
Psychiatric Diagnosis Found to Be “Scientifically Meaningless” - ada1981
https://www.technologynetworks.com/neuroscience/news/psychiatric-diagnoses-found-to-be-scientifically-meaningless-321555
======
hn_throwaway_99
While I think I am biased to agree with the results of this "study", I have a
big problem with using the language of scientific research to describe what
this is about:

> The study, led by researchers from the University of Liverpool, involved a
> detailed analysis of five key chapters of the latest edition of the widely
> used Diagnostic and Statistical Manual (DSM), on ‘schizophrenia’, ‘bipolar
> disorder’, ‘depressive disorders’, ‘anxiety disorders’ and ‘trauma-related
> disorders’.

So, basically, they read the DSM and gave their opinion of it. Which is fine,
but calling this some type of "study" is ludicrous. It's a bit rich to use
statements like "the main findings of this research are" when the "research"
just literally was Reading The F*ing Manual.

~~~
shkkmo
Um... what definition of study leads you to think that this does not fit? It
seems to fall quite cleanly inside the one that seems relevant:

"A detailed examination, analysis, or experiment investigating a subject or
phenomenon"

Similarly, "research" is a very broad term and quite clearly can involve just
reading without performing any experiments.

I would (less semantically) argue (and the editors of "Psychiatry Research"
would seem to agree) that pointing out inconsistent classification criteria is
important to understanding the reliability of experiments based on those
criteria.

~~~
ramblerman
I think empirical is what he expected, as did I frankly.

~~~
shkkmo
> I think empirical is what he expected, as did I frankly.

I am pretty clear about what he expected. The question is: on what basis was
this expected and is it reasonable to start a semantic debate about it on that
basis? What is the "big problem" here?

~~~
jaredklewis
Let’s say I think about it for a while and decide that C++ is more prone to
bugs than other languages.

If I present that opinion as, “Study finds C++ more prone to bugs than other
languages,” you don’t find it misleading?

