# TVAA-you don't know jackshit about mental illness **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 17, 2003, 11:45pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116 "2003-10-17T23:45:04Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 18, 2003, 2:32pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/61 "2003-10-18T14:32:54Z")
> [@](#): > > \*Originally posted by Guinastasia \* > \*\*Oh, and if **TVAA** said THIS: > > Then that proves, once and for all, he REALLY doesn’t know what he’s talking about. Hello-psychiatrists DO have MDs. They have to-otherwise they’d be psychologists, dumbass. \*\* I was talking about the first real psychiatrists, who were not regarded by the medical profession as being medical professionals. Even then, I was mistaken: quite a few of the founders of psychiatry did indeed have MDs. Now, if I had claimed that modern clinicians weren’t MDs, you’d be utterly correct in thinking I was an idiot. As things stand, you’re only partly correct in thinking so. Again, it would really help if you would read the original thread. > [@](#): > > \*\*As for you stating that mental illness doesn’t exist, well, then what exactly ARE you saying, **TVAA**? Because it sure looks as if that’s what you’re implying. \*\* I’m not debating whether people have immense problems. I’m debating the claim that psychiatric syndromes (disorders characterized and defined by a collection of symptoms) are necessarily physiological conditions that are currently known. With our current knowledge, we cannot validly claim that a person diagnosed with mental illness X has a physical problem with their brains. People used to claim that pellagra was a psychological disorder – now we know that it’s vitamin B12 deficiency. The problem wasn’t that we used to think it _might_ be psychological – it was “definitively” claimed that it was without anything approaching scientific evidence to back up that claim. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 18, 2003, 2:37pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/62 "2003-10-18T14:37:11Z")
> [@](#): > > \*Originally posted by Gyan9 \* > **TVAA: Didn’t you say the DSM defines the criteria, not discovers it? IOW, if you have criteria A,B,C,D then by definiton, you have disease X and so on.** Basically, yes. The DSM itself is determined by a vote of the members of the APA. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 18, 2003, 2:43pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/63 "2003-10-18T14:43:03Z")
I’m not suggesting I’m a psychiatrist or psychologist. I have formal training as a cognitive psychologist, and I’ve independently studied clinical psychology off and on for the past ten years or so. (I considered becoming a clinical psychologist once, until I learned more about it, and decided I couldn’t ethically do so.) My opinions are not to be taken as professional judgments; I’m an amateur in the oldest sense. Can we continue, please? ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 18, 2003, 2:55pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/64 "2003-10-18T14:55:17Z")
> [@](#): > > \*Originally posted by Calliope \* > \*\*In any case, we know how SSRIs work and they do indeed keep serotonin concentration levels high enough in brain synapses. Studies do bear out that people who suffer from serotinin related disorders do have a faulty processing of this and other neurochemicals. \*\* “Faulty processing” is not a particularly helpful term. We know how SSRIs achieve their primary effect, but we don’t understand how that actually affects symptoms. The antidepressants effects of SSRIs take weeks to manifest – it’s been suggested that they’re somehow related to receptor down-regulation, which is a known side effect of serotonin antidepressants that takes place at roughly the same time as the effects, but no one has any idea how that might be responsible. There have been plenty of neurotransmitter-based theories before the serotonin hypothesis that have now been discarded, and it isn’t any better supported than they were. > [@](#): > > \*\*I forgot to add that it is well established that these disorders have a high incidence of occurrence within families and the evidence for a genetic link is quite strong. And with my daughters, who were both diagnosed before the age of 5, their symptoms go through the roof whenever they have strep throat–a residual effect, perhaps, of PANDAS. In fact, I could make money placing bets on the results of their strep tests at the doctor’s office because the symptom-disease correlation is so strong. \*\* That’s deeply interesting, but what does that have to do with this debate? > [@](#): > > \*\*To claim there is no physiological syndrome happening, particularly with respect to OCD and Tourette Syndrome, is just not good science. \*\* To claim that the physiological symptoms observed are necessarily the cause instead of the effect is also not good science. ---
**Author:** ![Coldfire](https://avatars.discourse-cdn.com/v4/letter/c/a587f6/32.png) [@Coldfire](https://boards.straightdope.com/u/Coldfire)\ **Post date:** [October 18, 2003, 2:58pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/65 "2003-10-18T14:58:18Z")
> [@](#): > > \*Originally posted by TVAA \* > **My opinions are not to be taken as professional judgments; I’m an amateur in the oldest sense.** If you ask me, that ought to be your sig line, with posts like yours. ---
