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.
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.
But autism isn't defined by intelligence or age. You might as well say 'isn't alcoholism such a broad definition, when everyone from world leaders to young people to a perennial loner 80+ year old finally discovering that their traits are shared with many others.
The two extremes don't have the same traits in common whatsoever.
One will clearly be unable to communicate. The other will clearly communicate but allude to an internal torment. One will struggle with the activities of daily living. The other will have a family, a full time job, commitments in the community.
The two people supposedly lack the same abilities. In truth, Autism simply got tied up with entitlements and the diagnosis has been grossly abused as a lever to get access to said entitlements.
I'm dismayed at your large-scale, arbitrary diagnosis of fraud.
It is not at all the intent of my original comments, in which I only meant to imply that autism is currently a common term for a number of potentially separable conditions. In the sense that a 'spectrum' is quite literally 'a diverse set'.
Financial entitlements, such as to various medical services, higher welfare rates, reduced tax rates. (I've heard a psychologist flat out admit to giving people a diagnosis based wholly on the medical services they wanted them to receive, not based on if they actually qualified for the diagnosis)
Accommodations, such as extra time on tests, a more comfortable working environment, more attention and time having school staff attend to them.
Affirmative action schemes.
Exclusion from military drafts.
Extra leeway in social situations in general - in specific ways.
Entitlements. The fact of having a right to something. Privledges. Special treatment. A benefit granted by law or custom.
Now I am not suggesting that being diagnosed with a disability in fact makes your life better and easier on merit of having all these wonderful entitlements. If you talk to disabled people a lot you will notice what a lot of them stress how they don't want special treatment and make a point of independence. There's reason for that. Nevertheless, people often THINK these sort of entitlements would be very helpful for a person, since superficially entitlements seem awesome when you aren't yet thinking of second order effects.
I pay hundreds of euros each month for health insurance I expect something in return
> higher welfare rates
Anecdotally none of my neurodivergent friends are on welfare. But I imagine people with more severe types of autism cannot really function in a work environment. That's why it qualifies as a disability.
> Accommodations, such as extra time on tests
Never got it
> a more comfortable working environment
Ahahahahahaha
> more attention and time having school staff attend to them
You're tripping
> Affirmative action schemes.
???
> Exclusion from military drafts.
I don't know anything about military
> Extra leeway in social situations in general - in specific ways.
>Autism simply got tied up with entitlements and the diagnosis has been grossly abused as a lever to get access to said entitlements
I just love when narrowminded Americans (I would wager 1000$ that the poster is from that country) assume the thing that happens in their city/state/country is a worldwide phenomenon with the rest of us 8 billion people.
And even better writing in this snarky obfuscating style so the rest of us don't have a clue what they're talking about. Entitlements???
In my (EU) country talking about your mental issues is simply not done, let alone your actual diagnosis.
I think it's just the complexity of our brains that's the issue here. Your brains can be different in really many ways, and many of those differences can cause multiple symptoms, which are then used as a basis for diagnosis. That's why autism, adhd and others have such a high rate of comorbid diagnosis.
I don't think there are any as broad as "autism" in general, but "ADHD" in general is close. That's why both have been divided up in recent years for the sake of precision.
Seriously 5/10 people in my friends group have ADHD (some with autism too) and we all have such wildly different symptoms and struggles with it that it took quite some time for us to recognize our shared syndrome lol
I think that's likely a natural outcome of a diagnosing something that appears to be a spectrum rather than a discrete disorder. Perhaps analogous to how back pain can range from a mild inconvenience to completely debilitating. Or how there's a spectrum between someone who is harmlessly arrogant to a clinical narcissist.
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.
> 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.
That's a fundamentally reductionist perspective and assumes everything is biological in its etiology? For example, you could say we don't need a justice system once we have the biology worked out, or arts, or sports. At some level it's a fundamentally authoritarian argument as well: if you have the biology worked out, what's to keep the holders of power from altering people to whatever norm they want? Having the biology completely worked out won't magically reveal natural disorder states.
