His whole career revelved around promoting strategies for policing and incarceration that clearly don't work, and the APA celebrated him for it. They have a huge bias toword the notion that everyone needs their help. Problems with the DSM wouldn't matter so much, if the APA hadn't shoehorned themselves, and their bible of the DSM, into countless aspects of government and healthcare.
so ... apa ...the apa that writes the dsm-5, psychiatric disorders, the medical group, is the american PSYCHIATRIC assn.
the psychologists, they never went to medical school, so despite forming an organization and many publications, have little to do with diagnostic standards for medical doctors.
for clarity: THERE ARE TWO APA, the one written about in the article is not the same as the one in this comment.
Sometime in the early 2000's we passed a point where more than 50% of the population had an AXIS 2 or higher chemical disorder[1]. It was around this point that I became skeptical of the DSM.
If the majority of people are crazy, it's likely that our definition of "crazy" needs work.
That said, the situation isn't as dire as some folks with a vested interest would have you believe... If you're reading this and you're someone who needs to hear it: Keep taking your medicine! They'll work the kinks out eventually, and even if there is a conspiracy, it isn't against you personally.
[1] I meant personality disorder. Leaving the mistake to avoid making the thread confusing.
So these folks are implying that the rework of the DSM-4 into DSM-5 was tainted in some way by association of the authors with pharma or other industries? Do I understand that correctly?
Is there an example that anyone has pointed to where DSM-5 could have been written differently, to the detriment of a commercial enterprise? (What little I've read in the DSM-5 is enough to leave one with glazed eyes.)
I wonder how much of the DSM is based on loose correlations, non-replicated or fraudulent research.
I get the feeling that we understand how our brains work about as well as we understand how well mitochondria work - - and I see reports of new findings on mitochondria fairly regularly...
What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.
My inability of being in nature without a feeling of being tortured comes from my brain not working correctly and it's not "undesired behavior". Luckily, my ADHD meds are able to fix that.
> The most common type of payment was for food and beverages (90.9%) followed by travel (69.1%).
If I am a doctor on a task force, I'm not wasting my time doing that paperwork. Also, this essentially means that nearly every doctor would be in scope.
Why does psychiatry need to have an ‘equivalent’ of a sprained ankle?
Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first hand in patients I see.
To diagnose 'narcissistic personality disorder (NPD)' you have to be an Olympic class athlete of the ice who skates effortlessly around and between the edges of frozen lakes of "people I just do not like".
The DSM diagnostic categories are glorified billing codes that everybody (who actually has real ground contact with mental health care for real for real) recognizes as primitive, Stone Age relics.
In five or ten years, these categories will feel like missteps of the past (akin to calling all mental illness “hysteria”).
In principle, those being accused of a conflict of interest in the creation of DSM-5 could argue that, because the DSM is science-based, it's open to impartial statistical analyses and comparison with established scientific theory that would render moot any such accusation.
But the accused can't offer that defense, because the DSM is not based in science, and that in turn is because because human psychology isn't based in science.
The field of human psychology includes many scientific studies, some of them excellent, up to the point where a testable, falsifiable theory might be crafted based on those studies, but it stops there. Here's why:
For a study to be regarded as science, it must meet certain established standards, and many psychology studies meet or exceed those standards.
But for a field to be regarded as science, its practitioners must craft testable, falsifiable theories, based on natural phenomena, about their topic of study. Human psychology cannot do this, for the simple reason that human psychology studies the mind, and the mind is not part of nature.
In scientific fields, physics for example, a conflict-of-interest accusation is easily resolved: either a claim can be tested and potentially falsified by comparison with the field's defining theories, or it cannot (cold fusion comes to mind). But in psychology this doesn't work, because a claim cannot be compared to the field's testable, falsifiable scientific theories, theories that define the field, because ... wait for it ... such theories don't exist.