**Author:** ![greck](https://avatars.discourse-cdn.com/v4/letter/g/7ab992/32.png) [@greck](https://boards.straightdope.com/u/greck)\ **Post date:** [October 18, 2003, 3:40pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/66 "2003-10-18T15:40:33Z")
The DSM criteria look broad to you cause YOU HAVE NO FUCKING CLUE HOW TO USE THEM. You’re whining about it, and spreading your opinions as if they were fact, exactly that which you’re complaining the medical/psychological community does. It’s called projection. It’s what an asshole like you does when he can’t stand himself. TVAA you’re a fucking asshole. (aaah, better, that felt good). Pompous prick. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [October 18, 2003, 4:53pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/67 "2003-10-18T16:53:36Z")
> [@](#): > > **TVAA** : That’s deeply interesting, but what does that have to do with this debate? Friendly reminder: This isn’t a debate. It is a pitting. ---
**Author:** ![Hentor\_the\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/h/8edcca/32.png) [@Hentor\_the\_Barbarian](https://boards.straightdope.com/u/Hentor_the_Barbarian)\ **Post date:** [October 18, 2003, 5:13pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/68 "2003-10-18T17:13:59Z")
So, re: the unsupported TVAA claims made in this thread, again a pit thread calling him out for, in part, making unsupported claims: **1. TVAA claimed that schizophrenia is not a chronic disease in Africa.** His only support for this claim suggests exactly otherwise. The very page he links to opens with a statement that in general the consistency among countries and cultures for the disorder is high, but does indicate some variation among different **countries** in whether the disease comes on slowly or quickly, which of the symptoms people experience, and how they experience them. Nothing that says it lasts longer outside of Africa. It appears very much that there is no evidence from TVAA that supports his actual claim. I get so fucking irate when I read this shit, but I feel dirty after speaking harshly to TVAA. For some reason I feel like a bully picking on a weakling, so I’ll leave it at this. **2. TVAA also claimed that the criteria of the DSM were not those used by people to diagnose ODD.** He then presents the criteria, argues about the subjectivity of “often” and about the “clinically significant impairment.” We’ve been over this in the ODD thread. > [@](#): > > These criteria rely heavily on cultural effects and subjective interpretation, **TVAA** has never once supported this assertion. Though not perfect, the set of behaviors that is used to define DSM-IV ODD shows consistency, reliability and validity that suggests it is a good construct. I happen to feel that it needs to be revised for a number of reasons. None of which have anything to do with the spitball assertions of **TVAA**. > [@](#): > > which is obviously the case as the DSM doesn’t offer any operationalizations of the concepts it includes in the disorders’ criteria. Like a recipe that doesn’t offer any measurements but suggests “reasonable” amounts of one ingredient and “appropriate” amounts of another, the criteria as written cannot be used to evaluate anything. If this were true, the interrater reliability for the disorder would be 0. It is significantly better than chance, however. It isn’t where we want it to be, but clearly it is an error to say that the criteria cannot evaluate anything. **TVAA** has never presented any support for this assertion either. > [@](#): > > Yet diagnoses are made. Ergo, the criteria doctors use to decide whether a child has ODD or not are not contained within the DSM. (Without knowing the levels at which a clinician would consider something to be “often”, “clinically significant”, and so on, there’s no way to actually use the DSM.) Except of course, if you are a clinician. Ergo, oh brilliant one, where is the evidence that clinicians are “not using the DSM for diagnoses?” > [@](#): > > **3. Hey, you’re the one who suggested that the control group in that experiment was being studied.** You also ignored that the researchers failed to demonstrate the DSM model with the mathematical standards of validity, and you completely misunderstood their discussion of the possible causes of error. Fucking pathetically untrue. Patent bullshit! In response to the assertions of cultural specificity, I cited a huge study of 11 different samples in three countries (the US, Canada and the Netherlands) of data on children. Some of the data came from samples of children already in therapy, presumably more extreme in their problems, and some of the data came from community surveys of children, presumably akin to the general population in their level of problems. Since these were from different studies, the data came from three different interview instruments. This means that the specific wording of the questions about the behaviors differed. What the researchers did was to take the parent and teacher ratings of all these different kids in different places using different questionnaire techniques to see if the way the DSM says the behaviors will be associated with one another is the way that it turns out in reality. **TVAA has never once appeared to understand the methodology of that study, and continues to fail to grasp it.