Psychiatry: DSM vs. biological reality
May. 15th, 2017 11:33 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
apharLooks like I am not alone in being unhappy with the DSM approach:
2013: NIMH director says the DSM lacks biological validity in its diagnoses:
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:
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!)
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!)
no subject
Date: 2017-05-15 09:20 pm (UTC)btw, where did you get this from?
no subject
Date: 2017-05-15 09:58 pm (UTC)are you suggesting that modern psychiatrists are more conservative than their colleagues 45 years ago?
no subject
Date: 2017-05-15 10:03 pm (UTC)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
no subject
Date: 2017-05-15 10:15 pm (UTC)Nice to hear this!
could you please be more specific?
don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary.
no subject
Date: 2017-05-15 10:16 pm (UTC)no subject
Date: 2017-05-15 10:19 pm (UTC)huh?
no subject
Date: 2017-05-15 10:20 pm (UTC)i referred to the 3d one
no subject
Date: 2017-05-15 10:23 pm (UTC)what is the statement (as opposed to "definition") are you referring to?
no subject
Date: 2017-05-15 10:24 pm (UTC)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.
no subject
Date: 2017-05-15 10:28 pm (UTC)The first is a "comment".
The second is a "question".
The third is a "definition" (of a term "conservative").
I don't see how your can be applied to the definition.
no subject
Date: 2017-05-15 10:30 pm (UTC)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
no subject
Date: 2017-05-15 10:34 pm (UTC)really.
seriously.
honestly.
are you saying that it's good to be "conservative"?
bad?
they are not conservative?
they are?
can you write a complete grammatical sentence explaining what you were thinking when you wrote those two words?
no subject
Date: 2017-05-15 10:40 pm (UTC)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?
no subject
Date: 2017-05-15 10:54 pm (UTC)Finally we are talking. :-)
Yes, I think that, given possible irreversible effects on the patient's mind, the aggressive prescription policy you describe is unwarranted.
See, this is exactly the continuation of our previous conversation: normative is not necessarily the domain exclusive to the experts.
no subject
Date: 2017-05-15 11:24 pm (UTC)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
no subject
Date: 2017-05-16 12:07 am (UTC)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.
no subject
Date: 2017-05-15 10:28 pm (UTC)A: "don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary."
no subject
Date: 2017-05-15 10:18 pm (UTC)@(...)@notation, but the accepted standard is to use the<q>tag, you can select text and click on thequotebutton to get that automatically.no subject
Date: 2017-05-15 10:19 pm (UTC)did you understand that it was a quote?
no subject
Date: 2017-05-15 10:21 pm (UTC)how is that relevant to what I said?
do you understand how to quote correctly?
no subject
Date: 2017-05-15 10:23 pm (UTC)no subject
Date: 2017-05-15 10:25 pm (UTC)In that case I do not understand you.
PS. This is actually a good illustration of your cavalier attitude to communications.
You seem to think that I should be guessing at what you mean instead of using accepted terminology.
no subject
Date: 2017-05-15 10:36 pm (UTC)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
no subject
Date: 2017-05-15 10:47 pm (UTC)Please look up the word "cavalier" (небрежный).
It is not synonymous with "arrogant" (высокомерный).
You are not even re-reading what you wrote, so I don't understand what you are saying, and I have no intention to guess.
no subject
Date: 2017-05-15 10:49 pm (UTC)2. @You are not even re-reading what you wrote@ - presumptions. false
no subject
Date: 2017-05-15 10:58 pm (UTC)And, again, you should not have stopped at the first line.
The second line offers the obviously more relevant meaning.
However, on the second thought, the "arrogant" is also applicable:
If you did, you would have fixed the many typos.
You see, each typo is a burden either on the author (having to fix it) or on the reader (having to guess what was meant).
Why do you think that your reader's time is less valuable than yours?
no subject
Date: 2017-05-16 12:05 am (UTC)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.
no subject
Date: 2017-05-16 01:38 pm (UTC)no subject
Date: 2017-05-16 07:19 pm (UTC)