The biological explication of a behavior doesn't obviate the need to have some norm for intervention decisions. Biology doesn't have norms, psychosocial systems have norms. Non-behavioral medicine is still full of ethics. And that doesn't even get into issues about whether you could ever identify any biological substrate as synonymous with a human experiential state or history.
If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor. While the systems and even antidepressants aren't fully understood we have seen the shift away from psychology due to advances in treating the physical biological system. Simply projecting this natural trend to its limit is not reductionist IMO.
> If you understand the systems that manifest a mental illness then you can treat it more directly with medicine, you can test for the mental illness directly with physical sampling. We've already seen this shift from psychology to medicine with the invention of anti-depressants.
Except they only work in 30% the cases, regardless whether the patient has strong indication for depression and it's noted throughout literature that treatment with medication should go hand in hand with psychological counseling, because it increases recovery rate and leads to the patient not relying on medication anymore.
They're also massively overprescribed, have as of yet unexplainable side effects in a significant part of the population and there is surprisingly little information on how they achieve their intended effect.
I think you're also misrepresenting why people don't seek counseling: It's because it's far from readily available.
The arguments you provide are really one sided and it feels like you're intentionally leaving out information to justify your position.
Sure, people are prescribed psychotropic medication for depression. But as more stringent scrutiny has been paid to those, the effect sizes have gone down over time and with more adjustment for publication bias.
There's no shortage of demand for psychotherapy services, and head-to-head they are comparable and both in combination fare best.
There is no blood test for depression, and if there is, no one uses it in practice. Sure, we're seeing this sort of thing with alzheimer's dementia but that's one thing that has never been amenable to psychotherapy, and even then there's a lot of psychotherapy around it in a palliative and coping sense because it's still uncurable.
FWIW, I was involved in the creation of DSM-5 so I'm very familiar with the whole area of mental healthcare.
How familiar are you with factor analysis? I worry that because the best mathematical minds are often not attracted to psychology as a field, that psychologists as a group are somewhat blind to implications of statistical choices and assumptions that they inherit or make.
It’s poorly understood by many who use the DSM, and without understanding how arbitrary and or subjective it can be it may be difficult to avoid “overfitting” in the clinical setting.
I'm not sure I'm particularly convinced that this is an issue with the method of factor analysis and by extension psychometrics, per-se. Unless one specifies a causal model and actually tries to do a risky test of their theory, any other method is liable to the issue of arbitrariness and subjectivity. Psychometrics itself has come a long way and there have been many advancements to put it on firmer footing. If anything, the issue isn't with the method, but by the user of the method. I don't know if I agree that it's an issue of understanding a method, rather than an over-reliance on data (analysis) over theoretical guidance and trying to take a hammer to theories.
It’s not a problem with FA, it’s a problem with people using the DSM who don’t understand how the math behind it influences what they are doing. Ditto for IQ. If you use IQ measures professionally, you should grok FA.
But what would you have them do instead of FA? I think we're partially agreeing here, but my thinking is that no analytical technique on its-own will be a panacea whether the users really understand it or not. Why would increasing their understanding of the technique affect what they do, when there's not really any other truly different methodological alternative?
Even if we, as humans, collectively have the knowledge to reduce something down to some fundamental axioms, it does not mean there is no value to separating the disciplines. All fields of engineering are fundamentally just physics, math, and some civil knowledge. Likewise, being a biologist doesn't necessarily qualify you to be a doctor.
> We've already seen this shift from psychology to medicine with the invention of anti-depressants. Less people are seeking counsel from psychologists and instead just getting a prescription from their doctor.
I think that peaked somewhere between the 80s and 2000s; there's been a pushback both popularly and in parts of the medical community and therapy as opposed to jumping straight to medication is having a big moment currently.
I haven't seen such a shift at all. My country has a record shortage of psychologists, and mental health epidemics, particularly in the young. Antidepressants kind of suck too, major side effects and often barely better than placebo in studies.