And how could such theories exist? Again, human psychology studies the mind, legitimate science must focus on natural (not supernatural) phenomena, and the mind doesn't meet that description -- it's not part of nature.
Neuroscience doesn't have these structural problems, it may someday replace psychology, but we're not there yet, and may not be for decades to come.
The DSM is a bunch of nonsense. As long as they don’t provide physical mechanisms for disorders, it’s worthless. It clusters symptoms without knowing the underlying causes.
It’s like going to the doctor with a runny nose, who the claims it’s influenza, due to the runny nose, without testing for Covid.
You are wrong. Medicine does not need physical mechanisms for any diagnosis or therapy. It is preferable but not obligatory. A mere grouping of a symptom cluster forms a diagnosis as well as a therapeutic target.
I am doctor recieving financial support for over two decades. This is a weak and fragile correlation between unspecified financial support and a specific role of a doctor.
1) the support might be given for totally different purposes
2) how much directed material value can a _Diagnostic_ suggestion bring? Follow the editors of therapeutic protocols and you might find something
3) there are a dozen other more problematic arguments about DSM. Eg the choice of the panel comes before any support.
Easy to check by looking at records how DSM was worked on. Evidence of how financial conflicts translated into diagnostic expansion:
The Bereavement Exclusion Smoking Gun
100% of the DSM-IV mood disorders work group had financial ties to pharmaceutical companies Mad In America . This same group eliminated the bereavement exclusion in DSM-5, allowing normal grief to be diagnosed as major depression after just two weeks.
Kenneth Kendler, speaking for the group, explicitly argued “Either the grief exclusion criterion needs to be eliminated or extended so that no depression that arises in the setting of adversity would be diagnosable” Mad In America - essentially arguing that context should be irrelevant to psychiatric diagnosis.
This change was “perhaps the most controversial change from DSM-IV to DSM-5” PubMed Central and critics argued it would “result in an increasing number of persons with normal grief to be inappropriately diagnosed with MDD after only two weeks of depressive symptoms” American Academy of Family Physicians and lead to unnecessary antidepressant prescribing.
The ADHD Expansion:
DSM-5 systematically lowered ADHD diagnostic thresholds:
- Reduced symptom threshold from 6 to 5 symptoms for adults/adolescents over 17 PubMed Central Neurodivergent Insights
- Increased age of onset requirement from 7 to 12 years old Neurodivergent Insights
- Lowered impairment criteria - now only need to “reduce quality of functioning” rather than be “clinically significant” PubMed Central
Critics specifically identified ADHD expansion as worsening the “false positive problem” by “expanding diagnosis to adults before addressing its reliability in children”
27 comments
[ 2.5 ms ] story [ 60.1 ms ] threadHis whole career revelved around promoting strategies for policing and incarceration that clearly don't work, and the APA celebrated him for it. They have a huge bias toword the notion that everyone needs their help. Problems with the DSM wouldn't matter so much, if the APA hadn't shoehorned themselves, and their bible of the DSM, into countless aspects of government and healthcare.
the psychologists, they never went to medical school, so despite forming an organization and many publications, have little to do with diagnostic standards for medical doctors.
for clarity: THERE ARE TWO APA, the one written about in the article is not the same as the one in this comment.
Phillip Zimbardo, and the link you linked to, are the "American Psychological Association".
These are two different associations.
Theresa Miskimen is the president of the American Psychiatric Association, not Zimbardo.
If the majority of people are crazy, it's likely that our definition of "crazy" needs work.
That said, the situation isn't as dire as some folks with a vested interest would have you believe... If you're reading this and you're someone who needs to hear it: Keep taking your medicine! They'll work the kinks out eventually, and even if there is a conspiracy, it isn't against you personally.
[1] I meant personality disorder. Leaving the mistake to avoid making the thread confusing.
Is there an example that anyone has pointed to where DSM-5 could have been written differently, to the detriment of a commercial enterprise? (What little I've read in the DSM-5 is enough to leave one with glazed eyes.)
