[matt608]

Indeed, which adds to the argument that so called "mental" health problems are not actually mental. Many diseases cause some mental symptoms and get wrongly labelled as mental illnesses, when I dispute that there is such a thing.

[Jgrubb]

You dispute that mental illness is a thing that exists?

[d0mine]

It is known that the reliability of psychiatric diagnoses is non-existent https://en.wikipedia.org/wiki/Rosenhan_experiment

Edit: It is ok to downvote if you disagree. But think what it says about you if you are downvoting facts.

[Jgrubb]

That links to an experiment that -proves- suggests it's possible to game psychiatric diagnosis, not that mental illness doesn't exist.

edit: btw the way, I've been here for like 5 years now and I still don't know what flavor of Markdown is used here.

[jonah]

Linked from the FAQ at the bottom of the page: https://news.ycombinator.com/formatdoc

[Jgrubb]

Thanks. So it's sorta like "quarterdown".

[d0mine]

Yes. The experiment proves that we are in astrology stage of development regarding mental illnesses. It doesn't mean that stars or planets do not exist. It just means that astronomy is yet to be born. Psychiatry awaits its Copernicus.

btw, I don't see how could you explain the second part of the experiment where were no fake patients at all as "gaming". If a mere expectation of a fake patient screws the results so much; your methods are garbage. This and other counter-arguments are mentioned on the wiki-page.

[DanBC]

> But think what it says about you if you are downvoting facts.

You posted something from 40 years ago.

[d0mine]

Do you think if the same experiment were to be repeated today; the results would be different?

The link mentions related experiments with similar results as recent as 2008.

Anyway, judging by "The Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition (DSM-5) (2013) there has been no paradigm shift in the last 40 years.

It seems DSM-5 is bad even by psychiatry's own standards. People use phrases like "false 'epidemics'" https://en.wikipedia.org/wiki/DSM-5#Criticism

New DSM-5 Ignores Biology of Mental Illness http://www.scientificamerican.com/article/new-dsm5-ignores-b...

[DanBC]

> Do you think if the same experiment were to be repeated today; the results would be different?

Yes. Big institutions have closed. Smaller hospitals replaced them and most people get treated in the community.

For example: my county has a population of about 600,000 people. About 4,500 people are on the books of the local MH trust at any time. There are only about 150 inpatient beds at any time.

People only go into hospital if they are a danger to themselves or others - hearing a voice that says "empty" or "hollow" or "thud" is not something anyone would be hospitalised for.

To get a diagnosis of schizophrenia you have to match the symptoms over a six month period and be assessed by the same doctor during that time. one of the benefits of the DSM / ICD is that doctors now use a set of standards when diagnosing mental illness.

The paper suggests that this is only a problem with psychiatry. This is something you hear from lot of people. "No test exists to diagnose a psychiatric illness, thus psychiatry is a sham. Look, I can get diagnosed if I lie to doctors!" This ignores the fact that there are a bunch of physical-health diseases you can get diagnosed with if you lie to doctors, but we don't call those a sham. Your link even talks about that:

> Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient's report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein, psychiatrist Robert Spitzer quoted Kety in a 1975 criticism of Rosenhan's study :[5]

>If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.

Your link mentions RD Laing in the lead. RD Laing is now thoroughly discredited. (Although he did have some interesting ideas). You should read some of his books.

> Many defended psychiatry, arguing that as psychiatric diagnosis relies largely on the patient's report of their experiences, faking their presence no more demonstrates problems with psychiatric diagnosis than lying about other medical symptoms. In this vein, psychiatrist Robert Spitzer quoted Kety in a 1975 criticism of Rosenhan's study :[5] If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.

> The link mentions related experiments with similar results as recent as 2008

No it does not.

There's a probable hoax from someone who can't provide any evidence, from 2004; and a totally different "experiment" (tv show) from 2008 where doctors were not allowed to interact with patients. You'd get similar results if the patients had physical health ailments.

[d0mine]

How does the closing of big institutions improve the scientific rigor of a psychiatric diagnosis?

The misunderstanding is probably my fault -- the message was too short. Let's establish the basics: There can't be any science if you can't measure. Reproducibility (replication): theory and experiment (prediction <-> measurement spiral) are corner stones that support each other and build on the language of math.

"the results" -- as the very first message I've posted on the topic says -- are about the reliability of psychiatric diagnoses. If we can't have that (an ability to measure) there is nothing to discuss.

On "150 inpatient beds" -- how many people are in jail instead? And again, how does it relate to scientific foundations of psychiatry?

Both "lye to the doctor" excuse and "bleeding peptic ulcer" are addressed on the very same wiki-page where the quotes come from.

"Your link mentions RD Laing in the lead. RD Laing is now thoroughly discredited." Here's the only occurrence of the name in the article:

"while listening to one of R. D. Laing's lectures that Rosenhan wondered if there was a way in which the reliability of psychiatric diagnoses could be tested experimentally."

Does "the lead" mean "an inspiration"? In what way precisely anything about RD Laing changes the results of Rosenhan experiment?

I can go on pointing out imprecise statements but it don't see the point. What would be nice to see is even a single reference to an experiment that shows that yes we can reliably diagnose psychiatric illnesses and here's what changed in out assumptions -- where is the paradigm shift?

On 2008 experiment: the result: "The experts correctly diagnosed two of the ten patients, misdiagnosed one patient, and incorrectly identified two healthy patients as having mental health problems. If you think that the result:

  psychiatric diagnoses are unreliable

is invalid due to the way the experiment was conducted (some methodological issues) then do point them out.

> doctors were not allowed to interact with patients.

Diagnosing a mental illness is a serious business with long term consequences. Have any of the "experts" refused to diagnose on the account of insufficient information? -- I don't know.

I'd like to be proven wrong and see psychiatry in the hard science camp.

Have I mentioned that psychiatric diagnoses are unreliable ;)

[boomlinde]

The facts you present don't support an answer to the above question.