** Yet, factor analysis is a basic tool of scientific inquiry and the concept should be easily grasped by anyone with a modicum of training or experience. You can see that he is still talking about a control group! There is no control group in a factor analysis. He had also been talking about the study as if it compared clinicians’ diagnoses with some other measure, when there are neither clinician’s ratings nor diagnoses involved. Again, it is parent and teacher ratings of behaviors that are symptoms of the disorders. He also suggested at one point that the entirety of the sample was already clinically impaired, when it is clear that some of the children are from clinical samples and some are from general population samples. Finally, here, he fails to understand what the measure of model fit means. The findings of all these different kids in different places using different questionnaires ended up saying that the DSM is the best model of those tested to explain the way these particular behaviors hang together (i.e. individual symptoms of anxiety are associated with one another and not with individual symptoms of Oppositional Defiant Disorder, etc). The authors clearly state that, even though the DSM model is statistically significantly better in explaining the relationships between behaviors than the other models, the model does not meet the significance level for overall goodness-of-fit. This means that there is still variation unexplained within the model of what the DSM says should be here. The authors point out that the differing questionnaires will have a great deal to do with increasing variance among the ratings. Ultimately, the best interpretation of the study is that the current model is better than others, but can be improved. As to the need for improvement of the DSM, nobody but nobody has argued otherwise. Yet, **TVAA** is both incapable of interpreting these findings though anything other than an anti-DSM/anti-psychiatry/anti-psychology prism, and **STILL** does not understand the study. **There is no control group in factor analysis, you silly dope!** That would be appropriate for another analytic technique. You just cannot get this one right – still very embarrassing. I hope you are able to “(self) correct” sometime soon. > [@](#): > > It was embarassing. For everyone reading your posts. Um, yeah, I’m sure that’s how it was. > [@](#): > > **4. It’s not “typical”,** and it used to be considered a diagnostic difference until it was realized that there’s no difference between exogenous and endogenous depression as far as treatment is concerned. The criteria were broadened to include an “increase or decrease in sleep, appetite, weight, activity, etc.” Gee, that’s specific. This is a misrepresentation of the diagnostic criteria, again, on top of his original misrepresentation. For everyone’s benefit, **TVAA’s** original claim was > [@](#): > > Let’s look at one example: atypical depression. It’s almost the inverse of archetyped depression: instead of sleeping more, people often sleep less; instead of eating less and losing weight, people tend to eat more and gain weight. Almost the only factor in common is unhappiness – and that both types respond equally to standard therapies, including antidepressant treatments. Reading this, one might think that “archetyped” [???] (one presumes “typical”) depression criteria include excessive sleep and reduced appetite, in contrast to what he is presenting here. Well, this is just incorrect, as I said before. Changes in appetite (either way) and changes in sleep (either way) are symptoms of depression. As to unhappiness being “almost the only common factor” (which again is wrong for the reasons I noted in the previous sentence) is unhappiness. Actually, Major Depressive Disorder, Atypical Features, indicates that the person met criteria for Depression, but are noted for having mood reactivity (positive events may make them happy), and either two of four other symptoms: heavy, leaden feelings, a general pattern of sensitivity to interpersonal rejection, and then the two he has noted. Again, the DSM is imperfect, and is implemented imperfectly. This is without question. However, arguing through misrepresentation and ignorance is **TVAA’s** hallmark, and should not be tolerated. It gets people’s panties all wadded up. I’m sorry, **TVAA** , but whatever knowledge underlies them and whatever utility your contributions might have is completely washed out by your pointed misrepresentations and misstatements. You simply ooze support for the aphorism “A little knowledge is a dangerous thing.” Please cite, and then speak. I suggest a “take-a-number” system for all those waiting in line for support for the various assertions that **TVAA** has made. I know others have been waiting at least as long as I have, yet he simply keeps throwing out new ones like some deranged Johnny Appleseed. ---
