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Slate book review: Is Psychiatry Dishonest? And if so, is it a noble lie?

Discussion in 'Other Health News and Research' started by Esther12, May 4, 2013.

  1. Esther12

    Esther12 Senior Member

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    I think that the caring promotion of noble dishonesty has had a rather destructive impact upon CFS, so this general interest review of a book about the new DSM could be of interest. Unlikely to be full of new ideas for people already interested in this area, but an easy to read intro, and some people may be interested in the book reviewed too. If a doctor decides that it's in my best interests to be lied to, I cannot imagine a way that could end well.

    http://www.slate.com/articles/arts/..._psychiatry_by_gary_greenberg_reviewed.2.html

    Is Psychiatry Dishonest?

    And if so, is it a noble lie?

    By Benjamin Nugent|Posted Friday, May 3, 2013, at 1:42 PM
    [​IMG]
    Illustration by Lisa Hanawalt
    When I think of psychiatry, my first thoughts are unkind. I think of mildly sad people on antidepressants. I think of upper-middle-class parents putting their kids on Ritalin as soon as they flunk math, or misremember the lyrics to Dave Matthews songs. Pills seem so overabundant in our country that it’s possible to forget there are Americans who really and desperately need a pharmacological fix for an illness of the mind.

    Early in The Book of Woe: The DSM and the Unmaking of Psychiatry, Gary Greenberg describes one such American, a patient who locks himself in a hotel room and gibbers into the phone that his family has sucked out his bones. People like this look to psychiatry for salvation, and so, Greenberg argues, we must save the profession from overreach and corruption. These twin problems have become so dire in the last few years that even pillars of the psychiatric establishment have started to howl in protest. The Book of Woe is the behind-the-scenes story of the new, fifth edition of the American Psychiatric Association’s bible, the DSM-5, and it’s entertaining in some of the same ways that Moby-Dick is entertaining. The psychiatrists Greenberg interviews are willful, sharp-tongued men—they are mostly men—stuck on the same rickety ship, trying to chart a common course, and bound for disaster.

    Greenberg quotes Melville, declaring that too many psychiatrists “cherish expectations with regard to some mode of infallibly discovering the heart of man.” (Melville was referring to “earnest psychologists,” but that’s because psychiatry didn’t yet exist as a profession.) He wants them to stop acting like they know the truth about their patients’ minds. The repository of their contested knowledge is the DSM, which stands for Diagnostic and Statistical Manual of Mental Disorders, a wildly profitable taxonomy of illnesses that costs $189 and projects an air of medical authority by defining disorders with lists of criteria. The problem with these disorders, Greenberg argues, is that they treat the mind like the body. Trying to make their profession look like any other branch of medicine, psychiatrists treat undefinable mental states like “anxiety” as if they were scarlet fever.
    For example, as of June 2011, the first three criteria for Generalized Anxiety Disorder (GAD) in a draft of the DSM-5 were:

    A. Excessive anxiety and worry (apprehensive expectation) about two (or more) domains of activities or events (e.g., family, health, finances, and school/work difficulties).
    B. The excessive anxiety and worry occurs on more days than not, for 3 months or more.
    C. The anxiety and worry are associated with one or more of the following symptoms:
    1. restlessness or feeling keyed up or on edge
    2. muscle tension

    With scarlet fever, you can trace the symptoms to the presence of strepococcus bacteria in the body. With GAD, you must hope that you and your patient are properly measuring unquantifiables like “excessive,” “restlessness,” and “keyed up.” Greenberg is a psychotherapist—as well as a widely published journalist and author—and he believes psychiatrists must make clear to patients that such disorders are not diseases but “provisional categories.” This, he predicts, will mean “fewer patients, more modest claims about what [psychiatry] treats, less clout with insurers, and reduced authority to turn our troubles into medical problems simply by adding the word disorder to their description.”

