8 ms·

Psychiatric Diagnosis Found to Be “Scientifically Meaningless”

77 points by ada1981 7y ago

ajna91 7y ago
The main findings of the research were: • Psychiatric diagnoses all use different decision-making rules • There is a huge amount of overlap in symptoms between diagnoses • Almost all diagnoses mask the role of trauma and adverse events • Diagnoses tell us little about the individual patient and what treatment they need
deleted 7y ago
[deleted]
cjbprime 7y ago
Prescient reasoning from 1973: https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment
hn_throwaway_99 7y ago
While I think I am biased to agree with the results of this "study", I have a big problem with using the language of scientific research to describe what this is about: > The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related disorders’. So, basically, they read the DSM and gave their opinion of it. Which is fine, but calling this some type of "study" is ludicrous. It's a bit rich to use statements like "the main findings of this research are" when the "research" just literally was Reading The F*ing Manual.
- shkkmo 7y ago
  Um... what definition of study leads you to think that this does not fit? It seems to fall quite cleanly inside the one that seems relevant: "A detailed examination, analysis, or experiment investigating a subject or phenomenon" Similarly, "research" is a very broad term and quite clearly can involve just reading without performing any experiments. I would (less semantically) argue (and the editors of "Psychiatry Research" would seem to agree) that pointing out inconsistent classification criteria is important to understanding the reliability of experiments based on those criteria.
  - ramblerman 7y ago
    I think empirical is what he expected, as did I frankly.
    - shkkmo 7y ago
      > I think empirical is what he expected, as did I frankly. I am pretty clear about what he expected. The question is: on what basis was this expected and is it reasonable to start a semantic debate about it on that basis? What is the "big problem" here?
      - jaredklewis 7y ago
        Let’s say I think about it for a while and decide that C++ is more prone to bugs than other languages. If I present that opinion as, “Study finds C++ more prone to bugs than other languages,” you don’t find it misleading? I think most people assume the word “study” indicates something is backed by a rigorous method of research, like the scientific method. You can’t just make an opinion and then claim it’s a study.
        shkkmo 7y ago
        I would say that "C++ is more prone to bugs than other languages" is a quantitative claim and it is difficult to back up a quantitative claim without quantitative evidence. I don't think it calling itself a "study" should have any bearing on your desire to see that quantitative evidence or on your general epistemic stance towards the claims. > I think most people assume the word “study” indicates something is backed by a rigorous method of research, like the scientific method. You can’t just make an opinion and then claim it’s a study. I get that there may be some connotation in the context of headlines that empirical evidence gathering was involved. Does that make it ludicrous to use the term? Not at all. The paper and the article are both clear about what was involved in the study. I really don't see how there is a "big problem" here (especially compared to issues of reproducibility in studies that are back by empirical data.) My big concern is the assertions that papers like this are not part of a "rigorous method of research, like the scientific method" completely discount the important role that such papers play in drawing the solid conclusions from data.
deleted 7y ago
[deleted]
outlace 7y ago
It’s actually fairly uncontroversial between psychiatrists that the diagnoses as specified in the DSM are not biologically valid. We use them more as a communication tool to give a rough picture of a patient’s symptoms to other providers than as a map onto biology. We simply don’t understand the underlying biology well enough yet to do any better. But there’s a lot of exciting research cracking this area open and we may very well be able to diagnose and prognose based on objective data such as brain imaging, genetics and blood tests. Psych resident
- notfashion 7y ago
  A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No tests exist which can detect those imbalances. Your faith in "biology" as the ultimate underlying reality of mental illness is discouragingly close to that medical model of mental illness. This idea that mental distress is essentially biological in character has bad consequences because it ignores the fact that each patient is an agent in continuous interaction with his or her social environment. Mental illnesses, in general, don't develop organically from biological defects. They are often the consequence of trauma and adverse life events, as noted by the authors of this research. Sure, some mental illness is purely biological. Some disorders may be influenced by genetics. But the generic, classic phenomenon of somebody "going crazy" is unlikely ever to be attributable purely to physiological processes. These things come about because of profoundly dysfunctional psychosocial environments. As a psychiatric professional, you may find it reassuring to predict the future dominance of an objective medical model of mental illness. It would be braver to admit that the complexity of the mind and of the circumstances that lead to mental illness mean that medical research is a very long way from cracking this problem.
  - soup10 7y ago
