7 ms·

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americ

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

birn559 1y ago
My inability of being in nature without a feeling of being tortured comes from my brain not working correctly and it's not "undesired behavior". Luckily, my ADHD meds are able to fix that.
reorder9695 1y ago
How else would you do it? Unlike an e.g. viral infection there is no positive test you can look at. Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. I don't think you can be totally objective about this, and you get into things like if i.e. autism is mild is it a disorder? It's pretty clear to me it should be considered as such after a certain level of severity, but maybe it shouldn't always be if it has minimal impact on the person
- aleph_minus_one 1y ago
  > Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. With the same argument, we could arguue that working and social life are getting in the way how I am, thus working and social life should be considered disorders.
  - hn_throwaway_99 1y ago
    These reductio ad absurdum arguments are wholly unpersuasive. The fact that there are some debatable gray areas in the DSMs seems like poor reasoning to throw the baby out with the bathwater. E.g. things like schizophrenia, OCD, major depressive disorder, etc. are so highly disruptive to the individuals involved that arguing that they shouldn't be disorders (or, contrary, that anything else is a disorder) feels like an unhelpful semantic game.
  - ben_sisko 1y ago
    Sounds like you need to read better books Bromaster General!
    - aleph_minus_one 1y ago
      > Sounds like you need to read better books Bromaster General! I don't get this reference (that is likely rooted in US popular culture).
  - dns_snek 1y ago
    A ridiculous argument. Most often a disorder will impact activities you enjoy just as much as those you don't. Very broadly speaking, if all of your symptoms go away when you get home from work then you don't have a disorder, just a demanding, stressful job. That's certainly true for disorders like ADHD and ASD that are under attack these days.
gruez 1y ago
>What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm What's the alternative then? What would "empirically" determining what a "disorder" is look like? >…by Americans Most of the world outside of the US uses the ICD, not the DSM.
epgui 1y ago
> The DSM in many ways represents the worst of so-called social science. No. You need to read the thing. The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages. People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.
- sundarurfriend 1y ago
  But people do. Psychology courses do, with a similar "tool to help standardize communication" line recited robotically and then practically ignored. Most practicing psychologists do as well, to only a somewhat lesser degree. You cannot have an authoritative textbook proscribing definitions, and then expect people to treat them as just "a self-described ontology" with all the nuances and caveats around that just because it says so somewhere in the introduction. Psychology of all fields should know that.
  - epgui 1y ago
    I’ve had a bunch of neuro/psycho classes and this was always well understood. This stuff is complicated. People are going to get it wrong. That sucks. But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it.
    - aleph_minus_one 1y ago
      > But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it. As long as the boards don't go after the shrinks who "misrepresent" the DSM, I would claim that this misrepresentation is systemic of (and possibly even intended by) the psycho-industrial complex.
      - epgui 1y ago
        Boards are expected to “go after” professionals who do not provide a certain standard of care, but that has very little (if anything) to do with the DSM. I think this comment just reinforces a misunderstanding of what the DSM actually is.
brooke2k 1y ago
A "disorder" is just a collection of symptoms that have been empirically shown to benefit from certain treatments. If someone doesn't think they have those symptoms then they can just not seek a diagnosis or treatment. Nobody is forcing a diagnosis on somebody who doesn't want it.
- s5300 1y ago
  >> Nobody is forcing a diagnosis on somebody who doesn't want it. Ahh, you sweet summer child Tell that to all multiple sclerosis patients that were tortured by psych departments of hospitals before (and after) the MRI machine was created. Tell that to sleep apnea patients (especially the women, especially especially the younger thinner women in whom they say “it cannot happen to”) that are given a psych diagnoses for seeking treatment for symptoms before sleep disordered breathing issues are ever even brought into question. The main problem is that DSM diagnoses are indeed forced on people. Usually highly incorrectly, too.
- bjornsing 1y ago
