Psychiatric diagnosis 'scientifically meaningless

Freedive Ireland

https://www.sciencedirect.com/science/article/abs/pii/S0165178119309114?via%3Dihub

The Black Oil

Please contribute something to the discussion, don't just post a link.

Freedive Ireland

One of the authors was on Drivetime radio 1 yesterday evening. There is more and more of this type of research and pushback against the dominance of psychiatry in mental health. It will be a challenging time of transition for all concerned I think.

SuperRabbit

I don't see how a blanket statement like that is going to help anyone, in fact i would say it is harmful. Also it is not supported by the link you sent. In fact I don't know why that's allowed on the board. Is there no moderation? Would they let me say "scientists prove we should all stand on our heads" and then post a link to picture of a basket of puppies as evidence? I suppose maybe he said something about it on Drivetime?

A diagnosis is just a clue about what people who had similar problems found helpful before. For example lots of people who have the cluster of difficulties they call "bipolar" have had their lives saved by lithium, while some others have found it unhelpful. If you have a cluster of difficulties we call "OCD" we know that psychoanalysis will most likely harm you immensely and CBT will most likely help you, not that no one with OCD ever benefited psychoanalysis or CBT is guaranteed to work. So it's not scientifically meaningless, because the diagnosis + research helps us figure out what's statistically most likely to help someone who has a specific set of difficulties and psychiatrists make recommendations based on that.
Diagnosis also helps you reach out to other people who have the same difficulties and see what helped them and share experiences with someone who understands.

"All your suffering is infinitely complicated and we can't but you in a box or even begin to try to help you because you are so incredibly unique" oh lovely, thank you.

Tell me how

Last line of the abstract.

A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.

I had extensive experience over a 6 year period of being treated by various psychiatrists. All of them considered my diagnosis in the context of my individual experience. There is nothing new here. Rather it reads like something which can't be disputed as it is (in my experience) being practised already.

I have heard complaints from people that their particular psychiatrist didn't listen to them the way they wanted but, my personal view when talking to them was that they wanted the psychiatrist to diagnose or treat them in a particular way and were unhappy when they did not do so.

The Black Oil

Tell me how wrote: »

I have heard complaints from people that their particular psychiatrist didn't listen to them the way they wanted but, my personal view when talking to them was that they wanted the psychiatrist to diagnose or treat them in a particular way and were unhappy when they did not do so.

Dr Brendan Kelly touched on this when he was on the Tommy Tiernan show, early part of this clip 'desire to be labelled'.

https://www.youtube.com/watch?v=aPny6ypv8b8

Freedive Ireland

SuperRabbit wrote: »

I don't see how a blanket statement like that is going to help anyone, in fact i would say it is harmful. Also it is not supported by the link you sent. In fact I don't know why that's allowed on the board. Is there no moderation? Would they let me say "scientists prove we should all stand on our heads" and then post a link to picture of a basket of puppies as evidence? I suppose maybe he said something about it on Drivetime?
Maybe Psychiatry should have had provide evidence for when lobotomies were performed, for when insulin induced comas were performed, for when ECT was enforced oh wait we still do that just we've moved the electrodes around and now give you an anesthetic. Evidence for the rational of having homsexuality down as a treatable disorder. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/) Evidence for the long term use of SSRIs, no trust us again we kinda know what we are doing we just can't explain it fully.
https://www.moshersoteria.com/articles/resignation-from-apa/


A diagnosis is just a clue about what people who had similar problems found helpful before. For example lots of people who have the cluster of difficulties they call "bipolar" have had their lives saved by lithium, while some others have found it unhelpful. If you have a cluster of difficulties we call "OCD" we know that psychoanalysis will most likely harm you immensely and CBT will most likely help you, not that no one with OCD ever benefited psychoanalysis or CBT is guaranteed to work. So it's not scientifically meaningless, because the diagnosis + research helps us figure out what's statistically most likely to help someone who has a specific set of difficulties and psychiatrists make recommendations based on that.
Diagnosis also helps you reach out to other people who have the same difficulties and see what helped them and share experiences with someone who understands. (What's the one thing that bonds nearly every person with mental health distress?)

A diagnosis should be observable and repeatable to be scientific otherwise its an opinion. A certain score on your HBA1C means you have T2 diabetes. You can go to the GP next door and repeat the blood test, you'll get the same result. Not so with psychiatry. A diagnosis can mean many things to many people but that doesn't mean it's scientific.

"All your suffering is infinitely complicated and we can't but you in a box or even begin to try to help you because you are so incredibly unique" oh lovely, thank you.

