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> As far as I can tell from the article, the "study" is basically arguing that because most psychiatric diagnoses use circumstantial evidence Perhaps you would

by shkkmo 7y ago

> As far as I can tell from the article, the "study" is basically arguing that because most psychiatric diagnoses use circumstantial evidence Perhaps you would have been better served by reading the linked abstract of the paper. The paper specifically criticizes the heterogeneous and inconsistent of classification of identical symptoms in the the diagnostic criteria for similar diagnosis. >> Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. > If a person comes into the ER with the symptoms of a cold and you treat them for a cold, you can't say that the diagnosis of a cold wasn't evidence based simply because the doctor didn't run a test to identify rhinovirus fragments. You picked a particularly odd example. There is no treatment for colds, all that can be done is to alleviate the patients symptoms. Indeed, there a number of situations in which you would indeed want to confirm that the symptoms are caused by the common cold because there are other potential causes that can be life threatening. [0] [0] https://www.health.com/cold-flu-sinus/signs-more-serious-common-cold?slide=418194#418194 https://www.health.com/cold-flu-sinus/signs-more-serious-com... > And if research says that it is a duck 90% of the time, then making that inference is honestly and truly evidence based, even though it leaves open the possibility of 10% misdiagnosis rate. ... what? A 10% misdiagnosis rate because other possible explanation for symptoms are ignored is considered good science and medicine? > It's also not surprising that the assessment criteria would differ markedly between different types of ailments. The criteria for assessing a sprained ankle wouldn't look anything like that for a cold. Except the study explicitly compares similar ailments (more like "sprained ankle" vs "broken ankle" vs "torn ligament in ankle" The main point of the criticism is that unlike other medical diagnosis, psyciactric diagnosis minimize the role of trauma. This is like a doctor trying to diagnose ankle pain while not really considering the fact that you fell off your bike. > Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary.

wahern 7y ago
But none of that justifies saying that psychiatry isn't evidence based. They just think the diagnostic criteria are poor across the board. And they're probably right. We're still in the stone age when it comes to mental diseases, and as long as we have weak disease models, updating and pushing out improved diagnostic criteria will be more laborious.[1] But neither science nor evidence-based medicine is synonymous with advanced; you can't say something isn't scientific or evidence-based simply because it's not sufficiently advanced. Both are processes, which by definition means they'll always fall short of what could be at any point in time--it takes time for new knowledge to travel. [1] The fields of medicine and psychiatry are replete with examples of where supposedly revolutionary models and procedures were adopted by overly credulous practitioners, causing much harm and some of the most memorable horrors of recent history. Without better disease models practitioners will be more skeptical of new evidence, as it's more difficult to judge the quality and applicability of the evidence. It doesn't mean they're anti-evidence. Now, maybe these fields, especially psychiatry, are too skeptical and intransigent, or too indecisive, or too confused. It would be more constructive to just say that, rather than coming out swinging with conclusions that don't follow, effectively committing the same sins they're accusing of others.

by shkkmo 7y ago

wahern 7y ago

But none of that justifies saying that psychiatry isn't evidence based. They just think the diagnostic criteria are poor across the board. And they're probably right. We're still in the stone age when it comes to mental diseases, and as long as we have weak disease models, updating and pushing out improved diagnostic criteria will be more laborious.[1] But neither science nor evidence-based medicine is synonymous with advanced; you can't say something isn't scientific or evidence-based simply because it's not sufficiently advanced. Both are processes, which by definition means they'll always fall short of what could be at any point in time--it takes time for new knowledge to travel. [1] The fields of medicine and psychiatry are replete with examples of where supposedly revolutionary models and procedures were adopted by overly credulous practitioners, causing much harm and some of the most memorable horrors of recent history. Without better disease models practitioners will be more skeptical of new evidence, as it's more difficult to judge the quality and applicability of the evidence. It doesn't mean they're anti-evidence. Now, maybe these fields, especially psychiatry, are too skeptical and intransigent, or too indecisive, or too confused. It would be more constructive to just say that, rather than coming out swinging with conclusions that don't follow, effectively committing the same sins they're accusing of others.