    Most psychiatrists are well aware that their job is to manage and medicate people that have psychotic episodes, extreme emotional and/or behavioral problems(that deviate from the norm far enough to cause concern with the community but aren't necessarily criminal). Their education is in biology, psychology and clinical medicine, very few know much about computer science or AI approaches to the mind except a few of those involved in research, since it has little relevance in a clinical setting.
tootie 7y ago
Just to be clear, they are not discrediting psychiatric evaluation. They are saying that specific labels of syndromes are useless. I don't think that's really all that controversial a thing to say. Treatments are usually prescribed per symptoms which is still valid.
- DanBC 7y ago
  No, they are discrediting psychiatric evaluation. They're clear that any diagnostic process is a sham, and any attempt to supply a diagnostic label is unethical. They don't believe any psychiatric diagnostic label is valid.
subroutine 7y ago
This is nonsense. "This study provides yet more evidence..." What evidence? This is a book report. Sure, DMS diagnostics are not perfect. In an ideal world we'd compile a biomarker screen, genomic analysis, MRI/DTI/fMRI brain imaging data, covert/overt behavioral analysis, 100 question screener, family interviews, etc. etc. But in the real world, for a first-pass psychiatric triage, if you're not using DSM guidelines, you're using your own intuition.
- phkahler 7y ago
  In your ideal world with things like biomarker screens and MRIs, what exactly would you try to correlate any physical evidence with? You can't say "these genetic markers have a high correlation with schizophrenia" for example without first screening for schizophrenia via something like the DSM. But if you can diagnose it with that already....
  - subroutine 7y ago
    For the most part, I agree. There are some scenarios where you could profile a condition based on, say, gene sequencing data more readily than in a diagnostic interview. Maybe like... foster parents call a clinic asking about treatments for possible Fetal Alcohol Syndrome; you query the electronic med records of the child which include a recent dna test, and it turns out the diagnosis is William's Syndrome. https://ghr.nlm.nih.gov/condition/williams-syndrome#genes https://ghr.nlm.nih.gov/condition/williams-syndrome#genes Are we close to being able to do this for conditions like depression, schizophrenia, autism... not so much.
Rotten194 7y ago
Every good mental health professional I've had has understood this. Effective treatment treats the individual, not the diagnosis -- the diagnosis is only to get authotizarion from insurance and government agencies to get the necessary resources. My insurance paid $1500 for psychological testing that "confirmed" my severe ADHD -- which was completely obvious to my psychiatrist, she just wasn't allowed to diagnosis it -- just so I could get authotizarion to try stimulants... and find they didn't work for me at all. Psychiatric diagnosis is at the level of pre-scientific symptom-based diagnosis, for the most part. Imagine if you went to the doctor for a cough and, without any tests, they prescribed a month long course of antibiotics with no idea how effective they would be. A friend of mine was prescribed powerful antipsychotics to "fix" a problem that was actually being caused by another psychiatric medication they had been prescribed earlier to fix something else. Their mental health kept getting worse and worse, and what finally helped was starting a DBT (dialectic behavior therapy) program, and now they're in the process of getting off all those meds that turned out to be more harmful than helpful. We need to stop pretending that a point-scored questionnaire is a scientific way to distinguish a diagnosis, or that we understand the chemistry of the brain well enough that medication can be the first line of defense.
- shadowoflight 7y ago
  Stop me if this is too personal a question, but: As a fellow adult AD(H)D sufferer who is currently undiagnosed, how did you go about finding a diagnostic center that accepted your insurance? I've been trying to find one, but the list provider by my insurance provider (United HealthCare) is less hopelessly inaccurate, and every online psychiatrist/psychologist directory I've found does not have up-to-date insurance information.
  - Rotten194 7y ago
    It was awhile ago, but IIRC I just called around to a bunch of places. The best way to get information unfortunately ¯\_(ツ)_/¯
  - Mathnerd314 7y ago
    Insurance providers are required to keep their directories up to date with roughly the past 30 days: https://www.ahip.org/wp-content/uploads/2016/09/The-Provider-Directory-Dilemma-Availity.pdf https://www.ahip.org/wp-content/uploads/2016/09/The-Provider... But there's not much you can do if it's inaccurate besides start looking for another provider. I've written a few scripts to massage my provider's directory into something usable, now lost unfortunately. UnitedHealth is apparently working on a blockchain for provider data: https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-Website/downloads/Synaptic_Health_Alliance_Blockchain_White_Paper.pdf https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-W... I guess making a web service is too hard? https://www.managedcaremag.com/archives/2019/7/how-blockchain-has-strange-bedfellows-singing-kumbaya https://www.managedcaremag.com/archives/2019/7/how-blockchai... suggests it's mostly about getting management to sign off.
tony 7y ago
