6 ms·

Frances's concerns definitely aren't wrong on the whole, but I feel like he's not seeing the forest for the trees. This ultimately isn't just a question of whet

Frances's concerns definitely aren't wrong on the whole, but I feel like he's not seeing the forest for the trees. This ultimately isn't just a question of whether this or that DSM revision is helpful. The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are still unreliable and many of the theories still fairly reek of superstition and magical thinking. Practitioners are frequently defined more by which tradition or thought leader they adhere to than by their specialization in established subfields. It's not a great situation, and I don't see many signs that it's improving. A great deal is said about "awareness" and "stigma". Phrases like "get help" have been around long enough to turn from hero to villain (i.e. from an earnest plea to close friends or loved ones to a passive-aggressive dismissal of strangers). Who's seriously talking about materially improving the situation instead of promoting an allegedly more "correct" theory? Hell if I know. Please tell me if you do. I guess I broadly agree with the article author that the DSM process is "caught between paradigms" and has "no obvious way forward", but that's a profoundly unsatisfying place to find common ground.

triumphblr 2y ago
Frances I think was worried about his legacy disappearing with DSM-5, because there was a big push to change things in a major way compared to DSM-IV. Ultimately I don't think that really happened; DSM-5 was a change but not the radical change I think the chairs and primary committees wanted it to be. Frances' flooding of media outlets around that time was sort of strange in certain ways. He seemed to correctly identify potential problems in the mental healthcare system but then had this idea that changing things in the DSM to address some of its issues would make everything worse. It felt as if he was co-opting concerns everyone was having to argue for not changing anything at all, and in the process turned everything on its head. The DSM is a very political document with a lot of interest groups involved at all levels, which is why it didn't change even more than it did. As a result, you had NIMH circumvent the whole process with RDoC, which then in turn seems to have had a relatively short life (maybe?) associated with changeover in its own administration. It feels as if everyone has their own schema for thinking about mental illness, and the whole field moves along without any serious consequences. There's probably a lot of reasons for this, including scientific and medical sociology, and the complexity of mental wellness and illness as a domain. But it makes me wonder if some of the distinctions that are argued to be critical are really that critical in the end.
- cutoffyrdck 2y ago
  [flagged]
  - swores 2y ago
    The anti-trans arguments are the same as the anti-gay arguments from 40 years ago. High suicide numbers in a group of people constantly harassed in the media and in real life doesn't prove that their healthcare caused it. It's just sad bigotry.
    - transkillskids 2y ago
      [flagged]
      - swores 2y ago
        I'm not looking to have an argument about this bigotry, just needed to leave the actual common sense statement so yours didn't stand alone. Maybe consider that if other people are flagging you it's because your views are objectionable rather than because you're one of the few people to know the truth about a subject you have no actual experience of. Speak to some trans people to educate yourself.
    - gunchly 2y ago
      [flagged]
      - swores 2y ago
        40 years ago you'd have been telling me that seeing homosexual couples hold hands and kiss is unnatural and requires the whole of society to believe an unnatural lie that they aren't just horrible perverts. In both cases, a minority of people have non-mainstream feelings/understanding of their own gender or sexuality, and therefore wish to do things that affect their own body and either nobody else's (trans) or that only affect other people who feel the same way (gay). In both cases, people have argued that it's immoral, that it's about grooming children, and that the external visibility of being gay/trans - either seeing two people of the same gender holding hands, or kissing, or choosing to live their life together openly, or seeing someone who you once thought was one gender but has asked to be called the other gender and to be allowed to dress and act as culture considers "normal" for that gender. In both