I think it's questionable to treat something like depression with medicine without even fully understanding what causes depression, and how the medicine works. Of course it's the least bad option for some cases, but for many milder cases therapy, or even physical exercise, is likely to be a safer, and quite possibly just as efficient option. It's just not as profitable and easy to prescribe as SSRI's.
Do you have a source to back up your claim that "less people are seeking counsel from psychologists and instead just getting a prescription from their doctor"?
The shape of that argument works equally well for unduly centering psychosocial mechanisms, though. That's how we got pseudoscientific garbage like the "refrigerator mother" theory of autism, the "anal retentive" theory of OCD, "tabula rasa" theories of social behavior, and so on.
Maybe what I'm getting at is that double standards abound when it comes to mental illness, and it's fucking exhausting work to even attempt to avoid them. I'm not blaming anybody (least of all you). I suppose it's just one of those Lovecraftian/Cronenbergesque sorts of things where once you see it, the world never quite makes sense again.
Regarding the refrigerator mother theory, autism as a diagnosis has expanded over 100x since that was first debunked and I have no idea why people have any confidence whatsoever that bad parenting cannot cause Autism. This was from a time before people as functional as "Rain Man" were the norm. Twin/Sibling studies were used to debunk this but twin studies don't totally control for shared environmental influences.
It seems more like a politically controversial thing than something which has been seriously scientifically examined either way. It can't be the smoking gun only cause but I see no actual evidence that it's impossible that parental neglect can't be a contributing cause. I will note that it is more politically convenient to simply blame a child's inherent defects instead of parental neglect, since the children relative to their parents lack political power.
I'll also point out that contemporary autism diagnosis relies on parent reports to establish a diagnosis, and people often only get diagnosed if a parent actively seeks out a diagnosis. Autism is also based on observation, if somebody was socially impaired due to neglect, how exactly would an examiner know the difference between that and somebody being socailly impaired due to say epigenetics? I would be rather surprised if who raised somebody doesn't have a rather large impact on if somebody will end up with an autism diagnosis. As in an especially well resourced and attentive parent might mean somebody who would be considered autistic might not be, and somebody who was overstretched and inattentive might have a child who would otherwise not be considered autistic be considered autistic.
> But could you not plausibly define anyone who commits major crimes to be mentally ill? Mental illness could also be defined by a person's ability to function in their community and social constructs.
A converse is the way public/media perception will use mental health itself as the reason or motivator for major crime.
For example, with the just-happened knife attacker in Bondi Australia : the resulting public discourse urgently searches for a cause - "why did this person do this? was it terrorism? revenge? drugs?". But no, soon enough the media latches on to Mental Health, and everyone sighs in relief that the reason is now found. "Ahh!", the mainstream can reassure themselves, "It was a Mental Health Person that did this! Of course!".
I'm not sure I follow? If you rule out any other motive, someone stabbing someone else in broad daylight, unprovoked may be attributed to mental health issues.
But everyone has mental health. If you have a mind, then it's in some form of health. An extremely broad, arguably meaningless, classification. All it does in this context is reinforce the public stigma towards the millions of perfectly good people in the community dealing with hugely diverse situations from depression to autism and far beyond.
> Mental illness could also be defined by a person's ability to function in their community and social constructs.
No, I think mental illness should be defined relative to a person's capacity to change behaviour volitionally or in response to feedback signals, like a scolding or rehab or imprisonment. People who are mentally ill do not respond to feedback signals like this, they have little volition over their behaviours without significant pharmaceutical or other interventions first. It's like asking someone with Tourette's to stop having verbal tics as compared to someone who just likes swearing. There's a fundamental difference in volitional control and responsiveness to feedback.
So is being gay, transgender, an outspoken women, or left-handed mental illness since such people do not, by all appearance and objective measures, have the capacity to change their behaviours volitionally without for instance chemically castrating gay men or lobotomising women?
