Diagnosis

dsmThe Diagnostic and Statistical Manual, widely known as the bible of psychiatric medicine, is under revision and the American Psychiatric Association is accepting public comment at a new website.

Medpage Today reports that the revision has already been changed several times in response to these comments. These include several areas within the Sexual and Gender Identities categories, and modifications to the criteria for adjustment disorders and eating disorders.

By contrast, the American Physical Society is not asking the general public to weigh in on the prospects for supersymmetry, nor is the American Economic Association surveying the general public on the properties of dynamic stochastic general equilibria. So much for any pretense that psychiatry is a science.

Hat tip to Tom Amoroso, who called this to my attention though he might not endorse this commentary.

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17 Responses to “Diagnosis”


  1. 1 1 dave

    hrm.. i think your critique is a bit hasty. the dsm is like a cladistics manual or a field guide to mushrooms. for psychiatric science i think you would need to look at their journal which i would assume someone like myself would have a hard time getting words into.
    besides…we do not know the origin of the comments that predicated the changes.

    *refuses to give up his tin-foil hat*

  2. 2 2 Doctor Memory

    I’m going to assume you have your mathematician hat on here, not your economist hat. Glass houses and all that. :)

    (And hell, the snark is probably justified either way, but it’s best to occasionally recall that the systematic study of human psychology is, at best, about a century old. Versus physics, it’s maaaaaybe at the “organized alchemy” stage. Call me in another couple of centuries and maybe the point will actually be settled.)

  3. 3 3 Harold

    DSM tries to do what Victorian taxonomists did, and organise complicated things into groups with little understanding of the underying mechanisms. With the benefit of molecular science, we now know the Victorian taxonomists got quite a lot wrong, deceived by surface similarities. Psychiatrists today are also hindered by companies with very large vested interests in certain classifications. Imagine if Johnson and Johnson or Pfizer had of had a major interest in classifying the duck billed platypus as a type of duck. Whatever we like to think, big money does affect the conduct of science, and I suppose this consultation is a way to give at least the appearance of “balancing” the input. I agree that it reveals how unscientific the whole enterprise is.

  4. 4 4 Steve Landsburg

    Doctor Memory: Do you know of a case of economists turning to the general public to settle a question of economics?

  5. 5 5 Thomas A. Amoroso

    Oh, I don’t have a whole lot of love for psychiatrists, believe me. The best ones were, in general, real doctors before they chose to become psychiatrists, in me experience. And I have a jaundiced view of their scientific achievements, on the whole.

    There *may* be something to be said for the idea that people with what are, on the whole, fairly stigmatizing disorders might have some ideas about how they’d like them described. You can use some painful language, or language which is a little more conciliatory. So it depends on how they’re using the feedback, and there are edge cases which can be judgement calls.

    From the look of the thing, though, they are entirely willing to change the definition of a diagnosis to placate the interest groups, and I’m not down with that, myself.

  6. 6 6 Ken B

    Social science: noun. That field of human endeavour where any proposition may be proven with the appropriate survey.

  7. 7 7 Rocky Humbert

    Just last month you wrote: “Blogging… may also be changing the face of mathematical research. For the first time ever, a substantial mathematical problem has been solved via an accumulation of blog comments, all building on each other. Could this be the future of mathematical research?” (April 8th)

    You don’t seem to have a problem with the “public” contributing to mathematical progress. So one must conclude that you are either being logically inconsistent, or you just don’t like psychiatrists.

  8. 8 8 Diggle

    How I wish that the IAU considered public opinion when they said Pluto was not a planet.

  9. 9 9 Mike

    Regardless of whether or not you believe psychiatry is a science, there is some value to a large supply of input. As long as the APA is willing to sift through the mountains of garbage, why is it a bad thing for them to take a Wiki approach to their revision?

    Furthermore, would it be a bad thing for APS or AEA to ask for input in the same format? Borrowing from your recent entry regarding the difference between readers at various websites (I believed you compared this blog’s responses to emails you’d received for hating America publicly on Fox News), there is a high probability that the type of people that are going to take the time to try and impact those organizations are typically going to be people who care about and thus are at least somewhat knowledgable on the subject.

    One final point, even though you’re the expert on “Big Questions” such as physical reality, you asked us common-folk for input on your upcomming debate on religion. That seemed to go well for you (just saying…)

  10. 10 10 Dan

    @Harold: Wow, you cut right to the point. “DSM tries to do what Victorian taxonomists did, and organise complicated things into groups with little understanding of the underying mechanisms.” Great comparison.

  11. 11 11 Jonathan Kariv

    @Rocky: That is a really good point. I think there is slight difference between the 2 though.

    Which is that for the tic-tac-toe problem the only people likely to try and contribute (or find the blogpage at all) are members of the mathematical community. I realize this is a fuzzy distinction.

    Also I do have to admit to not knowing who is likely to hear about the psychiatric thing.

  12. 12 12 Ken B

    @Rocky
    Did Landsburg ask people to vote on which solutions they liked?

  13. 13 13 Rocky Humbert

    @KenB
    I believe the answer is negative. However, Professor Landsburg insinuates that the editor’s soliciting (but not necessarily incorporating) input from outside the cloisters of psychiatry somehow demonstrates that psychiatrists are not scientists.

    One notes that the Professor has himself written widely about mathematics, economics and philosphy. The world would be worse if his insights were summarily dismissed simply because his PhD was in the wrong field.

    Lastly, I note that the editors of the DSM did not include a condition affectionately known as Landsburgism. While the etiology, symptoms, and treatment are left as an exercise for the reader, I’m pleased to report that the prognosis for recovery is excellent.

  14. 14 14 S.V.

    In economics, they are trying to do experiments on people, and according to the results, they can settle a question in economics. Even the “rational man” dogma.

  15. 15 15 dave

    on a lighter note, it is the psychologists that have illuminated how malleable the human mind is.

    http://en.wikipedia.org/wiki/Milgram_experiment

    arent advertising and marketing the psychological branches of economics?

    hehe. dismal science.. ;]

  16. 16 16 neil wilson

    So much for any pretense that psychiatry is a science.

    Steven: Maybe economists don’t ask the general public for answers but it is absurd to think that economists agree on a set of facts.

    We are still arguing over the causes of the Civil War. We are still arguing over the causes of the Great Depression.

    We are arguing whether the tax cuts of 1981 hurt the economy while the tax increases of 1982 helped the economy.

    My view is that major phased in tax cuts actually cause recessions like they did in 1981 and 2001.

    Art Laffer had an article in the Wall Street Journal, I think, in the late 90′s, I think, where he said that since we knew that Income was going on sale in 82 and an even bigger sale in 83 that people put off “buying” income until 83. The market took off in August 82, more than 4 months ahead of the economy.

    Anyway, my point is that you are nuts for criticizing psychiatry when you claim that economics is only slightly better.

  17. 17 17 Patricia

    I’ve been told by psychiatrists that the DSM was originally formed for bureacratic rather than medical reasons – to categorise government funding into different streams, without scientific basis. Diagnoses are in lists grouped on arbitrary themes not necessarily organic distinctions.

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