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Clinical psychiatry and psychology are areas of neuroscience these days, so I don't quite understand the "historic meltdown" point, any references on that?

by mapist 13y ago

lutusp 13y ago
> Clinical psychiatry and psychology are areas of neuroscience these days ... Quote false. To a greater degree than in the past, psychiatry and psychology are moving away from science, not toward it. The situation has gotten so extreme and frankly embarrassing for those who want to see more science in mental health, that the director of the NIMH has decided to drop support for the new DSM (DSM-5), arguing that the mentally ill "deserve better": http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... Quote: " While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity." There's more. The editor of the previous DSM, DSM-IV, Allen Frances, watched the process that led to DSM-5 with increasing amazement and dismay. He now strongly recommends that professionals avoid the DSM entirely -- he recommends that people not teach it or use it: http://www.motherjones.com/politics/2013/05/psychiatry-allen-frances-saving-normal-dsm-5-controversy http://www.motherjones.com/politics/2013/05/psychiatry-allen... How important is this? The DSM is to psychiatry and psychology what the Standard Model is to physics -- to a large extent it defines the field and it is the leading reference for theory and practice. And it has gotten so embarrassing that the most influential psychiatrist in the country (the NIMH director) is abandoning it, choosing to move in a more scientific direction. > ... so I don't quite understand the "historic meltdown" point, any references on that? See above. And read what others are saying: http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100... Quote: "[Psychiatrist and writer] Greenberg is repeating a common criticism of contemporary psychiatry, which is that the profession is creating ever more expansive criteria for mental illness that end up labelling as sick people who are just different—a phenomenon that has consequences for the insurance system, the justice system, the administration of social welfare, and the cost of health care." Believe me when I tell you, I could produce scores of similar criticisms from within the field, by people who are mental health professionals but who are incensed by what's happening to the field. I have to say that anyone in the field of mental health who doesn't see fundamental changes coming, hasn't been keeping up with current events.
jacques_chester 13y ago
lutusp has a bit of a bee in his bonnet about psychology and psychiatry. His approximate view is that if a field can't be held to the same evidentiary standards as experimental physics, it's not a science. Because the two fields are imperfect, they are therefore of course completely and entirely wrong. But fear not! fMRI will save us!
- lutusp 13y ago
  > Because the two fields are imperfect, they are therefore of course completely and entirely wrong. Wrong? No, just dangerous to children and some especially foolish adults. http://en.wikipedia.org/wiki/Rebecca_Riley http://en.wikipedia.org/wiki/Rebecca_Riley http://en.wikipedia.org/wiki/Candace_Newmaker http://en.wikipedia.org/wiki/Candace_Newmaker > His approximate view is that if a field can't be held to the same evidentiary standards as experimental physics, it's not a science. That's how any scientist looks at a field that the public trusts to deliver medical care. In fact, because physicists don't have clinics, they are off the hook with respect to this issue, but happen to be far more scientific. http://xkcd.com/435/ http://xkcd.com/435/
  - jacques_chester 13y ago
    I understand that psychology and psychiatry are imperfect, that they have a checkered history, that observability is difficult, that falsification is often unavailable, that the subject of study is itself tremendously capable of introducing confounding factors and so on and so forth. This is all true. Physicists have subject domain advantages that psychologists and psychiatrists do not. Quarks do not self-deceive. Atoms will submit to any torture. Photons behave weirdly, but every photon behaves identically to every other photon. Humans are an altogether trickier subject of study and so the full apparatus of science is not always applicable. What a mature scientist does is say, "OK, let's accept the limits of our field and do the best we can". As better observational tools become available, I expect that psychologists and psychiatrists will change their theories to fit the evidence. They've already been doing that for a long time.
    - 13y ago

Clinical psychiatry and psychology are areas of neuroscience these days, so I don't quite understand the "historic meltdown" point, any references on that?

by mapist 13y ago

Clinical psychiatry and psychology are areas of neuroscience these days, so I don't quite understand the "historic meltdown" point, any references on that?

lutusp 13y ago

> Clinical psychiatry and psychology are areas of neuroscience these days ... Quote false. To a greater degree than in the past, psychiatry and psychology are moving away from science, not toward it. The situation has gotten so extreme and frankly embarrassing for those who want to see more science in mental health, that the director of the NIMH has decided to drop support for the new DSM (DSM-5), arguing that the mentally ill "deserve better": http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... Quote: " While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity." There's more. The editor of the previous DSM, DSM-IV, Allen Frances, watched the process that led to DSM-5 with increasing amazement and dismay. He now strongly recommends that professionals avoid the DSM entirely -- he recommends that people not teach it or use it: http://www.motherjones.com/politics/2013/05/psychiatry-allen-frances-saving-normal-dsm-5-controversy http://www.motherjones.com/politics/2013/05/psychiatry-allen... How important is this? The DSM is to psychiatry and psychology what the Standard Model is to physics -- to a large extent it defines the field and it is the leading reference for theory and practice. And it has gotten so embarrassing that the most influential psychiatrist in the country (the NIMH director) is abandoning it, choosing to move in a more scientific direction. > ... so I don't quite understand the "historic meltdown" point, any references on that? See above. And read what others are saying: http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100... Quote: "[Psychiatrist and writer] Greenberg is repeating a common criticism of contemporary psychiatry, which is that the profession is creating ever more expansive criteria for mental illness that end up labelling as sick people who are just different—a phenomenon that has consequences for the insurance system, the justice system, the administration of social welfare, and the cost of health care." Believe me when I tell you, I could produce scores of similar criticisms from within the field, by people who are mental health professionals but who are incensed by what's happening to the field. I have to say that anyone in the field of mental health who doesn't see fundamental changes coming, hasn't been keeping up with current events.

jacques_chester 13y ago

lutusp has a bit of a bee in his bonnet about psychology and psychiatry. His approximate view is that if a field can't be held to the same evidentiary standards as experimental physics, it's not a science. Because the two fields are imperfect, they are therefore of course completely and entirely wrong. But fear not! fMRI will save us!

lutusp 13y ago
> Because the two fields are imperfect, they are therefore of course completely and entirely wrong. Wrong? No, just dangerous to children and some especially foolish adults. http://en.wikipedia.org/wiki/Rebecca_Riley http://en.wikipedia.org/wiki/Rebecca_Riley http://en.wikipedia.org/wiki/Candace_Newmaker http://en.wikipedia.org/wiki/Candace_Newmaker > His approximate view is that if a field can't be held to the same evidentiary standards as experimental physics, it's not a science. That's how any scientist looks at a field that the public trusts to deliver medical care. In fact, because physicists don't have clinics, they are off the hook with respect to this issue, but happen to be far more scientific. http://xkcd.com/435/ http://xkcd.com/435/
- jacques_chester 13y ago
  I understand that psychology and psychiatry are imperfect, that they have a checkered history, that observability is difficult, that falsification is often unavailable, that the subject of study is itself tremendously capable of introducing confounding factors and so on and so forth. This is all true. Physicists have subject domain advantages that psychologists and psychiatrists do not. Quarks do not self-deceive. Atoms will submit to any torture. Photons behave weirdly, but every photon behaves identically to every other photon. Humans are an altogether trickier subject of study and so the full apparatus of science is not always applicable. What a mature scientist does is say, "OK, let's accept the limits of our field and do the best we can". As better observational tools become available, I expect that psychologists and psychiatrists will change their theories to fit the evidence. They've already been doing that for a long time.
  - 13y ago