**Author:** ![Mr.Svinlesha](https://avatars.discourse-cdn.com/v4/letter/m/22d042/32.png) [@Mr.Svinlesha](https://boards.straightdope.com/u/Mr.Svinlesha)\ **Post date:** [October 18, 2003, 5:26pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/69 "2003-10-18T17:26:09Z")
**greck** : Alright, that does it. Look, one might disagree with **TVAA** on some of the specific details that he’s mentioned, and yeah, he’s not been so great at backing up his argument with cites. But I’m completely at a loss as to why you and (to a certain extent, anyway) **Hentor** have been reacting so negatively to the point he’s trying to make. From my 10+ years of experience as a practicing psychotherapist here in Sweden I can’t find anything fundamentally incorrect in his criticism of the DSM system. And if **Hentor** is involved in research, that he must be aware that inter-rater reliability regarding diagnostic categories has been a continual problem in the field. Certainly, it’s not so bad that “10 psychologists have 10 different diagnoses” for a given patient, but often enough the criterion do require making some sort of judgement, and that judgement in its turn can vary from individual to individual, from culture to culture, and from country to country. In a way, the DSM represents an attempt to apply a medical paradigm to a field that it might not fit very well (i.e., human behavior). There is a risk that the DSM provides a sort of “diagnostic overlay” that doesn’t really correspond very well to the reality it attempts to describe. It can be employed to stuff people into general categories without taking cognizance of important, perhaps even crucially significant, individual variations, for example. In addition, there is some politicization of the classification system. Revisions in the DSM don’t just reflect advances in our understanding; in fact, they might not even reflect advances at all. New diagnostic categories are constantly being created and vying for a position in the manual (such as, for example, [Parental Alienation Syndrome](http://www.deltabravo.net/custody/rand01.htm)). There are requirements for the introduction of a new disorder, but the process is politically driven as well. At the same time, some old “disorders” (like homosexuality) are removed, not because of any real objective criteria, but rather as a direct result of social pressures. So – how many disorders are included, and how many excluded, on the basis of factors beyond the merely empirical? As I understand **TVAA’s** argument, the point is not that the conditions described by the rubrics “ADHD” or “ODD” don’t _exist_; he’s just critical with regard to way that we conceptualize and talk about them. There is a continuum of “unruliness” in children, but somewhere along that continuum we draw a line and say, “Here and further up the scale is ADHD.” How any individual practitioner marks that point, or decides on the diagnosis ADHD rather than ODD, for example, is _ **subjective** _. Period. For better and worse. Diagnosticians learn how to make those judgements in specific social and cultural contexts, and in a different context, the line might be drawn differently. I simply don’t understand what all the fuss is about. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [October 18, 2003, 7:04pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/70 "2003-10-18T19:04:20Z")
> [@](#): > > I’m not suggesting I’m a psychiatrist or psychologist. > > I have formal training as a cognitive psychologist, In my state, to say “I have formal training as a cognitive psychologist” would be taken as an assertion that you were one. This is a legal and ethical issue issue that falls under misrepresentation of training. You could say “I have formal training \*\* in cognitive psychology\*\*” and be on safer ground. > [@](#): > > (I considered becoming a clinical psychologist once, until I learned more about it, and decided I couldn’t ethically do so.) Which ethics? The Hippocratic oath? For the record, I certainly agree that the DSM is as problematic as any other taxonomy, and that it is possible to use it abusively or inaccurately. I also agree that “mental illness,” both as a general topic and in its specifics, is culturally constructed, even in disorders where a physiological basis is necessary or sufficient. What I don’t like is how **TVAA** becomes stubborn rather than compassionate, entrenched and argumentative rather than flexible, when other Dopers describe their experiences. These anecdotal self-reports should not be dismissed because they are not empirical. In order to know what questions to explore in a quantitative study, we rely on qualitative reports from the people who are experiencing the phenomenon to guide our inquiry. We may disagree about the congruence between their report and our “objective” report, but that does not mean that we dismiss the data they provide. If our report and their reports differ significantly, then we have not done a good job with our study, and need to return to the people involved in the phenomenon and ask “What are you experiencing? What are we missing?” This is how science progresses. Respect, curiosity, compassion, and welcome are essential. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [October 18, 2003, 7:14pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/71 "2003-10-18T19:14:24Z")