    He sees this humbling of the discipline as the path to an “honest psychiatry.” A nimble rhetorician, Greenberg implies that in its current state psychiatry is like the titular swindler of Melville’s The Confidence-Man, from which that “heart of man” quotation is drawn. Psychiatrists, he says, must learn restraint. They must say “I don’t know” more often. Because, from some angles, the profession looks like a confidence game. If it’s a scientific study of the mind, rather than simply a mirror of our cultural values, why was homosexuality listed as a disorder in the DSM until 1973? Go back even further in the annals of mental illness, and you find drapetomania, proposed by the New Orleans physician Samuel Cartwright in 1850: “the disease causing negros to run away.”

    Lest you believe we are in an era free from politically fraught mental disease, Greenberg notes that the DSM-5 looks set to apply Hoarding Disorder to people who collect piles of old newspapers, but not to people who collect astounding compensation packages while laying off employees. And lest you deem these concerns academic, Greenberg points out that psychiatrists hungry for grants from Big Pharma can, for instance, revise the boundaries of bipolar disorder so that disobedient toddlers are prescribed antipsychotics. Harvard psychiatrist Joseph Biederman advanced the notion of childhood bipolar disorder while accepting research funds from Johnson & Johnson, manufacturer of one of the antispsychotics often prescribed to the allegedly bipolar children. Eventually Sen. Chuck Grassley of Iowa ordered an investigation of Biederman’s activities and Harvard determined that Biederman violated its policies.

    Greenberg’s case is compelling. But he smartly devotes equal time to an alternative rescue plan advocated by Allen Frances, chief architect of the DSM’s previous edition, the DSM-IV. (The APA has switched from Roman to Arabic numerals.) Much of the drama in The Book of Woe flows from the tortured intellectual bromance of Greenberg and Frances, who are a bit like Ishmael and Ahab. Frances has a white whale he wants to slay, the DSM-5, which he considers rife with imprecision. He has launched a ferocious publicity campaign against it, arguing that its methodology must be overhauled if psychiatrists are to retain their credibility. Greenberg, like Ishmael, plays the bemused outsider. He’s not sure there should be a DSM at all. His role is mostly to stand by and watch the bloody spectacle.

    As presented by Greenberg, Frances’ view is that psychiatry can maintain the public trust and protect patients by being both more stringent and more open about the way mental disorders are defined. The DSM needs better field trials, clearer boundaries for many mental illnesses, and less deference to well-placed experts who want to get their off-the-cuff diagnoses in the book. He believes the manual-in-progress is full of the mischief he regrets allowing in DSM-IV: sloppy, poorly tested diagnostic categories and pet disorders promoted by insiders. Frances wants a “black-box warning about the dangers of overdiagnosis.”

    But—and this is where it gets really interesting—Greenberg depicts Frances as having much the same doubts about psychiatry’s fundamental scientific validity as Greenberg himself. He suspects that Frances, despite having supervised the writing of the DSM-IV, knows just as well as he does that psychiatry is “built on air.”

    But Frances says that if patients come to understand the limitations of psychiatry, they might fail “to do the calculation.” They might fail to conclude, “Well, maybe this isn’t perfect, but it’s still the best way available, and we shouldn’t just throw it out.” They might “get disillusioned and stop taking their medicine.” Frances wants to maintain the prestige of the profession until neuroscience improves, and “the complexity begins to clarify out of the mist.” Until then, “the full truth is usually best, but sometimes we may need a noble lie.” Frances, whom the New York Times once called “perhaps the most powerful psychiatrist in America,” understands, according to Greenberg, that because we cannot yet create “a taxonomy of disorders validated by biochemical findings,” psychiatry as we know it is a collection of fictions.

    Before I weigh in on Frances vs. Greenberg, I should note that Frances once wrote me an email saying nice things about an essay I wrote and asked me to contribute an autobiographical narrative to his book Saving Normal. That book, like The Book of Woe, is set to be published soon, around the same time as the DSM-5, and it too concerns the existential crisis confronting psychiatry. (I declined to contribute a piece.) I must also disclose that the essay Frances noticed makes an appearance in The Book of Woe. Recounting a flap over the news that the DSM-5’s authors might strike Asperger’s syndrome from the manual—they did, in the end, though they promised that many Asperger’s patients would qualify for treatment under “Autism Spectrum Disorder”—Greenberg recalls a New York Times op-ed “by Benjamin Nugent, a writer whose psychologist mother, an expert in Asperger’s, had gotten him diagnosed when he was a teenager, but who, after he ‘moved to New York City and … met some people who shared my obsessions,’ realized he wasn’t sick at all.”


