Psychologists Start Petition Against DSM 5

xtraordinaryevidence · **#21** by **xtraordinaryevidence** » Dec 12, 2011 10:10 pm

Grace wrote:My brother and sister were RUINED by psychiatric quackery. No child should EVER be placed on multipharma!

"we do have evidence that quite a few psychological disorders can indeed be treated." You betcha -- LOL!

If anecdotes are enough, the SNRI I am on has undoubtedly improved my condition and got my SAD under control. Therefore, if the circumstances permit, patients should ALWAYS be put on pharmaceuticals.

Who is correct? :think:

van00uber · **#22** by **van00uber** » Jan 29, 2012 7:29 pm

I prefer the ICD-10 tbh

orpheus · **#23** by **orpheus** » Jan 29, 2012 8:50 pm

Mr.Samsa wrote:
Grace wrote:Here's the reality. There is no cure for mental illness. Why is that? People spend $100,000, and 10 years in therapy without any benefit whatsoever when the money runs out and the time is up. There is no distortion to the reality. Too many people now days know of people who suffer from mental illness without receiving any lasting help. Families and friends are frustrated when the mentally ill slide to rock bottom without a job or assistance, or commit suicide out of desperation. The only people who seem to be happy are the pharmaceuticals and the filthy rich in psychiatry who are enjoying their fancy cars and expensive homes. What a racket.

*snip*

3) "The only people who seem to be happy are the pharmaceuticals and the filthy rich in psychiatry who are enjoying their fancy cars and expensive homes.": This is a double misconception. Firstly, a significant number of people who work in the mental health field (i.e. psychologists) cannot prescribe medication. This means that there is absolutely no advantage or benefit to them for doing so. Pharma reps don't target them because they have nothing to give them. So why do psychologists still continue to get their patients set up on medication sometimes? The clear answer is that the evidence unarguably demonstrates that medication is an effective form of treatment, at least for some conditions and sometimes in combination with therapy. The second part of the misconception here, following on from the first, is that medication isn't the only treatment for mental disorders. And why should it be, considering that a large number of mental disorders are not biologically caused.

I'd add that there is another category of people who seem to be happy: the many people whose mental illnesses are being effectively treated by pharmaceuticals. (Me among them.)

orpheus · **#24** by **orpheus** » Jan 29, 2012 8:52 pm

I've said it before in these threads, and I'll say it again: I would not be alive were it not for psychiatric medication.

And given that there is at present no cure for bipolar disorder, I'll stick with effective treatment* that keeps me alive and allows me to have an active, balanced, full and productive life.

So there's another personal anecdote to put into the mix.

*My treatment includes a combination of medications as well as regular, ongoing talk therapy.

Asta666 · **#25** by **Asta666** » May 05, 2012 7:04 pm

I see a lot of problems with the DSM and I think that it ignores pretty much all psychological research data. That claim that it is for "interdisciplinary use" and that is does not "subscribe to any theory" to me it's just an excuse because they have not yet found any consistent biological markers for the disorders, as the petition says. ¿Does that imply that we should ignore all research from psychology? ¿What's the point of having a diagnostic manual that does not take into account neither causal biological factors nor psychological ones and does not suggest any treatment guidelines? ¿What are we diagnosing then, that you suffer a combination of symptoms that statistically seem to generally appear together?
Empirical psychology basically proposes 3 etiological factors: current and past environment, schemas and personality traits (maybe 4 if we include intelligence). It also has good methods for assessing them. All of these would basically suggest a broad dimensional approach with strong consideration of contextual and social variables. But it is all that seems to be going to be ignored or reduced in the DSM V! Also based on these factors, psychologists don't need by any means as many distinct disorders as the ones listed in the DSM IV, to design a treatment plan.
So I don't see the point in using it, besides looking more like medical doctors. I think psychologists should use their own diagnostic methods based on the research data available from their discipline, even more given the fact that many psychological treatments work as well as drugs for many problems, also based on research data.
As the petition says: "We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers."
"“… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”
There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”"
To me this mess reflects the inner contradiction of psychiatry: a field between neurology and psychology that has not yet decided where to stand (because really it can't, either position would imply it's disappearance). But I don't think every mental health professional should suffer from that conflict.