Mr. Svinlesha, you say that you are a practicing psychotherapist. What is your exposure to psychiatric medicine (other than possibly as a patient or as a self-taught individual)? What qualifications are required to be a psychotherapist in Sweden? I’m not intending to be rude in asking, but others who have weighed in on the merits of TVAA’s comments from a professional point of view have been willing to share their credentials or, in my case and TVAA’s, lack of them. ---
**Author:** ![Hentor\_the\_Barbarian](https://avatars.discourse-cdn.com/v4/letter/h/8edcca/32.png) [@Hentor\_the\_Barbarian](https://boards.straightdope.com/u/Hentor_the_Barbarian)\ **Post date:** [October 18, 2003, 8:24pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/72 "2003-10-18T20:24:14Z")
**Mr. S.** , I am saddened to see someone who would give such thorough scrutiny to the assertions put forth by Bush regarding Iraq would give such a pass to a relatively similar set of intentionally misleading statements. It seems too common for folks like DSeid, Gadfly and now you to give a perusal of TVAA’s argument and conclude that it is at its core: There is subjectivity and imperfection in our diagnostic and treatment efforts. These things are true; they are far from the extent of TVAA’s argument. I wouldn’t really mind even the most extreme criticism, were it backed up by data. But when it is not at all backed up by evidence and continually biased toward a particular slant, I smell an agenda. I ask you, which of these quotes, taken from only two threads, the ODD and the ADHD threads, do you also agree with (in addition to the assertion from this thread that schizophrenia is significantly shorter in duration when experienced in Africa). They are all problematic and misleading, and at the very least demand support that has not been given. > [@](#): > > Unfortunately, the criteria for determining what “extremes” should be considered pathological often involve whether we can treat them effectively. Well, then there should be great treatments for most everything in the DSM. Are there? > [@](#): > > Cognitive psychology is a science. Clinical psychology is not, no matter how many professionals which it were. Unfortunately, it’s easier to treat it as a highly rigorous and objective discipline of medicine than to actually make it so. In the US, call your senators and congressmen, because millions of NIH dollars are being wasted annually for studies within a non-science. > [@](#): > > Until a few years ago, the method used to diagnose conditions like ADD in children were simple: prescribe stimulants, and if the bothersome symptoms improved, they had ADD. If not, they didn’t. TVAA has still presented no evidence that this was the method used for diagnosing ADD. The DSM-III goes back to 1980, and does not indicate that this was the method to be used. > [@](#): > > Reading material presented to clients and patients quickly shows that such claims are made in clinical psychology – haven’t you seen those atrocious television commercials for psychiatric medications? Clinical psychology has nothing to do with pharmaceutical advertisements. > [@](#): > > “Moving forward” requires that your constructs actually match reality. While some uncertainty about the nature of the constructs exists in all sciences, psychology’s are relatively poorly supported by evidence and (IMO) are desperately clung to because without them the whole field loses the appearance of a science. There is actually a great deal of evidence regarding psychological constructs. Some better than others, and I would say that all or nearly all could be improved. > [@](#): > > Why? If the standards of the DSM are truly definitional, anyone should be able to use them to reach accurate diagnoses. My complaint is that they’re not truly definitions, and they’re sufficiently broad that they apply to a very wide range of conditions. By their definitions, almost anyone can be considered to have at least one mental disorder. > [@](#): > > You do have any idea on how the DSM criteria are reached? Voting. Voting on what? On available evidence. Revisions are suggested and supported by data. Politics does come into play in voting on whether the evidence is sufficient or not. But this post and TVAA’s practice in general is to pretend that there is no evidence for the utility of DSM diagnoses. > [@](#): > > Clinical psychology relies on human opinion as its ultimate guide, not observations of the systems it studies. Thus it is necessarily not a science. > [@](#): > > From me: Can you tell me which lengths of time have not been supported in validity studies? I am actually interested to hear. > TVAA’s reply: Any of them. _Regarding treatment for ODD_: > [@](#): > > First of all, they were kept on the antipsychotics for weeks and months at a time. > Secondly, blunting people’s will and initiative may well be convenient for the people dealing with them, but it can’t be considered a healthy improvement by any rational standard. Psychological therapy is NOT about molding people to fit what we want them to be. _Here’s a good one for arrogance, pretending to expertise, and misleading by suggesting the exception is the norm_ > [@](#): > > This is quite possibly