Comments on: What Is the “Bible of Psychiatry” Supposed to Do? The Peculiar Challenges of an Uncertain Science

By: Zero Degrees Of Empathy by Simon Baron-Cohen « unfebuckinglievable

Zero Degrees Of Empathy by Simon Baron-Cohen « unfebuckinglievable — Wed, 10 Oct 2012 15:11:26 +0000

[...] more helpfully deal with them. (I think the way we classify “abnormal” behaviour is usually not very helpful as these classifications can become ends in themselves rather than simply targets of understanding. [...]

By: susurruss

susurruss — Fri, 15 Jun 2012 22:53:28 +0000

You fail to acknowledge the reason so many are calling for biological testing for mental illnesses. It is because of the phrase invented by psychiatrists: “chemical imbalance.” This catchphrase has been used so widely and for so many years, it is generally accepted to exist. It does not. Problem is, there is no known NORMAL brain chemical balance related to mental functionality, and no working test on living subjects has ever been devised. The vast majority of psychiatric drugs are marketed to ‘correct’ a ‘chemical imbalance’ that has never been proven to exist. This is what the true fight over the generalities in the DSM is about.

By: Lilgirlblue

Lilgirlblue — Sun, 10 Jun 2012 00:19:42 +0000

What a superb analogy – particularly the bit about analysing literature by the letter and character to come up with a definition that doesn’t necessarily map onto the genre really at all.

Through my psych studies I’ve started thinking about a great many things in terms of distance from a mean, and thinking of classification and categorisation in this manner has saved me a lot of mental wrangling when it comes to “is it X or is it not-X dammit” questions.

In this respect, this article reminded me of Eleanor Rosch’s work in categorisation. Technically, a chair and a fishtank are both furniture, and a sparrow and a penguin are both birds, but we tend to see the first as a more prototypical example, and the second as further from central definition of what we consider furniture. Or birds. Depending what you’re talking about. (Wow, writing this torturous paragraph has left me with even more respect for Mr. Mindhacks’ lucidity above!)

I think articles like this are tremendously important in ensuring that we think critically about what it is the DSM represents and what is designed to do. An understanding of its limitations is essential in order to exploit its strengths.

Additionally, Mindhacks rocks and I completely adore it!

By: Korthone

Korthone — Fri, 01 Jun 2012 17:23:20 +0000

Some of this I don’t agree with. Why is there a problem in defining “illness”/”disease”? It is very clear, really, that these terms should be used only when someone is disabled (unable to provide for oneself and fulfill basic social obligations) or when someone is seeking help with some condition (which may involve pain, etc.). Trying to define anything else as “illness” is a marketing ploy, which is particularly disgusting coming from among psychiatrists.

In reality, there can be a positive spin to medicine as a whole: instead of illness, doctors would encourage people to look for ways to increase one’s well-being. That is not to treat attention deficit, but to increase one’s attention. The difference is semantic but critical. Perhaps, in this way, our culture will become less sick.

By: canardtheduck

canardtheduck — Thu, 31 May 2012 06:55:29 +0000

Great summary of the challenges of devising a system of classification of psychiatric disorders. You do however fail to answer the most important question which is how valid are these disorders? Validity extends far beyond dysfunction and is not the same as utility Instead it speaks to the existence of these disorders in external nature. Psychiatric diagnoses for the most part are not valid. We assume the same process underlies what we see in patients with a similar diagnosis such as schizophrenia but this seems unlikely to be the case. That so much is invested in these diagnoses as valid constructs, guiding treatment, suggesting an etiology, identifying risk factors and so, suggests that DSM is more than just a framework or set of diagnostic guidelines that can be easily discarded.

By: Stanley Tolle

Stanley Tolle — Wed, 30 May 2012 22:47:19 +0000

One of the big mistakes that appears to be being made in the new diagnostic manual is the elimination of the Aspergers Diagnoses and its placement in the Autistic Spectrum category. As an adult who has been diagnosed with Aspergers I can attest that Aspergers is quite separate from Autism. In my case the little professor syndrome and the inability to socially connect was quite apparent. One of the things that is going on, though, is that conditions such as mine appear to be a developmental disorder. The brain is not quite wiring itself together properly ofter in the higher function part of the brain. Like in my case in areas of language communication and facial recognition, coordination there were extreme deficits. In other areas I appeared quite normal so an Autistic diagnose would not make sense.

What I do agree with is that the Developmental disorders appear to be related. While I have a Diagnosis of Aspergers this is not the only issue involved. I also have learning disabilities in the form of Dyslexia and ADD but excellent mechanical abilities. I also know of another individual who is Aspergic who has excellent writing skills but is completely befuddled by any thing mechanical. Both of us though have very similar social difficulties.

There is also the problem of the degree of impairment where the symptoms can vary from mild to extreme. I think this is where the diagnostic manual is having its problem with Aspergers. Since most people with Aspergers are relatively functional there is some thinking that these people are not sick but just a little out of the normal range. This I think is quite wrong since the people that I know that have this milder form of impairment are having real problems and that category such as Aspergers truly helps in obtaining assistance and understanding.

By: 3×5: Culture, Neuroscience, and Psychiatry Roundup | thefpr.org blog

3×5: Culture, Neuroscience, and Psychiatry Roundup | thefpr.org blog — Tue, 29 May 2012 16:50:02 +0000

[...] 4. Vaughan Bell’s 5/22/12 “What Is the Bible of Psychiatry Supposed to Do? The Peculiar Challenges of an Uncertain Science.” [...]

By: Tom Parmenter

Tom Parmenter — Tue, 29 May 2012 03:59:03 +0000

All this talk about the purpose of the DSM without mentioning one of the most common uses, coding the condition of the patient for the insurance companies. That is, you can charge for working on conditions named and numbered in the DSM. No other use is so important.

By: Theresa Meuse

Theresa Meuse — Fri, 25 May 2012 11:28:09 +0000

A presentation by a doctor talking about DSM-5 sayed that it does not include Executive Function disorders. How can this be? Many in the autism spectrum present themselves with EF disfuncion comorbidity. Not having seen the draft myself, I cannot comment further, but if does not metion EF, it makes me wonder what other things it might neglect as well.

By: Max

Max — Fri, 25 May 2012 00:47:08 +0000

In the course I had in the psychology of rheab I had both PhD Psychologist and a MD Psychiatrist, (no joke) names were Dr. Winer & Dr. Winer. I will never forget this statement
“Normal is a narrow line and we all walk on either side of that line.”
I say to physicians and my students ” Anyone can tell a compound fracture it is the variations less that that which are the hardest.”
I regret that so many have attacked this aspect of our health care at a time when I see more and more that are on the side of the rope that create problems for themselves and their families.
How about you use those analogies on heart disease, chronic pain etc.
You might want to expose your self to the SF-36+D and see where you are.