    I bring this up in part because the experience of being incorrectly diagnosed has no doubt influenced my perspective on The Book of Woe. But I also mention it because Greenberg, who is an excellent, thoroughgoing reporter, makes an understandable slip in his summary of my essay. My mother hadn’t “gotten me diagnosed.” She’d arrived at my diagnosis herself, after consultations with teachers and experts dating back to my infancy. Starting when I was in pre-school, teachers called her into conferences to share their concerns about me. I liked to play by myself, bent over my little projects, and seemed not to hear when someone said something to me irrelevant to those projects. I jumped up and down and flapped my hands. I was a tree sloth on the soccer field. In elementary school I acquired a group of close friends, but was shy and bad at eye contact. Apparently, I was spooked by powerful smells and loud sounds. She consulted with a local expert on Asperger’s before the diagnosis was fashionable. Though I have no memory of this, she remembers reading aloud the criteria for Asperger’s from the DSM-IV when I was a teenager. In her recollection, I responded, “Sounds like me.” By then I was mostly just pretentious, but my mother hadn’t forgotten the behaviors I exhibited as a child. In our house, Greenberg’s view toward the DSM—that it shouldn’t be taken too seriously—prevailed. We, like Greenberg, were hippie Jews with dubious hairstyles who preferred narrative, psychoanalytic accounts of human suffering to diagnostic categories. By giving my suffering a name, my mother hoped to do me a service. When she put me in an educational video about Asperger’s a few years later—I agreed to be in it because I didn’t know what Asperger’s meant—she hoped she was doing Aspies an important service by showing them how normal an Aspie could be.

    But I was intuitive about social interaction, and Aspies aren’t. (If you want to write fiction about people sitting around and talking, as I do, it can be useful to have some intuitive sense of social interaction. Although an advocate for Aspies might retort that perhaps I’ve studied social interaction precisely because I lack an intuition for it.) My mother’s well-intentioned diagnosis didn’t do me any lasting harm, but for a while it made me more paranoid and insecure than I might have been. The other subjects in that educational video, boys chanting in monotones about Power Ranger dolls and sea-creatures, were allegedly my neurological brethren, albeit from a different place on the spectrum. At 30, I might have shrugged it off. But I watched the finished video at 22, when the transition from dork to hopefully-semi-cool Brooklynite and aspiring writer was recent, fragile, and all-important. It made me feel insane.

    This is why I’m sympathetic toward Frances’ argument that the DSM must retain its air of certainty, its command of the field, while also becoming more stringent about what it includes. My mother is a discerning psychologist who cares deeply about the happiness of her children. She’s disinclined to pathologize adolescent behavior. (When a counselor at my school diagnosed me with attention deficit disorder, she respected my refusal to takes meds, and I am grateful for that to this day.) But she, like many therapists in the late ’90s, embraced Asperger’s as an elastic category. As Greenberg recalls, Glenn Gould and Vladimir Nabokov and Ludwig Wittgenstein were “all diagnosed—posthumously of course—into a Hall of Fame that, depending on which website you consult, also includes Isaac Newton, Emily Dickinson, and Albert Einstein.” If the DSM’s criteria for Asperger’s had been more restrictive—if it had borne the kind of black-box warning against overdiagnosis that Frances favors—it might have spared me and my mother shouting matches. Or, rather, episodes in which I shouted at her and she calmly reconsidered her position.

    Of course, it was the DSM that launched the Asperger’s craze in the first place. The DSM-IV’s publication in 1994 was the moment the hitherto obscure disorder, which had never appeared in previous editions, entered the mainstream. Allen Frances feels responsible for the explosion of diagnoses; it was under his watch that the expansive DSM-IV criteria for Asperger’s made it in. (At the last minute, and, Frances tells Greenberg, too loosely defined). By “saving normal,” Frances means that he wants the next generation of psychiatrists to erect a bulwark against the wanton expansion of diagnostic boundaries.