The major findings listed in the article make sense: > • Psychiatric diagnoses all use different decision-making rules > • There is a huge amount of overlap in symptoms between diagnoses > • Almost all diagnoses mask the role of trauma and adverse events > • Diagnoses tell us little about the individual patient and what treatment they need I think the alluring thing about diagnoses is it quickly gives closure, so we don't have to think, balance facts, or ask why. Check some boxes and we can draw a type of a person by characteristics as we would with the periodic table of elements. We've been raised in a culture (or multiple of them), have an upbringing and have a story behind that impacts how we trust others, we need to be loved, have complicated emotions, we have impulses and drives, and sometimes there is a biological/chemical aspect to it, we're made of elements. As a society, we're here now cooperating because we care to help each other. We're complex social beings, and it's hard to put us to a definition and have it do us justice. One of of the big papers criticizing mental illness is this: https://psychclassics.yorku.ca/Szasz/myth.htm https://psychclassics.yorku.ca/Szasz/myth.htm Another one is Rosenham Experiment: https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment https://youtu.be/1MbARnJqjnc?t=519 https://youtu.be/1MbARnJqjnc?t=519 - Some podcast talk on diagnosing mental illness / diagnosis and how not all clinicians would come to the same agreement on someone's behavior.
DoreenMichele 7y ago
I think there's at least four major components of mental illness: 1. Biochemical 2. Trauma, often made worse by social BS 3. General social BS 4. A mismatch between the person and expectations placed upon them I think the first is something we should work on a great deal more than we really do. It's much more readily quantifiable in a scientific manner than social BS and addressing it can dramatically reduce the impact of the other three, all of which entail varying degrees of social BS.
0xcde4c3db 7y ago
To my mind, this is a little too much like saying that diagnoses of AIDS were "scientifically meaningless" until HIV was definitively isolated. A syndrome isn't devoid of predictive power or other practical meaning just because we haven't identified a perfect biomarker or treatment protocol or diagnostic threshold for it. There's still considerable debate over the full etiologies of diagnoses like (for example) multiple sclerosis and muscular dystrophy, but we can't wave our hands and attribute those to deficits of character or an oppressive society or "unresolved trauma" [1] the way we can with mental illness diagnoses. Sure, the DSM is basically a dumping ground for various obnoxiously imprecise syndromes that don't clearly belong to another specialty such as neurology or endocrinology. But that doesn't make those syndromes "scientifically meaningless". It's one thing to say that these definitions should not be taken as gospel for determining future research directions. It's something else entirely to say that they're "meaningless" and "not fit for purpose" based on a philosophical notion of "meaning" or "purpose" that itself isn't rigorously defined. [1] It's funny how "biopsychiatry" is expected to identify precise molecular pathways or anatomical derangements or genetic markers, but once the paradigm is flipped to the more psychodynamic approaches, rigor suddenly doesn't matter so long as we can tell a compelling story about how our experiences shaped us.
mindgam3 7y ago
This is the heart of it: > Almost all diagnoses mask the role of trauma and adverse events... > The authors conclude that diagnostic labelling represents ‘a disingenuous categorical system’. The DSM fails miserably as a manual to alleviate suffering, because it downright ignores the influence of trauma on all but one major diagnosis (acute PTSD). Worse, complex trauma ("cPTSD") aka "developmental trauma" is still not an official diagnosis, which is absurd, given that it is well established in the research that child abuse can severely damage mental health. The whole thing is looking at the problem of mental health from the wrong angle. The so-called epidemic of mental illness will only subside once we ditch the dizzying array of overlapping symptoms, and focus on the root causes. Every single individual seeking professional counsel on mental health should be screened for trauma at intake. There's just no excuse for not doing that given how much trauma impacts outcomes.
adolimpio 7y ago
First, this is not discrediting psychiatric evaluation. It's just another article that tries to be controversial but really isn't. As pointed out in the comments, any professional is very aware of the problems outlined in this article and researchers are working on finding clearer markers for psychiatric diagnoses (see the emerging field of Computational Psychiatry for example) The one problem I'm familiar with and I'd like to point out is with Major Depressive Disorder (MDD). MDD is diagnosed if 5 or more symptoms are present for at least 2 weeks. Some of these symptoms are actually in contrast with each other. This means that is possible for two people to have completely different symptoms but still be diagnosed with the same disorder. This is shocking. So it is clear that the problem is with labelling these disorders. That's why researchers, to better understand how the neurological substrate affects the behaviours, are focusing on individual symptoms and only then relate them to categorical differences.
DanBC 7y ago
A reminder that some of the authors make money from pushing their anti-Psychiatry views. For example, this conference on the Power Threat Meaning Framework (and alternative to diagnosis) is charging huge amounts of money for their conferences.

