Needed - psychological meta-structure

Where? In DSM-V, if we really want to do mental health diagnosis and treatment better, Scientific American says. If not there, then in the next edition after that.

The idea is that the various categories in the current Diagnostic and Statistical Manual of Mental Disorders are too rigid for reality.

(A)n enormous number of family and genetic studies have not only failed to validate the major DSM disorders as natural kinds, but instead have suggested that they are more akin to chimaeras. ...

I would argue, is that, at least for the purposes of research, the current DSM diagnoses do not work. They are too narrow, too rigid, altogether too limited. Reorganization of the DSM is hardly a panacea, but science cannot thrive if investigators are forced into a cognitive straitjacket.

Agreed on that.

So, what's this about meta-structure?

Genetic studies focused on finding variations in DNA sequences associated with mental disorders have repeatedly found shared genetic risks for both schizophrenia and bipolar disorder. Other studies have found different sequence variations within the same genes to be associated with schizophrenia and autism spectrum disorders.

The bottom line is in these two points:

First, DSM disorders do not breed true. What is transmitted across generations is not discrete DSM categories but, perhaps, complex patterns of risk that may manifest as one or more DSM disorders within a related cluster. Second, instead of long-term stability, symptom patterns often change over the life course, producing not only multiple co-occurring diagnoses but also different diagnoses at different times of life.

The rest of the very insightful story tells us more.

Greenwald builds a straw man on de-institutionalization

I agree with a lot of what Glenn Greenwald writes. In fact, I'll often agree 100 percent iwth individual columns.

But, in writing a column about many American thought leaders wanting new legal powers in the wake of Jared Loughner's shooting of Gabrielle Giffords, Greenwald builds a straw man about 1960s de-institutionalization of the mentally ill, either out of ignorance of all the facts of that era, or deliberately setting them aside. It's more likely the former, but Greenwald is both smart enough and sharp enough it could be the latter.

I'm not denying that "Cuckoo's Nest" type institutions existed in the 1960s. I'm not denying that perfectly sane people were forcibly institutionalized, perhaps, even, for homosexuality.

But Glenn, in attacking William Galston for presenting 1960s-era psychiatric institutionalization as a golden age, ignores things himself in presenting de-institutionalization as at least close to a golden age.

The biggest fact he ignores is that deinstitutionalization, as it was driven first in California, itself had definite political overtones that went well beyond civil libertarianism.

As Fuller Torrey and others have documented, the California push largely came out of Orange County and was co-causally tracked by the push to get Ronald Reagan elected governor. (By the way, I hugely recommend Torrey's "The Insanity Offense." He tackles the politics behind the issue, too.)

Bircher types had paranoia about psychiatry; that was their angle. Budget hawks thought California was spending too much on state psychiatric services.

There's more here and here on the politics involved, as well as misperceptions involved. Google California + "Lanterman-Petris-Short Act" for more.

On the former, picture if we over-institutionalized the severely mentally ill today, and then, along came Scientology to lead a push to overthrow institutionalization, not just partly, but totally. Wouldn't we, in this case, ignore the cliche and look the gift horse in the mouth quite carefully, indeed?

Also missing from Greenwald's account is the degree of deinstitutionalization. An excellent Frontline episode from PBS pegs it at 98 percent. The show transcript also notes how many of these people wound up being incarcerated long-term for misdemeanor offenses simply because that was the least bad option available. (I've reported on the problem of mental illness within the Texas prison system.)

So, Glenn, your story's a bit incomplete. Rather than an apparent blanket defense of deinstitutionalization, a J'accuse of lack of spending for adequate institutionalization options would have been much better. Many other things were missing from Greenwald's blast, like (as Jared Loughner illustrates) mental illness and chemical dependency and more.

If ‘cramming’ for a Rorschach– or giving one …

You have plenty of other “issues” besides the question of whether Wikipedia is now a Rorschach cheat sheet.

Beyond psychologists getting bent out of shape over 10 original Rorschach plates being posted by Wiki, just what does it test?

Have psychologists and psychiatrists ever demonstrated that?

Per who else but Wikipedia, the short answer is “no”:

Some researchers have raised questions about the objectivity of psychologists administrating the test; inter-rater reliability; the verifiability and general validity of the test; bias of the test's pathology scales towards greater numbers of responses; the limited number of psychological conditions which it accurately diagnoses; the inability to replicate the test's norms; its use in court-ordered evaluations; and the proliferation of the ten inkblot images, potentially invalidating the test for those who have been exposed to them.

So, some psychologists are protesting that their priesthood has been violated and a pseudoscientific central tenet has been revealed.

Stanley Fish – why psychologists participated at Abu Ghraib

Stanley Fish has an thought-provoking column noting that many psychologists have a “hired gun” attitude, part of how he contrasts them with psychiatrists:

Psychology, on the other hand (vs. psychiatry), is not exclusively a healing profession. To be sure, there are psychologists who provide counseling, therapy and other services to patients; but there are many psychologists who think of themselves as behavioral scientists. ... Are psychologists experts for hire, or is it understood, as a matter of professional self-definition, that their expertise is to be deployed only for benign purposes?

As a matter of fact, psychological skills are purchased and deployed as commodities all the time. ... Large corporations employ psychological profilers to help make them make personnel decisions. Sports teams hire “coaches” whose job it is to motivate players and make them more aggressive. Hospitals use the results of psychological examinations to decide whether or not a patient should be released. And of course the military employs psychologists in an effort to identify techniques that lead prisoners to spill what they know.

Thought that was interesting? THIS is the nut graf:

In fact, the moment psychological knowledge of causes and effects is put into strategic action is the moment when psychology ceases to be a science and becomes an extension of someone’s agenda. Employing psychological skills in the course of any verbal interaction – be it a domestic conversation, classroom teaching, a performance in a law court, or an interrogation – will always have the effect of subordinating the facts and the truth of the matter to the desire for an outcome.

And, that’s exactly what happened at Gitmo and Abu Ghraib.

But, psychiatrists could have done the same things.

But, per some of the commentors to his column-length blog post, I think he has a point about the “persuasive professions” in general without drawing a largely artificial distinction between psychology and psychiatry. After all, psychiatrists have, in the past, used drugs in the service of the CIA and other organizations.

And, the whole premise of “Brave New World” was based on chemicals, not talk.

In fact, it wasn’t psychologists shooting up people at Gitmo, Abu Ghraib, or Bagram, with pentothal or other drugs, now, was it.

Rather, it probably was a difference in politics between the American Psychiatric Association and the American Psychological Association that led psychiatrists to proscribe participating in interrogations more than two years ago.

Then, Fish goes Socratic on us.

As a linguist and philosopher, Fish then ties this to the ancient Greek skill of rhetoric. Shades of the Protagoras! He argues that psychology, like rhetoric, risks being a content-free tool.

I’m just scratching the surface of an stimulating, if flawed, column; read it all for yourself.