  If you look into the history of psychiatry I think you’ll find quite a lot of examples when diagnosis and treatment was forced on people who didn’t want it. It’s not hard to find contemporary such examples either.
  - brooke2k 1y ago
    Yes, that did unfortunately happen in the history of psychiatry. I am talking about modern American psychiatric practices (say, the last 10-20 years). If the proposition here is that mental health disorders are fabricated maliciously in order to sell more medication or enforce some sort of social order, then I don't see how the very rare court-ordered enforcement of short-term stays at psychiatric institutions could be the mechanism for that. The vast majority of people in the US who receive psychiatric care do so voluntarily, because they experience real symptoms that really affect their life, for which they need real treatment.
    - creata 1y ago
connicpu 1y ago
But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.
- cyanydeez 1y ago
  unfortunately, what seems to be driving modern disorder diagnosis is what gets issurance to pay. That's why autism is now a spectrum.
  - eddythompson80 1y ago
    It’s the other way around AFAIK. Insurance pays for what’s categorized as a disorder by the DSM. Or did I misunderstand your statement?
  - estimator7292 1y ago
    [flagged]
  - sophacles 1y ago
    And atoms used to be the smallest division of matter. Then we learned about smaller things. Understanding changes as we do more research into a thing.
    - cyanydeez 1y ago
      No. This is lumping, not splitting Im not arguing people diagnosed with autism spectrum disorder shouldnt get benefits. Its that the spectrum isnt as related enough that insividual disorders would make more sense. But that would require getting the health insurance industry to do more adjustments.
- noosphr 1y ago
  Remember that in the US slaves wanting freedom was a mental disorder that made it past peer review: https://en.wikipedia.org/wiki/Drapetomania https://en.wikipedia.org/wiki/Drapetomania
NikolaNovak 1y ago
Agreeing that social science is harder than most, I see these definitions as “circle around a set of presentations / symptoms / behaviours “. As somebody who has several circles around them, it doesn’t bother me overly. Historical enforced procedures / incarcerations did, but I understand value of “common language”. In a wildly different area that may or may not resonate with HN, I find similar value in PMP or ITIL - it’s not the One True Way, it is not necessarily a permanent scientific best approach… but it does give people of today a way to communicate with each other across domains, companies, cultures and experiences .
naveensundar 1y ago
I think this is not a valid criticism. By this criteria, you can then say many other non-psych conditions are not disorders. What classifies as a disorder other than making life worse for someone? There is no universal book given by a holy entity that we can read to classify something as normal or a disorder. Why do we have arbitrary cutoffs for cholesterol, blood sugar, blood pressure, etc?
mcslambley 1y ago
“Empirical evidence” and “what is determined as undesirable, maladaptive, or outside the social norm” are not mutually exclusive.
riazrizvi 1y ago
Without a clear and agreed behavioral model, I don’t see how disorders can be properly defined.
ben_sisko 1y ago
The exercise and food science people are the worst of social science buddy. Or just “social” something, because it’s not science. “Science-based” always makes me laugh. The DSM only matters if somebody is actively seeking treatment for something that they have a problem with in their own situation. So what’s in there is totally irrelevant for the public at large. It’s only if somebody shows up and says there’s something going on that they don’t like. It’s really just billing codes, man. The reality is far different anyway, and it just gets distilled down to these primitive codes.
autoexec 1y ago
> What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. I've seen that used before to dismiss the severity of conditions like autism and especially ADHD. It's often coming from a well-meaning place, and sometimes it's just a comforting story people tell themselves in order to not feel as deficient ("The problem isn't me, it's the system!"). It's also absolutely true that the demands society places on all of us are unnatural and often excessive, but the fact is that even absent all external expectations some people with mental illness will be unable to accomplish what they themselves want and should be able to accomplish. Even the most utopian, accepting, accommodating society it wouldn't be enough to make up for some people's inability to function. I feel the same about a lot of the "super power" talk when it comes to mental illness. There are advantages and disadvantages to just about anything, but on the whole conditions like ADHD or autism tend to do way more harm than good.