77 points by ada1981 7y ago

The main findings of the research were: • Psychiatric diagnoses all use different decision-making rules • There is a huge amount of overlap in symptoms between diagnoses • Almost all diagnoses mask the role of trauma and adverse events • Diagnoses tell us little about the individual patient and what treatment they need

deleted 7y ago

[deleted]

cjbprime 7y ago

Prescient reasoning from 1973: https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment

hn_throwaway_99 7y ago

While I think I am biased to agree with the results of this "study", I have a big problem with using the language of scientific research to describe what this is about: > The study, led by researchers from the University of Liverpool, involved a detailed analysis of five key chapters of the latest edition of the widely used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related disorders’. So, basically, they read the DSM and gave their opinion of it. Which is fine, but calling this some type of "study" is ludicrous. It's a bit rich to use statements like "the main findings of this research are" when the "research" just literally was Reading The F*ing Manual.

shkkmo 7y ago
Um... what definition of study leads you to think that this does not fit? It seems to fall quite cleanly inside the one that seems relevant: "A detailed examination, analysis, or experiment investigating a subject or phenomenon" Similarly, "research" is a very broad term and quite clearly can involve just reading without performing any experiments. I would (less semantically) argue (and the editors of "Psychiatry Research" would seem to agree) that pointing out inconsistent classification criteria is important to understanding the reliability of experiments based on those criteria.
- ramblerman 7y ago
  I think empirical is what he expected, as did I frankly.
  - shkkmo 7y ago
    > I think empirical is what he expected, as did I frankly. I am pretty clear about what he expected. The question is: on what basis was this expected and is it reasonable to start a semantic debate about it on that basis? What is the "big problem" here?
    - jaredklewis 7y ago
      Let’s say I think about it for a while and decide that C++ is more prone to bugs than other languages. If I present that opinion as, “Study finds C++ more prone to bugs than other languages,” you don’t find it misleading? I think most people assume the word “study” indicates something is backed by a rigorous method of research, like the scientific method. You can’t just make an opinion and then claim it’s a study.
      - shkkmo 7y ago
        I would say that "C++ is more prone to bugs than other languages" is a quantitative claim and it is difficult to back up a quantitative claim without quantitative evidence. I don't think it calling itself a "study" should have any bearing on your desire to see that quantitative evidence or on your general epistemic stance towards the claims. > I think most people assume the word “study” indicates something is backed by a rigorous method of research, like the scientific method. You can’t just make an opinion and then claim it’s a study. I get that there may be some connotation in the context of headlines that empirical evidence gathering was involved. Does that make it ludicrous to use the term? Not at all. The paper and the article are both clear about what was involved in the study. I really don't see how there is a "big problem" here (especially compared to issues of reproducibility in studies that are back by empirical data.) My big concern is the assertions that papers like this are not part of a "rigorous method of research, like the scientific method" completely discount the important role that such papers play in drawing the solid conclusions from data.

