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Psychiatry a science? It has suffered new blow to prestige

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Its handbook is the Diagnostic and Statistical Manual of Mental Disorders (DSM). From Canada’s National Post:

For example, when director Thomas Insel recently announced the U.S. National Institute of Mental Health will henceforth ignore all the DSM’s diagnoses in deciding how to fund research, he bluntly declared that the book’s “weakness is its lack of validity.”

Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure,” he wrote. “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.”

But the good news is that it started to decline in prestige before we were saddled with “evolutionary psychiatry.” Oh wait. Well, it won’t really get off the ground now, all five (left) feet flying.

Hat tip: Stephanie West Allen at Brains on Purpose

We’ve talked about this before:

But why did anyone ever treat the Diagnostic and Statistical Manual of Mental Disorders as a Bible anyway?:

Only 3 per cent of DSM disorders have any known biological causes. The causes of the remaining 97 per cent – and this includes depression, anxiety, schizophrenia, attention deficit hyperactivity disorder (ADHD), bipolar and all personality disorders – are not known. The theory that chemical imbalances cause mental illness – that a serotonin deficiency causes depression, for example – is unproven. Billions of research dollars have been spent on trying to establish a link between neurotransmitters and mental disorder, and the attempts have failed. For all the scientific terminology, psychiatric diagnoses are based on subjective judgments.

Subjective judgements aren’t bad in fuzzy situations; the problem is pretending that they are something other than an experienced person’s best judgement.

7 Replies to “Psychiatry a science? It has suffered new blow to prestige

  1. 1
    Bateman says:

    Being a mental health provider (occasionally charged with restricting individuals’ freedom through hospitalization), I wholeheartedly agree with the spirit of this article. We (MH providers) generally have no clue about the “science” behind the DSM-IV.

    You think the research is subjective? Wait to you see how it is applied!

  2. 2
    Robert Byers says:

    They don’t know the causes of these mental disorders but bible believing christians do or should.
    It can’t have anything to do with soul thinking. Which is most of the thinking or all. Souls are not attached to the material world and so can’t mechanically break down.
    The only think that is attached to the material world is our memory.
    This memory is not unique to humans but animals have it and possibly just as good.
    Therefore in all disorders called mental disorders it is simply abot the interference with the triggering mechanism for the memory.
    They are all just of the same atomic structure as a song stick in your head.
    These things are distortions or stuck in the powerful memory of ours. This from triggering mechanism flaws.
    Its not complicated once presumptions are removed.
    its impossible for souls to get depressed. Opinions may linger but the effect is from the memory interference. Thats why removing the original opinion doesn’t instantly eliminate the depression. Its stuck in the memory.

  3. 3
    News says:

    Bateman, occasional restriction is the prudent action of a physician. The main reason it can’t easily be a science has to do with the very individual nature and commonsensical basis of the judgement calls.

    I once watched such a commitment. In my opinion, it was the right call. The ER patient had been picked up by the police for creating a disturbance at a coffee shop. The police brought that person to the ER to avoid charging them (due to their age and possibly infirm mental status).

    If not held overnight in a medical facility, they would have gone back again, probably, to that coffee shop or another one to “make their point” – resulting in criminal detention and a record.

    Held overnight, they had the right to see a psych first thing next morning. And to leave then too. But by experience, they are unlikely to end up in jail then, maybe on some kind of voluntary mental health care regime. But again it is not bench science, just some emergency services’ people’s idea of what to do. – O’Leary for News

  4. 4
    Bateman says:

    O’Leary: I know the process, I do it for a living. When I place a person under a detention order (hospitalization), it is for 3 days minimum with no option of leaving. Physicians don’t make those calls in my state.

    When I do the assessments, the psychological disorder is considered; however (and you hinted at this) decisions are largely based on a bit of civil law and a whole lot of common sense. The psych disorder is more of an afterthought.

    I think this supports the articles main point – we practitioners (largely) do not really hold the DSM in high regard either. In my practice, I treat clients based on the verbalized issue (i.e. parent/child relation or conduct disturbance) not “he has ADHD… fix it.” Cynically speaking, they are codes used for billing, to tell insurance or gov’t that payment for our service is necessary. As you said, psych diagnosis is mostly (educated) guessing – not hard science.

  5. 5

    News, could you explain the point you are trying to make?

    Clinicians always have, and always will, have to make the best clinical decisions about care of their patients with the information they have.

    Psychiatry isn’t about labelling people – it’s about making them well. If a diagnosis helps steer the clinician towards the most effective treatment helps, great. But it doesn’t always, because people aren’t all the same. Clinical practice is scientific in the best sense (evidence based) but that doesn’t mean that the best practice is to ignore the huge confidence intervals that lie behind diagnosis.

    And psychiatric research is science too – it’s difficult science, but that doesn’t make it not science.

    As regards “evolutionary psychiatry” – I’m not sure what you are thinking of. Evolutionary, particularly embryological, and certainly genetic, perspectives are very useful in psychiatric research, but I know of no such beast as “evolutionary psychiatry”.

    Neither my clinician colleagues nor my fellow non-clinical psychiatric researchers seem to have noticed being “saddled” with it, whatever it is.

    The DSM V is disappointing, but the fact remains that we still haven’t got very far in finding diagnostic methods that predict either prognosis or the best therapeutic approach very satisfactorily. Many people hoped that a more dimensional approach would make it into DSM V. We may have to wait for DSM VI.

    Or for US medicine to stop linking funding to categorical diagnoses, and instead to link it to likely benefit.

  6. 6
    Mark Frank says:

    There is a very interesting article on DSM V by Ian Hacking in the London Review of Books. I don’t think he is suggesting that Psychiatry is not a science though!

  7. 7
    t0mr says:

    I completely agree with Bateman. Psychiatry is not scientifically based. It is a subjective interpretation based on a lack of knowledge about the brain.

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