birn559 1y ago

My inability of being in nature without a feeling of being tortured comes from my brain not working correctly and it's not "undesired behavior". Luckily, my ADHD meds are able to fix that.

reorder9695 1y ago

How else would you do it? Unlike an e.g. viral infection there is no positive test you can look at. Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. I don't think you can be totally objective about this, and you get into things like if i.e. autism is mild is it a disorder? It's pretty clear to me it should be considered as such after a certain level of severity, but maybe it shouldn't always be if it has minimal impact on the person

aleph_minus_one 1y ago
> Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. With the same argument, we could arguue that working and social life are getting in the way how I am, thus working and social life should be considered disorders.
- hn_throwaway_99 1y ago
  These reductio ad absurdum arguments are wholly unpersuasive. The fact that there are some debatable gray areas in the DSMs seems like poor reasoning to throw the baby out with the bathwater. E.g. things like schizophrenia, OCD, major depressive disorder, etc. are so highly disruptive to the individuals involved that arguing that they shouldn't be disorders (or, contrary, that anything else is a disorder) feels like an unhelpful semantic game.
- ben_sisko 1y ago
  Sounds like you need to read better books Bromaster General!
  - aleph_minus_one 1y ago
    > Sounds like you need to read better books Bromaster General! I don't get this reference (that is likely rooted in US popular culture).
- dns_snek 1y ago
  A ridiculous argument. Most often a disorder will impact activities you enjoy just as much as those you don't. Very broadly speaking, if all of your symptoms go away when you get home from work then you don't have a disorder, just a demanding, stressful job. That's certainly true for disorders like ADHD and ASD that are under attack these days.

gruez 1y ago

>What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm What's the alternative then? What would "empirically" determining what a "disorder" is look like? >…by Americans Most of the world outside of the US uses the ICD, not the DSM.

epgui 1y ago

> The DSM in many ways represents the worst of so-called social science. No. You need to read the thing. The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages. People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.

sundarurfriend 1y ago
But people do. Psychology courses do, with a similar "tool to help standardize communication" line recited robotically and then practically ignored. Most practicing psychologists do as well, to only a somewhat lesser degree. You cannot have an authoritative textbook proscribing definitions, and then expect people to treat them as just "a self-described ontology" with all the nuances and caveats around that just because it says so somewhere in the introduction. Psychology of all fields should know that.
- epgui 1y ago
  I’ve had a bunch of neuro/psycho classes and this was always well understood. This stuff is complicated. People are going to get it wrong. That sucks. But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it.
  - aleph_minus_one 1y ago
    > But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it. As long as the boards don't go after the shrinks who "misrepresent" the DSM, I would claim that this misrepresentation is systemic of (and possibly even intended by) the psycho-industrial complex.
    - epgui 1y ago
      Boards are expected to “go after” professionals who do not provide a certain standard of care, but that has very little (if anything) to do with the DSM. I think this comment just reinforces a misunderstanding of what the DSM actually is.

brooke2k 1y ago

A "disorder" is just a collection of symptoms that have been empirically shown to benefit from certain treatments. If someone doesn't think they have those symptoms then they can just not seek a diagnosis or treatment. Nobody is forcing a diagnosis on somebody who doesn't want it.

s5300 1y ago
>> Nobody is forcing a diagnosis on somebody who doesn't want it. Ahh, you sweet summer child Tell that to all multiple sclerosis patients that were tortured by psych departments of hospitals before (and after) the MRI machine was created. Tell that to sleep apnea patients (especially the women, especially especially the younger thinner women in whom they say “it cannot happen to”) that are given a psych diagnoses for seeking treatment for symptoms before sleep disordered breathing issues are ever even brought into question. The main problem is that DSM diagnoses are indeed forced on people. Usually highly incorrectly, too.
bjornsing 1y ago
If you look into the history of psychiatry I think you’ll find quite a lot of examples when diagnosis and treatment was forced on people who didn’t want it. It’s not hard to find contemporary such examples either.
- brooke2k 1y ago
  Yes, that did unfortunately happen in the history of psychiatry. I am talking about modern American psychiatric practices (say, the last 10-20 years). If the proposition here is that mental health disorders are fabricated maliciously in order to sell more medication or enforce some sort of social order, then I don't see how the very rare court-ordered enforcement of short-term stays at psychiatric institutions could be the mechanism for that. The vast majority of people in the US who receive psychiatric care do so voluntarily, because they experience real symptoms that really affect their life, for which they need real treatment.
  - creata 1y ago