There's two big things wrong with this definition. First is that it makes non-compliance a pathology and assumes society is right and the patient is wrong. Second is that pays zero heed to ethics and what is actually good for the supposedly mentally ill person, it just labels them mentally ill if they don't do what people want without thinking of if that's best for them.
Of course, that's not THAT different from how mental disorders are defined in practice.
> First is that it makes non-compliance a pathology and assumes society is right and the patient is wrong.
My post said absolutely nothing about society or non-compliance, it spoke only about whether the patient can respond volitionally. Gay people absolutely can choose not have gay sex, it's just wrong to expect that. Outspoken women absolutely can choose to be silent, it's just wrong to expect that. Left handed people absolutely can choose to write with their non-dominant hand, it's just wrong to expect that. There is clear volitional control here.
I made this very clear with the example of Tourettes vs. someone who just likes to swear. The person with Tourettes cannot simply choose to not have verbal tics and then enact that choice, but the person who just likes swearing absolutely can. It's just a physical impossibility to regulate behaviour based on feedback or internal motivations.
> Second is that pays zero heed to ethics and what is actually good for the supposedly mentally ill person, it just labels them mentally ill if they don't do what people want without thinking of if that's best for them.
I have no idea what you mean. There's nothing unethical about pointing out that the mentally ill have a distinct behaviour in that they do not respond to specific kinds of feedback. It is in fact the starting point for ethical treatment of mental illness.
> No, I think mental illness should be defined relative to a person's capacity to change behaviour volitionally or in response to feedback signals, like a scolding or rehab or imprisonment. People who are mentally ill do not respond to feedback signals like this, they have little volition over their behaviours without significant pharmaceutical or other interventions first.
Yeah, this is exactly what someone without mental illness will never understand. Awareness is not static. It ebbs and flows. Sometimes I know that I'm saying/doing something but completely unaware of what it is. I have to ask someone else about my actions/words once I regain awareness. However, I do hold a full time position and can respond to feedback signals depending on the day. I was told growing up to think of consequences of my actions before doing it. Yeah right, for that to happen I need to understand what I'm doing let alone think through the consequences. Pharmaceutical or other interventions aren't a silver bullet to all mental illness issues. Yes, they do help and curb some symptoms but you can't predict when someone will have an episode. And they come with their own side effects. Their effectiveness also depends on the person being treated. Not everyone with depression responds equally well to anti-depressants. It's much more complicated than you think.
The page does say it, I'll agree with that. But I think that the classification as of the disorder basically is a method of classifying people who generally have real life experience with life going wrong, they have reason for behavior which doesn't make it a disorder but instead self preservation.
They are classifying the symptom, not the cause. "Treating" it is fixing their environment and not the person. Too bad drugging the individual is the cheapest solution to create compliant individuals who won't take action.
In a way, yes. That's why repressive governments here in Eastern Europe had started using psychology as a tool/weapon in order to institutionalise dissidents, because it was seen as a mental illness not to be on the same page as the predominant ideology back then.
I think a similar thing is starting happening in the West, even though (fortunately) not at the same scale just yet, meaning people who are seen as being against the system are already categorised by the powers that be as "deplorables" (to quote a recent US presidential candidate), i.e. one step way from those having a mental illness.
Later edit:
Something like this [1]
> Ken Stern, a former CEO of National Public Radio, in his new book Republican Like Me: How I Left the Liberal Bubble and Learned to Love the Right, explains that most of the media has been feeding America a negatively skewed view of Trump along with negative characterizations of the "deplorables," the people who hold more conservative viewpoints. Insistence that Trump is "mentally ill" can be regarded as part of this contemptuous discrediting of others whose beliefs differ from theirs.
"Mental illness" alone is not a defense. The defense is insanity, which term in law means that your mental condition was such that you had no way of knowing what you did was wrong. If you're schizophrenic, say, and you kill someone, but you are compos mentis enough to understand that you killed a person and that is wrong, you don't get to plead insanity. If, on the other hand, you were under the delusion that you were killing an alien or a demon or something, then a plea of insanity might work.
