9y ago
    Sounds like you're not familiar with sociology nor macroeconomics literature.
StanislavPetrov 9y ago
>3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s. Your post was okay until your last point. While it isn't the 1950s, its absurd to contend that "modern clinical psychiatry" isn't massively subjective in terms of both treatment and diagnosis. The fact is that the vast majority of psychiatrists reflexively shovel pills at those perceived to be afflicted with poorly-understood mental disorders. In reality, we are only beginning to scratch the surface when it comes to understanding how the brain works, let alone the human psyche. One of the most egregious illustrations of this fact are the over 1 million children under the age of 5 taking psychiatric drugs. We still don't know the long term outcomes of our tinkering with the developing brains of infants and small children, and its hubris (or worse) to pretend that we do. https://www.cchrint.org/psychiatric-drugs/children-on-psychiatric-drugs/ https://www.cchrint.org/psychiatric-drugs/children-on-psychi...
- rendaw 9y ago
  On the subject, I remember reading recently that most psychology studies are observational, and when attempts to duplicate the findings are made they mostly can't. I realize that GP's statement is qualified with 'clinical', and decisions based on observational studies are probably better than just making things up, but how much have we actually progressed?
numismatex 9y ago
Let's take a history of the DSM using trivia here: 1) By context it states still that drugs like LSD and MDMA will lead to psychosis. 2) It directly stated that Marijuana causes psychosis up until some years back (less than a decade). 3) Psychosis NOS (None Otherwise Specified) is used to categorize undesirables when nothing else fits. 4) People were still being forcibly sterilized in California up until less than a decade ago. 5) Modern clinical psychiatry is checklist-based, not evidence-based. If it were evidence-based they'd be basing it on bloodwork and MRI. 6) Recent findings regarding genetics, as well as astrocyte-damage being responsible for schizophrenia trump Freudian-based lunacy. 7) Psychiatric abuse has been common for over 100 years. If you're homosexual, anti-establishment, communist, atheist, Wiccan and more, you've likely been a victim of bias and discrimination. The cold-water baths and ECT to treat such terrible conditions as not being "like everyone else" are true. 8) It's delusional to think that the DSM represents fact -- for instance, the APA has stated that any group of people, large enough, holding a belief, is a religion and thus a protected class -- yet Wiccans, Rastafari and alternative religions are still persecuted like addicts and cults. As someone who survived the psychiatric establishments in Texas, finally meeting a doctor who started at square one, asking me questions, and rediagnosing me to PTSD and a victim of abuse from the slew of ever-changing diagnoses that my parents lied to the doctors to achieve, I think it's all barbarism, plain and simple. Times are changing, but mental institutions and Big Pharma pushing pills hasn't. Actual therapeutics and investigation are nonexistent. People don't ask the patients and instead rely on testimony from others. Full workups aren't done. Inspection for head trauma, meningitis and more isn't done. And you can pick this apart, and say that "hey those are just isolated possible situations" but the reality is, just like the prison systems, psychiatry is 100% flawed and biased. For fucks sake, my first doctor around year 2000 had been trained in fucking Russia in the fucking 1950s. You want psychiatry to be true? Give it 20 years for the tech to catch up and doctors to adopt it, then give it to AI to manage rather than flawed, biased humans with motives that aren't in line with the best treatment for a patient.

DanBC 9y ago

> Before criticizing modern psychiatry keep in mind: > 1. mental health patients are extreme in their dysfunction, never common. I agree with what you're saying, but the US does have a problem of over-testing, over-diagnosis, and over-treating illness. Not just mental ill health, but everything. In the US about 10% of children have ADHD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/ > Based on the Heath Resources and Services Administration's National Survey of Children's Health, the percentage of children aged 4–17 years diagnosed with ADHD increased from 7.8% in 2003 to 9.5% in 2007, representing a 21.8% increase in just 4 years (Centers for Disease Control and Prevention 2010). An estimates 3million US children take stimulant medication: > Experts estimate that approximately 60% of children with ADHD are treated with prescription stimulants (Center for Disease Control and Prevention 2005a); therefore, approximately three million children in this country take stimulants for problems with focusing. At the same time, many studies have revealed the numerous adverse effects associated with prescription stimulants when they are used inappropriately. These numbers are a bit worrying, especially if medication alone is being used, and it's not provided as a package of bio-psycho-social treatment.

mjburgess 9y ago
Ahh, sigh. I was writing with ADHD in mind actually. Up to 10% children really do have ADHD which is a delay in the development of the frontal lobe. Such a delay seems "somewhat common" amongst humans. More than half catch up, leaving upto 5% of adults with some form of ADHD. ADHD is serious. It is a severe impairment to planning, self-management, emotional regulation, etc. You are likely to be impoverished without substantial resources to rely on (family, etc.). > are a bit worrying > it's not provided as a package of bio-psycho-social treatment. ADHD researchers (serious neuroscientists & clinical psychiatrists) have for DECADES tried "biosocial blah blah". It has failed. ADHD is not a failure of child training (ie., parents "Raising Their Child Right!!!"). Overwhelmingly the effective treatment for ADHD is pharmocological. At this point comments like yours, along with the media hysteria, are doing real harm to children actually getting treatment. The problem we have with ADHD is significant under treatment and under diagnosis. It turns out all those "useless" people joked about in human history have not just been failures of character: in need of "social" intervention. They have had a physical impairment, a delay in their brain's development. Not Fixable by a good beating, or whatever the touchy-feely equivalent is. The suggestion that a child with a broken leg not receive crutches would be absolutely outrageous. Or a person with cancer not receive a daily pill treatment. The very same outrage should be felt here in the suggestion that people with ADHD not receive medication vital to their ability to even pay attention to their lessons (goals, etc.). Vital to their ability to socailize (ie., control their frustation in ways that doesnt alientate other children). And therefore vital to their future success. Yes there does need to be a fundamental reorganization to western education systems to, from the ground up, be aware of how wide-spread developmental issues are -- and to build in fundamental support structures. However this isnt a "treatment" for ADHD. There is no cure. This is just bracing the crutches. Overwelmingly the research over the last 30 years has shown the only significant impact on ADHD is pharmocological.
- xena 9y ago
  Honestly I think about half the problem is that psychiatric illnesses don't make people bleed, so there's no way to universally tell something is wrong.

algesten 9y ago

> 3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s. But isn't modern clinical psychiatry marred by the same problems social or economic sciences are? Ultimately you are studying/interpreting human behaviour, which doesn't lend itself well to quantisation or categorising.

mjburgess 9y ago
The most reasonable thing to think about any mental health disorder is whatever the consensus in clinical psychiatry is. That is the point. It is so overwhelmingly well-researched, that even if its conclusions are wrong, no lay person is going to be in a position to have "an argument" that hasn't already been considered and researched and folded into the consensus. This isnt the case with social sciences, and it isnt the case with macroeconomic policy. Both of these are about groups of humans, not individual humans, and are fundamentally about behaviour in the face of cultural/economic/social changes. That kind of analysis is purely speculative and historically accidental in the way that giving people adderall and measuring their cognitive performance isn't. A man on the street may well have good reasons to speculate differently about the evolution of his society that those speculations produced in some university in a foreign country. A man on the street can have no good reason to act against the consensus of research-based medicine. To do so is to fly blindly into an area of profound research depth and consideration. We have a problem today of these domains being equivocated. About people believing they are experts because the "Experts" they see are really political speculators and commentators of macro-cultural changes. And so everyone thinks everything is speculation. This is profoundly not the case for, let's say, what the best treatment plan for bipolar disorder, adhd, autism, clincial depression, psychosis, etc. etc. etc. is. ...which has folded in lifetimes of research on the way the brain works, the way that drugs work, CBT, social therapies, counselling, etc. etc. etc. ... An opinion on what "should be done" about a family member with bipolar disorder may as well be an opinion about what should be done about their thyroid problem, carpal fracture, lymphoma, etc.
- xapata 9y ago
  Sounds like you're not familiar with sociology nor macroeconomics literature.

StanislavPetrov 9y ago

>3. modern clinical psychiatry is an evidenced-based, research-driven field which treats and forms diagnoses on the basis of decades of research into any particular condition. It isnt the 1950s. Your post was okay until your last point. While it isn't the 1950s, its absurd to contend that "modern clinical psychiatry" isn't massively subjective in terms of both treatment and diagnosis. The fact is that the vast majority of psychiatrists reflexively shovel pills at those perceived to be afflicted with poorly-understood mental disorders. In reality, we are only beginning to scratch the surface when it comes to understanding how the brain works, let alone the human psyche. One of the most egregious illustrations of this fact are the over 1 million children under the age of 5 taking psychiatric drugs. We still don't know the long term outcomes of our tinkering with the developing brains of infants and small children, and its hubris (or worse) to pretend that we do. https://www.cchrint.org/psychiatric-drugs/children-on-psychiatric-drugs/ https://www.cchrint.org/psychiatric-drugs/children-on-psychi...

rendaw 9y ago
On the subject, I remember reading recently that most psychology studies are observational, and when attempts to duplicate the findings are made they mostly can't. I realize that GP's statement is qualified with 'clinical', and decisions based on observational studies are probably better than just making things up, but how much have we actually progressed?

numismatex 9y ago

Let's take a history of the DSM using trivia here: 1) By context it states still that drugs like LSD and MDMA will lead to psychosis. 2) It directly stated that Marijuana causes psychosis up until some years back (less than a decade). 3) Psychosis NOS (None Otherwise Specified) is used to categorize undesirables when nothing else fits. 4) People were still being forcibly sterilized in California up until less than a decade ago. 5) Modern clinical psychiatry is checklist-based, not evidence-based. If it were evidence-based they'd be basing it on bloodwork and MRI. 6) Recent findings regarding genetics, as well as astrocyte-damage being responsible for schizophrenia trump Freudian-based lunacy. 7) Psychiatric abuse has been common for over 100 years. If you're homosexual, anti-establishment, communist, atheist, Wiccan and more, you've likely been a victim of bias and discrimination. The cold-water baths and ECT to treat such terrible conditions as not being "like everyone else" are true. 8) It's delusional to think that the DSM represents fact -- for instance, the APA has stated that any group of people, large enough, holding a belief, is a religion and thus a protected class -- yet Wiccans, Rastafari and alternative religions are still persecuted like addicts and cults. As someone who survived the psychiatric establishments in Texas, finally meeting a doctor who started at square one, asking me questions, and rediagnosing me to PTSD and a victim of abuse from the slew of ever-changing diagnoses that my parents lied to the doctors to achieve, I think it's all barbarism, plain and simple. Times are changing, but mental institutions and Big Pharma pushing pills hasn't. Actual therapeutics and investigation are nonexistent. People don't ask the patients and instead rely on testimony from others. Full workups aren't done. Inspection for head trauma, meningitis and more isn't done. And you can pick this apart, and say that "hey those are just isolated possible situations" but the reality is, just like the prison systems, psychiatry is 100% flawed and biased. For fucks sake, my first doctor around year 2000 had been trained in fucking Russia in the fucking 1950s. You want psychiatry to be true? Give it 20 years for the tech to catch up and doctors to adopt it, then give it to AI to manage rather than flawed, biased humans with motives that aren't in line with the best treatment for a patient.