Showing posts with label Depression. Show all posts
Showing posts with label Depression. Show all posts

Monday, May 6, 2013

Controversy over the New Psychiatric Diagnostic and Statistical Manual

Since 1952, the American Psychiatric Association has published the Diagnostic and Statistical Manual of Mental Disorders (DSM for short) which has spelled out the criteria for diagnosing all of the known psychiatric disorders.  It has undergone four editions and two revisions with the fifth one due out this year.  In the past there were controversies such as whether or not homosexuality should be included in the manual and it was dropped from the DSM in the 1970s.  New changes are made to the manual as new information is brought to light and cultural views of what is and what is not a disorder change.

This year the fifth edition of the DSM proposes changes to 13 current diagnoses.  The most controversial of these is Asperger's Syndrome which is being eliminated as a separate diagnosis and is being placed under the  Autism spectrum of disorders.  Unlike the gay community in the 1970s, has deletion been met with resistance by those who have been previously diagnosed with Aspergers.  Other changes have been made to dyslexia, ADHD and other diagnoses.  At least 10 new diagnoses are included in the DSM such as post-traumatic embitterment disorder, skin picking disorder, and compulsive hoarding (maybe the American Psychiatric Association all watches TLC). 

Previously the DSM has been accepted as the Bible of psychiatric diagnosis but, right before the DSM-V comes out the National Institutes of Mental Health (NIMH) has announced that it will not use it as a standard for diagnosis in their research.  This means that they will not be funding studies that use the DSM-V as a diagnostic criteria.   The reason given by the NIMH is that Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."  This suggests a desire for exactness which the behavioral sciences have lacked relative to the physical sciences sometime termed physics envy.

There have been advances in neuroscience and genetics which shed light on many of these disorders and made many pharmacological treatments possible but the main reliance for diagnosis is still on behavioral symptoms.  The NIMH is creating a Research Domain Criteria for Diagnoses (RDoC) based on biological criteria which it believes are more objective.  The behavioral symptoms are often subject to interpretation and often still not enough is known about the brain and genetics to differentiate between pathologies.  Consider the figure at left.  Is this a rabbit with its head held high or a duck?  This image is subject to interpretation just as all behaviors and incomplete scientific data are.  Science is fundamentally a human endeavor where politics often plays a role.  
  

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Friday, December 14, 2012

'The Secret' Gets the CSI w/o Dead Bodies Treatment

In 2006 Australian author Rhonda Byrne published a self improvement book which became an international best seller followed by a movie.  A friend suggested I read her book called The Secret.  I've had similar suggestions before from friends who want to improve my life who have all meant well. 

The book presents a pretty simple law of self improvement called the Law of Attraction which Byrne says has been suppressed for over 3,000 years and is only known by the wealthy 1% and great men throughout history such as "Plato, Newton, Carnegie, Beethoven, Shakespeare, and Einstein."  It says that believing that positive things will happen will make it happen for you with wealth, health, and relationships and believing negative things will happen will make the opposite happen.  It goes on to present that secret in DaVinci Code/Scientology fashion with lots of testimonials and graphics but little hard data to show how the law of attraction always works.  The experts in the film even say that "the anti-war movement creates more war."  Here is trailer for the film.  The author is seen very little in the film.


 
The book has it's critics such as Barbara Ehrenreich who discusses her own struggle with cancer and how not being positive all the time helps her.  The problem with relying on testimonial evidence alone is that it's always possible to find one contradicting your theory.  The film presents no evidence of how this secret was suppressed all these years.

 

A closer look at the historical figures presented in the film and book shows that few of then had full happy lives.  The one who comes closest is Plato and that is only because he lived thousands of years ago and we know so little about his relationships and what sort of man he was.  Ludwig van Beethoven had a miserable life with many relationship, money, and health problemsIsaac Newton was "not a pleasant man" as described by Stephen Hawking (he holds the same professorship that Newton did) who never married and took pleasure in crushing his rivals.  Andrew Carnegie may have been a good husband and father and did lots of charity work but he also ruthlessly crushed the Homestead Steel Strike and was negligent in the Johnstown Flood with crony Henry Clay Frick.  William Shakespeare is another about whom there is little known and some controversy so I will not address.  Albert Einstein like the others did excel at what they were good at but you would not want to be married to him.

There is always a risk of disaster and the chance of success.  You can take steps to minimize the risk and maximize the chance but can never eliminate either.  The passengers and crew on the Titanic had lots of positive energy and optimism but were oblivious to the risks that icebergs posed and we all know how that turned out (see my post Titanic Perspective if you don't for a review of this and Andrew Carnegie's role in the Johnstown Flood). I'm all for having success but at who's expense?  Solutions can be found to the world's porblems but by realistically thinking through the risks and chances.  It gives the secret as the reason for "the richest 1% controlling 96% of the world's wealth" when Ehrenreich and other social critics would give very different reasons.  The Secret has definitely made Rhonda Byrne very wealthy.


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Monday, September 5, 2011

We Need Slightly Unstable Leaders?

The Colbert ReportMon - Thurs 11:30pm / 10:30c
Nassir Ghaemi
www.colbertnation.com
Colbert Report Full EpisodesPolitical Humor & Satire BlogVideo Archive

Last month Stephen Colbert had Dr. Nasir Ghaemi on his show who wrote a book titled A First Rate Madness leaders saying that America's more successful Presidents such as Lincoln or Franklin Roosevelt have had a predisposition to bipolar disorder (it used to be called manic depression) or depression while most of our less successful one's were more normal like Jimmy Carter, Herbert Hoover, or George HW Bush I.  These mood disorders are genetic according to Ghaemi and other psychiatrists.

Colbert uses the example of Ronald Reagan of someone who was normal and was a successful President and Ghaemi sort of agreed about him being normal but not really about his leadership.  I must point out that Reagan did have an alcoholic father growing up (which can be inherited but Reagan apparently wasn't an alcoholic himself) and his family disagrees about whether he suffered from Alzheimer's while President.  If one looks through other leader's backgrounds it's possible to find other abnormalities in their psyche. Some mental health struggles should not disqualify a person from elective office.

Another problem with Dr. Ghaemi's theory is that we often place too much emphasis on the characteristics of leaders to understand how things happen and too little on the circumstances that surround them.  This is called the Great Man Theory of history.  It may be irrelevant in the long run whether Barack Obama is too normal or not to handle our current crisis if the movements around him do not motivate him to do what is necessary as he prepares his jobs address.  Roosevelt and Lincoln were pushed to do great things like create social security and end slavery by popular movements which had been working for years to make these things happen.  This doesn't mean that leaders do not matter.  No one wants leaders like Nero or Caligula.


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