cases, it turns out that actually, no, these gay or trans (or any combination of the LGBTQ - many trans people identify as trans AND gay, it's not a case of gay people choosing to be trans to become straight as I've seen claimed) people roaming the streets doesn't make your life worse, it doesn't trick kids into thinking about sex too early any more than a married straight couple bringing a new baby into the world does, and telling kids that it's OK to be gay, and that it's OK to be trans, doesn't lead to more kids "deciding" to be gay or trans it just leads to more people admitting it rather than staying in the closet. Trans kids and gay kids aren't making a decision, any more than you never made a decision to be your birth gender, nor did you make a decision to be gay or not. Trans rights are human rights, and while I'm not trans if I decided tomorrow to get surgery to remove my penis and ask everyone to call me "she/her", how exactly does that affect you or anybody else any more than if I continue to have the gay sex I so often enjoy?
naasking 2y ago
> It's not a great situation, and I don't see many signs that it's improving. I think this is a little too pessimistic on the one hand, and very accurate on the other. On the accurate side: this discipline took one of the most significant hits from the replication crisis, and was one of the most resistant to acknowledging and changing practices. Everyone should keep pushing for open science and preregistered studies to improve quality of the evidence here. On the optimistic side, there is one potentially huge change that's just starting to crest as opinions improve and acceptance spreads: psychedelics. MDMA for PTSD was a huge win and indicates a potentially large untapped realm of possibilities for altering cognition in positive ways. There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades.
- 0xcde4c3db 2y ago
  > There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades. That definitely does happen, but so far it happens glacially, I assume because doing groundbreaking neuropsychiatric research is considerably harder and more expensive work than "evergreening" existing drugs or reading stuff like Meditations and Walden Two [1] while sipping expensive wine and then pulling an allegedly-modern psychosocial theory out of one's nether regions. My current favorite reference point is anti-NMDA-receptor encephalitis, a (class of?) autoimmune condition that was only definitively identified ca. 2007. One must assume that there are centuries of breathless accounts of "demonic possession" or "latent schizophrenia" or people who were "on drugs" (colloquially often referring to effects of heavy doses of ketamine, PCP, and other potent deliriant/dissociative agents, which tend to be NMDA antagonists) that are probably explained by this condition. And who can say what percentage of today's "schizophrenics" have arrived at a similar place along an as-yet-unidentified path? [1] Not to say those works aren't worth reading; they're iconic for legitimate reasons. I'm just saying that context and proportionality matter in ways that are often conveniently ignored.
  - naasking 2y ago
    Indeed, we need better tools and models to explain mental phenomena. It's getting better with models like predictive coding, but it's mostly still folk psychology at this point, just splitting progressively finer hairs.
mcmoor 2y ago
> The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are still unreliable and many of the theories still fairly reek of superstition and magical thinking. Ah this is also my stance. There are lots of good will in this subject, but trusting it is like trusting surgeons in 19th century. There may be no other option, but sometimes it's better to leave the bullet in your chest rather than letting it be infected by doctors with dirty hands.
matrix87 2y ago
> Legitimate advances are being made Like what? Realizing that lobotomies aren't a legitimate treatment?
- mtlmtlmtlmtl 2y ago
  No, like the Bergen 4 day treatment which is continuing to show highly promising results against severe anxiety disorders. The use of psychedelics and ketamine for treatment of ptsd and depression respectively are also very promising. There are advances being made in the treatment of psychotic disorders both on therapy side and on the medication side, with less harmful antipsychotics in development. And the need for chronic antipsychotic treatment(which is quite harmful in many ways) being questioned more and more. You might wanna do some research before implying the field hasn't moved at all in the last 50 years...

