Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Undisclosed financial conflicts of interest in DSM-5 (2024)

bmj.com

Post reply on HN
Print view View original

91–100 of 225 posts

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#91

Post by naveensundar »

IFC_LLC wrote: post #87
readthenotes1 wrote: post #14

I wonder how much of the DSM is based on loose correlations, non-replicated or fraudulent research. I get the feeling that we understand how our brains work about as well as we understand how well mitochondria work - - and I see reports of new findings on mitochondria fairly regularly...

I took the liberty of indulging in some reading. I must admit, it feels a bit strange. The truth is that I learned my first steps in programming by working through large, formidable books. In fact, my very first programming book was Assembly Language for Intel-Based Computers by Kip Irvine. After that, I read even larger books, many of them multiple times. I have always been fond of reading well-written books by know…

Logically, your example is not contradictory.

  1. We don't know actual prevalence
  2. But believe it is low
  3. Upper bound in some community is 2%
It is not at all contradictory.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#92

Post by naveensundar »

vjulian wrote: post #38

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

I think this is not a valid criticism.

By this criteria, you can then say many other non-psych conditions are not disorders.

What classifies as a disorder other than making life worse for someone?

There is no universal book given by a holy entity that we can read to classify something as normal or a disorder.

Why do we have arbitrary cutoffs for cholesterol, blood sugar, blood pressure, etc?

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#93

Post by cwmoore »

supportengineer wrote: post #67
epgui wrote: post #47

Earlier quoted context omitted.

This is the wrong question… The DSM is just an ontology that aims to standardize communication of otherwise ill-defined or nebulous clinical entities. It provides language for medical professionals of various backgrounds to understand each other across cultures. That’s all it is.

It's a sorting hat

So not a tinfoil sieve?

EDIT: missed Harry Potter reference

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#94

Post by Retric »

phren0logy wrote: post #83

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

> What’s the psychiatric equivalent of a sprained ankle?

A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#95

Post by sedivy94 »

Retric wrote: post #94
phren0logy wrote: post #83

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

> What’s the psychiatric equivalent of a sprained ankle? A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.

What’s the right word to differentiate this from a psychiatric diagnosis? Neurological?

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#96

Post by dlivingston »

noosphr wrote: post #79
connicpu wrote: post #57

Earlier quoted context omitted.

But conceptually in the DSM most disorders are defined by whether they cause hardship in the patient's life. Whether that means some disorders would not have to be considered disorders in an ideal society is irrelevant for this context, because people need help navigating the society we have.

Remember that in the US slaves wanting freedom was a mental disorder that made it past peer review: https://en.wikipedia.org/wiki/Drapetomania

Reading your linked article, it's clear that this was viewed as absolute quackery even back then, and is about as conflict-of-interesty as you can get: commissioned by Louisiana at the height of the Civil War, and proposed by a doctor who served in the Confederate Army [1]. His suggested treatment for Drapetomania was "whipping the devil out of them".

[1]: https://en.wikipedia.org/wiki/Samuel_A._Cartwright

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#97

Post by sedivy94 »

plandis wrote: post #85
noosphr wrote: post #79

Earlier quoted context omitted.

Remember that in the US slaves wanting freedom was a mental disorder that made it past peer review: https://en.wikipedia.org/wiki/Drapetomania

What is your point? Surely you’re not trying to draw some conclusion between an entire countries modern day medical field and a theory a person proposed in the 1800s, right?

Hi, not the parent poster here. I believe the argument being made is that diagnostic criteria, and diagnoses themselves, can be shaped by cultural norms. As the Overton window shifts, so do the thoughts and behaviors that we deem pathological.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#98

Post by dang »

lazide wrote: post #58
dang wrote: post #51

Earlier quoted context omitted.

Nationalistic flamebait is when someone makes a pejorative generalization about a country, usually in the context of a comment which has little information, but only denunciatory rhetoric. Your GP comment clearly fits that description, as I read it. This is not a borderline call! What happens when people post like that is that others, who have the opposite sympathies, get provoked and feel entitled to respond in kind…

As someone who has been here many, many years - this is truly mystifying to me. And not just me, apparently. And also notably, no one responded that way to that comment. But sure, it’s your show.

> no one responded that way to that comment

You're right, but we have to moderate based on how these things work in the general case.

> this is truly mystifying to me

It's inevitable that there will be different interpretations of specific comments, so I hope you can at least 'upgrade' us to "wrong in this case" and hopefully we will make more sense in the future!

p.s. I know what you mean about "it's your show" but we really don't think of this as "our" show - the community is the only thing that's valuable about HN

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#99

Post by aleph_minus_one »

reorder9695 wrote: post #44
vjulian wrote: post #38

What counts as a “disorder” is often not based on empirical evidence but on what is determined as undesirable, maladaptive, or outside the social norm…by Americans. The DSM in many ways represents the worst of so-called social science.

How else would you do it? Unlike an e.g. viral infection there is no positive test you can look at. Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment. I don't think you can be totally objective about this, and you get into things like if i.e. autism is mild is it a disorder? It's pretty clear to me it should b…

> Generally a disorder is considered something that significantly impacts someone's life, getting in the way of things like working, social life, life enjoyment.

With the same argument, we could arguue that working and social life are getting in the way how I am, thus working and social life should be considered disorders.

Re: Undisclosed financial conflicts of interest in DSM-5 (2024)

#100

Post by ssivark »

phren0logy wrote: post #83

I’m a psychiatrist, so if you consider that a significant bias I’m disclosing it. While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider: What’s the psychiatric equivalent of a sprained ankle? Does something have to be catastrophic to warrant a diagnosis?

Doesn't that presume that human psychology (cognitive functioning) is uniform at a level that would obviate the need even for personalities and styles?

Our physiological system does have that uniformity across the population but our psychological system does not seem to. Isn't it then misguided to try characterizing small deviations when we don't even have a uniform "background" to subtract?

Post reply on HN