[lutusp]

> The OP clearly has Social Anxiety Disorder, also known as "social phobia".

Has anyone considered that giving an empty name to a description adds nothing to the conversation? Until the day Social Anxiety Disorder shows up in an electron micrograph (pics or it didn't happen), it's something that psychologists made up, like Asperger Syndrome (now abandoned) or homosexuality as a mental illness (abandoned in the 1970s).

The fight against homosexuality as a mental illness was terrifying to watch. Many professionals appeared before hearings wearing masks, to argue against this addition to their oppression, before psychologists finally realized their disease mongering was causing real harm and removed homosexuality from the DSM.

With Asperger's it was exactly the opposite -- it was an attractive diagnosis, everyone wanted it, such that psychologists finally realized they had created a monster lacking the clear definition that might have brought it under control.

[tedks]

I really wish the Scientology-esque anti-psychology crowd would stop using the struggles of queer people as an excuse to be anti-scientific.

Social anxiety disorder definitely exists, it can be treated chemically (meaning that it is biologically real), and arguing about this anyway is a fundamental misunderstanding of how mental illnesses are defined and diagnosed.

Virtually every mental illness include a diagnostic criteria of interference with normal life functioning. If you have the symptoms the OP has and you feel you live a normal, happy life, you do not have social phobia.

Further, saying that social anxiety is something "psychologists made up" is grossly insulting to people who actually have the disorder. Saying that recognizing it as a disordered state and not as "just being shy" adds nothing is grossly insulting as well. Some people live their whole lives, afraid of making eye contact, ruminating on every interaction, thinking that they are just "awkward" or "shy" or "introverted" and as a result never form close connections to humans and die alone.

I hope the OP gets the help he or she needs, and I hope that you stop standing in his or her way.

[lutusp]

> I really wish the Scientology-esque anti-psychology crowd would stop using the struggles of queer people as an excuse to be anti-scientific.

You mean, like Thomas Insel, sitting director of the NIMH, who recently described psychiatry as pseudosciene and announced the abandonment of the DSM, on the common-sense ground that it has no scientific content? Read more here:

http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h

Maybe you could read up on current events in the field before posturing as though you know what's up?

As to "anti-scientific" there is nothing more anti-scientific than a group of people who invent diseases by voting rather than research, that we're all supposedly suffering from. Asperger's was included in DSM-IV by vote, not research. Asperger's was removed from DSM-5 by vote, not research. As a result, the DSM is being abandoned along with Asperger's.

> Virtually every mental illness include a diagnostic criteria of interference with normal life functioning.

That's true, and that is why the DSM is being abandoned -- it's a description of symptoms with no hint of causes, and in a scientific era, that is both absurd and offensive. Here's what NIMH director Insel said as he announced the DSM's abandonment:

http://www.nimh.nih.gov/about/director/2013/transforming-dia...

Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

"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. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."

By the way. Insel isn't a Scientologist, he's a psychiatrist. Like many in the field, it has come to him that psychiatry is standing in the way of progress toward a scientific approach to mental illness diagnosis and treatment.

[tedks]

Personal attacks are unbecoming. I probably have more experience in this area than you do. But I'm not going to stoop so low as to use logical fallacies, because I'm confident that I'm on the right side of this particular disagreement. You don't seem to be. It's worth noting your entire argument is an appeal to authority or a personal attack.

For what it's worth, though, I think that it's positive for the NIMH to move away from DSM guidelines for research, because research should inform the DSM, not the other way around. Further, the DSM and mental health as a whole has been trending towards cultural models of mental illness rather than authoritarian mindsets that attempt to proscribe rather than describe.

Ironically, the main reason for doing so is the backlash the psychology community suffered from the categorization of homosexuality and gender identity disorder. This is why modern mental illness diagnosis requires an interference with life functioning, as decided by the patient, not the medical establishment. I think this is generally the right way for the community to go in, for a couple of reasons.

For one, very few mental illnesses will have an empirically detectable "cause" aside from some combination of experiences. It's not clear by any stretch that all mental illnesses have even a biological component. The (empirically detectable) success of cognitive-behavioral therapy seems to indicate that since minds can be built in any number of ways, they can also be broken and need repair purely using their own mechanisms.

If someone has PTSD because they were sexually assaulted, it's not clear to me that you could ever say with empirical validity (beyond what the DSM already provides you) that they have any disorder. You could be neurologically reductionist, but even if that's possible it's several years off before that's an effective diagnostic mechanism, and even then the original cause of the disorder is far removed from the person's life, leaving only... the symptoms.