I think most people assume the word “study” indicates something is backed by a
rigorous method of research, like the scientific method. You can’t just make
an opinion and then claim it’s a study.

~~~
candiodari
This is not the same, nor does anyone claim it's the same. People just see
"science" and think physics, which is only one standard of science. However
physics (70%-80% of it at least, big exceptions are theoretical physics and
philosophy of physics) is an empirical science, psychology and psychiatry is
_not_. Or to put it in more clear terms, if proof is how you think of science,
then none of the sciences other than physics, chemistry and math are science
at all.

[https://en.wikipedia.org/wiki/Outline_of_academic_discipline...](https://en.wikipedia.org/wiki/Outline_of_academic_disciplines)

Psychology (and psychiatry) fall under the social sciences. These do not claim
to be value-free. In other words, they draw conclusions because people feel
those conclusions to be "needed", or socially relevant. Not even valid, in
terms of truth versus fiction.

The problem is that with psychiatry you have quite a few studies that point
out it's not empirically valid _at all_ :

1) diagnoses of mental illness are made on factors _other than_ the patient or
the symptoms:

(for example they are made on available space, how "necessary" bed & meals are
for the patient, whether the referring person needs them to be admitted, ...)

[https://en.wikipedia.org/wiki/Rosenhan_experiment](https://en.wikipedia.org/wiki/Rosenhan_experiment)

Worse, the same goes for involuntary mental treatment and even youth care. All
of those interventions, including everything from limiting study choice to
locking a kid up for 2 decades, are based on whether a social worker considers
such a thing socially needed. These determinations are made not on the child
or person, but on the perceived need from the people asking for such a
"diagnosis" and intervention. And that's the _normal_ practice, not cases of
abuse (which happen regularly, because of course admitting a patient pays, as
well as the need for validation these people have)

So, for instance, and as shown in the experiment, psychiatrists will lock up,
place in isolation, medicate and use violence against patients to get them to
admit/confess to a diagnosis by an earlier mental health professional. This is
the normal practice, and not exceptional.

2) mental health treatment does not actually make patients better, or at
least, despite 2 centuries of searching, there is no empirical or statistical
evidence beyond "professionals say it works".

Or, more dramatically:

[https://www.buzzfeednews.com/article/esmewwang/psychiatric-h...](https://www.buzzfeednews.com/article/esmewwang/psychiatric-
hospital-inpatient-collected-schizophrenias)

2b) furthermore effectiveness studies keep, again and again, pointing out that
only factors that have nothing to do with mental health theories and nothing
to do with mental health treatment matter for the number of afflicted.

Chiefly it is pointed out that mental health clinics tend to get filled. So
the number of afflicted is determined by supply of care rather than by patient
demand.

Second studies keep pointing out that the relationship with carers matters for
outcomes, and that specifically treatment, medicine, duration, ... doesn't
matter at all.

Third studies keep pointing out that "care" is used as a coercive social
control tool

Fourth when it comes to severity of problems the economic situation matters a
lot more than anything the professionals do or know.

3) there are _many_ abuses of the system by mental health professionals, and
these have persisted over centuries

"historical" (which should not be taken as "past" in most cases)

[https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-
House](https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-House)

[https://en.wikipedia.org/wiki/Aktion_T4](https://en.wikipedia.org/wiki/Aktion_T4)

[https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...](https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union)

[https://www.scmp.com/news/world/europe/article/3016435/angel...](https://www.scmp.com/news/world/europe/article/3016435/angels-
and-demons-police-italy-arrest-18-accused-brainwashing)

[https://www.bbc.com/news/health-48367071](https://www.bbc.com/news/health-48367071)

[https://www.bbc.co.uk/news/resources/idt-
sh/norways_hidden_s...](https://www.bbc.co.uk/news/resources/idt-
sh/norways_hidden_scandal) (pedofile using state power to kidnap children and
place them ... with himself)

[https://www.commissiegeweldjeugdzorg.nl/onderzoek/english/](https://www.commissiegeweldjeugdzorg.nl/onderzoek/english/)

[https://en.wikipedia.org/wiki/Rotherham_child_sexual_exploit...](https://en.wikipedia.org/wiki/Rotherham_child_sexual_exploitation_scandal)

[https://www.bbc.com/news/world-
europe-49320260](https://www.bbc.com/news/world-europe-49320260)

[https://www.washingtonpost.com/nation/2019/06/05/an-
anguishe...](https://www.washingtonpost.com/nation/2019/06/05/an-anguished-
dutch-teenager-who-was-raped-child-is-euthanized-her-request/)

...

4) truth be told there are many abuses of the system by "patients".

Just visit a mental health facility or psychiatrist and ask about the homeless
that want to be taken "into care". I guarantee details will be forthcoming.

~~~
wahern
> 2) mental health treatment does not actually make patients better, or at
> least, despite 2 centuries of searching, there is no empirical or
> statistical evidence beyond "professionals say it works".

Here's a randomized control trial that says otherwise:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312318/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312318/)

According to you it would be mere coincidence that lithium appears to work so
well to treat the misdiagnosis of bipolar disorder.

~~~
candiodari
Like any other sedative, lithium, yes, prevents mood swings and "makes you
happy". I've personally verified Belgian beer does the same last friday ...

Is this a joke ? Of course that's what it does.

Does it help against the actual problem ? No.

------
Rotten194
Every good mental health professional I've had has understood this. Effective
treatment treats the individual, not the diagnosis -- the diagnosis is only to
get authotizarion from insurance and government agencies to get the necessary
resources. My insurance paid $1500 for psychological testing that "confirmed"
my severe ADHD -- which was completely obvious to my psychiatrist, she just
wasn't allowed to diagnosis it -- just so I could get authotizarion to try
stimulants... and find they didn't work for me at all.

Psychiatric diagnosis is at the level of pre-scientific symptom-based
diagnosis, for the most part. Imagine if you went to the doctor for a cough
and, without any tests, they prescribed a month long course of antibiotics
with no idea how effective they would be. A friend of mine was prescribed
powerful antipsychotics to "fix" a problem that was actually being caused by
another psychiatric medication they had been prescribed earlier to fix
something else. Their mental health kept getting worse and worse, and what
finally helped was starting a DBT (dialectic behavior therapy) program, and
now they're in the process of getting off all those meds that turned out to be
more harmful than helpful.

We need to stop pretending that a point-scored questionnaire is a scientific
way to distinguish a diagnosis, or that we understand the chemistry of the
brain well enough that medication can be the first line of defense.