    Whereas Greenberg sees more honor in frank ambiguity:

    “No one knows what would happen if psychiatrists simply let themselves out of their epistemic prison by no longer pretending to know what they can’t know. No one knows what would happen if they simply told you that they don’t know what illness (if any) is causing your anxiety or depression or agitation, and then, if they thought it was warranted, told you there are drugs that might help (although they don’t really know why or at what cost to the brain, or whether you will be able to stop taking them if you want to; nor can they guarantee that you—or your child—won’t become obese or diabetic or die early), and offer you a prescription.”

    That sounds pretty appealing when the examples you use are “anxiety or depression or agitation.” In fact, as Greenberg points out a page later, the above conversation is probably the one a lot of family doctors have with their patients when they prescribe antidepressants. But what if the example you use is the autism spectrum, and the patient is a kid? It seems problematic to tell a 10-year-old, or even a 20-year-old, that she might be on the autism spectrum. Can you imagine taking on adolescence while harboring the knowledge that you might be socially and/or cognitively impaired? Would you be able to say, “Aw hell, this quote-unquote disorder is just an intellectual construct anyway”? That strikes me as a situation in which transparent conjecture might cause substantial harm.

    And besides, a lot of medicine is mysterious, not just psychiatry. Doctors of all kinds are forced to make educated guesses as a matter of routine. They still try to follow an exacting set of common guidelines for treatment. Greenberg anticipates this argument, countering that “psychiatry, much more than other medical specialties, is still deeply in the debt of ancient medicine.” But he does not address the intrusion of politics and culture on all manner of healthcare. Surely the debate about whether childbirth should be medicalized is a cultural and political one. As is the fight over whether we should consider an ailing 95-year-old “sick,” when said 95-year-old demands constant medical attention and a poor 40-year-old can’t afford to see a doctor. If the difference between psychiatry and the rest of medicine is a matter of the degree of uncertainty, is psychiatry really trapped in its own “epistemic prison?”

    There is a reasonable case for a psychiatric bible designed to nip protestant speculation in the bud and written in a papal cast of mind. Greenberg argues persuasively that the current DSM encourages psychiatrists to reach beyond their competence. But perhaps we can save the DSM by making its definitions of mental illness stingy enough to encourage reticence. That DSM would not be hard science but a set of highly constrictive rules about what you are allowed to prescribe a patient and under what circumstances you’re allowed to evoke a diagnosis. It seems to me—and I am a novelist, not a mental health professional, and so have no dog in this fight, no drug company consulting gig, no claim on insurance payments to protect— that the DSM’s great purpose should be to curb the exuberance with which enterprising doctors and laymen invent, buy, and sell diagnoses for fun and profit. To be sure, this is a Kissingerian stance: Let’s prop up the dictator with the medals on his chest so long as he keeps the guerillas at bay. But if the DSM ceases to be the sourcebook doctors and patients use to determine the parameters of diagnoses, other sourcebooks will proliferate. Like those websites spreading the good news that Nabokov and Dickinson had Asperger’s.

    I’m impressed by Greenberg’s reporting, his subtlety of thought, his dedication to honesty, and his literacy. I made almost coital sounds of assent, reading The Book of Woe, when Greenberg rebutted public health bureaucrats with Melville. But I list toward Frances in the great debate Greenberg stages over how to save psychiatry. Greenberg has written a very good book. But before we kill off the DSM, let’s recall another line from the The Confidence-Man. It’s on page two: “Where the wolves are killed off, the foxes increase.”

    http://www.slate.com/articles/arts/..._psychiatry_by_gary_greenberg_reviewed.2.html
     
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  2. alex3619

    alex3619 Senior Member

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    Some of what is discussed here will feature in my book, though my path to similar conclusions is different and more formal. :) Greenberg is interesting to me. Transparency, accountability and embracing uncertainty, not denying it, are important.
     
  3. biophile

    biophile Places I'd rather be.

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    http://www.sciencedaily.com/releases/2013/04/130430105714.htm

    Over-Diagnosis and Over-Treatment of Depression Is Common in the U.S.