Second, disregarding the subjective distress of the patient is the path towards medicalization of abnormality, just as happened with homosexuality, hysteric personality disorder, etc.. In the extreme cases, legal structures exist to determine if a person is not responsible for themselves. At the end of the day, mental health is inherently socially constructed rather than objective, and you're never going to be able to bottom out to something objective.

To say that the DSM is devoid of scientific context is simply false; the DSM is written by scientists, based on all available scientific research available at present. It evolves, like everything else does. I don't think there's any better way to resolve disagreements among scientists than by voting; it's worth noting that medicine as a whole merely allows individual practitioners to make their own judgments as opposed to regulating the field, which is a definite trade-off without a clear winner.

[lutusp]

> It's worth noting your entire argument is an appeal to authority or a personal attack.

You mean, like when I pointed out that Asperger's was created and destroyed by votes rather then scientific evidence? Or was it when I pointed out that the NIMH is abandoning the DSM because it lacks scientific content?

As to personal attack, physician, heal thyself.

> To say that the DSM is devoid of scientific context is simply false ...

Don't tell me. Tell NIMH director Insel, who says that same thing I do for the same reason -- the DSM lacks scientific substance. Insel recently said (http://www.nimh.nih.gov/about/director/2013/transforming-dia...):

"While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

"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. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."

On that basis, on that evidence, you should address your beliefs about the DSM to the highest-ranking psychiatrist in the country, rather than to me. Of course, if you actually understood what constitutes science, you wouldn't be taking the position you are.

> I don't think there's any better way to resolve disagreements among scientists than by voting ...

Ah. Now I see the problem. Scientific questions are never resolved by voting -- not ever. They are all resolved by empirical evidence. For questions that cannot be resolved by evidence, scientists adopt the null hypothesis, the precept that an idea is false until it is supported by evidence.

The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

This is why Insel, and his predecessor, Steve Hyman, have taken the positions they have. This is why psychiatry and psychology are in the midst of an historical transformation, one that faces up to the fact that they are not scientific enterprises and considers a course of corrective action.

[tedks]

Yes, I read that quote when you posted it the first time. I notice you've posted it many times in this thread, so maybe you got confused.

By the way, the director of the NIMH isn't the "highest-ranking psychiatrist". That title doesn't exist.

>Ah. Now I see the problem. Scientific questions are never resolved by voting -- not ever. They are all resolved by empirical evidence. For questions that cannot be resolved by evidence, scientists adopt the null hypothesis, the precept that an idea is false until it is supported by evidence.

This is not true.

In most fields, including general medicine, there is no governing licensing body similar to the APA. This is because psychiatry is the only medical discipline that postdates the concept of regulatory bodies.

In general medicine, it's very common for two doctors to treat the same illness differently. This is why cancer patients can choose between radiology and surgery and chemotherapy.

Now, the APA could abandon the concept of regulation and allow any licensed psychiatrist to treat anything in any way, but as a society we've democratically (by vote) decided that psychiatry should be regulated, so its regulatory body decides the treatments that can and cannot be administered, and what constitutes something worth treating. (If you want to go outside this structure, you just can't call the person you're getting treatment from a psychiatrist. Priests, consolers, social workers, etc., are examples of alternatives.)

So, the world does not work the way you think it does. This is because you're espousing a philosophy of science called Positivism or Verificationism: https://en.wikipedia.org/wiki/Logical_positivism

This school of thought was abandoned in the early 1900s. Currently, the dominant philosophy of science is Falsificationism: https://en.wikipedia.org/wiki/Falsifiability#Falsificationis...

...which holds that ideas compete via aggregate evidence judged by each individual scientist, gaining ground via confirmatory evidence (though never being proven) and losing ground via falsifying evidence.

>The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

This is also not true. Doctors offer treatments that aren't definitively explained all the time. It's far better to treat something however you can than to hold off for some logical positivist verification of your claim.

--------------

But, you've said a lot about what other people think. What is your opinion, and how did you form it?

[lutusp]

> By the way, the director of the NIMH isn't the "highest-ranking psychiatrist". That title doesn't exist.

Of course it does. In psychiatry, authority matters. In science, it doesn't. How else could Insel unilaterally describe psychiatry as a pseudoscience and rule that the DSM is to be abandoned, as he recently did? That would never be accepted in a scientific field, where authority is disparaged.

How else could a panel of authorities vote to include some imaginary conditions, and exclude other imaginary conditions, from the latest DSM? They did just that, and one change from the past was that the votes were held in secret. Another difference was that the governmental agencies that rely on the DSM have decided to abandon it.

>>The bottom line is that a scientist would never say, "We don't know what this is, but let's offer clinical treatments anyway -- because the public doesn't understand either science or our poverty of knowledge."