I know that this is Hackernews, and the perspective that there's no such thing as responsibility for our actions, because we are all products of our biology and environment; and hence no such thing as evil, is popular here. But whether and how mental illness absolves, or does not absolve, you from criminal culpability is a fairly rigorous area of law.
Indeed. As I understand it (ianal), insanity is a positive defense, meaning that you have to prove to the judge/jury in court that you were insane, i.e., that you were functionally incapable of distinguishing right from wrong at the moment you committed the crime. This is because a mens rea, or guilty mind, is necessary to establish guilt and thus criminal culpability, in addition to the actus reus or the criminal deed itself; you have to be in a state where you know, or could/should have known, not to do what you did. Proving a negative, especially when it comes to this, is extremely difficult. You will have to undergo an extensive psychiatric evaluation by a psychiatrist and they have to come to the very strong conclusion that you were well and truly out of your mind at the time of the commission of the crime. Otherwise, just the evidence that you did the crime is enough to establish guilt.
Oh, and if you somehow successfully plead insanity, you will spend quite possibly the rest of your life in a mental institution instead of prison, which isn't much better.
And yes, it's good to remember that police procedurals are to criminal justice what Hackers (1995) is to hacking: a lot of stuff is distorted to make good cinema/television. In the UK, judges on cop shows use gavels (that is strictly an American custom); how can we expect them to get the details of rare events like an insanity defense right?
It only came into existence fairly recently, and it continues to innovate and develop new approaches.
Good psychologists can provide enourmous value to their clients, and contrary to what the drug pushers want people to believe, mental illness isn't a physiological problem but a complex problem involving much more than that.
>But could you not plausibly define anyone who commits major crimes to be mental ill?
Yes, and it makes punishment in the manners we do it [US] frankly unconsciable for being torturous. What else do you call forcing a man to sit in a concrete and iron box for ten years involuntarily, if he would willingly expatriate instead? Imprisonment should become optional with expatriation. It is assinine that we take away passports from criminals; you should be wanting them to depart for good! Throwing a man in a box completely involuntarily and without any reachable alternative recourse except to wait it out, in lieu of just seizing all assets and kicking them out permanently if they so choose as the prison-alternative, is assuaging what internet trolls would call... your booty-blastedness for him giving you a really bad time.
Does deterrance actually work? Show me someone in the US who doesn't know about jails. Also a secure border was assumed but not stated. This presumes social groups want to be exclusive and are choosey of membership.
> Does deterrance actually work? Show me someone in the US who doesn't know about jails.
I don't know how to address this disconnection in logic. Do you assume that knowledge of a deterrent should create zero crimes ?
You are right though, maybe deterrence doesn't work and summary execution will be the only long term solution to prevent any possible reoffending. I for one welcome Judge Dredd-like overlords.
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.
Frances I think was worried about his legacy disappearing with DSM-5, because there was a big push to change things in a major way compared to DSM-IV. Ultimately I don't think that really happened; DSM-5 was a change but not the radical change I think the chairs and primary committees wanted it to be.
Frances' flooding of media outlets around that time was sort of strange in certain ways. He seemed to correctly identify potential problems in the mental healthcare system but then had this idea that changing things in the DSM to address some of its issues would make everything worse. It felt as if he was co-opting concerns everyone was having to argue for not changing anything at all, and in the process turned everything on its head.
The DSM is a very political document with a lot of interest groups involved at all levels, which is why it didn't change even more than it did. As a result, you had NIMH circumvent the whole process with RDoC, which then in turn seems to have had a relatively short life (maybe?) associated with changeover in its own administration.
It feels as if everyone has their own schema for thinking about mental illness, and the whole field moves along without any serious consequences. There's probably a lot of reasons for this, including scientific and medical sociology, and the complexity of mental wellness and illness as a ___domain. But it makes me wonder if some of the distinctions that are argued to be critical are really that critical in the end.
