So, I'm going to ask you, very bluntly:
Did you only disagree with the fact that I used the DSM-IV? Because, if you agree that people that have ADHD should be medicated... what were we debating?
I'll start with your "blunt" question. I do not disagree with you using the DSM-IV as a reference, I just wanted to give my criticism on the DSM. So I'll be honest, half of my post was offtopic. The other half however, dealt with why and if ADHD was overdiagnosed (the debate has somewhat shifted to this question) and was also a response to the OP. Here's what I said again:
Also, I'm NOT in any way saying ADHD isn't real. I'm just saying that there are many faulty diagnoses. When a child suffers under its hyperactivity or attention problems, of course help is needed. And psychiatrists should indeed give medication even when there's a good chance the child doesn't really have adhd, suppose they didn't give the meds and the kid DID have adhd, wouldn't that be awful for the kid and his parents.
You ask "what were we debating?". Well, I gave an opinion on why and if ADHD is overdiagnosed - Yes. And I gave an opinion on the OP - it should be medicated. I even put these two opinions together and I concluded that even when it's overdiagnosed, it's better to err on the side of caution and give medication.
On to the discussion about the DSM-IV, I know it's offtopic, but I think I'm entitled to a rebuttal.
Okay, first off, let me give you an example of vaguer criteria. Just to point out how vague one can be.
Example: If the subject has a deficit in their attention, and have hyperactive tendencies, they have ADHD.
Now, that's not what it says. But, as an example of vague... It's fairly vague.
My question was rhetorical.
First off, the quantification comes in the varying degrees of disorders it has. Major Depressive, Dysthymic Disorder, Manic Depressive, and how it states, very clearly, that those that present with one of the disorders are often ruled out from others.
This is NOT quantification. However, I might have been too harsh, there are some statistics on gender, age of onset, treatment effectivity,... but its main purpose which is diagnosing is not quantified at all (how much is often, sometimes,etc. when determining if a patient qualifies for a criterion?). I'm not saying it's even possible to quantify it, I'm just saying the name "statistical" might not be deserved
When they state that those present with one of the disorders are often ruled out from others, they're only talking about the ones you mentioned and a few others like ADHD. When you get into axis 2, the personality disorders, categories get fuzzy and validity and reliability become very low. Also the ones you mentioned and ADHD have greater reliability, but they are also the ones for which a diagnostic tool is least required, as they are more easily recognised.
There's no argument that personality disorders can be seen in different ways by different people. That's just how the world works. If I hand you a broken glass, and say, "What's wrong with it, specifically?" you, and your three closest friends, will write down different observations about the exact way the glass is broken.
True, but then the DSM should not claim it is a reliable diagnostic tool, something which still happens a lot. To be a good diagnostic tool it should have interrater reliability, which it doesn't have when it comes to personality disorders. It's like measuring temperature with a thermometer, but depending on the person using it you get a different result. The categories are too fuzzy and the criteria are arbitrary. The third most frequently diagnosed personality disorder is "personality disorder not otherwise specified", this is a good example of how these categories fail.
http://www.sciencedirect.com/scienc...serid=10&md5=dd9ee485d468a6c9716ac222c48d51d4
Now, as to your statement, I'd like to remind you, ADHD is not a personality disorder. I'll refer to the DSM-IV, again, to point out what is considered personality disorders:
Now, I skipped two of the items on Axis II, which are "Other Personality Disorder" (paraphrased), and Mental ***********. They were excluded because the first one is nonspecific, and the second one is not really a personality disorder. Still, you'll find no mention of ADHD, ADD, or any of the other Clinical Disorders (Axis I, if you wanted to know).
I know, I admit half my post - the criticism of DSM-IV - was entirely offtopic and had almost nothing to do with ADHD.
Did you read that? Carefully? Absorb every word of it?
It reads like a cult manuscript.
If I may quote from it (and, I'm going to): "The DSM is a powerful tool of social control, as its criteria is a primary tool used to judge who is normal or abnormal, sane or insane or who should remain free or be hospitalized against their will."
Read that to yourself a few times. Think about it. Mentally digest it.
Then, realize how out of one's mind you sound. It suggests that the DSM is used to control people. The DSM is a guide, to help people diagnose. It's not a rigid end all be all. It's a tool. In the same sense that you can build a house without tools, but a hammer would make it go a LOT faster, the DSM is the hammer for those that are trying to diagnose people.