~~~
shadowoflight
Stop me if this is too personal a question, but: As a fellow adult AD(H)D
sufferer who is currently undiagnosed, how did you go about finding a
diagnostic center that accepted your insurance? I've been trying to find one,
but the list provider by my insurance provider (United HealthCare) is less
hopelessly inaccurate, and every online psychiatrist/psychologist directory
I've found does not have up-to-date insurance information.

~~~
letsmakeanewone
I'm a mid-30s engineer in a tech hub and am ~45 days into my Adderall
prescription.

I decided to seek treatment for ADHD because my inability to focus was having
a negative impact on my career and, indirectly, my well being. For context,
I've lost more than one job where I've done good work on the interesting
parts, but failed to carry my weight on the boring parts to the point where I
simply wore out my welcome. I'm trying to start a family and I felt I was
beginning to tread a familiar path with my otherwise very understanding and
welcoming new boss.

This probably varies per provider, per locale, etc, but for me the process
was:

\- Used my insurers website to look up psychiatrists in my area. Had issues
with less than great data here also and long appointment waiting times for
some, just kept calling around

\- called and scheduled an appointment

\- told the psychiatrist that I believed I had ADHD

\- went through a verbal assessment with the psychiatrist

\- got blood work and an EKG done

\- had my psychiatrist look over these results

\- picked up prescription for first 30 days

\- come back in for assessments at 3 weeks, 7 weeks, 11 weeks. Can get
prescriptions over the phone afterwards

For me it has been life changing. There's a stigma within my family about
mental health so for a long time I've suspected I had this problem but just
tried to discipline myself and stick to a system instead of asking for help.
AIUI I use a relatively small amount (10mg in the morning, then either 5mg or
10mg in the afternoon). The biggest differences for me have been a) I start
the work that sounds boring in a timely manner instead of putting it off to
the last minute, b) when I dig into these boring items, I find that the stuff
I considered boring before actually can be interesting too sometimes - and at
the very least solving them correctly gives me a little rush of dopamine, and
c) I make fewer mistakes on the boring stuff because I'm not rushing through
it under self-induced time pressure just trying to accept the first "looks
right" explanation.

~~~
yowlingcat
"I've lost more than one job where I've done good work on the interesting
parts, but failed to carry my weight on the boring parts to the point where I
simply wore out my welcome. "

I experienced this quite a bit earlier on in my career (and still do, to a
certain degree), but I eventually arrived at the realization that this had a
lot more to do with anxiety for me than with ADHD. For me, the "boring stuff"
was either

1) all the little details and maintenance work that needs to be done to bring
a project from complete implementation to complete deployment and rollout and

2) things that someone else could probably do better than me, or that I could
ask for help with.

With respect to 1), I began to realized after working through multiple
projects that the thing wasn't really done until it had been used in the wild
for a while and I had gone through enough iteration cycles of gradual
refinement to know it was in a stable state -- that let me launch things a lot
more comfortably and be "okay" with the knowledge that it would never really
be done, just good enough, and that I could always come back later and improve
it more if needed.

With the latter, I used to be a lot worse at asking for help. I found it
embarrassing and seemingly a tacit admission of my incompetence. I've also
gotten better at that by understanding that productivity gets done through
teams, and the more that I ask for help, the more the team is growing and that
I'm increasing my own mental context on all the things I otherwise wouldn't
know. Asking questions wasn't a sign of my incompetence; it was a sign of my
curiosity, and a desire to keep improving.

I'm not sure if any of those strike a chord, but if so, these could be things
to think through. As an aside, I found that when I worked in unhealthy work
environments, these things came up a lot more because I reported to and worked
with folks in a low trust environment. This meant that they'd simplify things
to saying that I've done "good work on the interesting parts, but failed to
carry my weight on the boring parts" when in all actuality, it was painful to
do the parts I didn't do -- not just for me, but for everyone. I was just the
squeaky wheel.

