4 ms·

Science is certainly more difficult to apply to psychiatry than other branches of medicine - due to the relatively subjective endpoints, lack of useful animal m

Science is certainly more difficult to apply to psychiatry than other branches of medicine - due to the relatively subjective endpoints, lack of useful animal models, and conflict with profit-based motives within the pharmaceutical industry - but your assertion that there is no scientific component to it at all really is quite the overexaggeration.

DanBC 12y ago
lutusp is a troll on the subject of psychiatry. Discussions with lutusp about psychiatry are unlikely to be useful.
- geographomics 12y ago
  Are you sure he's deliberately trolling, perhaps he genuinely believes this? Distrust of psychiatry is not uncommon, and there certainly are some really awful facets of psychiatry to selectively draw an extremist position on, especially if one looks into its abuses in recent history.
  - pessimizer 12y ago
    Distrust of SSRIs is also mainstream science, although it's still mainstream practice. The meta-analysis that showed that studies don't show a significant affect on depression from SSRIs was not published in a crank journal, and has very few serious disputes or alternative ways to view the numbers. People who cite that paper and others (and this one in the future) get treated like cranks still, though. There are a lot of people that feel like they owe their lives to SSRIs, and that they will die if they stop taking them, sent back to the same mental state as they were in during a period that they will all identify as the worst in their lives. There are also a lot of people who make an enormous amount of money in encouraging that belief. I'm not against the treatment of depression, and even possible chemical treatments of depression. I just would prefer them to work better than placebo.
    - glenra 12y ago
      > The meta-analysis that showed that studies don't show a significant affect on depression from SSRIs ... has very few serious disputes or alternative ways to view the numbers. Here's one: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... A couple relevant bits include: "Effect size is a hard statistic to work with (albeit extremely fun). The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision. Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”." ...and... "They also note that Kirsch’s study lumps all antidepressants together. This isn’t necessarily wrong. But it isn’t necessarily right, either. For example, his study used both Serzone (believed to be a weak antidepressant, rarely used) and Paxil (believed to be a stronger antidepressant, commonly used). And in fact, by his study, Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. But since the difference was not statistically significant, he averaged them together and said that “antidepressants are ineffective”. In fact, his study showed that Paxil was effective, but when you average it together with a very ineffective drug, the effect disappears. He can get away with this because of the arcana of statistical significance, but by the same arcana I can get away with not doing that. So right now we have three different effect sizes. 1.2 for placebo + drug, 0.5 for drug alone if we’re being statistically merciful, 0.3 for drug alone if we’re being harsh and letting the harshest critic of antidepressants pull out all his statistical tricks."
  - DanBC 12y ago
    Trolling does not have to be deliberate to be effective. Lutusp makes very good points about the awful state of science reporting; about the very poor quality of a lot of research; about the lack of scientific rigour in some areas. But the rest of it is kook-like noise that refuses to address the actual thing being discussed.
    - lutusp 12y ago
      If psychologists read your contentless posts, and aware of how you make psychology look, they would beg you not to be on their side.
  - DanBC 12y ago
    https://news.ycombinator.com/item?id=8261002 https://news.ycombinator.com/item?id=8261002 Here's a thread about cosmology where he drops in his cut'n'pasted screed about psychiatry. Derailing a thread to rant about some unrelated topic is trolling or kook-like. Frustratingly he has useful stuff to say about other things.
lutusp 12y ago
> but your assertion that there is no scientific component to it at all really is quite the overexaggeration. Guess what? The NIMH has recently taken my position for the same reason: http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h You need to understand that psychiatry was never a science and is not one now. Don't take my word for it -- ask a psychiatrist. Ask Thomas Insel, psychiatrist, director of the NIMH, and the person behind the recent ruling described above. Or ask Freud, who eventually acknowledged that psychiatry cannot be a science.
- xorblurb 12y ago
  You cannot reduce psychiatry to Freud.
  - lutusp 12y ago
    True, one cannot. It's much easier to reduce it to pseudoscience on dozens of lines of evidence, including Freud.
- geographomics 12y ago
  The article you linked, and Insel's related pronouncements (as detailed in his NIMH blog) do not support your position. His quite reasonable criticisms of the DSM as a framework for categorising and funding mental health research (and suggestion of what may be a more suitable replacement) does not imply that the entire field of psychiatry is unscientific.
  - lutusp 12y ago
    > The article you linked, and Insel's related pronouncements (as detailed in his NIMH blog) do not support your position. Here's my position: "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. Patients with mental disorders deserve better." Source: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... > ... does not imply that the entire field of psychiatry is unscientific. But I never made that claim anywhere, and certainly not with respect to Insel's views -- I don't need to. It's sufficient to note that there's no science in psychiatry. It's sufficient to say that the DSM, the sum of psychiatric knowledge, is being discarded by the NIMH for the reason that is has no scientific content. It's sufficient to ask for the identity and location of the unifying corpus of theory in psychiatry, a theory that forges a consensus between psychiatrists, that demonstrates its scientific standing, a theory such as exists in every legitimate science without exception. If you will name a science, I will tell you the theory that defines it and legitimizes it as a science. Even though all scientific theories are subject to falsification and many are in fact falsified, at any given time a central corpus of theory guides research and practice in each and every scientific field. But for the sake of argument, let's say the above isn't a requirement for science, see where this takes us. Let's say that we don't need a falsifiable explanation for what we're studying, that descriptions -- the descriptions that Insel complains about with respect to the DSM above -- are all we have. Is it still science? This example may help you over this intellectual hurdle. An imaginary Doctor Dubious invents a new treatment for the common cold. His treatment is to shake a dried gourd over the cold sufferer until the patient gets better. Sometimes the treatment takes a week, but it always works — the cold sufferer always recovers. So, why doesn't Doctor Dubious get a Nobel Prize for his breakthrough? The answer is that the procedure is only a description — shake the gourd, patient recovers — without an explanation, without a basis for actually learning anything or being truthful about the connection between cause and effect. It's the same with psychiatry.