PS: This is by no means an attack to the usefulness of psychotropic drugs, just a critique of the diagnostic manual.

Beatsong · **#26** by **Beatsong** » May 05, 2012 7:52 pm

Mr.Samsa wrote:
Ironclad wrote:There's a cure for autism?

It depends on a number of issues like what you think autism actually is, and what "cure" actually means, but essentially, if caught early, a person diagnosed with autism can reach the point where they no longer meet the requirements to be diagnosed as autistic. Some people argue that this means that they are still autistic "underneath it all" but have superficially figured out how to cope, but this excuse is similar to saying that someone still has cancer, they just don't have any cancerous cells in their body after treatment. The tool used is behavioral therapy, and it works through intensive behavioral training (i.e. 40+ hours a week) to reverse many of the problems associated with autism. Depending on the severity of the condition, and how early it is caught, the success rates will differ - but a large proportion reach the point where they can no longer be classified as having autism, and nearly all will increase to some degree in functional abilities.

I'd sure like some further information on that because I'm pretty sure (being married to an autism specialist) that it's complete bollox. An autistic person who has learnt certain coping strategies to the extent of being able to function pretty well in the world is not the same thing as a non-autistic person - not by a long way.

Unless you're only talking of the mildest cases of people who might loosely be described as "on the spectrum" and somehow wangle a diagnosis from a crap lazy doctor on a bad day, I'm pretty sure what you're saying here flies in the face of current knowledge in the field.

paceetrate · **#27** by **paceetrate** » May 05, 2012 8:12 pm

I'm sure we don't need Cali to come in here again and link to us all the evidence about the serious physical differences in brain structure between autistic and non-autistic people. So I think it's safe to say that there is no "cure" for autism anymore than there is a "cure" for someone born without a leg. There's just good ways of getting around it.

Mr.Samsa · **#28** by **Mr.Samsa** » May 06, 2012 3:31 am

Beatsong wrote:
Mr.Samsa wrote:
Ironclad wrote:There's a cure for autism?

It depends on a number of issues like what you think autism actually is, and what "cure" actually means, but essentially, if caught early, a person diagnosed with autism can reach the point where they no longer meet the requirements to be diagnosed as autistic. Some people argue that this means that they are still autistic "underneath it all" but have superficially figured out how to cope, but this excuse is similar to saying that someone still has cancer, they just don't have any cancerous cells in their body after treatment. The tool used is behavioral therapy, and it works through intensive behavioral training (i.e. 40+ hours a week) to reverse many of the problems associated with autism. Depending on the severity of the condition, and how early it is caught, the success rates will differ - but a large proportion reach the point where they can no longer be classified as having autism, and nearly all will increase to some degree in functional abilities.

I'd sure like some further information on that because I'm pretty sure (being married to an autism specialist) that it's complete bollox. An autistic person who has learnt certain coping strategies to the extent of being able to function pretty well in the world is not the same thing as a non-autistic person - not by a long way.

Unless you're only talking of the mildest cases of people who might loosely be described as "on the spectrum" and somehow wangle a diagnosis from a crap lazy doctor on a bad day, I'm pretty sure what you're saying here flies in the face of current knowledge in the field.