the stupidest and most ignorant thing I have ever seen at here at the Straight Dope. > > Children and adolescents have no way in the therapies they are forced to undergo. Many mental patients are also compelled to undergo therapies that are far more invasive than psychotherapy. > > I’ve seen psychologists and psychiatrists define patients’ behaviors and beliefs as “unhealthy” without anything even approaching a rational reason. I’ve seen them consider any opinion or belief they didn’t understand as symptoms of illness. I’ve watched them judge people as “sick” because they didn’t want to be what the doctors thought they should be. > [@](#): > > If the kid has friends, but they’re the “wrong kind” of friends, it’s a social impairment. If the kid has a trait which we do not see as bad but drives away others, we tell the kid they weren’t appropriate friends because they didn’t value him for what he is. If the kid has a trait which we see as bad and drives away others, we tell the kid he should change. > [@](#): > > Psychiatry and clinical psychology are neither “Cuckoo’s Nest” nor a helpful science, and I’m quite familiar with the nature of sciences, so I should know. > [@](#): > > This is precisely why some homosexual adolescents are forcibly imprisoned in special psychiatric “hospitals” and “treated” for their “condition” against their will. Where is this being done? How many are experiencing this abuse? No evidence or support? Hmm. > [@](#): > > Even a rudimentary study of the history of psychiatry and psychology demonstrates that there have been countless attempts to understand mental illness by an appeal to known psychological and physiological forces – and they’ve all failed. Time after time, people are convinced that they’re found the one true explanation, and been shot down by the evidence. > [@](#): > > stimulants have similar effects in all children: reduced initiative, reduced enthusiasm, and vague feelings of distress. > [@](#): > > It’s not uncommon for children who take these drugs to complain about how they make them feel. More to the point, they can often be observed to be noticably less cheery. Whether this occurs is partially dependent on how positively the child himself feels about taking the drugs – kids whose lives are significantly improved by them are less likely to find them objectionable. I am personally not particularly impressed by your claims to knowledge when you’re not familiar with the history of this disorder. > [@](#): > > In addition, the supposed “standards” of the DSM are more like the recipe I posted earlier: give them to ten different people and let them reach their conclusions independently, and you’ll have ten different diagnoses. > [@](#): > > I’m not even sure how to interpret this rather incoherent set of claims. The distinction between psychiatry and neurology was initially that neurologists were medical professionals with degrees while psychiatrists were not. Some have suggested that the resulting “physics envy” has persisted to this day. > [@](#): > > Nice try. Pinel was not a psychiatrist. Neither was Kraepelin – although he’s now considered the Father of Psychiatry, his work was ignored throughout much of the twentieth century because of Freud. Freud wasn’t a practicing physician, and Freudian psychotherapists were generally not doctors. ---
**Author:** ![TVAA](https://avatars.discourse-cdn.com/v4/letter/t/c57346/32.png) [@TVAA](https://boards.straightdope.com/u/TVAA)\ **Post date:** [October 18, 2003, 10:44pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/73 "2003-10-18T22:44:19Z")
[QUOTE] \*Originally posted by Hentor the Barbarian \* \*\*So, re: the unsupported TVAA claims made in this thread, again a pit thread calling him out for, in part, making unsupported claims: > [@](#): > > \*\*The very page he links to opens with a statement that in general the consistency among countries and cultures for the disorder is high, but does indicate some variation among different **countries** in whether the disease comes on slowly or quickly, which of the symptoms people experience, and how they experience them. Nothing that says it lasts longer outside of Africa. \*\* 1) Studies indicate that about 40% of schizophrenia cases in sub-Saharan Africa are acute schizophreniform disorder, which essentially means people rapidly develop schizophrenia-like conditions that don’t act like normal schizophrenia. 2) There have been plenty of studies examining the sociocultural differences in the treatment and acceptance of schizophrenia in non-Western cultures – it’s often regarded as a temporary form of spiritual possession. 3) That 40% of cases are usually acute _only_. This contradicts Western ideas about schizophrenia, in which it’s rather unusual for a person to go into “remission”. > [@](#): > > \*\ ***2. TVAA also claimed that the criteria of the DSM were not those used by people to diagnose ODD.