I get the feeling that we understand how our brains work about as well as we understand how well mitochondria work - - and I see reports of new findings on mitochondria fairly regularly...
If I am a doctor on a task force, I'm not wasting my time doing that paperwork. Also, this essentially means that nearly every doctor would be in scope.
Rather than define an objective measure of the problem, they (by definition) effectively define the percentage of the population affected.
In other words, osteopenia is defined in such a way that it is not curable, preventable, etc.
What is the point saying, “disease X affects 5% of the population by definition”.
It’s like throwing away half the resumes for a job position and saying we don’t hire unlucky people…
While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider:
What’s the psychiatric equivalent of a sprained ankle?
Does something have to be catastrophic to warrant a diagnosis?
Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first hand in patients I see.
Not sleeping a night.
In five or ten years, these categories will feel like missteps of the past (akin to calling all mental illness “hysteria”).
But the accused can't offer that defense, because the DSM is not based in science, and that in turn is because because human psychology isn't based in science.
The field of human psychology includes many scientific studies, some of them excellent, up to the point where a testable, falsifiable theory might be crafted based on those studies, but it stops there. Here's why:
For a study to be regarded as science, it must meet certain established standards, and many psychology studies meet or exceed those standards.
But for a field to be regarded as science, its practitioners must craft testable, falsifiable theories, based on natural phenomena, about their topic of study. Human psychology cannot do this, for the simple reason that human psychology studies the mind, and the mind is not part of nature.
In scientific fields, physics for example, a conflict-of-interest accusation is easily resolved: either a claim can be tested and potentially falsified by comparison with the field's defining theories, or it cannot (cold fusion comes to mind). But in psychology this doesn't work, because a claim cannot be compared to the field's testable, falsifiable scientific theories, theories that define the field, because ... wait for it ... such theories don't exist.
And how could such theories exist? Again, human psychology studies the mind, legitimate science must focus on natural (not supernatural) phenomena, and the mind doesn't meet that description -- it's not part of nature.
Neuroscience doesn't have these structural problems, it may someday replace psychology, but we're not there yet, and may not be for decades to come.
It’s like going to the doctor with a runny nose, who the claims it’s influenza, due to the runny nose, without testing for Covid.
1) the support might be given for totally different purposes
2) how much directed material value can a _Diagnostic_ suggestion bring? Follow the editors of therapeutic protocols and you might find something
3) there are a dozen other more problematic arguments about DSM. Eg the choice of the panel comes before any support.
The Bereavement Exclusion Smoking Gun 100% of the DSM-IV mood disorders work group had financial ties to pharmaceutical companies Mad In America . This same group eliminated the bereavement exclusion in DSM-5, allowing normal grief to be diagnosed as major depression after just two weeks. Kenneth Kendler, speaking for the group, explicitly argued “Either the grief exclusion criterion needs to be eliminated or extended so that no depression that arises in the setting of adversity would be diagnosable” Mad In America - essentially arguing that context should be irrelevant to psychiatric diagnosis. This change was “perhaps the most controversial change from DSM-IV to DSM-5” PubMed Central and critics argued it would “result in an increasing number of persons with normal grief to be inappropriately diagnosed with MDD after only two weeks of depressive symptoms” American Academy of Family Physicians and lead to unnecessary antidepressant prescribing.
The ADHD Expansion: DSM-5 systematically lowered ADHD diagnostic thresholds: - Reduced symptom threshold from 6 to 5 symptoms for adults/adolescents over 17 PubMed Central Neurodivergent Insights - Increased age of onset requirement from 7 to 12 years old Neurodivergent Insights - Lowered impairment criteria - now only need to “reduce quality of functioning” rather than be “clinically significant” PubMed Central Critics specifically identified ADHD expansion as worsening the “false positive problem” by “expanding diagnosis to adults before addressing its reliability in children”