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A lesson for pop science in the troubled history of psychiatry?

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Edward Shorter, author of How everyone became depressed: The rise and fall of the nervous breakdown, a medical historian who specializes in psychiatry, offers some thoughts on the rise of popular psychiatric diagnoses—thoughts that provide a useful analogy to the pop science theories we skewer daily here.

The problem isn’t that these theories exist, in either case, but that they are taken seriously, made into beliefs about life in general, and acted on—and in some case signed into law. Anyway, here’s Shorter:

Historians are well situated to appreciate how fragile current diagnoses are because you can see, over a long period, what psychiatry has considered to be the main diseases and also you get a sense over the centuries of the treatments that actually worked and were effective.

By contrast, you look at what’s happening in psychiatry today, and many of the diagnoses were created out of whole cloth in 1980 with the famous DSM III [Diagnostic and Statistical Manual III, meaning third edition].

I went back through the archives of the American Psychiatric Association, and looked at all the correspondence surrounding the DSM III. I was just amazed at how unscientific they were. The ideas were based on consensus, which implicitly is unscientific. Also, the whim of one man, Robert Spitzer, played an overpowering role in the creation of diagnoses such as bipolar disorder and major depression. [colour added]

Over the years, psychiatry has gained an enormously powerful sense of what real illness is, and the DSM III flew in the face of that consensus. Major depression, for example — which is probably the most popular diagnosis in the DSM III — was simply put together by collapsing two very different depressive illnesses psychiatry always recognized: melancholic illness and non-melancholic illness. There is a lot of scientific evidence to back up that differentiation.

They flicked this aside in 1980, and said one kind of depression is the same as any other, so why make this distinction? It was a completely arbitrary, ruthless way of coming up with a diagnostic category. We’re paying the price for that today.

This is a concrete illustration of how knowledge of the history of something like diagnosis can give us an effective critique of current concepts. More.

One could say the same for a history of Darwinism, the multiverse, evolutionary psychology, origin of life studies … etc. …

See also: The psychiatric Bible?

3 Replies to “A lesson for pop science in the troubled history of psychiatry?

  1. 1

    This is a greater problem, I think, in the US, where funding follows diagnostic category rather than clinical need, as is more the case (although less than desirable) in, say, Canada, or Europe.

    I think there is a real tension between using the DSM, or the ICD-10 for funding purposes and for clinical purposes. Clinically, diagnostic categories clearly overlap and merge – the categories themselves are simply descriptions of symptoms that tend to be associated with each other. Sometimes a category has good predictive power regarding prognosis, and treatment response, for instance children who meet criteria for ADHD often respond well to methylphenidate; people who meet criteria often respond to SSRI’s, and people who meet criteria for psychosis often respond to antipsychotics. So it’s not that the diagnoses aren’t clinically useful. Where the problem sets in, I suggest, is when they are regarded as discrete and categorical accounts of a specific pathological process, and that tends to happen when funders have an interest, not in funding a treatment that will help a patient, but in deciding whether or not a patient “qualifies” for the treatment.

    Used in that latter sense, I agree that the diagnostic manuals are “non-scientific”, in that they simply do not describe discrete pathological processes that are either present or absent in a patient. However, they are “scientific” in the sense that they arise from good research into the co-occurrence of clinical symptoms, and the patterns of treatment response.

    They are also of enormous help in actually conducting that research, because they enable us to compare findings across separate studies, with good control over the characteristics of the patient samples. Ironically, that is precisely the kind of research I think we need if we are ever to move towards a more dimensional approach to psychiatric illness that most people think would be a better model of what is going on – in other words to address the question: how do people who meet these diagnostic criteria differ, and how can we better serve their needs?

    My dream, as it were, is to see a day when we can abandon diagnostic labels in psychiatry altogether, and instead instead of “diagnostic” criteria, we will simply have “therapeutic indicators”, and criteria that allow everyone to evaluate the helpfulness of the therapy (whether pharmocological, psychological, cognitive, social, or a combination).

    I think we are getting closer.

  2. 2
    bornagain77 says:

    In other news, during 165 million years of evolution Darwinian processes accomplished the amazing feat of evolving small fleas from big fleas:

    Early Cretaceous flea found to “fill the transitional gap.” – July 15. 2013
    Excerpt: Last year the discovery of fossilized giant fleas in Chinese formations conventionally dated at 165 million years revealed that, while giant fleas had some variations distinguishing them from modern fleas, they were still fleas. However, there remained in this scenario “a considerable gap”1 between the evolutionary ancestors of modern fleas and today’s fleas that torment animals and people. The recent discovery of medium-sized fleas in China’s Yixian Formation (conventionally dated 125 million years) supposedly fills in the “early evolutionary history” of the flea.,,
    Some modern fleas are larger than the more recently found Saurophthyrus specimens, and some Pseudopulicidae specimens were substantially smaller than the two-centimeter giants found with them,,, the largest fossil fleas are nearly twice the size of the largest modern flea (about four fifths of an inch.) ,,,

    Referenced paper:

    New Transitional Fleas from China Highlighting Diversity of Early Cretaceous Ectoparasitic Insects – June 2013

    I bet the only guy truly impressed with giant fleas in the past is this guy:

    Flea Circus

  3. 3
    Robert Byers says:

    Actually I think its a accurate direction to see depressions as a single equation of sickness. I don’t think there is bi polar depression etc as thats working off ideas of segregating the mind operations.
    As a YEC creationist I would depression is simply a reaction of the memory.
    its just another phobia. Its just a stuck conclusion of negativity.
    Depression probably is provoked by problems, not always, however it sticking around beyond the merits of the problem means its stuck in the memory. or rather the triggering mechanism is not allowing it to be forgotten. its like a song stuck in ones head.
    healing depression should aim at dealing with the memory and possibly shocking the triggering mechanism to let go the bad memory.
    If one should not be depressed then its not the intellectual merits but rather simply a memory problem.
    A soul believing christian should always realize our mind is not from the parts in our head.
    Our souls do all our thinking. Only memory is the materialistic element to human thought.

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