aphar: (lambda)
[personal profile] aphar
Looks like I am not alone in being unhappy with the DSM approach:

2013: NIMH director says the DSM lacks biological validity in its diagnoses:
Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

2017: Insel brought to NIMH a commitment to finding neurochemical and other quantifiable markers for psychiatric disorders rather than relying on behavior and self-reported feelings:
I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.

Any volunteers to repeat the Rosenhan experiment? (Note that modern drugs are probably much more powerful than those used 40 years ago, so the experiment is much more dangerous!)

Date: 2017-05-15 09:20 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
@(Note that modern drugs are much more powerful than those used 40 years ago, so the experiment is much more dangerous!)@

btw, where did you get this from?

Date: 2017-05-15 10:03 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
I am suggesting that your phrase has so many layers and meanings that I am hesitant to say what i can possibly think about it.

drugs are different, there are NOT more powerful.
if anything, they are LESS powerful, they are generally MILDER, more directed to particular receptors with fewer side effects

Side effects are more closely monitored then decades ago.

the approaches to hospitalization are different, much more autonomy. it is not that simple to get admitted.
i have not idea what do you mean by "conservative"

and so on...

I have gone through Psych Emergency as a part of my training, and I know quite a bit about Psych and drugs and complications
Edited Date: 2017-05-15 10:12 pm (UTC)

Date: 2017-05-15 10:16 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
3. why not?

Date: 2017-05-15 10:20 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
you made 3 statements

i referred to the 3d one

Date: 2017-05-15 10:24 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
1. " drugs are different, there are NOT more powerful.
if anything, they are LESS powerful, with fewer side effects
Nice to hear this!

2. the approaches to hospitalization are different, much more autonomy
could you please be more specific?

3. i have not idea what do you mean by "conservative"
don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary.

Date: 2017-05-15 10:30 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
"don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary." - is a statement

i have no interest talking about semantics
you understood me well

if you do not want to converse - just say so
придирки к словам мне не интересны
мне интересно только по существу

Date: 2017-05-15 10:40 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
i wrote "why not?" on you statement starting with "do not..."
reasons: i. it is a common practice to prescribe medications even before the final diagnosis is made, ii. the reaction to a specific treatment is a part of a diagnostic process; iii. trial treatment is an acceptable strategy


"are you saying that it's good to be "conservative"?"
i am saying that i did not know what do you mean by "conservative"
prescibe less? prescibe more? withhold prescription?

Date: 2017-05-15 11:24 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
the paradigm has changed

45 years ago - prescription meant an order
now days it is a suggestions

a patient is under no obligation to take the medication
it is up to an expert to make a general judgement based on his/her expertise how diagnose and what to prescribe
it is NOT to an expert to make a judgement (or a decision) for a patient to take or not to take

ps
although I am still amused with your fascination of positive/normative - I personally do not care much

Date: 2017-05-16 12:07 am (UTC)
signamax: (Default)
From: [personal profile] signamax
@Yes, I think that, given possible irreversible effects on the patient's mind, the aggressive prescription policy you describe is unwarranted.@

you are entitled to you opinion and you are entitled (as any patient) to your autonomy - to take or not to take the prescribed medication.

your opinion, however, how and what to prescribe has very little value in this field of expertise, similar to the value of a psychiatrist’s opinion in your field of expertise.

Date: 2017-05-15 10:28 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
Q: what is the statement (as opposed to "definition") are you referring to?

A: "don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary."

Date: 2017-05-15 10:19 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
i never claimed to be computer savvy

did you understand that it was a quote?

Date: 2017-05-15 10:23 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
no I do not understand - or care - how to quote "correctly" as long as I am understood.

Date: 2017-05-15 10:36 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
well... if you think that my attitude is cavalier/arrogant than i should just stop talking to you

i had/have no intention to be arrogant (with you or anybody else) and if you perceive me as such, you should have told me earlier.

а я то думаю почему не получается нормального разговора
я говорю по существу а ты мне отвечаешь какими то passive aggressive придирками
ну и закончим
не по существу мне говорить неинтересно
мне было интересно твое мнение и я совершенно не держал в голове что все это время ты переживаешь мой cavalier attitude to communications.

на этом можно и закончить
когда будешь желание поговорить по сущестсву - тогда и поговорим

Date: 2017-05-15 10:49 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
1. following your advice I looked up the word cavalier which came in my search as a synonym to arrogant

2. @You are not even re-reading what you wrote@ - presumptions. false

Date: 2017-05-16 12:05 am (UTC)
signamax: (Default)
From: [personal profile] signamax
@The second line offers the obviously more relevant meaning.@
I cannot read your mind
what is obvious to you, is not obvious to me and vise versa

@However, on the second thought, the "arrogant" is also applicable@ - see
I guess I was right first time around.

@If you did, you would have fixed the many typos.@ - why?
why do you assume that I would do that?

@Why do you think that your reader's time is less valuable than yours?@
1. i do not think about it at all
2. I watch my time, a reader watches his/her time. my time is more valuable to me, reader’s time is more valuable to a reader. I do my best to be understood, but if I am not I am OK with that. you are under no obligation to read or respond to smth that irritates you. it is your free choice.

like i said, if you think that I am cavalier in first or second meaning i rather avoid talking to you.
мне нравится доброжелательно разговаривать с доброжелательными людьми которые не выискивают в том что я говорю typos
собственно я всегда разговариваю с людьми доброжелательно - this is my default
Yes, i have been informed that SOME people tend to misunderstand me and perceive me as “arrogant”. I have accepted this fact - there always will be SOME people who would think this way.
It bothers me no longer.
Basically, the choice is yours - you either accept the default fact that I am NOT arrogant towards you (and to anyone else for that matter), or you keep thinking that way, in which case I do not see much point of communication.

simple example - this post
my comment to your post was curiosity - i really did not understand how did you draw such general conclusions based on the interview with that guy.
To me - and I know the field a little bit - the field has a lot of challenges, but there is a HUGE progress for the past few decades in terms of diagnostics, treatment, prevention, and prognostication. basically, there was none back then.
Something is not perfect? well - it’s the nature of science and medicine - it will NEVER be perfect.
What the guys says - usual speech of highly-knowledgeable highly-specialized expert who had his share of struggle in science and bureaucracy - he exaggerates things and uses figures of speech. I was under the impression that you have taken his figures of speech literally. I asked you “why?” Maybe you know something I do not know? that’s all.
I am pretty surprised with the way the conversation turned out.

Date: 2017-05-16 01:38 pm (UTC)
ymarkov: (Default)
From: [personal profile] ymarkov
Вы знаете, господа, это я далеко не первый раз вижу, как разговор двух умных, образованных людей распадается из-за разнобоя в стиле онлайн общения.

Date: 2017-05-16 07:19 pm (UTC)
signamax: (Default)
From: [personal profile] signamax
бывает

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