Shrink Validity Is Shrinking

Should you trust the diagnosis of a psychiatrist?  If it helps, individuals are free to choose.  Behind the scenes, however, there are severe, deep-seated debates about whether professional shrinks understand disorders, let alone diagnose them properly.

In New Scientist, James Davies reported about protests at the American Psychiatric Association’s (APA) annual meeting.  Some protestors feel that psychiatry is “not even wrong”; psychiatrists don’t know what they are doing, and sometimes end up abusing patients:

The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification.

That list includes major changes with each new edition of the psychiatry “bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM).  Edition V is coming out, loaded with new maladies that were never diagnosed before, and altering the description of other disorders – changes that can have major effects on prescriptions, insurance policies and scientific “explanations” for various behaviors.

Davies said that some psychiatrists who filed past the protestors acknowledged that they had some legitimate concerns.

In another article on New Scientist, “Trials highlight worrying flaws in psychiatry ‘bible’,” Peter Aldhous focused on flaws in tests that psychiatrists use to diagnose mental illness.  “While for some diagnoses reliability was good, others yielded scores little better than chance,” he said.  Some of the worst results concerned some of the most common diagnoses:

The conditions with questionable reliability include subtly altered descriptions of two of the most common diagnoses in psychiatry: major depressive disorder and generalised anxiety disorder. That has opened a can of worms, leaving some mental health professionals wondering about the reliability of even established psychiatric diagnoses.

The final wording of DSM-5, scheduled for publication in May 2013, will have profound effects on people’s lives. The manual not only helps determine who is given psychoactive drugs, but in the US may determine whether treatment is covered by health insurance. Some diagnoses are even used to justify holding people indefinitely in secure mental hospitals.

There are others that Aldhous worried about: diagnoses of autism, and an alleged precursor of schizophrenia dubbed “attenuated psychosis syndrome.”  Psychiatrists use a value called kappa that is supposed to measure the “the consensus between different doctors assessing the same patient, with 1 corresponding to perfect diagnostic agreement, and 0 meaning concordance could just be due to chance.”  Unfortunately, chance could not be ruled out as a hypothesis for some of the most common disorders.  For instance, regarding attenuated psychosis syndrome, “While field trials gave a kappa of 0.46, the variability was so large that Darrel Regier, APA’s head of research, told the meeting that the result was “uninterpretable”.

One theory escape mechanism for the questionable reliability of “major depressive disorder” and “generalized anxiety disorder” diagnoses was to suggest that depression and anxiety are like the “fevers” of a deeper mental disorder whose symptoms can mask a variety of conditions.  Aldhous did not seem impressed; “if depression and anxiety can’t be reliably diagnosed, many patients will wonder how many more disorders stand on similarly shaky ground.”

For more on problems with the DSM, see the 2/17/2010 and 4/21/2011 entries.

Psychiatrist: “Our new textbook indicates that your delusions of grandeur were misdiagnosed.  In other words, you’re cured.”

Patient:  “Some cure!  I used to be Napoleon.  Now I’m nobody!”

Psychiatry is a pseudoscience acting like a religion (i.e., telling people their problem and the solution), but masquerading as a science with big words and lots of money.  Since it is a pseudoscience, we can have a little fun with it by imagining a world in which the Darwin skeptics have the money and the power.  Like them (e.g., 2/27/2010), we can use scientific jargon to diagnose our foes as mentally ill. We could publish our manual in the DSM, Darwinian Symptoms of Madness.

Suppose, for instance, we were to diagnose Richard Dawkins with “Design denial disorder” (DDD) with symptoms including (1) obsessive acts of self-persuasion that what one is observing was not designed, but evolved; (2) incessant repetition of Dobzhansky’s proverb that nothing in biology makes sense except in the light of evolution; (3) willingness to believe in intelligent design when it comes to aliens seeding life on Earth, but only if the aliens evolved by natural selection; (4) a compulsion to persuade others that there is no God by making money selling books, and (5) an illogical preference to live in a theistic country while promoting atheism.  With the right consensus, we could probably obtain high kappa values to prove our etiology is valid and our diagnosis reliable.  We might even get insurance companies to cover prescription drugs aimed at curing DDD.  Anyone protesting our actions we could diagnose with “DDD co-dependent syndrome” (DDD-CDS), and drug them, too.  Remember, we have the power and the self-serving science to back it up.

We would never do such a thing, of course, since we believe in compassionate persuasion and intellectual integrity.  We would never wish to manipulate power by imitating psychiatry’s flawed methods and Darwinian “survival of the fittest” ethics.  We would wish to be transparent and consistent about our belief that “mental illness” is an oxymoron, believing instead that people’s behavioral problems are caused by either sin or physical flaws such as brain damage.  But our imaginary power play is certainly a conceivable thought experiment.  It turns the tables on what some Darwinians actually do: calling their critics insane.

The evolutionists’ bible is Darwin’s Origin of Species, with its evolutionary tree of life, and the shrinks’ bible is the DSM-V, with its man-made judgments of what constitutes normal and abnormal behavior.  These ‘bibles’ have their genesis in the flawed assumption that human brains were not designed, but evolved.  The authentic trees of life and of knowledge of good and evil are known by their fruits (02/28/2010).