You asked for evidence. https://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens-between-those-mental-illness-and-general-popula

Things are getting worse not better, but let's not challenge the status quo? The reason for posting was to have a discussion about it.

Freedive Ireland

The Black Oil wrote: »

Dr Brendan Kelly touched on this when he was on the Tommy Tiernan show, early part of this clip 'desire to be labelled'.

https://www.youtube.com/watch?v=aPny6ypv8b8

So does that make it right or scientific? Often (imho) it lets society off the hook.
In a few years time when the kids that are currently developing and growing up in hotel rooms enter mental health services, will we acknowledge that what happened to them shouldn't have happened or will they be diagnosed and given medication?
Also while many families go through tremendous hardship with a family member others are the initial cause of the distress. Sometimes mad people don't seem so mad when you see them in the family dynamic.

Black Swan

"Psychiatric diagnosis" is at the case study level of analysis. Generally speaking, this level is restricted to individuals, and may not be representative of populations. If someone like Freud attempts to generalise his results to a population from a non-random convenience sample of patients, he commits an ecological fallacy, jumping from one unit of analysis to another (e.g., Civilization and Its Discontents). He also lacks a random selection in his patients. For example, women patients were drawn from those who could pay his fees, suggesting a bias selection method, and no controls for comparative measurement purposes.

Is there any value in the case study method? It generally falls within the qualitative research domain, where phenomenology, ethnography, and grounded theory have been used to guide such researches. When first examining a phenomenon where little or no scholarly research has been conducted, qualitative methods may lead the way, later followed by more rigourous research designs and methods, often multi-method or quantitative.

The Black Oil

Medication is sometimes used because CAMHS isn't sufficiently developed in an area, so GPs turn to the prescription pad rather than turn people away with nothing. That's been the case in the UK.

I haven't particularly come across what Dr. Kelly said in mental health, but more so in education.

I don't know if there have been any studies that have followed children during the recession, outside of an economic lens.

SuperRabbit

Black Swan wrote: »

"Psychiatric diagnosis" is at the case study level of analysis. Generally speaking, this level is restricted to individuals, and may not be representative of populations. If someone like Freud attempts to generalise his results to a population from a non-random convenience sample of patients, he commits an ecological fallacy, jumping from one unit of analysis to another (e.g., Civilization and Its Discontents). He also lacks a random selection in his patients. For example, women patients were drawn from those who could pay his fees, suggesting a bias selection method, and no controls for comparative measurement purposes.

Is there any value in the case study method? It generally falls within the qualitative research domain, where phenomenology, ethnography, and grounded theory have been used to guide such researches. When first examining a phenomenon where little or no scholarly research has been conducted, qualitative methods may lead the way, later followed by more rigourous research designs and methods, often multi-method or quantitative.

The DSM is no longer influenced by psychoanalytic theory and hasn't been in a long time, though there are some terms that survive from those days, like "Borderline" for example. Psychoanalysis is one type of talk therapy, not one I am a big fan of for many reasons, including the ones you listed, but anyway it doesn't work with diagnosis any more and is not related to psychiatric diagnosis.

There have been RCTs done on psychoanalysis, it has changed a lot since Freud. All the RCTs show it is generally better than nothing, but we could spent a whole thread debating whether the research shows it is better than other types of therapy or better than placebo. It has nothing to do with this thread and psychiatric diagnosis.

Freedive Ireland

SuperRabbit wrote: »

The DSM is no longer influenced by psychoanalytic theory and hasn't been in a long time

Curious as to what is the biggest influence on the DSM?

SuperRabbit

It's an interesting question but could you say what you mean by "the biggest"? Do you mean what kind of training do psychiatrists in the US get nowadays? Do you mean what is the professional philosophy of the APA? Do you mean what influences each individual disorder? That question is so broad and there aren't any psychiatrists here to give a full answer

For example for ages they said people with Borderline Personality Disorder were untreatable (because they hadn't found a reliable way to help yet) and lumped loads of people in together under that umbrella, now that they have treatments they are discussing renaming the disorder (EDD) and breaking it into subtypes, so in that case the researchers who came up with the therapies, DBT especially, are the ones who are influencing that discussion and maybe it will be renamed and have subtypes when DSM 6 comes out (in the distant future). If it gets renamed you could say that Marsha Linehan was the "biggest" influence on that one page in the DSM, but it will have had thousands of influences as so much research is being done on DBT and BPD with different types of therapies and meds

Freedive Ireland

Imho, I'd argue that the biggest influence are the pharma companies. Again I'd refer to the APA's Presidents resignation letter. The removal of the grief exception, explored somewhat here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/
although I'd agree the paper doesn't strengthen my argument 100%. It's the medicalisation of the human condition I see as the biggest influence.

