Before you start reading this, you may want to first check out Creating Mental Illness, One Student at a Time for some context.
I’m a firm believer in the idea that mistakes are opportunities in disguise – I mean, as long as they don’t result in the irreversible maiming of innocents, or the inadvertent destruction of something that costs more than your house – if you’ve done either of these things, uh, I apologize for my insensitivity. Although most missteps can be considered a kind of failure – especially if they’re made in front of a crap-ton of people, on a very public forum, let’s say – you stand to elevate your understanding about an issue that you simply didn’t know enough about. My last write-up was one of those situations.
The topic of my last post stemmed from an earlier argument I had with a cohort about the etymology of the word gender – apparently, in Sociology the word gender is a term for a social role, which isn’t synonymous with the term sex – which is a biological tag that describes a reproductive function. What does this have to do with the Diagnostic and Statistical Manual of Mental Disorders? I have no idea. The whole discussion pissed me off, because it seemed that certain examinations of human-behavior contrive categorizations for certain things that have already been categorized, or are just different enough to start parsing the meaning of certain things that don’t need to be parsed – which got me thinking about how these principals even come about. Assumptions were made. I tried interlacing everything with subtle disclaimers (I said things like, I suspect and don’t take my word for it, etc.) but one person saw right through my bull, and he wasn’t shy about calling me out. I was stewing all day before my last post – I got home, it was a blog day, I needed something to write about – bam – public humiliation train, single passenger: me.
Anyway, somehow my blog post made it across the desk of one Mike Samsa, a scientist who specializes in the field of Behaviorism. I had two options: I could ignore him and move on with my pride intact, or I could swallow it and remedy the issue. For science.
I’m not deluded enough to think that sometimes my ego doesn’t inflate beyond dangerous proportions, but the public’s perception of me is infinitely less important than the integrity of the scientific process – which I believe in with every fiber of my being. Perhaps there’s a cultural difference at play here? Perhaps the process is different in the UK (where I suspect Samsa’s from, judging by the way he puts S’s where I put Z’s – I could be wrong) but the reality is that he’s the expert, and I’m the angsty arm-chair contrarian – it’s more likely that I’ve made a series of misunderstandings than stumbled onto a grand pharmaceutical conspiracy. So I decided to allow Mike the opportunity to clean up the unfortunate assumptions I made yesterday. Thanks Mike.
And because he’s awesome, stop by his blog and let him know that we appreciate the time he’s taken to educate us a little bit http://thelastbehaviorist.blogspot.com/
Here’s Mike Samsa’s response to my last blog post:
It seems that your article put more effort into thinking up conspiracy theories than trying to learn the basics of how clinical psychology works. In the hopes that you’ll take on constructive criticism, I’ll provide a few points of feedback rather than just posting a dismissive one-liner, and hopefully something positive will come from this.
· “New disorders being created is bad”: I’ve summarised your first basic argument in that statement and it’s quite clear where you’ve gone wrong. Clinical psychology has only been systematically defining disorders for around 50 years, and in the last few decades it radically changed the way it organised and conceptualised mental disorders, meaning that our categorisation of mental disorders is only a little older than a teenager.
So is it surprising that new disorders are being discovered? Of course not. I doubt that medicine found all diseases within 50 years of being formalised as a field (in fact, medicine adds diseases to their textbooks every year as well and they’ve been going for centuries!). It’s also important to note that many disorders are also removed or merged with each revision of diagnostic manuals like the DSM.
· “PhD students invent the mental disorders”: New mental disorders are not invented in theses and dissertations. For a disorder to be defined, it first has to affect a significant subsection of society and enough of these people have to visit mental health professionals saying, “I have a problem, can you help me?”. As the number of these people asking for help increases, professionals in the world of academia starting talking more and more about their problems, and then begin trying to identify commonalities among them to see if they are exhibiting the same/similar symptoms or whether it is just a lot of people with a lot of problems.