    ScienceDaily.com, Apr. 30, 2013 — Americans are over-diagnosed and over-treated for depression, according to a new study conducted at the Johns Hopkins Bloomberg School of Public Health. The study examines adults with clinician-identified depression and individuals who experienced major depressive episodes within a 12-month period. It found that when assessed for major depressive episodes using a structured interview, only 38.4 percent of adults with clinician-identified depression met the 12-month criteria for depression, despite the majority of participants being prescribed and using psychiatric medications. The results are featured in the April 2013 issue of Psychotherapy and Psychosomatics.

    "Depression over-diagnosis and over-treatment is common in the U.S. and frankly the numbers are staggering," said Ramin J. Mojtabai, PhD, author of the study and an associate professor with the Bloomberg School's Department of Mental Health. "Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication."

    Using a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, Mojtabai assessed clinician-identified depression based on questions about conditions that the participants were told they had by a doctor or other medical professional in the past 12 months. The study indicates that even among participants without a lifetime history of major or minor depression, a majority reported having taken prescription psychiatric medications.

    "A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians' uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes," said Mojtabai. "Previous evidence has highlighted the under-diagnosis and under-treatment of major depression in community settings. The new data suggest that the under-diagnosis and under-treatment of many who are in need of treatment occurs in conjunction with the over-diagnosis and over-treatment of others who do not need such treatment. There is a need for improved targeting of diagnosis and treatment of depression and other mental disorders in these settings."

    "Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses," was written by Ramin J. Mojtabai.
     
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  4. Sean

    Sean Senior Member

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    http://www.newscientist.com/article/dn23487-psychiatry-divided-as-mental-health-bible-denounced.html
    And here is the fun bit:
    "needs to be based on underlying science that is reliable,"

    :zippit:
     
  5. alex3619

    alex3619 Senior Member

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    Sean, I wonder how he views the irony?
     
  6. Sean

    Sean Senior Member

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    He is truly shameless.
     
  7. Merry

    Merry Senior Member

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    I'm a fan of Gary Greenberg and am glad to see -- just checked -- that the public library has already purchased seven copies of The Book of Woe.
     
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  8. Marco

    Marco Old blackguard

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    Thanks Esther.

    That was an entertaining and though provoking read.
     
  9. Esther12

    Esther12 Senior Member

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    Pleased to hear it was of interest. Thanks for those follow up articles too.
     
  10. PhoenixDown

    PhoenixDown Senior Member

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    Foxes like rheumatology, neurology? I don't mind those guys as much, they seem far more reasonable and less susceptible to selection bias, at the research level at least. They also don't use the cache 22 of "You're just saying that because you're trying to avoid a neurological diagnosis".
     
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  11. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Just had this link about the DSM-5 in Physician's First Watch:

    http://annals.org/article.aspx?articleid=1688399

    The piece in Physician's First Watch reads:

    DSM-5 Debuts to a Scornful Review in Annals, Skepticism from NIMH
    By Joe Elia

    The new, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been panned in an Annals of Internal Medicine commentary. The author, chair of the DSM-4 task force, advises that clinicians use it "cautiously, if at all."

    Separately, the director of the National Institute of Mental Health says that "patients with mental disorders deserve better." Late last month he wrote that the institute will be "re-orienting its research away from DSM categories" to focus on biomarkers of mental disease rather than clusters of symptoms.

    The Annals commentator seems especially disappointed with the proliferation of diagnoses "at the fuzzy boundary with normality." He says the result "will probably lead to substantial false-positive rates and unnecessary treatment." Perhaps most damning is his charge that the American Psychiatric Association has a financial conflict of interest driven by DSM revenues (the new edition costs about $200), which led to "premature publication of an incompletely tested and poorly edited product."

    It is very much at odds with what Wessely said in the recent BBC Radio 4 programme All In the Mind - see my second message here:

    http://forums.phoenixrising.me/index.php?threads/wessely-on-bbc-radio-psychology-programme.23104/
     
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  12. Shell

    Shell Senior Member

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    I saw that the man who "discovered" ADHD has said it doesn't really exist.

    And to quote my friend who has worked in (mainly forensic) psych for over 26 years, "It's all bollocks anyway." I think she has just about covered it.
     