deleted 7y ago

[deleted]

outlace 7y ago

It’s actually fairly uncontroversial between psychiatrists that the diagnoses as specified in the DSM are not biologically valid. We use them more as a communication tool to give a rough picture of a patient’s symptoms to other providers than as a map onto biology. We simply don’t understand the underlying biology well enough yet to do any better. But there’s a lot of exciting research cracking this area open and we may very well be able to diagnose and prognose based on objective data such as brain imaging, genetics and blood tests. Psych resident

notfashion 7y ago
A lot of people in the psychiatric field believe that mental illness is due to chemical imbalances in the brain. No tests exist which can detect those imbalances. Your faith in "biology" as the ultimate underlying reality of mental illness is discouragingly close to that medical model of mental illness. This idea that mental distress is essentially biological in character has bad consequences because it ignores the fact that each patient is an agent in continuous interaction with his or her social environment. Mental illnesses, in general, don't develop organically from biological defects. They are often the consequence of trauma and adverse life events, as noted by the authors of this research. Sure, some mental illness is purely biological. Some disorders may be influenced by genetics. But the generic, classic phenomenon of somebody "going crazy" is unlikely ever to be attributable purely to physiological processes. These things come about because of profoundly dysfunctional psychosocial environments. As a psychiatric professional, you may find it reassuring to predict the future dominance of an objective medical model of mental illness. It would be braver to admit that the complexity of the mind and of the circumstances that lead to mental illness mean that medical research is a very long way from cracking this problem.
- soup10 7y ago
  Most psychiatrists are well aware that their job is to manage and medicate people that have psychotic episodes, extreme emotional and/or behavioral problems(that deviate from the norm far enough to cause concern with the community but aren't necessarily criminal). Their education is in biology, psychology and clinical medicine, very few know much about computer science or AI approaches to the mind except a few of those involved in research, since it has little relevance in a clinical setting.

tootie 7y ago

Just to be clear, they are not discrediting psychiatric evaluation. They are saying that specific labels of syndromes are useless. I don't think that's really all that controversial a thing to say. Treatments are usually prescribed per symptoms which is still valid.

DanBC 7y ago
No, they are discrediting psychiatric evaluation. They're clear that any diagnostic process is a sham, and any attempt to supply a diagnostic label is unethical. They don't believe any psychiatric diagnostic label is valid.

subroutine 7y ago

This is nonsense. "This study provides yet more evidence..." What evidence? This is a book report. Sure, DMS diagnostics are not perfect. In an ideal world we'd compile a biomarker screen, genomic analysis, MRI/DTI/fMRI brain imaging data, covert/overt behavioral analysis, 100 question screener, family interviews, etc. etc. But in the real world, for a first-pass psychiatric triage, if you're not using DSM guidelines, you're using your own intuition.

phkahler 7y ago
In your ideal world with things like biomarker screens and MRIs, what exactly would you try to correlate any physical evidence with? You can't say "these genetic markers have a high correlation with schizophrenia" for example without first screening for schizophrenia via something like the DSM. But if you can diagnose it with that already....
- subroutine 7y ago
  For the most part, I agree. There are some scenarios where you could profile a condition based on, say, gene sequencing data more readily than in a diagnostic interview. Maybe like... foster parents call a clinic asking about treatments for possible Fetal Alcohol Syndrome; you query the electronic med records of the child which include a recent dna test, and it turns out the diagnosis is William's Syndrome. https://ghr.nlm.nih.gov/condition/williams-syndrome#genes https://ghr.nlm.nih.gov/condition/williams-syndrome#genes Are we close to being able to do this for conditions like depression, schizophrenia, autism... not so much.

