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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.
How else would you do it? Unlike an e.g. viral infection there is no positive test you can look at. Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. I don't think you can be totally objective about this, and you get into things like if i.e. autism is mild is it a disorder? It's pretty clear to me it should be considered as such after a certain level of severity, but maybe it shouldn't always be if it has minimal impact on the person
> The DSM in many ways represents the worst of so-called social science.
No. You need to read the thing.
The DSM only aims to be a tool to help standardize communication of often nebulous and otherwise ill-defined entities. It says so in the introductory pages.
People shouldn’t treat it like a biology textbook, it’s a self-described ontology at most.
>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
What's the alternative then? What would "empirically" determining what a "disorder" is look like?
>…by Americans
Most of the world outside of the US uses the ICD, not the DSM.
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...
The DSM isn't about understanding how the brain works, it's about correlating sets of symptoms to treatments. If your issues are characterized by this broad set of symptoms, then likely you'll benefit from these sorts of treatments, and etc. We don't have a good understanding of how the brain works, but we're pretty confident that people with schizophrenia often benefit from antipsychotic medications.
In some ways the financial conflicts of interest make sense, because the people that best understand a set of symptoms probably also are the ones in the best position to create new treatments. Being undisclosed makes it feel way more scummy than it might actually be.
That should be true across medicine. A biotech is best suited to invent new medications for existing diseases consulting with or acquiring in-house talent that knows the disease inside and out.
Experts generally benefit from their expertise. Nothing new, shouldn't be controversial.
It's hard to tell honestly. I studied psychology for two years in uni, and I dropped out rather disillusioned about the field. Some of my least favorite aspects included:
- Acknowledgement by our professors that P-hacking (pruning datasets to get the desired results) was not just common, but rampant
- One of our classes being thrown in limbo for several months after we found out that a bunch of foundational research underpinning it was entirely made up (See: Diederik Stapel).
- Experiencing first-hand just how unreproducible most research in our faculty was (SPSS was the norm, R was the exception, Python was unused).
- Learning that most psychology research is conducted on white psychology students in their early/mid-twenties in the EU and US. But the findings are broadly generalized across populations and cultures.
- Learning that the DSM-IV classified homosexuality as a mental disorder. Though the DSM-V has since dropped this.
Though I do generally hold psychologists in high regard (therapy is good), I'm not particularly impressed by psychology as a science. And in turn don't necessarily trust the DSM all that much.
The brain is certainly difficult to study, but does it not stand to reason that there should be a collection of the current understanding of how to treat things when they go wrong? No one is calling the DSM V the final, definitive, work, there's a reason it's numbered.
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.)
> 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?
Yes
This has been known to economists for a long time
Medicine generally has had its progress (as a general good) held back by misaligned incentives for a long time
See "neglected tropical diseases"
As true in psychiatry as anything else
The OP did ask that first question, but to me it read as being more rhetorical so that we could maybe get specific answers about what in the DSM-5 would have been written differently otherwise.
> As true in psychiatry as anything else
Wouldn't we expect it to be more true the fewer objective measures there are? Like if a treatment is supposed to improve blood sugar, and we can measure blood sugar cheaply in real time... we should expect misaligned incentives to have diminished effect compared to something where there is less ability to objectively measure, such as pretty much anything in psychiatry.
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.
What is an Axis II chemical disorder? I'm fairly certain that Axis II was personality disorders and intellectual disabilities in the DSM IV.
70% of people 60 years of age and older have high blood pressure[1], 50% of men regardless of age. Does this mean that our definition of high blood pressure needs work?
I'm not arguing that the DSM is perfect, but it's possible for something to be bad and also common. But I appreciate the "Keep taking your meds" sentiment as well, it has bigger problem overall, but it can still help people.
>I'm fairly certain that Axis II was personality disorders and intellectual disabilities in the DSM IV.
You are 100% correct, I thought personality disorders and typed chemical disorders for some reason. I'll leave the mistake so the thread makes sense.
> Does this mean that our definition of high blood pressure need work?
I think there's a difference between a disorder that is defined mechanistically and a disease that is only defined relatively. For example, if you're missing an arm, or at huge risk of stroke that's fairly obvious. However, if you are less happy than average, and more than 50% are also less happy then average... something is wrong with the math.
*EDIT* To make matters worse I should have said Axis 1 instead of 2. This is what I get for trying to remember a 20+ year old reference without citing it.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
Ok, so we're on the same page as to what we're referring to, but, to be clear, that 50% claim is incorrect[1], it's much lower than that.
Who is claiming that more than 50% of people are "less happy than average"? That's not a disorder. I'm fairly certain that the DSM doesn't make a claim like that, does the APA? It feels straw-manish.
I know that it's hard to diagnose these more intangible issues, but they are still very important regardless. If more than 50% of people in a society were unhappy, isn't it possible that the society is making them that way and it's not something wrong with the scale?
I tried to correct myself above, and included the source this time.
The actual statistic I was misremembering says that 50.8% of people will meet the requirements for an Axis 1 or higher diagnoses before the age of 75. You're right that it's important to be accurate. Mea Culpa.
To the actual point of my wildly incorrect claim: If most people are judged to be mentally ill at some point in their life, and most of the diagnoses can only be made relative to some baseline that's deemed to be "normal", isn't that just a different way of saying that it's "normal" to be mentally ill?
Most mental health diagnoses are transient. If half of people at some point experience diagnosable mental illness in their lives, that doesn't seem all that outlandish to me. Most of us will, at some point, have some kind of non-psychiatric illness, too.
You, and SketchySeaBeast, both make a good point.
I can't reply to Sketchy anymore (throttled maybe?), but I appreciate you both taking the time to have this conversation today. You've made me think a bit harder about something I've believed for 20+ years, and I think I agree now.
I don't think that it's incorrect at all to say that half of us will at some or multiple points in time suffer from some disorder, in fact I find it comforting to recognize that we will all go through this at some point.
We all go through rough patches that can make our mental health slip, just like we go through rough patches where our physical health slips. What's important is that we recognize when something is wrong and get the help we need.
Just like my first point, it's normal to be older and have high blood pressure, but if that's the case, you should probably be taking medication.
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It helps to think of these as clusters of symptoms or personality traits anyone might have, which occasionally interfere on your life enough to need treatment. A lot of mental illnesses aren't like a class of person but something that's happening to a person for a while
> If the majority of people are crazy, it's likely that our definition of "crazy" needs work.
you'd have to be crazy to not believe in demons
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Please keep nationalistic flamebait off this site. It leads to nationalistic flamewars, which we want to avoid here.
Surely this is a mistake dang? It's prima facie absurd and if not that unnecessarily stifling. The thread is already talking about the statistics of America, it's not flamebait to bring that up. One may disagree with op, but who would actually complain about it being added to the discussion itself? Doesn't creating a situation where something like this can't even be said more contribute to an atmosphere of passive aggressiveness than not?
Huh? And what is nationalistic flame bait about it? Speaking as someone living it.
There is a reason why depression, anxiety, and a host of other issues have escalated for decades, and nationalism has nothing to do with it.
(2024)
Added. Thanks!
When the APA elected Philip Zimbardo, creator of the infamous Stanford Prison Experiment (https://en.wikipedia.org/wiki/Stanford_prison_experiment#Cri...), as their president (https://www.apa.org/about/governance/president/bio-philip-zi...) they lost my trust. He came up with a hypothesis on human behavior, then did everything he could to force the data to reflect that, including coercing volunteers into torturing each other.
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.
The DSM-5 is from the "American Psychiatric Association".
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.
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Since we just asked you to stop breaking the site guidelines and you've continued to do it, I've banned this account.
If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.
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Please don't respond to a bad comment by breaking the site guidelines yourself. That only makes things worse.
Calling a comment "ridiculous" is against the guidelines?
Okay. Hopefully it isn't against the guidelines to say I think that's a silly guideline. Apparently saying "ridiculous" in response to a comment is very selectively enforced, must be my lucky day.
Anyways, this is probably the reminder I needed to stop commenting to HN. Some of the moderator decisions you guys are making lately are just.. way off base to me. Either you've changed or I have. Probably me.
Time to randomize the password. Cheers.
The HN mod's lust for power and control grows daily.
Thiel must really be tightening the screw.
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.
There's also the American Philosophical Association.
There used to be an American Philological Association, but they decided to change their name to the "Society for Classical Studies," because most people don't know the word "philology."
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What a surprise.
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