I can't fully tell, but from the way you talk about it, it's possible this is
the case with your work environments. It's miraculous how much less prevalent
these kinds of issues are in a supportive environment where you're working
with not just competent but caring and kind team members and leaders.

~~~
letsmakeanewone
This sounds similar but not quite the same. Specifically:

> I experienced this quite a bit earlier on in my career (and still do, to a
> certain degree), but I eventually arrived at the realization that this had a
> lot more to do with anxiety for me than with ADHD.

I was pretty anxious about work, the quality of work I was doing, etc. As I've
been improving at execution of the boring parts, this anxiety has evaporated
for me. My psychiatrist touched on this briefly - it can be tricky diagnosing
people who have characteristics of ADHD and anxiety, because ADHD medication
can exacerbate anxiety. You have to try to understand if anxiety is the root
of the problem (your anxiety is preventing you from being effective day to
day, which sounds like might have been your case) or ancillary (being
ineffective day to day is a problem for you, which is also causing you
anxiety).

> With the latter, I used to be a lot worse at asking for help. I found it
> embarrassing and seemingly a tacit admission of my incompetence. I've also
> gotten better at that by understanding that productivity gets done through
> teams, and the more that I ask for help, the more the team is growing and
> that I'm increasing my own context on all the things I otherwise wouldn't
> know.

This is a good lesson to learn. I tend too much toward trying to understand
everything in a system and preferring to understand it from first principles
rather than blackboxing it and being satisfied with a high level explanation
from someone else. What you say about low trust environments also resonates
for some roles I've had in the past, but isn't core to my case imo.

My downfall has usually been stuff like this:

\- receive client ticket on thing I know. Work on more interesting tasks until
SLA period is almost over, then look into client issue too quickly and give
first plausible answer which later comes back wrong (and trivially so)

\- rush through a modification to the system I made because it's the end of
the sprint and I spent the whole time noodling around with interesting, low
priority thing <x> instead. See bug occur in testing on client site, dismiss
it as "it's a really bad site though, probably unrelated" because I see it
isn't everywhere on their site and I don't take the time to try to understand
what is happening. Bug is real, client fires us for money the bug causes them
to lose.

"Bad at the boring stuff" isn't the assessment I've been given from HR people
or bosses. It's me looking back on where I make mistakes, acknowledging that I
have a tendency to be sloppy on the grind work that everybody on a team needs
to do but that nobody wants to, and that the extent to which I was sloppy on
these sorts of tasks has had serious effects on my career.

------
outlace
It’s actually fairly uncontroversial between psychiatrists that the diagnoses
as specified in the DSM are not biologically valid.

We use them more as a communication tool to give a rough picture of a
patient’s symptoms to other providers than as a map onto biology. We simply
don’t understand the underlying biology well enough yet to do any better. But
there’s a lot of exciting research cracking this area open and we may very
well be able to diagnose and prognose based on objective data such as brain
imaging, genetics and blood tests.

Psych resident

~~~
notfashion
A lot of people in the psychiatric field believe that mental illness is due to
chemical imbalances in the brain. No tests exist which can detect those
imbalances. Your faith in "biology" as the ultimate underlying reality of
mental illness is discouragingly close to that _medical model_ of mental
illness. This idea that mental distress is essentially biological in character
has bad consequences because it ignores the fact that each patient is an agent
in continuous interaction with his or her social environment. Mental
illnesses, in general, don't develop organically from biological defects. They
are often the consequence of trauma and adverse life events, as noted by the
authors of this research. Sure, some mental illness is purely biological. Some
disorders may be influenced by genetics. But the generic, classic phenomenon
of somebody "going crazy" is unlikely ever to be attributable purely to
physiological processes. These things come about because of profoundly
dysfunctional psychosocial environments.