For people outside of psychology it might seem like some maverick has come along, invented a new disorder, and everyone has gone along with it. But when you are reading the journals regularly, keeping up to date with new arguments, evidence, and data, you find that these disorders often take years or decades to make it into diagnostic manuals. The idea is proposed and their peers within the scientific world bat the idea back and forth to see whether it is valid. They look at the empirical evidence, test it, and discuss where it could fit into our current understanding of mental disorders.
· “Disorders are created to sell more medications”: Most of the people working on developing these disorders have absolutely no ties to pharmaceutical companies and benefit in no possible way by “inventing” disorders. Psychologists, for example, cannot prescribe medications at all so they have no way of making money from it, and most of the studies defining these disorders come from universities with researchers who do not practice clinical psychology (meaning that they never even see or treat a patient).
· “Biologically, what’s the difference between cigarette addiction and video game addiction in the brain? I suspect nothing”: Why “suspect”? Why not look up the papers on the topic and the arguments behind why they are treated differently? Sometimes similar disorders are defined differently because they have important practical or conceptual differences; for example, with cigarette and gaming addictions, the first has a physical addiction component that the other does not. Behaviorally the symptoms may be the same but the physical component means that the therapist has to be aware that there are extra issues that need to be addressed (like weaning them off nicotine).
Sometimes the distinction is made simply for practicality sake, as one of the main functions of diagnostic manuals is to make communication between researchers easier. So whilst it may be true that the fundamental features of cigarette and gaming addiction are the same, researchers need to know whether a study on addiction was looking at an addiction to a substance like cigarettes or whether it was to gaming as the differences could produce different complicating effects.
· “I see one solution to the whole problem – make university free. If you shift university from a for-profit organization to a public institution, I bet the whole academic value-system changes. I bet you’ll get more selective and streamlined standards for scientific degrees – and subsequently better science”: Not a wholly unreasonable argument but why speculate? Universities in many countries were free up until very recently. If charging for university results in lower standards then the evidence should be abundant and easy to point out. Ironically enough, I imagine there are a few psychology papers out there looking at the effect of free education on achievement standards.
· “Personally, I see ambiguous and vague schools of psychology disappearing altogether, as neuroscience, biology and ecology begin to blend into something entirely less confusing and more streamlined for ACTUAL progress”: What ‘vague’ schools of psychology have you seen disappear? We tried to kick off psychoanalysis nearly a century ago but it still hangs around in shittier universities, like that elusive dangleberry that just won’t drop.
· “Knowing what we know about how some parties author certain mental disorders, if a mental health professional is too eager to sign off on some prescription or other, chances are you need to be looking for someone else”: What exactly do we know about “how some parties author certain mental disorders”? These are huge, dramatic, and worrying claims and it is something you need to back up with some reasoning and evidence.
Also, the blanket claim that being eager to sign off on some prescription is an indicator of a bad physician is nonsense. It would depend on the condition and the evidence behind available treatments. If the disorder being treated has been shown to respond the best, or only, to medication then I would argue that people should avoid any physician who didn’t eagerly try to prescribe you medication.
I understand why you might be wary of some of the complicated processes within psychology – they can certainly be interpreted as nefarious to someone who doesn’t know anything about the field or how it works, and the idea of a big conspiracy can be appealing to some. We’ve all gone through that phase where we read Thomas Szasz and think we’ve found the death knell of psychology, so when others disagree, the only way to ease our dissonance is to conclude that everyone must be “in on it”.
In reality, what happens is that as you learn more about psychology, you realise that your previous assumptions were naive at best and often simply wildly inaccurate. It is impossible for grand conspiracies to hold up in the field and it’s not even possible for pharmaceutical companies to have a dominant grip on its practices. There are valid criticisms of aspects of psychology, even the DSM itself, but you’ve touched upon none of them.
Shane Lindemoen is an American author, journalist, and an occasional literary critic; he is also the National Affairs Editor of Secret Laboratory. Shane is a self-described “poor white boy from the east side who happens to read about politics and stuff.” He has a science-fiction novel set for an August 13 release called Artifact – published by Boxfire Press. You can learn more about Shane’s upcoming novel atwww.boxfirepress.com. Also, check out Shane’s blog: www.shanelindemoen.com