Monday, December 12, 2005


Aspazia has a post up on MMF that is insightful, as well as being wryly amusing.  It "inspired" me to write a lengthy comment.  When I do that, I hate to have the work buried in a comment section somewhere, so I generally elevate it to a full post of my own.

Be advised, this will not make a lot of sense unless you read her post first.  

So, here is my comment, edited and expanded a bit:

I am not clever enough to come up with catchy drug names.  If I were, I would have retired in comfort a long time ago.  However, I would like to comment on what you've said about the DSM, and about psychiatric diagnosis in general.

Advocates of a rigorous approach to diagnosis admit readily, that the DSM is flawed.  That is why it is revised continuously.  It will never be perfect.  Therefore, it is imperative that it be interpreted with extreme caution.  

A good rule of thumb is to remember that one cannot infer anything from the DSM.  It is meaningful only when interpreted literally.  That is, if a person meets the diagnostic criteria for a given disorder, then you can say that the person is "a person with X,” where X is the disorder.  This does not imply anything about good or bad, right or wrong, guilty or innocent, worthy or unworthy, treatable or untreatable.  

When applied properly, the DSM does not generate any value judgments; it also says nothing about treatment.

Having said that, I have found that it does not seem to matter how carefully and repetitively one teaches that point.  It seems that the point usually is missed.

In forensic psychiatry, there are specific criteria for exculpability that are entirely separate from the criteria for mental illness.  Merely having an illness does not get you off the hook, in a court of law.  

I would say that the DSM is an entirely reasonable document, it is the people who read it that are unreasonable.  But as I write that, I am troubled by the parallel with the argument that guns don't kill people, people do.  I think we should not have so many guns around, so shouldn't I think also that we should have fewer DSM's around?

No, not really, just that people need to appreciate how to use it properly.  That caveat could be applied to any highly specialized, technical reference book.  You can't read the CRC Handbook and Chemistry and Physics and think you know everything there is to know about benzene.  More to the point, you cannot read the book and then infer from what you read whether benzene is a good molecule or a bad molecule.  

Value judgment and diagnosis have nothing to do with each other.  Nothing.  To the extent possible, diagnosis is purely descriptive.

I do like her point about drug companies rushing products to market to treat the new diagnoses, but that it partly an artifact of how the FDA approves drugs.  Drugs are approved for a specific purpose, to treat a specific disease.  No disease, no approval.  That actually does not make any sense, but it is the way things are done.  

To be fair and balanced, though, it is not just the drug companies that do this.  You can bet that all kinds of  healers of all stripes -- some legitimate; others not -- would open offices claiming to have expertise in the treatment of X.  And there would be a proliferation of web sites full of claims for various remedies.  Books too; It seems as though everyone gets into that particular act.

HRT = Harmony Replacement Therapy?