It's undebatable in the autism world that applied behavior analysis is practically the only treatment for autism and has had massive success - this is why most countries (at least in the developed world) fund behavior analysts for children who are affected by it. Obviously, as I mention, a lot of the "cured" kids are the ones who aren't at the extreme range, but they certainly aren't just the kids who are a little introspective and slightly nerdy - they are kids who are often non-verbal, can't make eye contact, can't hold their attention for any extended time, etc. It cannot be explained by a "lazy doctor", as all autistic kids make improvements with the treatment, so that even the near-catatonic ones will usually end up living semi-independent lives, where they are able to cook, clean, and hold down simple jobs. Also, of course, in the research they independently confirm the diagnosis with a couple of psychiatrists who are blind to the purposes of the research and really, you can't "accidentally" label a kid who can't speak, make eye contact, etc etc, as having autism when really they're just 'really weird'.

There's a report from an autism task force here that discusses all these details and summarises a lot of the research. Importantly, I'm not talking about the people who are able to "function pretty well in the world", I'm talking about the ones who are indistinguishable from any other person.

paceetrate wrote:I'm sure we don't need Cali to come in here again and link to us all the evidence about the serious physical differences in brain structure between autistic and non-autistic people. So I think it's safe to say that there is no "cure" for autism anymore than there is a "cure" for someone born without a leg. There's just good ways of getting around it.

That doesn't make sense. Of course there are structural differences in the brain of autistic and non-autistic people - the brain is, essentially, just a physical representation of our thoughts and behaviors, so if the thoughts and behaviors of two people significantly differ, then there will be structural differences between the two. That's why we find different brains between conservatives and liberals, depressed and non-depressed, atheists and theists, etc etc. None of this means that any damage or changes are permanent or unchangeable though, so the comparison to the man without a leg doesn't work. Instead, it would be more like comparing it to a man who had a stroke that ruined his speech centres so that he could no longer talk properly, giving him a diagnosis of aphasia. If we provide him with enough language training, his brain will generate new pathways and structures which take on the task of language, and with time he could speak entirely normally with no difficulties or functional issues. Does it make sense to say that he still has aphasia (a speech disorder) even though his speech is entirely normal?

paceetrate · **#29** by **paceetrate** » May 06, 2012 4:42 am

All the training in the world is not going to spontaneously grow the Superior Olive in an autistic person's brain. So I think it makes perfect sense to say that although a person who is autistic may have ways of coping around it so much so that they do not, from the outside, look autistic; they are still autistic.

Mr.Samsa · **#30** by **Mr.Samsa** » May 06, 2012 5:43 am

paceetrate wrote:All the training in the world is not going to spontaneously grow the Superior Olive in an autistic person's brain. So I think it makes perfect sense to say that although a person who is autistic may have ways of coping around it so much so that they do not, from the outside, look autistic; they are still autistic.

Well they don't need to grow a superior olive since autistic people don't lack this structure. Rodier's case study of a single woman found that she lacked it, but follow up studies have failed to replicate this. Instead they find malformations of the superior olive, involving different cell shapes and fewer neurons, but the structure is still there. Regardless, even assuming that they lacked it, training would not required to regrow that structure - other brain areas can take on the necessary roles.

In other words, in the example I presented above, are you arguing that the man is still aphasic because he has a damaged part of the brain, despite the fact that he has no speech difficulties at all as other parts of the brain have taken on the role?

Mr.Samsa · **#31** by **Mr.Samsa** » May 06, 2012 6:09 am

I think part of the confusion is over what the word "cure" means. There's an interesting article on this topic here: Clarifying Comments on the UCLA Young Autism Project. The authors argue that if "cure" is defined as "removing the original cause and associated problems", then it is more accurate to describe the patients as having been "recovered", which suggests that no symptoms remain and they have reached normal functioning. This compares it to cancer, like Hodgkin's lymphoma, where even though you've removed the tumour(s) and given them radiation therapy and chemo, etc, so that no cancer remains in their body, they aren't "cured" in the strict sense and instead they are "recovered".

I can accept that the autism is not "cured" by ABA if people just want to argue that the kids are "recovered", in the same way a successful and permanent elimination of cancer is not a "cure" but just a "recovery". Interestingly, the research in the article linked above found that half of the children who undergo ABA no longer meet the criteria for autism and are considered normal functioning (and the remaining 50% improve significantly, in both severity of symptoms and level of independence), which was higher than what I thought it was but not entirely surprising.