** He then presents the criteria, argues about the subjectivity of “often” and about the “clinically significant impairment.” We’ve been over this in the ODD thread. **TVAA** has never once supported this assertion. Though not perfect, the set of behaviors that is used to define DSM-IV ODD shows consistency, reliability and validity that suggests it is a good construct. \*\* When untrained individuals use those criteria, their reliability is much lower. We’ve already discussed how clinicians learn what kinds of behavior are considered pathological from feedback. That is why vague standards like “is often resentful” can be reliably used: because they’re merely referents for the actual standards. You’re also confusing your nomenclature. Reliability and consistency are the same thing. No one’s ever been able to demonstrate the empirical validity of those criteria, because the disorders themselves lack empirical definitions. > [@](#): > > \*\*If this were true, the interrater reliability for the disorder would be 0. It is significantly better than chance, however. \*\* No, and only an absolute idiot would think so. It is not at all unreasonable to presume that two randomly chosen people from similar cultures would be somewhat similar ideas about what an unusually disruptive and defiant child would be like. The reliability would be zero only if everyone had utterly different ideas, which is clearly not the case. However, without a precise and specific empirical definition, conceptually it’s not possible to show that any person’s interpretation of that standard is incorrect. > [@](#): > > \*\*Except of course, if you are a clinician. Ergo, oh brilliant one, where is the evidence that clinicians are “not using the DSM for diagnoses?” \*\* 1) In the US, it’s generally not possible to get insurance reimbursement without receiving a DSM diagnosis, so clinicians will sometimes give someone a diagnosis that only approximately fits. 2) The criteria themselves are vague, yet clinicians are able to give diagnoses reasonably consistently. Ergo, the implicit standards they use aren’t the standards of the DSM in a strict sense. If I give several people the instructions to “go north for a while, then head east, then walk south-southeast until you reach the destinationi”, and they all end up in the same place even though they travelled independently, it’s clear they’re not really following the instructions – they’re following a more specific set of instructions that isn’t obviously incompatible with my much looser set. I don’t have the strength to quote **Hentor** ’s complaints about the study, so I’ll just cover some quick points. As the authors of the study pointed out, those questionnaires hadn’t been empirically evaluated before. The whole point of the study was to see whether certain symptoms were actually correlated the way psychological theories of certain mental disorders suggested they should (which is what the DSM criteria are based on). As the study points out, it’s necessary to find out what the default association between those symptoms is in the general population. It’s entirely possible that two symptoms like “cries often” and “is frequently anxious” are inherently associated even in normal people. Therefore, in order to compensate for any underlying correlation among the symptoms (as the paper clearly says they did), it’s necessary to examine a group of presumably normal children. This is the “control group” I referred to, although technically observational studies don’t have control groups. It would be more accurate to say that they’re the baseline. The children being studied, though, were the ones who were diagnosed with some clinical condition. **Hentor** doesn’t understand this. The study examined whether the patterns of associations between the symptoms suggested that there were distinct groups of symptoms linked together – in other words, whether the data suggested there might be underlying mental illnesses. They tried to explain the data with multiple models – and they found that the six-categoried DSM model fit the data best. However, this match wasn’t statistically significant, and the authors said there was quite a lot of room for improvement. Specifically, they offered some explanations for possible error: the wordings of the instruments was too vague (which implies that the DSM is vague, since if it were precise it would be easy to write precise instruments), and there were too many symptoms that were common to multiple categories. > [@](#): > > **TVAA’s** original claim was Reading this, one might think that “archetyped” [???] (one presumes “typical”) depression criteria include excessive sleep and reduced appetite, in contrast to what he is presenting here. Well, this is just incorrect, as I said before. Changes in appetite (either way) and changes in sleep (either way) are symptoms of depression. \*\* You miss the point. “Typical” depression is associted with insomnia, reduced appetite, lowered levels of activity, etc. In fact, those were once the standards for depression. Over time, it was realized that there were lots of people that didn’t fit those criteria, but were still quite unhappy: some people would eat more and gain weight, or sleep for long periods of time, etc. That’s why they were considered to have “atypical” depressions. Duh. The diagnostic criteria were eventually changed so that any change (positive or negative) in certain behaviors was a symptom of depression. Nevertheless, we can still talk about typical or stereotypical depression and atypical or nonstandard depression. Indeed, some people suggest that they’re distinct disorders. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [October 18, 2003, 11:38pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/74 "2003-10-18T23:38:35Z")