  13. A.B.

    A.B. Senior Member

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    My two cents.

    The idea of psychosomatic illness came from a moralistic and religious view of illness being caused by sin (or in other words, character flaws).

    A psychiatric diagnosis is an anti-diagnosis. It is the absence of a diagnosis.

    Psychiatry and psychology both operate under the unproven assumption that so-called "mental illnesses" are brain disorders.

    From my point of view, the theories behind psychiatry and psychology are indistinguishable from superstition and thus ripe grounds for serial incompetence and abuse. I used to have faith and believe in the beautiful, empowering psychological theories which told me that I could solve every problem by merely thinking positively and admitting my "sins". After 13 years of illness, I now realize that this was a beautiful lie that did significant damage to my healthy by delaying the interventions that actually helped me. Every progress I have made was borne out of viewing my health problems as concrete, if undefined, physical illness and subsequently directing my efforts towards elucidating its nature with the imperfect tools of lab testing, reading, experimentation and trial and error.

    In other words, I think these professions are wildly out of touch with reality, which is not surprising considering they are not founded on reality either. Since the underlying theories are not falsifiable, they can persist and continue to seduce minds.
     
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  14. lansbergen

    lansbergen Senior Member

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    I agree
     
  15. alex3619

    alex3619 Senior Member

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    Hi A.B., Richard Webster in his book on Freud makes a good case that its really a religious viewpoint. Samuel Wales likens it to the Inquisition, the hunting of witches. I have called it a superstition myself, and some schools in psychiatry appear to function like a cult - the very notion of a "school" is a cult-like notion. Indeed I wrote a very satirical blog on this a few years back: http://forums.phoenixrising.me/index.php?entries/evil-spirit-therapy-for-cfs-a-satirical-chant.732/

    Yet its not that simple. Modern notions of science actually derive from the middle of last century. Much older notions of science, generally discredited and abandoned, linger on in psychiatry. Some subdisciplines in psychiatry (and I do not know how prevalent this really is) are practicing nineteenth century science, with a twenty first century gloss. There are good reasons why most sciences abandoned their approaches - they produce very poor science, and can be rife with dogma.

    There are also reasons why psychiatry did not fully abandon obsolete scientific methods. Many of the hypotheses underlying diagnosis and disease process in psychiatry are nonscientific: they cannot be tested. In the old school science this did not matter; since Karl Popper this has been increasingly discredited. Psychiatry needs to get out of the nineteenth century before it loses even more credibility than it has. Psychiatrists and the medical profession need to wake up to the failings of nonscience and begin to embrace modern science. Many are doing so, and movement has begun to advance psychiatry in this direction. The Old Guard, as usual, seem unwilling or unable to do this, though I note a few make vague agreeing comments while doing the exact opposite. I will not name names ... that might be in my book on this topic though.

    The Old Guard are also typically, well, older and have more power, more connections with the established authorities. There are so many political, social and economic factors at play that nobody has mapped them all out, and I doubt I can either - but I am going to try.

    There are solutions, but the big non-solution I am against is the biopsychosocial movement. Its a failure, and appears to survive only because its on political life support - its useful support for social agendas that many of us find morally repugnant.

    Alex.
     
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  16. Enid

    Enid Senior Member

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    It obviously is dishonest - can't see the point of this. But don't we all know it is lacking real science/medical knowledge as that increases - where are they - lost in some imagined land of their own making.
     
  17. A.B.

    A.B. Senior Member

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    What solutions do you see?
     
  18. Merry

    Merry Senior Member

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    If I hadn't read in the past couple of years Suzy Chapman's posts on the work underway to revise DSM (had I even been aware of DSM before her posts?), and if I hadn't already known what an engaging writer Gary Greenberg is, I probably would not have read The Book of Woe. My interest in psychology/psychiatry has long been marginal.* But The Book of Woe, I'm happy to report, is an enlightening and fun read. I laughed!