As a psychiatric professional, you may find it reassuring to predict the
future dominance of an objective medical model of mental illness. It would be
braver to admit that the complexity of the mind and of the circumstances that
lead to mental illness mean that medical research is a very long way from
cracking this problem.

~~~
outlace
You’re absolutely right. But the brain is a biological organ, a biological
information processor. Experiences shape it’s physical structure and function.
Whether mental illness arises from purely environment causes (eg trauma) or
purely nature (eg genetics, physical injury), in both cases the phenomena
reside in the physical substrate of the brain.

When someone has psychosis (eg hearing voices), maybe it was caused by a
severe trauma or maybe it was mostly genetic. In either case the person is
suffering from psychosis and is unable to normally function in society (if
severe enough). In both cases, in principle, we should be able to detect the
problem at the level of the brain in structure and function, and should be
able to intervene at the level of the brain.

The intervention required depends on the nature of the brain change. We can
change brain function in many cases by intensive therapy. In some cases
sensory inputs alone (via talk therapy) are insufficient to change the brain
to rectify an issue. That’s when we have to consider direct intervention on
the brain itself either via medications or neuromodulation technology.

I don’t think lay people understand how profoundly mentally ill some people
are and that they can really have dramatic improvements with treatment. Lay
people think of psychiatrists just peddling drugs to mildly depressed patients
or people who are mildly oddly behaved. That’s just not the case. I’m working
with people who sometimes literally stop eating because they think their food
is poisoned, or attempt to kill themselves with minor frustrations, etc. And
many patients, mostly not that sick, come in voluntarily because they feel
they can’t handle some problem on their own. You’re right that much I mental
illness is caused by psychosocial stressors, but some people have just
intractably messed up life situations and they’ve just spiraled downward as a
result and wouldn’t be able to get on a better path without treatment.

------
subroutine
This is nonsense. "This study provides yet more evidence..." What evidence?
This is a book report. Sure, DMS diagnostics are not perfect. In an ideal
world we'd compile a biomarker screen, genomic analysis, MRI/DTI/fMRI brain
imaging data, covert/overt behavioral analysis, 100 question screener, family
interviews, etc. etc. But in the real world, for a first-pass psychiatric
triage, if you're not using DSM guidelines, you're using your own intuition.