The anti-trans arguments are the same as the anti-gay arguments from 40 years ago. High suicide numbers in a group of people constantly harassed in the media and in real life doesn't prove that their healthcare caused it. It's just sad bigotry.
40 years ago you'd have been telling me that seeing homosexual couples hold hands and kiss is unnatural and requires the whole of society to believe an unnatural lie that they aren't just horrible perverts.
In both cases, a minority of people have non-mainstream feelings/understanding of their own gender or sexuality, and therefore wish to do things that affect their own body and either nobody else's (trans) or that only affect other people who feel the same way (gay). In both cases, people have argued that it's immoral, that it's about grooming children, and that the external visibility of being gay/trans - either seeing two people of the same gender holding hands, or kissing, or choosing to live their life together openly, or seeing someone who you once thought was one gender but has asked to be called the other gender and to be allowed to dress and act as culture considers "normal" for that gender.
In both cases, it turns out that actually, no, these gay or trans (or any combination of the LGBTQ - many trans people identify as trans AND gay, it's not a case of gay people choosing to be trans to become straight as I've seen claimed) people roaming the streets doesn't make your life worse, it doesn't trick kids into thinking about sex too early any more than a married straight couple bringing a new baby into the world does, and telling kids that it's OK to be gay, and that it's OK to be trans, doesn't lead to more kids "deciding" to be gay or trans it just leads to more people admitting it rather than staying in the closet. Trans kids and gay kids aren't making a decision, any more than you never made a decision to be your birth gender, nor did you make a decision to be gay or not.
Trans rights are human rights, and while I'm not trans if I decided tomorrow to get surgery to remove my penis and ask everyone to call me "she/her", how exactly does that affect you or anybody else any more than if I continue to have the gay sex I so often enjoy?
> People have been fired from their jobs, harassed by trans activists
You could say the exact same thing about people being fired for racism or homophobia and being "harassed" (I wouldn't use that word for fighting bigotry, personally) for being racist or homophobic. Is that evidence that racism should be allowed everywhere?
> The reason was that heterosexual males (who called themselves women) had attended previous such events, despite lesbian women of course not being interested in them, and were being creepy.
There is literally no evidence of this being a common thing, while there is quite a bit of evidence of nutty anti-trans people accusing cis women of being trans because they "looked manly", even though they were just women born looking like that. Meanwhile, the idea that male sex offenders would rather pretend to be female to gain access to private spaces (where if they start doing anything creepy, they can be kicked out by the majority regardless of whether the majority can tell what their birth gender is or not) as opposed to doing what actual sexual abusers do, which is using strength and or manipulation in one on one situations, not joining women-only groups for the opportunity.
It's all just fear mongering lies by a minority of bigots who hate gays just as much as trans people, which are then believed by another minority of people who believe the bigots really do have women's interests at heart. Statistics don't show that people who claim to be trans are more likely than people who don't to sexually offend, and in fact the vast majority of sexual offenses are committed by straight, cis men who aren't trans nor are pretending to be trans. And that fear of "men" can translate into fear of women who were born as men, even though statistically they're less likely to be sexual abusers.
This isn't about some women "looking manly" as you put it, it's about some males ignoring a lack of consent and imposing themselves on female-only spaces. Regarding the lesbian speed dating incidents, here's what the organiser had to say about what happened:
"One transwoman pushed himself against a lesbian in the toilets, and another, clad in purple lycra, was sporting a visible erection."
It should be obvious why she needed to explicitly point out that her events are female-only after that sort of behaviour from the heterosexual males who were intruding. And why these incidents, and the reaction she got from furious trans activists after standing up for the sexual orientation of herself and other lesbian women, has driven her to open a private members club for lesbian women where they can rightfully exclude any and all males.
She's fighting homophobia, yet is accused of being a bigot for doing so.
Do see what I mean by this, and similar such incidents, being examples of a clash of rights?
> > People have been fired from their jobs, harassed by trans activists
> You could say the exact same thing about people being fired for racism or homophobia and being "harassed" (I wouldn't use that word for fighting bigotry, personally) for being racist or homophobic. Is that evidence that racism should be allowed everywhere?