Asta666 · **#32** by **Asta666** » May 16, 2012 10:43 am

Samsa, what do you think of the issues mentioned by some behaviorists like Hayes: "concerns raised by Bissett, Hayes, and Staats: (a) we are essentially proposing the melding of two theoretically incongruent approaches, and that such a melding is inherently not viable or useful; (b) the behavior analytic approach cannot account for personality or psychological constructs; and (c) that categories based on topography do not have demonstrated treatment utility. We also discuss points of agreement with our respondents: (d) a theoretically-based descriptive classification system is required to ultimately advance clinical science, (e) the DSM personality disorder classification system, to remain viable, needs a stronger empirical base; and (f) that alternatives to DSM classification that more strongly emphasize behavioral principles are in need of development."
http://www.sciencedirect.com/science/ar ... 6798001454
I think D) is pretty important. In this sense, psychodynamic oriented therapists seem to have developed an alternative to the DSM (http://www.pdm1.org/). Do you think it would be useful for cognitive-behavioral ones to do something similar?

Mr.Samsa · **#33** by **Mr.Samsa** » May 16, 2012 11:13 am

Asta666 wrote:Samsa, what do you think of the issues mentioned by some behaviorists like Hayes: "concerns raised by Bissett, Hayes, and Staats: (a) we are essentially proposing the melding of two theoretically incongruent approaches, and that such a melding is inherently not viable or useful; (b) the behavior analytic approach cannot account for personality or psychological constructs; and (c) that categories based on topography do not have demonstrated treatment utility. We also discuss points of agreement with our respondents: (d) a theoretically-based descriptive classification system is required to ultimately advance clinical science, (e) the DSM personality disorder classification system, to remain viable, needs a stronger empirical base; and (f) that alternatives to DSM classification that more strongly emphasize behavioral principles are in need of development."
http://www.sciencedirect.com/science/ar ... 6798001454
I think D) is pretty important. In this sense, psychodynamic oriented therapists seem to have developed an alternative to the DSM (http://www.pdm1.org/). Do you think it would be useful for cognitive-behavioral ones to do something similar?

Unfortunately I don't have access to that journal to read the articles, but I don't think most of the claims are supportable. I'm not sure which approaches are supposedly "theoretically incongruent", but why does Hayes argue that behavior analysis cannot account for personality or psychological constructs? That sounds absurd.. And categories based on topography is the staple for behavior analysis, so I'm not quite sure what he means there - is he arguing that the categories should be based on the "cause" of the disorder? We don't do that with medical diseases and it seems to work well for them, why would we change it for mental disorders? What exactly does he mean by "theoretically-based descriptive classification system", and how is that not currently satisfied by the DSM? The DSM, as controversial as may be, is obviously based on evidential and empirical grounds, so I don't quite understand (E). And I suppose (F) is alluding to the idea that individuals should be treated according to their individual symptoms, and not to have their symptoms grouped together and given a label? If so, then that's essentially how patients are treated anyway...

Asta666 · **#34** by **Asta666** » May 16, 2012 5:07 pm

I think, in general lines, they mean that the desire to keep the DSM atheoretical might sometimes contradict some theoretical statements or might not be very useful for planning psychological treatments. For instance, what's the point of having so many distinct disorders when psychological therapies are usually composed of a few principles and techniques that are applied more or less the same to a lot of them but adapted heavily to each individual?
I'm not saying the DSM is inherently a bad thing, I'm just wondering if it wouldn't be more useful to have psychological diagnostic manuals based on specific theories and practices, like that one of psychodynamic therapies.
Here's a full article that expands a bit more on those ideas by Hayes:
http://www.google.com.ar/url?sa=t&rct=j ... CC0m41wMDQ