~~~
phkahler
In your ideal world with things like biomarker screens and MRIs, what exactly
would you try to correlate any physical evidence with? You can't say "these
genetic markers have a high correlation with schizophrenia" for example
without first screening for schizophrenia via something like the DSM. But if
you can diagnose it with that already....

~~~
subroutine
For the most part, I agree. There are some scenarios where you could profile a
condition based on, say, gene sequencing data more readily than in a
diagnostic interview. Maybe like... foster parents call a clinic asking about
treatments for possible Fetal Alcohol Syndrome; you query the electronic med
records of the child which include a recent dna test, and it turns out the
diagnosis is William's Syndrome.

[https://ghr.nlm.nih.gov/condition/williams-
syndrome#genes](https://ghr.nlm.nih.gov/condition/williams-syndrome#genes)

Are we close to being able to do this for conditions like depression,
schizophrenia, autism... not so much.

------
0xcde4c3db
To my mind, this is a little too much like saying that diagnoses of AIDS were
"scientifically meaningless" until HIV was definitively isolated. A syndrome
isn't devoid of predictive power or other practical meaning just because we
haven't identified a perfect biomarker or treatment protocol or diagnostic
threshold for it. There's still considerable debate over the full etiologies
of diagnoses like (for example) multiple sclerosis and muscular dystrophy, but
we can't wave our hands and attribute those to deficits of character or an
oppressive society or "unresolved trauma" [1] the way we can with mental
illness diagnoses.

Sure, the DSM is basically a dumping ground for various obnoxiously imprecise
syndromes that don't clearly belong to another specialty such as neurology or
endocrinology. But that doesn't make those syndromes "scientifically
meaningless". It's one thing to say that these definitions should not be taken
as gospel for determining future research directions. It's something else
entirely to say that they're "meaningless" and "not fit for purpose" based on
a philosophical notion of "meaning" or "purpose" that itself isn't rigorously
defined.

[1] It's funny how "biopsychiatry" is expected to identify precise molecular
pathways or anatomical derangements or genetic markers, but once the paradigm
is flipped to the more psychodynamic approaches, rigor suddenly doesn't matter
so long as we can tell a compelling story about how our experiences shaped us.

------
mindgam3
This is the heart of it:

> Almost all diagnoses mask the role of trauma and adverse events...

> The authors conclude that diagnostic labelling represents ‘a disingenuous
> categorical system’.

The DSM fails miserably as a manual to alleviate suffering, because it
downright ignores the influence of trauma on all but one major diagnosis
(acute PTSD).

Worse, complex trauma ("cPTSD") aka "developmental trauma" is still not an
official diagnosis, which is absurd, given that it is well established in the
research that child abuse can severely damage mental health.

The whole thing is looking at the problem of mental health from the wrong
angle. The so-called epidemic of mental illness will only subside once we
ditch the dizzying array of overlapping symptoms, and focus on the root
causes.

Every single individual seeking professional counsel on mental health should
be screened for trauma at intake. There's just no excuse for not doing that
given how much trauma impacts outcomes.

------
ajna91
The main findings of the research were:

• Psychiatric diagnoses all use different decision-making rules

• There is a huge amount of overlap in symptoms between diagnoses

• Almost all diagnoses mask the role of trauma and adverse events

• Diagnoses tell us little about the individual patient and what treatment
they need

------
tony
The major findings listed in the article make sense:

> • Psychiatric diagnoses all use different decision-making rules

> • There is a huge amount of overlap in symptoms between diagnoses

> • Almost all diagnoses mask the role of trauma and adverse events

> • Diagnoses tell us little about the individual patient and what treatment
> they need

I think the alluring thing about diagnoses is it quickly gives closure, so we
don't have to think, balance facts, or ask why. Check some boxes and we can
draw a type of a person by characteristics as we would with the periodic table
of elements.

We've been raised in a culture (or multiple of them), have an upbringing and
have a story behind that impacts how we trust others, we need to be loved,
have complicated emotions, we have impulses and drives, and sometimes there is
a biological/chemical aspect to it, we're made of elements.

As a society, we're here now cooperating because we care to help each other.
We're complex social beings, and it's hard to put us to a definition and have
it do us justice.

One of of the big papers criticizing mental illness is this:
[https://psychclassics.yorku.ca/Szasz/myth.htm](https://psychclassics.yorku.ca/Szasz/myth.htm)

Another one is Rosenham Experiment:
[https://en.wikipedia.org/wiki/Rosenhan_experiment](https://en.wikipedia.org/wiki/Rosenhan_experiment)

[https://youtu.be/1MbARnJqjnc?t=519](https://youtu.be/1MbARnJqjnc?t=519) \-
Some podcast talk on diagnosing mental illness / diagnosis and how not all
clinicians would come to the same agreement on someone's behavior.

------
tootie
Just to be clear, they are not discrediting psychiatric evaluation. They are
saying that specific labels of syndromes are useless. I don't think that's
really all that controversial a thing to say. Treatments are usually
prescribed per symptoms which is still valid.

~~~
DanBC
No, they are discrediting psychiatric evaluation. They're clear that any
diagnostic process is a sham, and any attempt to supply a diagnostic label is
unethical. They don't believe any psychiatric diagnostic label is valid.

------
cjbprime
Prescient reasoning from 1973:
[https://en.wikipedia.org/wiki/Rosenhan_experiment](https://en.wikipedia.org/wiki/Rosenhan_experiment)

------
DoreenMichele
I think there's at least four major components of mental illness:

1\. Biochemical

2\. Trauma, often made worse by social BS

3\. General social BS

4\. A mismatch between the person and expectations placed upon them

I think the first is something we should work on a great deal more than we
really do. It's much more readily quantifiable in a scientific manner than
social BS and addressing it can dramatically reduce the impact of the other
three, all of which entail varying degrees of social BS.

------
DanBC
A reminder that some of the authors make money from pushing their anti-
Psychiatry views.

For example, this conference on the Power Threat Meaning Framework (and
alternative to diagnosis) is charging huge amounts of money for their
conferences.

