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> We have no similar guarantee that the same applies to classifications of behaviors. Not yet, anyway. In the long term, there's hope that neuroscience will un

by lutusp 13y ago

> We have no similar guarantee that the same applies to classifications of behaviors. Not yet, anyway. In the long term, there's hope that neuroscience will uncover root causes in genetics and other objective disciplines, thus moving beyond psychology entirely. This is a future goal, not at all something just around the corner. On the other hand, psychology has been trying to crack this egg since before the Civil War and has gotten nowhere. Notice that, when President Obama launched his new research program, he called it the "brain initiative", not the "mind initiative". This was a not-so-subtle signal that psychology is no longer looked on as the cutting edge of mental research. > That said - and let me qualify this by saying I have many complaints with the DSM (particularly the DSM V) - the fact that the DSM classifications may not be helpful for research purposes does not mean that they are not helpful for clinical treatment. That's true, but clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. This issue is discussed in the NIMH link I provided in my prior post, where the NIMH director provides much detail on the problems caused by addressing only symptoms, not causes. > The DSM provides a convenient library, but the clinician still has to identify which portions are relevant and which are not, and to write the "code" that glues those relevant portions together. But whenever a clinician goes beyond the DSM, s/he enters uncharted territory. This subjective territory led Tom Widiger, who served as head of research for DSM-IV, to say, "There are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don't systematically assess for other disorders. They have a bias in reference to the disorder that they are especially interested in treating and believe that most of their patients have."

dragonwriter 13y ago
> In the long term, there's hope that neuroscience will uncover root causes in genetics and other objective disciplines, thus moving beyond psychology entirely. The idea that understanding the biological/physiological basis of behavior is part of psychology has been part of the field since the 19th century. Establishing those things -- whether under the comparatively new label of neuroscience or any of the older labels under which such exploration have been done (e.g., "psychobiology") -- isn't "moving beyond psychology", its just grounding psychology in the same way that physics grounds chemistry, and establishing that grounding has always been understood to be part of chemistry. > That's true, but clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases.
- lutusp 13y ago
  > The idea that understanding the biological/physiological basis of behavior is part of psychology has been part of the field since the 19th century. Yes, but as an unrealized goal. William James stated that it was an unrealized goal in the late 19th century, and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... >> ... clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. > This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases. Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false. A quote from the above link: "The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. 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." "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment." So tell me -- which word didn't you understand?
  - dragonwriter 13y ago
    > Yes, but as an unrealized goal. Right. So what? You are falsely asserting that this is a separate domain, rather than just an area in which results have been incomplete. This is false -- neuroscience is a new name for something that has always been part of the domain of exploration of psychology, and in which important results have been made -- though not broad and deep enough to be widely useful across the field -- for a long time, even before the name "neuroscience" was applied to them. > and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content The "no scientific content" claim you make is not, in fact, contained anywhere in Director Insel's announcement regarding RDoC that you link. A better description of Insel's position (and the one that is consistent with his later statement on the relation between DSM and RDoC [1]) would be that RDoC was announced because the tools for the investigation of the physical causes of mental illness have progressed to the point where it seems likely that we can productively move toward a better model of diagnosis with a fresh look unconstrained by symptom-based descriptive categories, which have always (as is the case with syndrome-based diagnoses elsewhere in health where causes are not well-established) been recognized as troublesome but have been the best that the science to date has been able to support. > > his is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases. > Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false. You can keep saying that, but its not going to make it true; psychology and psychiatry do address causes, as does, in certain cases, the DSM. For instance, the different neurocognitive disorders identified in the DSM-5 are differentiated by causes. You can pick up a copy and look it up, or you keep repeating the same ignorant statements you make in every discussion which touches on psychology on HN. [1] http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdo...

by lutusp 13y ago

dragonwriter 13y ago

> In the long term, there's hope that neuroscience will uncover root causes in genetics and other objective disciplines, thus moving beyond psychology entirely. The idea that understanding the biological/physiological basis of behavior is part of psychology has been part of the field since the 19th century. Establishing those things -- whether under the comparatively new label of neuroscience or any of the older labels under which such exploration have been done (e.g., "psychobiology") -- isn't "moving beyond psychology", its just grounding psychology in the same way that physics grounds chemistry, and establishing that grounding has always been understood to be part of chemistry. > That's true, but clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases.

lutusp 13y ago
> The idea that understanding the biological/physiological basis of behavior is part of psychology has been part of the field since the 19th century. Yes, but as an unrealized goal. William James stated that it was an unrealized goal in the late 19th century, and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... >> ... clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. > This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases. Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false. A quote from the above link: "The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. 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." "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment." So tell me -- which word didn't you understand?
- dragonwriter 13y ago
  > Yes, but as an unrealized goal. Right. So what? You are falsely asserting that this is a separate domain, rather than just an area in which results have been incomplete. This is false -- neuroscience is a new name for something that has always been part of the domain of exploration of psychology, and in which important results have been made -- though not broad and deep enough to be widely useful across the field -- for a long time, even before the name "neuroscience" was applied to them. > and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content The "no scientific content" claim you make is not, in fact, contained anywhere in Director Insel's announcement regarding RDoC that you link. A better description of Insel's position (and the one that is consistent with his later statement on the relation between DSM and RDoC [1]) would be that RDoC was announced because the tools for the investigation of the physical causes of mental illness have progressed to the point where it seems likely that we can productively move toward a better model of diagnosis with a fresh look unconstrained by symptom-based descriptive categories, which have always (as is the case with syndrome-based diagnoses elsewhere in health where causes are not well-established) been recognized as troublesome but have been the best that the science to date has been able to support. > > his is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases. > Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false. You can keep saying that, but its not going to make it true; psychology and psychiatry do address causes, as does, in certain cases, the DSM. For instance, the different neurocognitive disorders identified in the DSM-5 are differentiated by causes. You can pick up a copy and look it up, or you keep repeating the same ignorant statements you make in every discussion which touches on psychology on HN. [1] http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtml http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdo...