Wednesday, April 6, 2011

There are Psychiatric Diagnoses and Then There is Reality

Reality is a hard thing to pin down sometimes.  Why do the stars spin in a circle overhead?  Why are the people born under the constellation of Scorpio always such jerks?

I suppose the scientific method comes in there somewhere.  But let’s face it, our empirically grounded bodies of knowledge have their limits.  We can be hopeful that we will continue to expand our horizons of knowledge, but knowing what we really know and how we know it is probably a good thing.  I mean, isn’t that part of the whole scientific endeavor?

Well, I know you agree with me, but can someone help me understand how this message got so mixed up in the field of psychology?  In psychology, “scientific findings” and diagnostic labels seem to be thrown around with about as much critical scrutiny as a gibbering glossolalic soliloquy might receive in the midst of a writhing Pentecostal congregation.

Among practitioners, it seems to me, that the diagnostic categories of the DSM are typically taken with several cobblestone-sized grains of salt.  Not so among journalists or among the ubiquitous faceless internet-based free-advice-givers with their pop-up ad business models.  Doubly not so among purveyors of “evidence-based” therapies who use flashy headlines from the world of scientific research to prove their wares (acupuncture, Blood-LettingÒ, Eye Movement Desensitization Reprogramming, etc.).

It bothers me, not a little, that DSM labels are thrown around the way they are and it troubles me that so many researchers build their research designs as if these committee-written categories are unquestionable real-world phenomena.  Does anyone really believe that there is a discrete Major Depressive Disorder that is a distinct and separate process from Dysthymia?  Even that most archetypal of mental disorders, Schizophrenia, is quite fuzzy around the edges, and there continues to be some question as to whether we are dealing with a single disease process or multiple phenomena with similar and overlapping symptoms.

It is a truism that, in young disciplines, where there is a dearth of causal understanding, we tend to fall back on simple categorization of observable phenomena.  That, in fact, accounts for every single mental health diagnosis now in use.  These are loose categories based on our sad attempts to group complex human behaviors into digestible and palatable portions that we can pretend to understand and try to get the insurance companies to swallow without puking all over us.

With the upcoming DSM-V we are going to realign our categories by shifting our bullet-item-symptoms from one list to another and rebranding our labels, but still we will end up with somewhat arbitrary diagnostic descriptions authored by compromising, wordsmithing  committees and deeply confounded by cultural assumptions, political correctness and insurance driven language games.

Some day, maybe, we will have our grand synthesis of psychology, neurology and genetics, but we are not there yet people.  Please let’s stop playing pretend.

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