Is there any condition with as broad a definition as autism?
It can cover anywhere from a non-verbal 9 year old with an IQ of 70, to a popular attractive valedictorian genius with incredible masking skills. A slow developing 3 year old labelled early and for life, or a perennial loner 80+ year old finally discovering that their traits are shared with many others.
This conundrum reminds me of a thought experiment. You have people use a mental illness as a defense in courts of law. But could you not plausibly define anyone who commits major crimes to be mental ill? Mental illness could also be defined by a person's ability to function in their community and social constructs. But a healthy species, evolutionary speaking, requires these outliers. These deviations from the "norm" offer the species a safety net should conditions change rapidly. Should we really be trying to herd everyone back to a norm?
Also, psychology is a dying profession. A mental illness is described as a set of symptoms manifested from physical biological systems we don't fully understand yet. But once understood, psychology becomes obsolete.
Frances's concerns definitely aren't wrong on the whole, but I feel like he's not seeing the forest for the trees. This ultimately isn't just a question of whether this or that DSM revision is helpful. The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are still unreliable and many of the theories still fairly reek of superstition and magical thinking. Practitioners are frequently defined more by which tradition or thought leader they adhere to than by their specialization in established subfields.
It's not a great situation, and I don't see many signs that it's improving. A great deal is said about "awareness" and "stigma". Phrases like "get help" have been around long enough to turn from hero to villain (i.e. from an earnest plea to close friends or loved ones to a passive-aggressive dismissal of strangers). Who's seriously talking about materially improving the situation instead of promoting an allegedly more "correct" theory? Hell if I know. Please tell me if you do.
I guess I broadly agree with the article author that the DSM process is "caught between paradigms" and has "no obvious way forward", but that's a profoundly unsatisfying place to find common ground.
I find the debate about the utility of the diagnostic model to be so polarizing as to be useless. You can't totally reject some of these diagnoses, regardless of how porous the boundaries, without depriving a lot of people of the care they need. On the other hand, it's hard to argue that the current diagnostic categories are working especially well for the people who aren't bullseyes.
I stumbled on this paper when I was thinking about my own diagnoses of bipolar disorder and ADHD that explores why the comorbidity is so high, and ends up with a fascinating meta-analysis of how we think about diagnostic categories. I have no idea if this paper is respected, or has been totally debunked, because I don't have any context on the field. I did find it very helpful for myself, personally.
The problem of classification is one not useful by defect. In stead it should go by effect, on the individual and on society, as it cycles through the situations encountered by a old, tribal, militaristic clan based society. The adaptations we define as ails today were useful back then in the role of * and gave the individual a place as *.
It helps to understand what it was of yore.
EDIT: this was an attempt to get past the paywall, but looks like it's javascript driven, so this archived version breaks after a moment, unless you disable js
https://web.archive.org/web/20240324050221/https://www.wired...
It's kind of strange that psychology has this dual role of both giving advice to the sane and managing the insane. The same division was a thing in psychoanalysis too with neurotics vs psychotics
Why does it do both? Why do people use it as a go-to source for life advice?
People will go to a psychologist for marriage troubles, and they'll also go to a psychologist for psychosis. Seems like a weird place to go to marriage help for unless your wife is psychotic
It's like psychologists have been given this role that religion used to occupy
Even today, we don’t have a definition of “species”, a definition acceptable to biologists working in this domain. What is needed is a theory, and further development of that theory.
Those who quibble about definitions should develop theories and test them, amend them, replace them. All these activities help understand the phenomenon in the question. When people engage in definitional disputes, it shows that intuitions about the phenomenon conflict. That’s all. To settle these issues, one should do science: that is, develop theories, derive consequences, add back ground theories to test these consequences.
No escape from the mass mind rape
Play it again Jack and then rewind the tape
And then play it again and again and again
Until your mind is locked in
Believin' all the lies that they're tellin' ya
Buyin' all the products that they're sellin' ya
They say, "Jump" and you say, "How high?"
You brain-dead, you got a fuckin' bullet in your head> Frances, who claims he doesn't care about the royalties (which amount, he says, to just 10 grand a year)
for a writer these days, 10 grand is definitely not chump change.
It's very sad. DSM was never strictly meant to be a clinical diagnostic tool, but rather it was originally meant to define specific illnesses in a manner that would facilitate further research by allowing investigators to at least be talking about the same phenomena when comparing results. (and it unintentionally became very popular with lawyers, who argued that presence in the DSM equated to unimpeachable evidence of an illness in a client, another use that it was never designed to accommodate)
It's still true that there are only on the order of 8-12 well-validated diagnoses in the manual. Increases in the number of included diagnoses over editions is primarily due to concessions to important researchers as opposed to clear identification of previously undescribed illnesses.
There are lumpers and splitters in academic psychiatry. Lumpers are suspicious that there are several hundred discrete disorders of the brain that can't be more parsimoniously explained with existing, better validated illnesses.