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IS Psychiatry mostly non-scientific?

Discussion in 'Other Health News and Research' started by Snowdrop, Feb 14, 2017.

  1. Snowdrop

    Snowdrop Rebel without a biscuit

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    This is not specific to ME. I have briefly perused the topic and found a few articles on the subject that might be of interest.

    They are too long for me to have done anything more than scan the content. It may be that this thread will not be very active if the articles prove too long for others but I thought at least to open up the subject and to offer up the articles as a resource to be referenced.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843011/

    This is particularly long but I think it covers some interesting ideas.

    https://www.cchrint.org/psychiatric...cians-on-lack-of-any-medicalscientific-tests/

    http://www.newyorker.com/tech/elements/does-psychiatry-need-science
     
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  2. trishrhymes

    trishrhymes Senior Member

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    Wow, that New Yorker article really pins down psychiatry's reluctance to consider biological scientific evidence. Skewers the whole BPS thing without actually mentioning it, the focus for the article being melancholia. Fascinating.

    EDIT: Later posts from more knowledgeable folk tell me the NY article is rubbish. Shows how gullible I can be!
     
    Last edited: Feb 16, 2017
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  3. lilpink

    lilpink Senior Member

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  4. Molly98

    Molly98 Senior Member

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    WOW!!!
    That is quite mind blowing and extraordinary while at the same time being very familiar and close to home.
    I think this kinda ends the discussion quite conclusively.
    Question answered.
     
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  5. alex3619

    alex3619 Senior Member

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    I will have to check out the links but its about time for me to get some shuteye. Over time actually. However I think its a trick question. If the question were to be is most of psychiatry lacking in sound science I think I would answer it differently, with a tentative yes. As it stands it implies all or none, and I don't think we can say all of psychiatry is unscientific. What we can say is that, in general, psychiatric professionals appear to accept unscientific psychiatry without any public qualms. That has to change.
     
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  6. Sidereal

    Sidereal Senior Member

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    The bit about melancholia is complete nonsense. :lol: Same old dexamethasone suppression test crap being trotted out by a small group of people who can't let go of what they thought they knew in the 1970s. I'm not saying that the DSM category of major depressive disorder has any scientific validity (it doesn't). It's just that whatever way people have tried to slice and dice depression into "subsets" has never worked out. Similar to how many people get overwhelmed by the complexity of clinical presentation of ME/CFS and think it must be made up of different diseases.
     
  7. trishrhymes

    trishrhymes Senior Member

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    Thanks, @Sidereal. Just shows how people ignorant about a field (like me) can be misled...

    A pity, I was very taken with the thesis of the New Yorker article that melancholy was rejected because the psychs couldn't accept biomedical findings for one illness when all the others are defined purely by observation and symptoms.
     
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  8. Sidereal

    Sidereal Senior Member

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    Pretty much everyone working in academic/research psychiatry is interested in biological markers of disease and treatment response. Biological psychiatry is the ruling paradigm in the field and has been for decades now. The purported diagnostic test for 'melancholia' was rejected because it has low sensitivity and specificity, not because there is an organised conspiracy against biomedical findings. People who reject the DSM diagnoses have no viable alternative to offer, just some pie in the sky bullshitting about endophenotypes.

    The NY article is complete nonsense by a journalist who knows nothing.
     
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  9. trishrhymes

    trishrhymes Senior Member

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    Thanks again, @Sidereal for putting me right. I should know better than believing something written by a journalist just because I liked the idea!
     
  10. trishrhymes

    trishrhymes Senior Member

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    So that means Wessely and co are even out of step with psychiatry, since they are implacably opposed to any biomedical tests having any meaning in ME, and assess their studies entirely on questionnaires.

    Ah, but I'm forgetting, for them ME isn't a psychiatric illness. It isn't an illness at all. It's just false illness beliefs and deconditioning.
     
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  11. Sidereal

    Sidereal Senior Member

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    Exactly.
     
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  12. Snowdrop

    Snowdrop Rebel without a biscuit

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    I'm not functioning well but I'll try to respond to my own thread.

    I'm not sure this is the case. SW has opined that he wished neuroscience was a part of psychiatry back when he was studying. Neurology despite it's sounding very scientific seems to be full of half baked ideas from psychology when it comes to explaining neurological tests.