Mr.Samsa · **#35** by **Mr.Samsa** » May 18, 2012 2:32 am

Asta666 wrote:I think, in general lines, they mean that the desire to keep the DSM atheoretical might sometimes contradict some theoretical statements or might not be very useful for planning psychological treatments. For instance, what's the point of having so many distinct disorders when psychological therapies are usually composed of a few principles and techniques that are applied more or less the same to a lot of them but adapted heavily to each individual?
I'm not saying the DSM is inherently a bad thing, I'm just wondering if it wouldn't be more useful to have psychological diagnostic manuals based on specific theories and practices, like that one of psychodynamic therapies.
Here's a full article that expands a bit more on those ideas by Hayes:
http://www.google.com.ar/url?sa=t&rct=j ... CC0m41wMDQ

Thanks for the link. I disagree with Hayes here. I think leaving the DSM as an atheoretical, descriptive manual, is far better than his suggestion. In its current state, researchers and clinicians can still use it in the sense that he wants to - by identifying the causes and functions behind the disorders, find if underlying etiologies are causing multiple forms of disorders, etc etc. I think the DSM serves much better as simply an identification and classification tool, and that the researcher's experience and knowledge should guide things like treatment options, or discovering the cause of the disorder, rather than having it all spelt out in the DSM.

Asta666 · **#36** by **Asta666** » May 18, 2012 3:52 pm

Mr.Samsa wrote:Thanks for the link. I disagree with Hayes here. I think leaving the DSM as an atheoretical, descriptive manual, is far better than his suggestion. In its current state, researchers and clinicians can still use it in the sense that he wants to - by identifying the causes and functions behind the disorders, find if underlying etiologies are causing multiple forms of disorders, etc etc. I think the DSM serves much better as simply an identification and classification tool, and that the researcher's experience and knowledge should guide things like treatment options, or discovering the cause of the disorder, rather than having it all spelt out in the DSM.

Your welcome. I also think that what Hayes proposes is not precisely viable now, but maybe it is worth working towards something like that. In my opinion, the word "descriptive" can be deceptive. For instance, the DSM includes "personality" disorders and "defense mechanisms", which are constructs that different theories conceptualize pretty differently, and there is not so much consensus to say they are purely "descriptive" terms.
Also, I think ultimately the goal of the DSM is to conceptualize disorders in terms of bodily malfunctions, like Federico and others suggested in the other thread about it. That would be hard to integrate with psychological perspectives, and although evidence was lacking in the past, now we can pretty much find somewhat steady neural correlational patterns with anything we like, and to suppose that that correlation means causation in mental disorders would be considered by many just a "logical assumption". But maybe I'm just being paranoid. Time will tell.

Shrunk · **#37** by **Shrunk** » May 18, 2012 4:14 pm

Asta666 wrote: Your welcome. I also think that what Hayes proposes is not precisely viable now, but maybe it is worth working towards something like that. In my opinion, the word "descriptive" can be deceptive. For instance, the DSM includes "personality" disorders and "defense mechanisms", which are constructs that different theories conceptualize pretty differently, and there is not so much consensus to say they are purely "descriptive" terms.
Also, I think ultimately the goal of the DSM is to conceptualize disorders in terms of bodily malfunctions, like Federico and others suggested in the other thread about it. That would be hard to integrate with psychological perspectives, and although evidence was lacking in the past, now we can pretty much find somewhat steady neural correlational patterns with anything we like, and to suppose that that correlation means causation in mental disorders would be considered by many just a "logical assumption". But maybe I'm just being paranoid. Time will tell.

There also remains the issue that so many seem to have difficulty grasping: We may well be able to find "neural correlation patterns" with anything, period. So there still remains the question of which "anythings" are considered illnesses. You can't determine that just by looking at the brain.

Asta666 · **#38** by **Asta666** » May 18, 2012 7:50 pm

Shrunk wrote:There also remains the issue that so many seem to have difficulty grasping: We may well be able to find "neural correlation patterns" with anything, period. So there still remains the question of which "anythings" are considered illnesses. You can't determine that just by looking at the brain.