> [@](#): > > In the US, it’s generally not possible to get insurance reimbursement without receiving a DSM diagnosis, so clinicians will sometimes give someone a diagnosis that only approximately fits. This is a general allegation of insurance fraud. I can’t argue that it never happens, but I can report that I have never “give someone a diagnosis that only approximately fits,” nor have I heard from another psychologist that they have done so. ---
**Author:** ![wring](https://avatars.discourse-cdn.com/v4/letter/w/838e76/32.png) [@wring](https://boards.straightdope.com/u/wring)\ **Post date:** [October 18, 2003, 11:50pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/75 "2003-10-18T23:50:44Z")
did **TVAA** , an admitted non clinician, just suggest that they ‘know’ what ‘some’ clinicians have written in case files and on insurance claims (and been privvy to a discrepancy between the diagnosis and reality?) ---
**Author:** ![presidebt](https://avatars.discourse-cdn.com/v4/letter/p/c37758/32.png) [@presidebt](https://boards.straightdope.com/u/presidebt)\ **Post date:** [October 18, 2003, 11:59pm UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/76 "2003-10-18T23:59:30Z")
I “have” bi-polar disorder, and my question from day one (of the diagnosis) has been: Can you show me how? Can you measure it? They can’t, generally speaking. The lithium angle isn’t a faultless measure because lithium doesn’t even work for many people diagnosed BPD, as it doesn’t for me. As it was explained to me, they couldn’t test my lithium level to provide evidence of the disorder, but they _could_ test it to provide evidence of treatment–or in my case, the lack thereof, since more lithium didn’t solve the problem. In other words, there is no objective test: they say it’s an imbalance, but they can’t measure that imbalance. For me, I take my medicine because it makes for a nice, tidy existence for my daughter, but I’m still not convinced that this is physiological–or genetic. Maybe the problem is that society is now so homogenous it can’t accomodate such extremes in personality, and so promotes medicating me into a more acceptable, assimilated member. And I do notice that there is a sort of girl/boy-scout-badge-culture among a lot of people with mental disorders. For some that I know, their mental condition became their identity. That disturbs me a great deal, as does the reality that one can hardly question the mental health industry (and that is what it is) without accusations of being cruel and lacking compassion. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [October 19, 2003, 12:23am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/77 "2003-10-19T00:23:15Z")
**TVAA** , you are misunderstanding and misusing terminology. “Typical” depression does not mean “stereotypical depression.” “Atypical” depression" does not mean “nonstandard depression.” You continue to demonstrate the point of this thread that “you don’t know jackshit about mental illness.” You continue to proliferate misinformation. I think you do it intentionally – at best, casually. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [October 19, 2003, 12:36am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/78 "2003-10-19T00:36:29Z")
> [@](#): > > **presidebt** one can hardly question the mental health industry (and that is what it is) without accusations of being cruel and lacking compassion. That wasn’t why TVAA was pitted. ---
**Author:** ![Gadfly](https://avatars.discourse-cdn.com/v4/letter/g/aeb1de/32.png) [@Gadfly](https://boards.straightdope.com/u/Gadfly)\ **Post date:** [October 19, 2003, 3:06am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/79 "2003-10-19T03:06:44Z")
STOP. TVAA has made some questionable points while defending this, but they were made to defend against what was essentially a strawman attack in the first place. TVAA never said that mental disorders weren’t real, just that we have a middling understanding of them, and maybe they aren’t all physical problems. A point I tend to agree with. This whole debate spiraled out of a problem that didn’t exist in the first place. It’s just silly! It’s not a pit topic, it’s a debate, so go to GD. There’s nothing pit-worthy that TVAA has said, as far as I can tell. ---
**Author:** ![Primaflora](https://avatars.discourse-cdn.com/v4/letter/p/898d66/32.png) [@Primaflora](https://boards.straightdope.com/u/Primaflora)\ **Post date:** [October 19, 2003, 5:35am UTC](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116/80 "2003-10-19T05:35:10Z")
Fine then **Gadfly** , you wander back to GD and debate with him until your eyeballs bleed and the rest of us will do what we want in the Pit. The problem exists. The lack of valid, reputable, relevant cites exists. The representing of himself as something he most definitely is not exists. I don’t find any of that silly. [Previous page](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116.md?page=3) [Next page](https://boards.straightdope.com/t/tvaa-you-dont-know-jackshit-about-mental-illness/208116.md?page=5)