    I expect that SW would do anything in his power to stop the kind of testing being done in say Metabolomics (he might try to downplay the validity of said) but neurology holds such promise for making the biological into psychological. I know very little about neurology but it would be good if we could find someone to give us a layman's primer on what the limits are to neurology's ability to diagnose.

    Re: @alex3619 I have amended the title.

    Re: @lilpink I read the first half or so of wiki article. It seems to me that it only highlights the fact that there is no good and conclusive way to diagnose schizophrenia. The subjects did indicate that they had auditory hallucinations indicative of such so not surprising that medics felt they needed treatment for that. Schizophrenia is still mostly unknown territory so they would not feel comfortable just accepting a simple resolution of symptoms.

    What would be more interesting is if the subjects presented with physical symptoms that indicted some known biological illness --but included a psychiatric symptom to see how they then fared.

    Mostly I was surprised they were released so fast. Such is my expectation of psychiatric help.

    @Sidereal highlights the fact that those whose job it is to treat depression waaaay over reach in declaring what is actually known about the illness.
     
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  13. arewenearlythereyet

    arewenearlythereyet Senior Member

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    I think science is defined by key parameters of logic, hypothesis , testing protocols to validate the idea, leveraging established knowledge, isolating variables etc.

    I've never considered psychiatry as a form of science, probably due to my own ignorance. It just seems to a layman more like philosophy where you come up with a series of concepts that are clustered around a premise that often doesn't get validation or testing?. This tends to make practice more under the influence of opinion rather than evidence based. It seems that concepts fall in and out of fashion rather than stick because they are logical and correct.

    If there are psychiatric specialists that apply scientific principles, then I would call them scientists. For those that don't I would call them philosophers or bad scientists (there are a lot of these about).

    I think psychiatry has a role in complementary therapy alongside neuroscience and endocrinology etc for some conditions, and if properly regulated it can do good. I worry that there is a lot of poor practitioners out there using unvalidated methods and concepts that are damaging vulnerable people who deserve better.
     
  14. Snowdrop

    Snowdrop Rebel without a biscuit

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  15. Snowdrop

    Snowdrop Rebel without a biscuit

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    There is of course potential for psychiatry to do a great deal of good. Sadly, we have not yet discovered enough about the illnesses of the mind for there to be anything beyond rudimentary treatment. Although even this can at least enhance Quality of Life for some.

    I would argue too that what is missing when dealing with mental illnesses in particular is compassion. Some lovely caring individuals may exist but the system does not encourage a view of compassion IMO (although this is off topic re the science).

    The new problem will be 'evidence based medicine' which is a very good idea that will be abused by shoddy research masquerading as evidence. The science community needs to be more vigilant in this regard.
     
  16. Jenny TipsforME

    Jenny TipsforME Senior Member

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    From a blog post I wrote a few months ago https://tipsforme.wordpress.com/2016/03/31/paradoxicalfunding/

    I have no spoon left to comment further right now but this seems relevant to the thread.

    * to avoid misunderstanding, we're not furious because we don't want people to think we're mentally ill but because ME is not mental illness. I've come across plenty of people with ME who are also comfortable being open about comorbid depression or anxiety (usually secondary as a consequence of the repercussions of chronic illness). We object to miscategorisation which delays appropriate research and prevents effective treatment.
     
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  17. alex3619

    alex3619 Senior Member

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    I describe it as a very good idea but very poor implementation. The PACE trial fiasco, amongst other issues, shows how easily EBM can be manipulated. So do the NICE guidelines on ME and CFS. Its clear that these are really managerial processes, and not scientific ones, to a large extent. It really hurts that some doctors do not seem to understand EBM and use it as yet another way to legitimize medical dogma.
     
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  18. Snowdrop

    Snowdrop Rebel without a biscuit

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    Pointing out this distinction helps. I think if it was presented to medics as such they'd understand that from a more general life experience.
     
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  19. Solstice

    Solstice Senior Member

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    I'm starting to wonder that with all the new methods of research coming up, psychiatric disease might turn out to be physical disease that affects the brains. For M.E. there are clear effects on the brain like brain fog, slower cognition etc. It seems like when we finally get to the root of the problem, those effects will be mediated. Not by psychiatric treatment, but maybe by treating the gut, the immune system or whatever. I can imagine this being true for most "diseases of the brain" for lack of a better term from my part.
     
  20. Barry53

    Barry53 Senior Member

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    Not a bad summing up.
     
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