Yeah, although I think that also affects any kind of disease. Talking specifically about the causation of behavior, it results from the relationship of the whole organism with it's environment and not one of it's parts, which are intervening variables. A nervous system makes certain kinds of behavior possible, but that doesn't mean it is it's final or only cause. So even if we can map a perfectly healthy and normal brain we can't expect it to always behave in the same way, because that depends also on it's environment. It would be like trying to tell if an animal's trait (like flying or having 8 legs) is adaptive or not without considering that organisms' habitat.
As Rachlin suggests, neuroscience can tell us how behavior is possible or what forms it can take, but not why it occurs, which depends also on the environment. In someone with autism, the environment also affects behavior, only that it affects different potential manifestations of it. In other scenarios environmental influence can provoke changes in brain chemistry or activation patterns, not only inherited defects can. Of course, this should be targeted by any clinical means possible, but it will still be intervening variables of behavior among others. Sadly, I think some people are eager to take this intervening variables as the single or main cause of behavior, maybe because they think there cannot be a successful science of behavior, or because it would be more in line with the rest of medical fields, or maybe because it's better for the ruling classes to hide that for instance unemployment or poverty can cause mental illness, with the same degree of certainty that a tumor can. That's why I think that if the DSM is heading in that direction clinical psychologists should not go along with it. Psychiatrists would seem to me to accept this kind of reduction more easily, but hopefully not all of them will either.
PS: Of course, treating every disease as behavioral would be equally idiotic, even if every disease has behavioral consequences. For instance instead of giving someone with a cold a drug against it we could use conditioning techniques so he stops sneezing and complaining that he feels bad. Ultimately the problem IMO is making absolute claims or guiding diagnostic/treatment by unsupported assumptions.

Asta666 · **#39** by **Asta666** » May 23, 2012 9:09 pm

Mr.Samsa wrote:why does Hayes argue that behavior analysis cannot account for personality or psychological constructs? That sounds absurd.

How would you understand/explain personality from behavior analysis? Given that it's usual definition (for instance Millon's) is patterns of behavior that are partially inherited and probable to appear mostly independently of the particular environment and are stable over time (after adulthood is reached).

Mr.Samsa · **#40** by **Mr.Samsa** » May 24, 2012 2:47 am

Asta666 wrote:
Mr.Samsa wrote:why does Hayes argue that behavior analysis cannot account for personality or psychological constructs? That sounds absurd.

How would you understand/explain personality from behavior analysis?

The same way personality is generally understood. Even Skinner's ideas are consistent with how we currently view it:

A self is a repertoire of behaviour appropriate to a given set of contingencies. A substantial part of the conditions to which a person is exposed may play a dominant role, and under other conditions a person may report, 'I'm not myself today,' or, 'I couldn't have done what you said I did, because that's not like me.' The identity conferred upon a self arises from the contingencies responsible for the behaviour. Two or more repertoires generated by different sets of contingencies compose two or more selves. A person possesses one repertoire appropriate to his life with his family, and a friend may find him a very different person if he sees him with his family or his family if they see him with his friends. The problem of identity arises when situations are intermingled, as when a person finds himself with both his family and his friends at the same time.

(From "Beyond Freedom and Dignity").

Asta666 wrote:Given that it's usual definition (for instance Millon's) is patterns of behavior that are partially inherited and probable to appear mostly independently of the particular environment and are stable over time (after adulthood is reached).

How would any of that be inconsistent with behavior analysis? It includes the axiom of behaviorism which argues that we need to understand the genetics and biology of a behavior ("inherited"), that behavior becomes stable over time through aggregated responses and SDs ("mostly independent of the particular environment"), and involves a claim of development which is covered by behaviorism's dependence on other causal factors like biology and culture.

Psychologists Start Petition Against DSM 5

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