Friday, May 10, 2013

DSM-5 = "lack of validity"

Says the Dr. Thomas R. Insel, director of the National Institute of Mental Health. From the NY Times:


While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

Insel describes the problem of all psychiatric diagnoses:

“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.”

It's interesting, a lot of people will come on here and baldly assert, "sociopaths don't do this" or "that's not what borderline personality disorder is." And that's fine. I understand the flaws and ambiguities in my own working definitions of psychiatric disorders. And I also understand that despite the fuzziness of the definitions, it's still useful to acknowledge that there seems to be commonalities between certain categories of people that deserve further explanation. But I do believe that people have used the DSM unquestioningly for far too long, taking it to the level of being DSM apologists rather than accepting new information with an open-mind, and I'm glad that there is now more pressure to provide actual science behind the various assertions.

For more on the DSM-5's explicit rejection in one instance of actual scientific proof of a separate psychiatric disorder, see this New Yorker article's discussion of melancholia:

[T]he inclusion of a biological measure [for melancholia] would be very hard to sell to the mood group." Coryell explained that the problem wasn’t the test’s reliability, which he thought was better than anything else in psychiatry. Rather, it was that the D.S.T. would be "the only biological test for any diagnosis being considered." A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring.
***
This notion—that the apparent mental condition is all that can matter—underlies not only the depression diagnosis but all of the D.S.M.’s categories. It may have been conceived as a stopgap, a way to bide time until the brain’s role in psychological suffering has been elucidated, but in the meantime, expert consensus about appearances has become the cornerstone of the profession, one that psychiatrists are reluctant to yank out, lest the entire edifice collapse.

"What can be asserted without evidence can be dismissed without evidence."






65 comments:

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  4. I nearly mentioned this myself, as I saw it on a news article yesterday.

    I have no real knowledge of psychology/psychiatry, although I do find one aspect of the practice intriguing. The use of mind-altering drugs as therapeutics is negatively colored due to their recreational use. We can all 'self medicate' with caffeine, nicotine, and alcohol, primarily due to the fact that these drugs are so widely spread.

    However, other drugs such as psilocybin (active compound in shrooms), marijuana, mescaline, and LSD have their use largely criminalized, simply due to the fact that they alter the mind and people enjoy using them. To me, that is like finding a natural compound that dulls pain, and banning its use because it dulls pain. The stigma attached to mental illnesses suggests that the sufferer is responsible for their own pain, and need tough it out on their own.

    I find it amusing that Dr. Insel provides anhedonia, the inability to experience pleasure, as a discrete mental issue that should be studied. Anhedonia is forced upon people, and the natural compounds that might relieve it are heavily restricted. To me, that seems sadistic.

    ReplyDelete
    Replies
    1. Yes, I know LSD is synthetic, I merely listed it as a psychoactive compound.

      Delete
    2. You may, but you would need to fill me with something first.

      Delete
    3. Mercy...this is getting kinda hot!

      Delete
    4. Oh, I see how that could be perceived to have a sexual connotation. Please excuse my impropriety. I was merely indicating that the glass is empty.

      Delete
    5. I know, but I do have a very dirty mind :)

      Delete
    6. In your defense, I have been told I have a rather dry sense of humor, though perhaps it's also a tad fruity?

      Delete
    7. Don't worry, Andy. You can sound a little like you've read one too many Anne Rice novels, if you know what I mean..but I actually kind of like that.

      As for having a dirty mind:

      http://www.youtube.com/watch?feature=endscreen&v=nYRQFVSvSPc&NR=1

      The music is awful, but it's cute otherwise.

      Delete
    8. Oh, Lestat, your priorities are so very clear. You first learn to piss, shit, and eat , then spend the rest of your time trying to convince an old man to fuck you.

      Delete
    9. Haha! Nice!
      Curious, what do you like to do for fun, Andy?

      Delete
    10. Well, I rather enjoy a good conversation, as well as toying with people's heads, which is fortunate because the two go hand in hand.

      Yourself, my dear?

