

Psychiatry’s Guide Is Out of Touch With Science, Experts Say - stfu
http://www.nytimes.com/2013/05/07/health/psychiatrys-new-guide-falls-short-experts-say.html?src=me&ref=general

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tokenadult
The New York Times article submitted here is a very good overview of the key
issues, well reported with historical and policy context. As I've commented in
other submissions on this issue, it's helpful to read the article hand in hand
with the National Institute of Mental Health director's blog post
"Transforming Diagnosis"

[http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

for the research background on why the DSM is an unsatisfactory framework for
advancing psychiatric research. I am part of a local "journal club" of
psychology researchers and graduate students in psychology at my alma mater
university, and what several of those researchers are seeking are more
reliable diagnostic criteria based on more scientifically replicable criteria
than merely the gut reactions of a therapist.

By the way, the several previous Hacker News discussions of this issue over
the last week have focused mostly on the issue of medical treatment of
psychiatric disorders, with much decrying of "big pharma," but an even worse
problem in diagnosis of psychiatric disorders is carry-over of prescientific
ideas about human thought and emotion from, for example, Freudian or Jungian
psychology. There are whole brands of talk therapy that are demonstrably
ineffective, but still sought by some patients, and still paid for by some
chump insurance companies. Medical treatment is far from perfect, and
diagnosis is far from perfect whether preceding medical therapy or talk
therapy, but the problem of needing to seek better, science-based standards of
diagnosis and treatment is not confined to medical approaches to treatment.

~~~
brudgers
My beloved is a clinical social worker of two decades experience in hospice,
oncology, Alzheimer's and geriatrics. There are effective talking therapies,
but they are not of the ten-years of Freudian analysis once a week variety -
taking payment to listen to a wealthy person complain is a business.

By its nature therapy is about meeting an individual's individual needs. What
is appropriate for one boy's fidgeting is not appropriate for another's. Or in
programming terms, there needs to be a closure over each person's
circumstances and behavior. Mental health standardization is how we wound up
with asylums and witch trials.

------
brudgers
The DSM takes a pragmatic approach to mental disorders - pragmatic in the
sense of the pragmatic maxim:

 _Consider what effects, that might conceivably have practical bearings, we
conceive the object of our conception to have. Then, our conception of these
effects is the whole of our conception of the object. -- C.S. Pierce_

This should not be surprising. William James, who wrote the book on
psychology, was a pragmatist.

The emphasis on chemical and genetic causes will have as its consequence
increased use of profitable pharmaceutical drugs and gene therapies and a
deprecation of counciling and cognitive therapies. There is a role for drugs,
but it is not a one size fits all solution.

Just because we no longer believe schizophrenic behavior is caused by demonic
possession, it does not mean that we are currently assigning causality
correctly.