That comparison doesn't make sense. Is it racist to state, for instance, that Rachel Dolezal isn't black?
If people don't believe that men become women by announcing that they are women, then why would they call such a man 'she' and 'her'? Makes no sense does it.
Your argument is like claiming it's Islamophobic and bigoted to state that Mohammed wasn't any sort of prophet and that the Quran is not actually a divine revelation. If you don't believe it then you shouldn't have to act like you do believe it.
I'm not looking to have an argument about this bigotry, just needed to leave the actual common sense statement so yours didn't stand alone. Maybe consider that if other people are flagging you it's because your views are objectionable rather than because you're one of the few people to know the truth about a subject you have no actual experience of. Speak to some trans people to educate yourself.
> 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.
Ah this is also my stance. There are lots of good will in this subject, but trusting it is like trusting surgeons in 19th century. There may be no other option, but sometimes it's better to leave the bullet in your chest rather than letting it be infected by doctors with dirty hands.
> It's not a great situation, and I don't see many signs that it's improving.
I think this is a little too pessimistic on the one hand, and very accurate on the other.
On the accurate side: this discipline took one of the most significant hits from the replication crisis, and was one of the most resistant to acknowledging and changing practices. Everyone should keep pushing for open science and preregistered studies to improve quality of the evidence here.
On the optimistic side, there is one potentially huge change that's just starting to crest as opinions improve and acceptance spreads: psychedelics. MDMA for PTSD was a huge win and indicates a potentially large untapped realm of possibilities for altering cognition in positive ways.
There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades.
> There's also hope that neuroscience can start to supplant at least parts of psychology in a few decades.
That definitely does happen, but so far it happens glacially, I assume because doing groundbreaking neuropsychiatric research is considerably harder and more expensive work than "evergreening" existing drugs or reading stuff like Meditations and Walden Two [1] while sipping expensive wine and then pulling an allegedly-modern psychosocial theory out of one's nether regions. My current favorite reference point is anti-NMDA-receptor encephalitis, a (class of?) autoimmune condition that was only definitively identified ca. 2007. One must assume that there are centuries of breathless accounts of "demonic possession" or "latent schizophrenia" or people who were "on drugs" (colloquially often referring to effects of heavy doses of ketamine, PCP, and other potent deliriant/dissociative agents, which tend to be NMDA antagonists) that are probably explained by this condition. And who can say what percentage of today's "schizophrenics" have arrived at a similar place along an as-yet-unidentified path?
[1] Not to say those works aren't worth reading; they're iconic for legitimate reasons. I'm just saying that context and proportionality matter in ways that are often conveniently ignored.
Indeed, we need better tools and models to explain mental phenomena. It's getting better with models like predictive coding, but it's mostly still folk psychology at this point, just splitting progressively finer hairs.
No, like the Bergen 4 day treatment which is continuing to show highly promising results against severe anxiety disorders.
The use of psychedelics and ketamine for treatment of ptsd and depression respectively are also very promising.
There are advances being made in the treatment of psychotic disorders both on therapy side and on the medication side, with less harmful antipsychotics in development. And the need for chronic antipsychotic treatment(which is quite harmful in many ways) being questioned more and more.
You might wanna do some research before implying the field hasn't moved at all in the last 50 years...
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.
>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.
Which is precisely why the DSM is a political document, designed for clinical utility, and not a scientific one.
I will mention that several of the barriers to create we create to care are artificial. One of the most common fears I've heard from those with ADHD is that without their diagnosis being taken seriously they will lose access to their medication. Yet that's only an issue because we won't give people drugs, even if they find them helpful, unless prescribing physicians believes they are disordered. Consequently, there are ADHD communities who ban people diagnosed with ADHD for having too positive of a self-outlook.
The entire system is deeply twisted. We've made acceptance of an intrinsically derogatory pseudoscientific nosology a gatekeeper, and put reflexively categorising patients as disordered at the centre of our care model.
