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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. |
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.