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Reader responses to the article Science of Mind
Copyright © 2014, Paul Lutus — Message Page
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The tests don't attempt to explain their results, they're only descriptions. As a result, they have no depth and cannot make reliable predictions. It is on this same ground that the NIMH has recently decided to drop support for the DSM. Like personality tests, the DSM is only a set of descriptions with no scientific depth, a depth that would require explanation. Both psychological testing and the DSM show some correlations with behavior, but as has been often said, correlations aren't science until a cause-effect relationship is uncovered.
The history of psychological testing shows no progression from crude to refined, and from hypothetical to reliable and scientific. As one example, psychologists who serve on parole boards and who rely on various kinds of psychological evaluations including testing, cannot produce worthwhile predictions of the future of parolees above the chance level. This is a particularly telling example because those receiving the psychological evaluations are tracked by the legal system and either do, or don't, meet the psychologist's expectations later.
The history of psychological testing is filled with examples in which tests were used to support the goals of those who designed the tests, rather than any objective criteria. One example are the I.Q. tests that were designed and administered by R. M. Yerkes in the early 20th century, tests that seemed to show that Eastern European people were genetically inferior and should be denied immigration to the U.S.. Later reevaluation demonstrated that the cohort to which these people belonged in fact have a higher-than-average I.Q. when tested using different methods. This is not to argue that one result or the other is "right", only that they differed dramatically (the later tests came to the opposite conclusion), and the earlier results had the very unfortunate effect of denying immigration status to many people who were later exterminated by the Nazi regime.
"Insel announced that that the D.S.M.’s diagnostic categories lacked validity, that they were not 'based on any objective measures,' and that, 'unlike our definitions of ischemic heart disease, lymphoma or AIDS,' which are grounded in biology, they were nothing more than constructs put together by committees of experts. America’s psychiatrist-in-chief seemed to be reiterating what many had been saying all along: that psychiatry was a pseudoscience, unworthy of inclusion in the medical kingdom."So, which part of this public stand by America's highest-ranking psychiatrist — and most influential authority — didn't you understand? Insel has written extensively on this topic in his NIMH blog:
"The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been 'reliability' – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."In this quote, Insel takes exactly, precisely, the same position I have taken — psychiatry relies on anecdote, on a listing of symptoms instead of a knowledge of causes, on description instead of explanation, on narrative instead of science.
"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. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better."
"When debating any issue, there is an implicit burden of proof on the person asserting a claim. An argument from ignorance occurs when either a proposition is assumed to be true because it has not yet been proven false or a proposition is assumed to be false because it has not yet been proven true.This has the effect of shifting the burden of proof to the person criticizing the assertion, but is not valid reasoning."As freely acknowledged by Freud and his descendants, psychiatry has never been a science, therefore to defend it as a science, psychiatry must shoulder its burden of evidence. This means you must shoulder your burden of evidence. In this exchange, by quoting the authorities in your field — all of whom freely acknowledge that psychiatry isn't a science — I have been meeting a burden of evidence that isn't mine.
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