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 *.
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
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
I look at this from the other direction and find psychology's obsession and fixation on trying to discover what is wrong with their patients and labelling them to be an uncalled for and likely harmful.
I feel the idea that a psychologist should make your life better regardless of how healthy you are to be the normal, obvious idea. It's the compulsive pathologization that is truly bizarre. Why is that helping them?
It is exactly the role religions used to play - more so in the past, yes, but still pretty much in scene today still, although perhaps weaker - so this answer your question:
> Why does it do both?
Demand. For what? For adaptation to the current metagame.
While writing this reply, I remembered a few passages from a great thinker, that I think may contribute and expand the conversation, for those interested:
"Art, ethics, philosophy bear witness:
under the crust of words and concepts, the living reality of
non-adaptation to the world is always crouched, ready to
spring. Since neither gods nor words can manage to cover it
up decently any longer, this commonplace creature roams
naked in railway stations and vacant lots; it confronts you
at each evasion of yourself, it touches your elbow, catches
your eye; and the dialogue begins." [0]
"After all, if an individual refuses both to adapt to the
violence of the world, and to embrace the violence of the
unadapted, what can he do? If he doesn't raise his will to
achieve unity with the world and with himself to the level
of coherent theory and practice, the vast silence of
society's open spaces will raise around him the palace of
solipsist madness." [1]
"People are bewitched into believing that time slips away, and
this belief is the basis of time actually slipping away. Time
is the work of attrition of that adaptation to which people
must resign themselves so long as they fail to change the world." [2]
I'm not sure if its my internal bias, but I'm reading that as the way to prevent the slow slip into insanity is violence with an intent to change the world. The funny part is there may be truth to that.
You can go to the doctor to get advise on how to prepare for a sports event, you can also go to the doctor if you are sick. You can also go to the mechanic to tune the performance of your car and also to replace a broken head gasket. And while computer engineers are not repair technicians, they usually know better than the average person on how to fix a computer.
When you know about a subject, you are generally in a good position to both give advise and deal with problems, though you can specialize in one or the other.
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.
Incidentally, the species debate is fairly simply summarized / resolved, at least for typical sexual organisms: There is nothing whatsoever in first-principles evolutionary biology that says that these can always be partitioned into discrete categories that one might call "species". What evolutionary biology says is
1. When two populations overlap in space and time and have the opportunity to interbreed, they might do so.
2. In the absence of interbreeding, populations evolve, divergently w.r.t. most markers other than the occasional selection-mediated convergence.
So, divergence might be the result of lack of opportunity to interbreed (this allows genetic and phenotypic diversity to accrue, but does not itself represent a biologically real division), or it might be the result of inability to interbreed (biologically meaningful, but impossible to discern if opportunity to interbreed is absent). And that's it, for sexual organisms that is the gist. In general there's nothing to say that our systems of related populations spread through space and time can always be divided into "species". On the other hand any cursory look around a single locality shows that many discrete biological entities do exist; there's nothing wrong with giving them the name "species" as long as we acknowledge that for closely related allopatric populations the question of whether they are the same "species" is not defined.
There are various problems. One is that some humans are attached to the idea that entities exist for which the word "species" is apt; or put another way they are convinced that "species" must mean _something_ and they ask what (e.g. because they like their neatly divided up bird lists).
Another is that if scientists go around saying "animals can't always be divided into things which it makes sense to call 'species'" then it significantly weakens certain arguments for the protection of populations in conservation biology / legal contexts, since these invariably name the species-level taxa they are intended to protect. Since the modern trend is towards splitting subspecies (i.e. geographical races) into species (as opposed to lumping), many conservation initiatives are based on protecting "species" for which the species designation is subjective. That doesn't mean they are flawed of course -- they are nearly always protecting valuable ecosystems. It's just that as we split geographical races, we (by definition) create rarer and more vulnerable taxa, and so conservation initiatives arise around these.
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
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.