DanBC 12y ago

lutusp is a troll on the subject of psychiatry. Discussions with lutusp about psychiatry are unlikely to be useful.

geographomics 12y ago
Are you sure he's deliberately trolling, perhaps he genuinely believes this? Distrust of psychiatry is not uncommon, and there certainly are some really awful facets of psychiatry to selectively draw an extremist position on, especially if one looks into its abuses in recent history.
- pessimizer 12y ago
  Distrust of SSRIs is also mainstream science, although it's still mainstream practice. The meta-analysis that showed that studies don't show a significant affect on depression from SSRIs was not published in a crank journal, and has very few serious disputes or alternative ways to view the numbers. People who cite that paper and others (and this one in the future) get treated like cranks still, though. There are a lot of people that feel like they owe their lives to SSRIs, and that they will die if they stop taking them, sent back to the same mental state as they were in during a period that they will all identify as the worst in their lives. There are also a lot of people who make an enormous amount of money in encouraging that belief. I'm not against the treatment of depression, and even possible chemical treatments of depression. I just would prefer them to work better than placebo.
  - glenra 12y ago
    > The meta-analysis that showed that studies don't show a significant affect on depression from SSRIs ... has very few serious disputes or alternative ways to view the numbers. Here's one: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... A couple relevant bits include: "Effect size is a hard statistic to work with (albeit extremely fun). The guy who invented effect size suggested that 0.2 be called “small”, 0.5 be called “medium”, and 0.8 be called “large”. NICE, a UK health research group, somewhat randomly declared that effect sizes greater than 0.5 be called “clinically significant” and effect sizes less than 0.5 be called “not clinically significant”, but their reasoning was basically that 0.5 was a nice round number, and a few years later they changed their mind and admitted they had no reason behind their decision. Despite these somewhat haphazard standards, some people have decided that antidepressants’ effect size of 0.3 means they are “clinically insignificant”." ...and... "They also note that Kirsch’s study lumps all antidepressants together. This isn’t necessarily wrong. But it isn’t necessarily right, either. For example, his study used both Serzone (believed to be a weak antidepressant, rarely used) and Paxil (believed to be a stronger antidepressant, commonly used). And in fact, by his study, Paxil showed an effect size of 0.47, compared to Serzone’s 0.21. But since the difference was not statistically significant, he averaged them together and said that “antidepressants are ineffective”. In fact, his study showed that Paxil was effective, but when you average it together with a very ineffective drug, the effect disappears. He can get away with this because of the arcana of statistical significance, but by the same arcana I can get away with not doing that. So right now we have three different effect sizes. 1.2 for placebo + drug, 0.5 for drug alone if we’re being statistically merciful, 0.3 for drug alone if we’re being harsh and letting the harshest critic of antidepressants pull out all his statistical tricks."
- DanBC 12y ago
  Trolling does not have to be deliberate to be effective. Lutusp makes very good points about the awful state of science reporting; about the very poor quality of a lot of research; about the lack of scientific rigour in some areas. But the rest of it is kook-like noise that refuses to address the actual thing being discussed.
  - lutusp 12y ago
    If psychologists read your contentless posts, and aware of how you make psychology look, they would beg you not to be on their side.
- DanBC 12y ago
  https://news.ycombinator.com/item?id=8261002 https://news.ycombinator.com/item?id=8261002 Here's a thread about cosmology where he drops in his cut'n'pasted screed about psychiatry. Derailing a thread to rant about some unrelated topic is trolling or kook-like. Frustratingly he has useful stuff to say about other things.