E.g from a real life example. Person being physically and emotionally abused by a family member, resulting in anxiety and depression. The answer here (to my mind) is to deal with/remove the family member, (I appreciate that's easier to type than to do). Instead the abused has been sent to see a psychiatrist to help them deal with their resulting feelings and who, unless they are lucky, will more than be given medication.
There is only one winner from this situation and it's repeated regularly.

Johan Harri's Lost Connections, Robert Whitakers, Anatomy of an epidemic and Bessel Van Der Kolks, The Body keeps the score all argue along the same lines. I'm aware of Harri's past misdemeanors.
For the record I'm not anti-medication but am anti the dominance of it.

Freedive Ireland

SuperRabbit wrote: »

It's an interesting question but could you say what you mean by "the biggest"? Do you mean what kind of training do psychiatrists in the US get nowadays? Do you mean what is the professional philosophy of the APA? Do you mean what influences each individual disorder? That question is so broad and there aren't any psychiatrists here to give a full answer

Almost every presentation I have seen by a visiting psychiatrist has been sponsered as has their research. They have flashed up and I mean flashed up a slide with their funding listed and in the same breath asked us to "hopefully" take what they say as impartial and unbiased.
The individual disorders really are subjective and hence people have end up with numerous diagnoses. I take issue with the term disorder. From my experience it has been a normal reaction to an abnormal situation. It would be a disordered person if they went through some trauma and carried on as nothing had happened.
I'm about 5% open to the idea of a medical disease in some cases but that was a higher percentage in the past. All the evidence I have witnessed is making that % smaller and smaller.

Freedive Ireland

Worth a watch
https://www.youtube.com/watch?v=cQ4fSa18de8

The Black Oil

Freedive Ireland wrote: »

One of the authors was on Drivetime radio 1 yesterday evening. There is more and more of this type of research and pushback against the dominance of psychiatry in mental health. It will be a challenging time of transition for all concerned I think.

Do you know his/her name? I had look at the podcasts page, didn't spot anything. Here's a Guardian piece about it anyway. https://www.theguardian.com/commentisfree/2019/jul/09/mental-health-diagnosis-patient-story

Sheridan81

In my personal experience, psychiatry and psychology are absolute bollocks.

Gremlinertia

Sheridan81 wrote: »

In my personal experience, psychiatry and psychology are absolute bollocks.

I have felt the same, i get frustrated with the process i really need something but it doesn't always feel linear.. What have you gon through or given up on?.

Freedive Ireland

The Black Oil wrote: »

Do you know his/her name? I had look at the podcasts page, didn't spot anything. Here's a Guardian piece about it anyway. https://www.theguardian.com/commentisfree/2019/jul/09/mental-health-diagnosis-patient-story

Yes it was Kate Allsop, one of the authors.
In the same paper,
https://www.theguardian.com/science/2019/jul/12/ketamine-like-drug-for-depression-could-get-uk-licence-within-the-year

This article should have a paid for advertorial warning on it. Look at the language as it tries to explain it. "seems to," "thought to", " appears to act" there is nothing new in ketamine just now it's in a spray and is heralded as something wonderful.
"Ketamine is now the prototype of the future generation of antidepressants that will have rapid robust effects within a few hours and are long lasting"

I find it incredible that someone could make such a statement and our old serotonin friend is trotted out once again just to re-enforce the now debunked but still useful chemical imbalance theory. There is some counter balance at the end of the article to be fair.

Sheridan81

Gremlinertia wrote: »

I have felt the same, i get frustrated with the process i really need something but it doesn't always feel linear.. What have you gon through or given up on?.

I won't go there. I'll just say that I have never met a bigger bunch of charlatans than those within the profession.

Freedive Ireland

Sheridan81 wrote: »

I won't go there. I'll just say that I have never met a bigger bunch of charlatans than those within the profession.

Sorry to hear that Sheridan. There are some excellent people in psychiatry imho. Unfortunately change is difficult and takes time when some people don't have time.

SuperRabbit

If psychology as a whole was bollox coca-cola wouldn't have taken over the world with carbonated sugar water, but I am open to the idea that parts of psychology may be utter bollox

vriesmays

Anything based on statistics usually is.

SuperRabbit

We so agree on that, I'd love to take away the name disorder. I'd love to call it, for example "Post traumatic stress treatment pathway" and you'd come away from the psychiatrist saying "She says PTSD treatment will probably help me".

What's wrong with multiple diagnosis? I can't have the flu because I have dyslexia?

Or if we reword it, doesn't it make sense we have multiple treatment pathways considering how complicated people are