    Any of you who closely examined the numbers in the PACE trials -- and mapped the changing definition of recovery -- would, I'm sure, find especially entertaining a scene near the end when the revision committee presents to the public their success of the clinical field trials held to validate the breakthrough their revisions represent. The presenter (sorry, I can't recall her name, and the book has gone back to the library) gives a glowing report of the results -- in front of graphs that show that the results were dismal. When a New York Times blogger stands up to challenge her, the presenter stumbles about and admits that perhaps she could have chosen different adjectives. "This is appalling!" the blogger exclaims. He grabs his backpack and storms out.

    The Slate reviewer's characterization of the relationship between writer Gary Greenberg and Allen Frances as a bromance I can't agree with. Gary Greenberg's portrayal of the father of DSM-IV, and leader of the movement to condemn DSM-5 revisions, is not particularly flattering. For example, he describes how in conversation Alan Francis attempts to control opponents by pinching their cheeks and kissing them. Gary Greenberg himself got his cheeks pinched but, much to his relief, managed to escape the kissing.



    *I'd like to thank, however, the related field of neuroscience for giving me a framework for understanding the people who have treated me badly in spite of my chronic illness and because of it: the little fuckers are brain-damaged.
     
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  19. Enid

    Enid Senior Member

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    Phew - can we escape the kissing here and rely on real science/medicine please.
     
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  20. alex3619

    alex3619 Senior Member

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    This is the point of my book, and it will take me years to flesh them all out. How to achieve these goals might well be beyong me though .. this is big. What I want to start is a debate on how to do these things, and I do not mean amongst ME patients. Psychiatrists and psychologists, other doctors and scientists, who recognize the problems need to get involved ... this is already happening, but it needs much more. All these should be considered preliminary ideas only, though number 3 was scheduled to be a blog this month until I had to take a 3 month break.

    1. Open research findings - both data and papers freely downloadable - is essential.
    2. An end to legal privilege on psychiatric diagnoses in courts ... this is going to be hard to push for, and will require a global effort, which means not primarily ME patients. No diagnosis which has not been extensively objectively validated should be given any privilege in court. That specifically includes all psychosomatic diagnoses, none of which has any objective validation.
    3. A counter to psychobabble propaganda: we need a press release institute, a one stop shop for all neuroimmune biomedical and responsible press releases, including commentaries from doctors and leading advocacy organizations on everything. An online collaborative website will do. Then we need to promote it to the media, and always refer to it.
    4. An culture shift in medicine from cover-up to open enquiry. The medical professional bodies will almost fight against this idea tooth and nail.
    5. Open debate amongst scientists, and consequence free debate amongst doctors (no medical associations banning this) about the issues and possible solutions. This is happening already, sporadically, but this needs to be fostered.
    6. Direct challenge to poor management of medicine. Doctors need more control over what they do, in terms of economic and treatment decisions.
    7. Evidence based medicine needs to be made independent of government agencies, and discredited when it isn't. Government agencies can follow evidence based medicine, but they cannot be trusted to lead the charge.
    8. A recognition that medicine is largely unaccountable, there is essentially no effective governance. Medical issues need to be transparent and accoutable. In terms of governance at least, medicine needs to lose some power.
    9. A transfer of funding arrangements from big pharma and other players in research. Research should be independent - paid for by big pharma or whoever, but not conducted by them.
    10. Investigation of all proposals to improve the situation. Many of these are coming from within the medical community, there is growing realization that something is very wrong.
    11. A medical paradigm shift ... but I am not ready to talk about this one. Ask me in two years. What I will say is that the entire focus on research and patient interaction needs to change.

    Methods must also be investigated to halt the march of Zombie Science ... thats not going to be easy. Economic and political interests distort medical research and management.

    This is all work in progress. I don't start focussing on solutions to any extent till 2015 or later. This is a 10 year project and I am only in year 2. I have read a few proposed solutions, but most appear to be nonsense, and a few gems exist here and there, such as proposed mechanisms to open up research data for scrutiny. These will be in section four of my book, probably, due for release maybe 2020 or so. Section one is due to release in 2015, and will be primarily an overview and general discussion ... but a very long one.

    PS I almost forgot, section two will make a very credible case that psychosomatic medicine is pseudoscience, and pervasively distorted by logical fallacies ... thats not a solution exactly, but its a step toward one. Section one will introduce the general arguments and criteria I will be using.
     
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