connicpu 1y ago

But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.

cyanydeez 1y ago
unfortunately, what seems to be driving modern disorder diagnosis is what gets issurance to pay. That's why autism is now a spectrum.
- eddythompson80 1y ago
  It’s the other way around AFAIK. Insurance pays for what’s categorized as a disorder by the DSM. Or did I misunderstand your statement?
- estimator7292 1y ago
  [flagged]
- sophacles 1y ago
  And atoms used to be the smallest division of matter. Then we learned about smaller things. Understanding changes as we do more research into a thing.
  - cyanydeez 1y ago
    No. This is lumping, not splitting Im not arguing people diagnosed with autism spectrum disorder shouldnt get benefits. Its that the spectrum isnt as related enough that insividual disorders would make more sense. But that would require getting the health insurance industry to do more adjustments.
noosphr 1y ago
Remember that in the US slaves wanting freedom was a mental disorder that made it past peer review: https://en.wikipedia.org/wiki/Drapetomania https://en.wikipedia.org/wiki/Drapetomania

NikolaNovak 1y ago

Agreeing that social science is harder than most, I see these definitions as “circle around a set of presentations / symptoms / behaviours “. As somebody who has several circles around them, it doesn’t bother me overly. Historical enforced procedures / incarcerations did, but I understand value of “common language”. In a wildly different area that may or may not resonate with HN, I find similar value in PMP or ITIL - it’s not the One True Way, it is not necessarily a permanent scientific best approach… but it does give people of today a way to communicate with each other across domains, companies, cultures and experiences .

naveensundar 1y ago

I think this is not a valid criticism. By this criteria, you can then say many other non-psych conditions are not disorders. What classifies as a disorder other than making life worse for someone? There is no universal book given by a holy entity that we can read to classify something as normal or a disorder. Why do we have arbitrary cutoffs for cholesterol, blood sugar, blood pressure, etc?

mcslambley 1y ago

“Empirical evidence” and “what is determined as undesirable, maladaptive, or outside the social norm” are not mutually exclusive.

riazrizvi 1y ago

Without a clear and agreed behavioral model, I don’t see how disorders can be properly defined.

ben_sisko 1y ago

The exercise and food science people are the worst of social science buddy. Or just “social” something, because it’s not science. “Science-based” always makes me laugh. The DSM only matters if somebody is actively seeking treatment for something that they have a problem with in their own situation. So what’s in there is totally irrelevant for the public at large. It’s only if somebody shows up and says there’s something going on that they don’t like. It’s really just billing codes, man. The reality is far different anyway, and it just gets distilled down to these primitive codes.

autoexec 1y ago

> What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. I've seen that used before to dismiss the severity of conditions like autism and especially ADHD. It's often coming from a well-meaning place, and sometimes it's just a comforting story people tell themselves in order to not feel as deficient ("The problem isn't me, it's the system!"). It's also absolutely true that the demands society places on all of us are unnatural and often excessive, but the fact is that even absent all external expectations some people with mental illness will be unable to accomplish what they themselves want and should be able to accomplish. Even the most utopian, accepting, accommodating society it wouldn't be enough to make up for some people's inability to function. I feel the same about a lot of the "super power" talk when it comes to mental illness. There are advantages and disadvantages to just about anything, but on the whole conditions like ADHD or autism tend to do way more harm than good.