      Delete
    11. Likewise.
      Also a sucker for good art and poetry, as well as more physically challenging pursuits.

      Delete
    12. More physically challenging pursuits? How embarassing, it seems I'm the one now with a dirty mind.

      Delete
    13. Or just maybe it was intended to sound that way :)

      Delete
    14. Seriously though, I'm not flirting with you. I simply enjoyed reading Marquis De Sade a tad too much during my formative years.
      So what do you enjoy other than a nice mindfuck?

      Delete
    15. S'up green eyes.

      How's life and your husband?

      Delete
    16. Why, I would never be so presumptuous! If you at all resemble the picture next to your name, I'm afraid you're far too lovely for the likes of me. Yes, it's best we not travel down that road, for surely it ends with my broken heart.

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    17. How's it going, anonymous?

      Life and husband are both wonderful, thank you.

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    18. What a relief to hear it! I'm poorly suited to that sort of thing. Well, besides a good 'mindfuck' as you so eloquently pit it, I enjoy a good book. They provide ample fuel for my delusions and daydreams. Here I am, talking too much about myself. Tell me dear, can I call you something other than green eyes, preferably something I can capitalize? It would feel more like I'm talking to a person than a pair of veridian orbs.

      Delete
    19. You can call me GE if you wish.
      What type of books do you enjoy? You already know I'm a fan of the Marquis after all.

      Delete
    20. Nothing so interesting as the father of Sadism, I'm afraid. Your run of the mill fantasy, horror, and science fiction novels. Fuel for nightmares and dreams. Though I have recently taken a liking to LaVey, so we may share a blasphemous nature.

      Delete
    21. Interesting.
      Not a fan of fantasy or science fiction personally.
      Have yet to find a book (or movie) that would scare me, but always on the lookout.

      Why the sudden liking of LaVey?

      Delete
    22. You are a curious one, aren't you?

      I think it's good the NIMH is moving away from the DSM and towards a more scientific approach to mental health issues. Ultimately, diagnosis could be made through looking for pathological patterns of brain activity, and treatment efficacy could be examined the same way.

      Delete
    23. Relentlessly curious :)

      And I do agree with you.

      Delete
    24. I believe you about the eyes, but doubt you are a cat. Though, I guess that's hardly stranger than a girl named Chet. If it's short for Chester, I'd of course be more inclined to believe you are a cat!

      Delete
    25. Not as curious as someone I know, E ;)
      How is the family?

      You sure are, Chet.

      Delete
    26. They are quite well, thank you for asking :)

      I have an open invitation to catch a "mess of bluegill" with my father that I will likely take him up on.

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    27. How lovely.
      Never enjoyed fishing, personally. Get too bored.

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    28. I will not fish if there is not alcohol involved. Period.

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  16. Up From The SofaMay 10, 2013 at 5:53 PM

    I went into the vortex and I was at the center just like I left myself.

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  18. I think it's ridiculous to assert that a laboratory criterion is needed to define a pathology. Many organ systems in the body are defined as pathological or healthy based on how they work or "function" or not. Heart failure is defined by a specifically low threshold of ejection fraction (the amount of blood entering the heart that leaves when it pumps). Renal failure is defined by the amount of creatinine that the kidneys can process each minute. Yes, these involve chemistry panels or technology or whatever, but that doesn't mean that observation is moot. Pathologists "look at" slides of cells all the time to identify cancer and other pathologies.

    It's interesting because I too have thought about how psychiatry will be better accepted into the fold of medical practice (not medical "science") once it achieves the landmark threshold of diagnosis: Visualization. And I'm sure that won't be hard or uninteresting. But to say that simple observation of behaviors in the meantime is not a valid metric is ridiculous. It's just not held in high esteem by the visually biased, which is most if not all of medicine.

    ReplyDelete
  19. I am currently taking a psychology class and I find it interesting how you can't be diagnosed if you don't fit every single aspect of the definition provided by the Dsm. Then they turn around and change the definition. At one point homosexuality was part of the Dsm as a mental disorder, and now it is considered a choice.

    ReplyDelete

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