| > 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. |
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.