On diagnosis being bullshit

"It's bullshit," was originally a comment by Allen Frances, the Chairman of the APA committee which wrote DSM-IV, to psychologist Gary Greenberg, in 2011. Keeping that point closely applied to the DSM itself is a good idea for two reasons.

First, the DSM is the single most important modern source by far, of the idea that mental illnesses are discrete medical conditions that can and should be diagnosed. It names hundreds of such medical conditions, and details precisely how anyone should decide whether or not any one of them exists in any individual. It is a manual (that's what the M stands for). It is strongly reminiscent, as I have frequently said before, of the Malleus Maleficarum, which preceded it by about 500 years.

Very few people read the Malleus any more. They may read more recent historical perspectives, analyses and commentaries about it; but there's no substitute for the whole medieval text itself, in a reliable English translation assuming a reader is not proficient in Latin. This was a manual eerily similar to the DSM. It continued in widespread use for the detection and prosecution of witches, and it remained in print, for about 300 years. (The DSM has only been around for about 50.) The Malleus was probably not known by common people in the 16th and 17th Centuries, at least not nearly as well as the DSM is known by the general population in the West today: the "Hammer of Witches" was a handbook only for the most educated and powerful men in Europe.

My point is that the DSM has had similar influence and cultural impact to the Malleus. Allen Frances' 2011 statement would be comparable to a hypothetical admission in the year 1500 by Jacobus Sprenger and Heinrich Kramer that after all, there were no witches.

The second reason one might limit application of Frances' honest admission, "It's bullshit," is to save time and headaches. Psychiatric "diagnosis" evolved into such an incredible rabbit hole in the last seventy-five years that even trying to follow what is called research about it now becomes an endless maze of confusion and a very long journey through strange lands of arcane nomenclature and weird acronyms.

For example, "e-mhGAP-IG." You may laugh... but this stands for the World Health Organization's latest mobile app. It's intended to improve detection of depression in primary care, which has supposedly not been up to par in certain countries that only use the standard "mhGAP-IG" (an earlier non-screen, paper version of the same tool). Here's a research report all about it from no less authority than the Journal of the American Medical Association (JAMA), published just last week!

I spent at least an hour going down this rabbit hole this morning. I never got a better understanding of anything being done in the real world, beyond the thought I had when I read the first sentence of this report, which identified a purpose, "to improve detection of depression." 

My thought, immediately, was that detection of depression isn't really detection of a fact, it's promotion of a theory or proposed explanation. Real diseases are actually detected by medical tests. Psychiatric disorders are merely alleged by evaluations from checklists in the DSM. Big difference. Huge!

Read this research report. By the end, you'll laugh at yourself for even caring what these ridiculous people are talking about, but you'll cry for the human wastage: so much blood, uncountable treasure, a century of lost progress in mental health knowledge.

And read the Malleus Maleficarum. Tom Szasz wrote a whole book comparing the European witch hunts to the modern mental health movement, and it may have been his best book.

Torquemada had "research," too. The Church and APA are scientists!