IS Psychiatry mostly non-scientific?

Snowdrop

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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
 

trishrhymes

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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!
 
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alex3619

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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.
 

Sidereal

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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.
 

trishrhymes

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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.
 

Sidereal

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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.
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.
 

trishrhymes

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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.
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.
 

Snowdrop

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

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.
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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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.
 

Snowdrop

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

The Row
Following ongoing, rumbling tension a heated row has erupted between UK psychologists and funders this week. It is over the allocation of funding to mental illness research. Apparently funding bodies such as the Medical Research Council (MRC) have been allocating millions of pounds of funding to the biological side of mental illness and almost nothing to psychological or social elements. The figure quoted is that only 3% of funding goes to psychological research on mental illness. This is clearly counterintuitive. However valid the BPS Model is, it is at least relevant to study psychology in mental illness, as well as biology.

There are political and social justice implications to this bias, which are largely beyond the scope of this post. For example, if the main causes of depression are factors such as childhood trauma and unemployment then this can’t be fixed easily by cheap approaches such as CBT, it requires long term psychotherapy or massive feats such creating full employment.

You can read more in this Telegraph article or listen to this BBC radio Today Show episode.

Relevance to ME
Paradoxically and confusingly, using the BPS Model for ME has led to almost exclusively PsychoSocial research in the UK. From 1990 to 2012 no proper biomedical studies on ME/CFS were funded by the UK Medical Research Council. The MRC funded 5 small studies in 2012, but no further studies were funded in 2013 or 2014, clearly indicating to researchers that this continues to be an unsupported area to specialise in. The UK government spent more money on immediate repair of Eastbourne pier than 30 years of biomedical research for ME (thanks go to Graham McPhee for some of these statistics).

This focus on PsychoSocial research has often made people with ME furious because we keep saying that we are not mentally ill*. However, a tongue-in-cheek reading of the news this week may indicate funders don’t think it’s mental illness after all or we’d be getting biomedical research! Perhaps we’ve been barking up the wrong tree…
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.
 

alex3619

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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.
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.
 

Solstice

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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.
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.
 

Barry53

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The general public has been lead to believe that a diagnosis of mental disorder is the same as a legitimate medical diagnosis of disease, which is false. This is common knowledge among psychiatrists, but not something they often admit to the public at large, simply because it is the foundation upon which psychiatry is built. The fact is, all mental disorders are contained within psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and are arrived upon by psychiatrists literally voting on what is, or is not, considered a mental disorder. Unlike the rest of medicine, mental disorders are arrived at by a political, not medical process. The statements above are not opinion. In the United States, the nation’s leading mental health organization is the National Institute of Mental Health (NIMH), and this is what the head of NIMH stated in 2013:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary…. 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.” — Thomas Insel, Director of the National Institute of Mental Health
Not a bad summing up.