triumphblr 2y ago

Frances I think was worried about his legacy disappearing with DSM-5, because there was a big push to change things in a major way compared to DSM-IV. Ultimately I don't think that really happened; DSM-5 was a change but not the radical change I think the chairs and primary committees wanted it to be. Frances' flooding of media outlets around that time was sort of strange in certain ways. He seemed to correctly identify potential problems in the mental healthcare system but then had this idea that changing things in the DSM to address some of its issues would make everything worse. It felt as if he was co-opting concerns everyone was having to argue for not changing anything at all, and in the process turned everything on its head. The DSM is a very political document with a lot of interest groups involved at all levels, which is why it didn't change even more than it did. As a result, you had NIMH circumvent the whole process with RDoC, which then in turn seems to have had a relatively short life (maybe?) associated with changeover in its own administration. It feels as if everyone has their own schema for thinking about mental illness, and the whole field moves along without any serious consequences. There's probably a lot of reasons for this, including scientific and medical sociology, and the complexity of mental wellness and illness as a domain. But it makes me wonder if some of the distinctions that are argued to be critical are really that critical in the end.

cutoffyrdck 2y ago
[flagged]
- swores 2y ago
  The anti-trans arguments are the same as the anti-gay arguments from 40 years ago. High suicide numbers in a group of people constantly harassed in the media and in real life doesn't prove that their healthcare caused it. It's just sad bigotry.
  - transkillskids 2y ago
    [flagged]
    - swores 2y ago
      I'm not looking to have an argument about this bigotry, just needed to leave the actual common sense statement so yours didn't stand alone. Maybe consider that if other people are flagging you it's because your views are objectionable rather than because you're one of the few people to know the truth about a subject you have no actual experience of. Speak to some trans people to educate yourself.
  - gunchly 2y ago
    [flagged]
    - swores 2y ago
      40 years ago you'd have been telling me that seeing homosexual couples hold hands and kiss is unnatural and requires the whole of society to believe an unnatural lie that they aren't just horrible perverts. In both cases, a minority of people have non-mainstream feelings/understanding of their own gender or sexuality, and therefore wish to do things that affect their own body and either nobody else's (trans) or that only affect other people who feel the same way (gay). In both cases, people have argued that it's immoral, that it's about grooming children, and that the external visibility of being gay/trans - either seeing two people of the same gender holding hands, or kissing, or choosing to live their life together openly, or seeing someone who you once thought was one gender but has asked to be called the other gender and to be allowed to dress and act as culture considers "normal" for that gender. In both cases, it turns out that actually, no, these gay or trans (or any combination of the LGBTQ - many trans people identify as trans AND gay, it's not a case of gay people choosing to be trans to become straight as I've seen claimed) people roaming the streets doesn't make your life worse, it doesn't trick kids into thinking about sex too early any more than a married straight couple bringing a new baby into the world does, and telling kids that it's OK to be gay, and that it's OK to be trans, doesn't lead to more kids "deciding" to be gay or trans it just leads to more people admitting it rather than staying in the closet. Trans kids and gay kids aren't making a decision, any more than you never made a decision to be your birth gender, nor did you make a decision to be gay or not. Trans rights are human rights, and while I'm not trans if I decided tomorrow to get surgery to remove my penis and ask everyone to call me "she/her", how exactly does that affect you or anybody else any more than if I continue to have the gay sex I so often enjoy?

naasking 2y ago

> It's not a great situation, and I don't see many signs that it's improving. I think this is a little too pessimistic on the one hand, and very accurate on the other. On the accurate side: this discipline took one of the most significant hits from the replication crisis, and was one of the most resistant to acknowledging and changing practices. Everyone should keep pushing for open science and preregistered studies to improve quality of the evidence here. On the optimistic side, there is one potentially huge change that's just starting to crest as opinions improve and acceptance spreads: psychedelics. MDMA for PTSD was a huge win and indicates a potentially large untapped realm of possibilities for altering cognition in positive ways. There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades.

0xcde4c3db 2y ago
> There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades. That definitely does happen, but so far it happens glacially, I assume because doing groundbreaking neuropsychiatric research is considerably harder and more expensive work than "evergreening" existing drugs or reading stuff like Meditations and Walden Two [1] while sipping expensive wine and then pulling an allegedly-modern psychosocial theory out of one's nether regions. My current favorite reference point is anti-NMDA-receptor encephalitis, a (class of?) autoimmune condition that was only definitively identified ca. 2007. One must assume that there are centuries of breathless accounts of "demonic possession" or "latent schizophrenia" or people who were "on drugs" (colloquially often referring to effects of heavy doses of ketamine, PCP, and other potent deliriant/dissociative agents, which tend to be NMDA antagonists) that are probably explained by this condition. And who can say what percentage of today's "schizophrenics" have arrived at a similar place along an as-yet-unidentified path? [1] Not to say those works aren't worth reading; they're iconic for legitimate reasons. I'm just saying that context and proportionality matter in ways that are often conveniently ignored.
- naasking 2y ago
  Indeed, we need better tools and models to explain mental phenomena. It's getting better with models like predictive coding, but it's mostly still folk psychology at this point, just splitting progressively finer hairs.

mcmoor 2y ago

> The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are still unreliable and many of the theories still fairly reek of superstition and magical thinking. Ah this is also my stance. There are lots of good will in this subject, but trusting it is like trusting surgeons in 19th century. There may be no other option, but sometimes it's better to leave the bullet in your chest rather than letting it be infected by doctors with dirty hands.

matrix87 2y ago

> Legitimate advances are being made Like what? Realizing that lobotomies aren't a legitimate treatment?

mtlmtlmtlmtl 2y ago
No, like the Bergen 4 day treatment which is continuing to show highly promising results against severe anxiety disorders. The use of psychedelics and ketamine for treatment of ptsd and depression respectively are also very promising. There are advances being made in the treatment of psychotic disorders both on therapy side and on the medication side, with less harmful antipsychotics in development. And the need for chronic antipsychotic treatment(which is quite harmful in many ways) being questioned more and more. You might wanna do some research before implying the field hasn't moved at all in the last 50 years...