lutusp 12y ago

> but your assertion that there is no scientific component to it at all really is quite the overexaggeration. Guess what? The NIMH has recently taken my position for the same reason: http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h You need to understand that psychiatry was never a science and is not one now. Don't take my word for it -- ask a psychiatrist. Ask Thomas Insel, psychiatrist, director of the NIMH, and the person behind the recent ruling described above. Or ask Freud, who eventually acknowledged that psychiatry cannot be a science.

xorblurb 12y ago
You cannot reduce psychiatry to Freud.
- lutusp 12y ago
  True, one cannot. It's much easier to reduce it to pseudoscience on dozens of lines of evidence, including Freud.
geographomics 12y ago
The article you linked, and Insel's related pronouncements (as detailed in his NIMH blog) do not support your position. His quite reasonable criticisms of the DSM as a framework for categorising and funding mental health research (and suggestion of what may be a more suitable replacement) does not imply that the entire field of psychiatry is unscientific.
- lutusp 12y ago
  > The article you linked, and Insel's related pronouncements (as detailed in his NIMH blog) do not support your position. Here's my position: "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. Patients with mental disorders deserve better." Source: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml http://www.nimh.nih.gov/about/director/2013/transforming-dia... > ... does not imply that the entire field of psychiatry is unscientific. But I never made that claim anywhere, and certainly not with respect to Insel's views -- I don't need to. It's sufficient to note that there's no science in psychiatry. It's sufficient to say that the DSM, the sum of psychiatric knowledge, is being discarded by the NIMH for the reason that is has no scientific content. It's sufficient to ask for the identity and location of the unifying corpus of theory in psychiatry, a theory that forges a consensus between psychiatrists, that demonstrates its scientific standing, a theory such as exists in every legitimate science without exception. If you will name a science, I will tell you the theory that defines it and legitimizes it as a science. Even though all scientific theories are subject to falsification and many are in fact falsified, at any given time a central corpus of theory guides research and practice in each and every scientific field. But for the sake of argument, let's say the above isn't a requirement for science, see where this takes us. Let's say that we don't need a falsifiable explanation for what we're studying, that descriptions -- the descriptions that Insel complains about with respect to the DSM above -- are all we have. Is it still science? This example may help you over this intellectual hurdle. An imaginary Doctor Dubious invents a new treatment for the common cold. His treatment is to shake a dried gourd over the cold sufferer until the patient gets better. Sometimes the treatment takes a week, but it always works — the cold sufferer always recovers. So, why doesn't Doctor Dubious get a Nobel Prize for his breakthrough? The answer is that the procedure is only a description — shake the gourd, patient recovers — without an explanation, without a basis for actually learning anything or being truthful about the connection between cause and effect. It's the same with psychiatry.