Rotten194 7y ago

Every good mental health professional I've had has understood this. Effective treatment treats the individual, not the diagnosis -- the diagnosis is only to get authotizarion from insurance and government agencies to get the necessary resources. My insurance paid $1500 for psychological testing that "confirmed" my severe ADHD -- which was completely obvious to my psychiatrist, she just wasn't allowed to diagnosis it -- just so I could get authotizarion to try stimulants... and find they didn't work for me at all. Psychiatric diagnosis is at the level of pre-scientific symptom-based diagnosis, for the most part. Imagine if you went to the doctor for a cough and, without any tests, they prescribed a month long course of antibiotics with no idea how effective they would be. A friend of mine was prescribed powerful antipsychotics to "fix" a problem that was actually being caused by another psychiatric medication they had been prescribed earlier to fix something else. Their mental health kept getting worse and worse, and what finally helped was starting a DBT (dialectic behavior therapy) program, and now they're in the process of getting off all those meds that turned out to be more harmful than helpful. We need to stop pretending that a point-scored questionnaire is a scientific way to distinguish a diagnosis, or that we understand the chemistry of the brain well enough that medication can be the first line of defense.

shadowoflight 7y ago
Stop me if this is too personal a question, but: As a fellow adult AD(H)D sufferer who is currently undiagnosed, how did you go about finding a diagnostic center that accepted your insurance? I've been trying to find one, but the list provider by my insurance provider (United HealthCare) is less hopelessly inaccurate, and every online psychiatrist/psychologist directory I've found does not have up-to-date insurance information.
- Rotten194 7y ago
  It was awhile ago, but IIRC I just called around to a bunch of places. The best way to get information unfortunately ¯\_(ツ)_/¯
- Mathnerd314 7y ago
  Insurance providers are required to keep their directories up to date with roughly the past 30 days: https://www.ahip.org/wp-content/uploads/2016/09/The-Provider-Directory-Dilemma-Availity.pdf https://www.ahip.org/wp-content/uploads/2016/09/The-Provider... But there's not much you can do if it's inaccurate besides start looking for another provider. I've written a few scripts to massage my provider's directory into something usable, now lost unfortunately. UnitedHealth is apparently working on a blockchain for provider data: https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-Website/downloads/Synaptic_Health_Alliance_Blockchain_White_Paper.pdf https://cdn2.hubspot.net/hubfs/4801399/18-SYN-001-Synaptic-W... I guess making a web service is too hard? https://www.managedcaremag.com/archives/2019/7/how-blockchain-has-strange-bedfellows-singing-kumbaya https://www.managedcaremag.com/archives/2019/7/how-blockchai... suggests it's mostly about getting management to sign off.

tony 7y ago

The major findings listed in the article make sense: > • Psychiatric diagnoses all use different decision-making rules > • There is a huge amount of overlap in symptoms between diagnoses > • Almost all diagnoses mask the role of trauma and adverse events > • Diagnoses tell us little about the individual patient and what treatment they need I think the alluring thing about diagnoses is it quickly gives closure, so we don't have to think, balance facts, or ask why. Check some boxes and we can draw a type of a person by characteristics as we would with the periodic table of elements. We've been raised in a culture (or multiple of them), have an upbringing and have a story behind that impacts how we trust others, we need to be loved, have complicated emotions, we have impulses and drives, and sometimes there is a biological/chemical aspect to it, we're made of elements. As a society, we're here now cooperating because we care to help each other. We're complex social beings, and it's hard to put us to a definition and have it do us justice. One of of the big papers criticizing mental illness is this: https://psychclassics.yorku.ca/Szasz/myth.htm https://psychclassics.yorku.ca/Szasz/myth.htm Another one is Rosenham Experiment: https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment https://youtu.be/1MbARnJqjnc?t=519 https://youtu.be/1MbARnJqjnc?t=519 - Some podcast talk on diagnosing mental illness / diagnosis and how not all clinicians would come to the same agreement on someone's behavior.

