[epgui]

> The DSM in many ways represents the worst of so-called social science.

No. You need to read the thing.

The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages.

People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.

[sundarurfriend]

But people do. Psychology courses do, with a similar "tool to help standardize communication" line recited robotically and then practically ignored. Most practicing psychologists do as well, to only a somewhat lesser degree.

You cannot have an authoritative textbook proscribing definitions, and then expect people to treat them as just "a self-described ontology" with all the nuances and caveats around that just because it says so somewhere in the introduction. Psychology of all fields should know that.

[epgui]

I’ve had a bunch of neuro/psycho classes and this was always well understood.

This stuff is complicated. People are going to get it wrong. That sucks.

But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it.

[aleph_minus_one]

> But if you’re going to judge the book, judge it by how it presents itself, don’t judge it by how a third party misrepresents it.

As long as the boards don't go after the shrinks who "misrepresent" the DSM, I would claim that this misrepresentation is systemic of (and possibly even intended by) the psycho-industrial complex.

[epgui]

Boards are expected to “go after” professionals who do not provide a certain standard of care, but that has very little (if anything) to do with the DSM.

I think this comment just reinforces a misunderstanding of what the DSM actually is.

[dotancohen]

If the DSM merely described sets of symptoms and gave them names, I'd buy that. But by also mentioning (e.g. suggesting) specific treatments, the book is used as a prescription tool, not just a diagnostic tool.

  > But if you’re going to judge the book, judge it by how it presents itself

Quite so. I just as we judge people by their actions, not their words, I judge the DSM by how it's actual content is structured, not by its introductory quip.

[autoexec]

Why shouldn't it include a bunch of treatments if they've been shown to be beneficial? How would it be better if people had to go to some other book and look up those same conditions using the names listed in the DSM in order to find out which treatments might be useful?

Doctors (at least the good ones) aren't usually going in blind and just doing whatever the DSM tell them to as if they were following a flowchart or checklist. The DSM (which I'm not even fully defending here, I personally it feel has all kinds of problems) is just a guide. It's not the only tool in a doctor's arsenal and they aren't obligated to follow it.

[dotancohen]

  > Why shouldn't it include a bunch of treatments if they've been shown to be beneficial?

It most certainly should, I'm not saying it shouldn't. My argument is that, by suggesting specific treatments, the DSM is a prescription tool. Not merely a diagnostic tool.

[epgui]

Oftentimes in psychiatry the treatments are just as important as anything else in establishing a diagnosis.

There’s a well-known concept of “diagnosis by treatment” because unfortunately that’s often the best we can do in practice. It sounds backwards, and yeah, it is backwards, but oftentimes it’s the best we’ve got.

At the same time you want treatments and clinical presentations to be somewhat coherent, and you don’t want practitioners going totally rogue and deviating from the standard of care in a way that could harm people, so yeah the conditions and their potential treatments are associated.

Most discussion of treatments in the DSM are various forms of therapy. Most pharmaceutical treatments that are mentioned are about broad classes of medications, and they’re all old drugs with generics on the market. It’s not a book you consult for pharma info.

[dotancohen]

I'm not disagreeing with anything you say, although I did not know the concept of diagnosis by treatment is actually formerly recognised. That is exactly why the DSM is a prescription tool, not merely a diagnostic tool as reading of the introductory text would have one believe.

[epgui]

I don't know that it's formally recognized, but it's a thing.