The title says: "summary of the critique of the DSM" and this is exactly what it gives you. Some things may seem nuts at first glance, but that could be because they are stated in an abbreviated form. Don't think the writer is biased just because he writes a summary of the criticism on the DSM, that would be a fundamental attribution error.
http://en.wikipedia.org/wiki/Fundamental_attribution_error
It's also not as biased as you might think, look at what he says in the beginning:
Because most undergraduate, graduate and postgraduate courses uncritically present the DSM as an objective scientific document, this summary focuses exclusively on the rarely acknowledged critical view. It neither provides a complete analysis of psychiatric diagnosis nor denies that the DSM, if used cautiously and appropriately, can be useful, nor does it advocate against psychiatric diagnostic.
The primary goal of this web page is to promote critical thinking of psychology and psychiatry by presenting an important, however, rarely acknowledged critique of psychiatric diagnosis.
Many of the same criticisms are noted here:
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#Criticism
http://www.minddisorders.com/Del-Fi/Diagnostic-and-Statistical-Manual-of-Mental-Disorders.html
I really want to stress that I don't think the DSM is the root of all evil, far from it. In fact it has done a lot of good, I'll even refer to the article I gave:
The constructors of the DSM point to the following positive uses for its system of psychiatric diagnostic codes: It can be helpful for clinicians and mental health practitioners as they construct treatment plans, especially evidence based treatment plans. It provides a consistent structure and vocabulary for professionals, which helps with communication and collaboration. It can facilitate continuity of medical care and collaboration between professionals of varying treatment modalities. It is consistent with many forms of current medical record keeping. It can facilitate unified data collection for survey, pharmacological and other research purposes. It can be instrumental for the compilation and retrieval of statistical health information. It simplifies the reporting of unified data to interested third parties, such as the World Health Organization and insurance companies.
Well, I think you should understand that the panel exists, due in no small part to our growing knowledge of the human brain, our changing understanding of mental disorders, and our fundamental changes as a society.
Example: Homosexuality used to be listed in the DSM. It is now widely felt that it's not a disorder. There's nothing wrong with the person. This said, there's still some fifty pages (ish) on Sexual and Gender Identity Disorders. As a society, we have largely come to accept that people are born gay, lesbian, bi, straight, and so on. We still list off more than a handful of other problems. The DSM-IV reads:
I can't say for a fact, as I simply don't know, wether or not there is marked distress and interpersonal difficulty in being gay. I'm straight, and even if I asked a thousand people that weren't, I'd never KNOW if that was true. And, it's not always like that for everyone (again, to my knowledge.) The point I'm making here is that you can't have things cut and dry when it comes to disorders.
Now, to address your issue with pharmaceutical ties. Ties to drug companies doesn't really change the fact that things will be put in the DSM. Even your linked article states, rather clearly, that the ties to a drug company shouldn't exclude anyone from being on the panels for the DSM. It simply calls for transparency. Transparency is, of course, valuable, and should be looked upon with nothing less than respect, or if not, a requirement. Until it is, however, there's very little one can do, other than say that it raises some concern.
I just hope the panel reaches its decisions based on scientific data and not based on financial ties, individual opinion or society's morality (the last one is nearly impossible though). Decisions based on social morality are things like paedophilia or other paraphilias being a disorder, in my opinion these should belong to the realm of forensic psychiatry, not general psychiatry.
If the DSM truly wants its scientific reputation, transparency is an absolute necessity. I think that's clear to everyone. I can see no good coming out of it having no transparency, it's suspicious to say the least.
Nifty. Of course, one COULD argue that a continuum is even more rigorous than the categorical approach, as a continuum leaves you the wide area of possibilities, but then says you can't go beyond those listed ones. Categorical allows for the individual to state what parts they feel are strongest, versus weakest, and interpret the diagnosis themselves. But, I digress.
The continuum is probably somewhat different than you imagine. It's actually a scale (like on a questionnaire) which represents a continuum. Like 1 2 3 4 5 or 1 2 3
There are advantages and disadvantages to both approaches, that's why some say the DSM-V should have both.
You can reply to this if you like, but I won't reply back. I don't want this thread to be filled with my offtopic posts.