DoreenMichele 7y ago

I think there's at least four major components of mental illness: 1. Biochemical 2. Trauma, often made worse by social BS 3. General social BS 4. A mismatch between the person and expectations placed upon them I think the first is something we should work on a great deal more than we really do. It's much more readily quantifiable in a scientific manner than social BS and addressing it can dramatically reduce the impact of the other three, all of which entail varying degrees of social BS.

0xcde4c3db 7y ago

To my mind, this is a little too much like saying that diagnoses of AIDS were "scientifically meaningless" until HIV was definitively isolated. A syndrome isn't devoid of predictive power or other practical meaning just because we haven't identified a perfect biomarker or treatment protocol or diagnostic threshold for it. There's still considerable debate over the full etiologies of diagnoses like (for example) multiple sclerosis and muscular dystrophy, but we can't wave our hands and attribute those to deficits of character or an oppressive society or "unresolved trauma" [1] the way we can with mental illness diagnoses. Sure, the DSM is basically a dumping ground for various obnoxiously imprecise syndromes that don't clearly belong to another specialty such as neurology or endocrinology. But that doesn't make those syndromes "scientifically meaningless". It's one thing to say that these definitions should not be taken as gospel for determining future research directions. It's something else entirely to say that they're "meaningless" and "not fit for purpose" based on a philosophical notion of "meaning" or "purpose" that itself isn't rigorously defined. [1] It's funny how "biopsychiatry" is expected to identify precise molecular pathways or anatomical derangements or genetic markers, but once the paradigm is flipped to the more psychodynamic approaches, rigor suddenly doesn't matter so long as we can tell a compelling story about how our experiences shaped us.

mindgam3 7y ago

This is the heart of it: > Almost all diagnoses mask the role of trauma and adverse events... > The authors conclude that diagnostic labelling represents ‘a disingenuous categorical system’. The DSM fails miserably as a manual to alleviate suffering, because it downright ignores the influence of trauma on all but one major diagnosis (acute PTSD). Worse, complex trauma ("cPTSD") aka "developmental trauma" is still not an official diagnosis, which is absurd, given that it is well established in the research that child abuse can severely damage mental health. The whole thing is looking at the problem of mental health from the wrong angle. The so-called epidemic of mental illness will only subside once we ditch the dizzying array of overlapping symptoms, and focus on the root causes. Every single individual seeking professional counsel on mental health should be screened for trauma at intake. There's just no excuse for not doing that given how much trauma impacts outcomes.

adolimpio 7y ago

First, this is not discrediting psychiatric evaluation. It's just another article that tries to be controversial but really isn't. As pointed out in the comments, any professional is very aware of the problems outlined in this article and researchers are working on finding clearer markers for psychiatric diagnoses (see the emerging field of Computational Psychiatry for example) The one problem I'm familiar with and I'd like to point out is with Major Depressive Disorder (MDD). MDD is diagnosed if 5 or more symptoms are present for at least 2 weeks. Some of these symptoms are actually in contrast with each other. This means that is possible for two people to have completely different symptoms but still be diagnosed with the same disorder. This is shocking. So it is clear that the problem is with labelling these disorders. That's why researchers, to better understand how the neurological substrate affects the behaviours, are focusing on individual symptoms and only then relate them to categorical differences.

DanBC 7y ago

A reminder that some of the authors make money from pushing their anti-Psychiatry views. For example, this conference on the Power Threat Meaning Framework (and alternative to diagnosis) is charging huge amounts of money for their conferences.