> This is also not true. Doctors offer treatments that aren't definitively explained all the time.

This kind of reply makes me wonder what is the point of this exchange. Doctors are not scientists, they are to medical research what an engineer or a technician is to a scientist in another field. Further, if a doctor really offered a treatment not vetted by research, he would have his license pulled.

> What is your opinion, and how did you form it?

My opinions are irrelevant, and I have not been expressing opinions, but facts. Note my use of literature references to support any facts I post.

[tjradcliffe]

Axis 2 disorders like Social Anxiety Disorder appear in the data as stable clusters of symptoms. Attaching a name to that stable cluster of phenomena is no different from attaching a name to the stable cluster of phenomena we call "smallpox". And attaching a name to the phenomenon is the first step toward identifying the causes and figuring out the cure (or even if it needs to be cured.)

So yes, lots and lots of people have considered whether or not giving something a name adds anything to the conversation, and we have generally found it does. We have a lot of powerful tools for thinking, and words are one of the better ones.

Does this mean we never make mistakes? Of course not, but unlike every other approach, isolating clusters of symptoms by an act of selective attention and reifying them with a name has long proven to be an extremely useful approach, so we keep on doing it even though we get it wrong sometimes. The great thing about science is that unlike every other approach to the world, it corrects itself fairly reliably, although sometimes it takes more than a generation to do so.

[lutusp]

> Attaching a name to that stable cluster of phenomena is no different from attaching a name to the stable cluster of phenomena we call "smallpox".

False! The difference, as you would know if you had any understanding of science, is that we know what causes smallpox. Mental illnesses are defined by their symptoms, not by their causes, for the simple reason that we don't know their causes.

This is why the DSM is being abandoned -- it's a listing of symptoms of ailments no one understands. And the man behind the program to abandon it is a psychiatrist:

http://www.nimh.nih.gov/about/director/2013/transforming-dia...

> We have a lot of powerful tools for thinking, and words are one of the better ones.

Sure, here's one. A mental illness diagnosis dating back to before the Civil War -- Drapetomania, the tendency of slaves to run away from their masters:

http://en.wikipedia.org/wiki/Drapetomania

Do you know why slaves who ran away were diagnosed with a mental illness, instead of their masters for owning human beings? Easy to answer -- the masters had money to pay psychologists.

A quote from the article: "Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity.[1]:41 Today, drapetomania is considered an example of pseudoscience,[2]:2 and part of the edifice of scientific racism.[3] Thomas Szasz mentions Drapetomania in his book, The Myth of Mental Illness, as an example of how psychiatry, when calling certain people "diseased", attempts to deny them responsibility as moral agents, in order to better control them."

> ... isolating clusters of symptoms by an act of selective attention and reifying them with a name has long proven to be an extremely useful approach ...

Yes, but it cannot compare to doing science. Science requires explanations, falsifiable theories, empirically testable against reality. Psychology is satisfied with descriptions.

[CocaKoala]

I wouldn't describe it as an illness, but Asperger Syndrome is absolutely a thing and I'm not sure why you think it's abandoned.

It's an attractive diagnosis because it gives jerky nerds an excuse to act like a jerk, but (just like so many things), the fact that it's over-self-diagnosed doesn't mean that there aren't people with legitimate problems.

Edit: Ah, I guess you're saying that it's "abandoned" because the diagnosis is no longer "You have Aspergers Syndrome" and now "You fall somewhere on the autistic spectrum"?

[lutusp]

> I wouldn't describe it as an illness, but Asperger Syndrome is absolutely a thing and I'm not sure why you think it's abandoned.

Excuse me? It has been abandoned -- it was voted out of DSM-5 (the current version), by the same people who voted it into DSM-IV. It is gone. Read more:

http://www.slate.com/articles/health_and_science/medical_exa...

Quote: "You Do Not Have Asperger’s"

Simple enough? The reason it was abandoned is because it was widely abused by opportunistic therapists to exploit people who think mental illnesses can be made up without benefit of science.

> It's an attractive diagnosis because it gives jerky nerds an excuse to act like a jerk, but (just like so many things), the fact that it's over-self-diagnosed doesn't mean that there aren't people with legitimate problems.

Yes, and the fact that "vapors" is no longer accepted as a medical condition doesn't mean no one gets cancer -- it means there are fewer quacks practicing medicine.

> Edit: Ah, I guess you're saying that it's "abandoned" because the diagnosis is no longer "You have Aspergers Syndrome" and now "You fall somewhere on the autistic spectrum"?

Yes, exactly as though someone now says, "You're more interesting than the average person" instead of saying, "Your're queer and need therapy." Yes, there is a difference.