a non-event…

Posted on Thursday 19 February 2015

Living in the South for a lifetime, one’s tolerance for this kind of cold is an undeveloped skill. People race to the grocery to stock up on things they usually don’t buy as if the Siege of Leningrad is beginning. Schools, clinics, and stores close in the morning [and regret it in the afternoon]. The worst part is the scorn and laughter coming from people who have emigrated here from the North as they watch us slide off the road because we don’t know how to negotiate the icy patches [and they actually own clothes appropriate for this kind of weather]. The dogs lobby constantly to go out, and then lobby constantly to come back in. And the woodpile, planned to be more than adequate for the season, grows smaller at an alarming rate.

It’s not a time conducive to blogging, I must say. If you have a 4-wheel drive Jeep and it’s icy, you suddenly become more popular, sure enough, and there are lots of calls. But it’s more than that. Things just aren’t right, and there’s just a lot busy-ness involved when things just aren’t right. There’s an article that has been open on my computer desk-top for several days. It’s a thoughtful discussion of the DSM-5 and particularly the Major Depressive Disorder category by an academic clinical psychologist [Marco Castiglioni] and an professor in the philosophy of science [Laudisa Federico] – both in Milan, Italy. The abstract is only an outline, but the full text is available on-line and worth reading. The topics are old friends to most of us – biological reductionism; the myth that the DSM-III, -IIIR, -IV, and -5 have been atheoretical; the fatally flawed DSM category of Major Depressive Disorder; and the failure of the DSMs to address subjectivity and relatedness:
by Marco Castiglioni and Federico Laudisa
Department of Human Sciences, University of Milano-Bicocca, Milan, Italy
Frontiers in Psychology. 2014 5:1517.

The aim of this paper is to argue that a strictly reductionist approach to psychiatry represents a theoretical and clinical obstacle to a fruitful synthesis between neurobiological and sociocultural aspects of the sciences of mind. We examine the theoretical and practical motivations underlying this approach, by analyzing the case of depressive disorders, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM], and the related removal of the “bereavement exclusion clause.” We first explore the claim that DSM is atheoretical, observing that, far from being atheoretical, DSM adopts an implicit, biologically inspired view of the mind; we show that such a view leads to a sort of circularity in the definition of depressive disorders, in which psychopharmacology seems to play a key role. We then turn to further problems deriving from this position, analyzing the issue of placebo effects in the treatment of depressive disorders and the philosophical question of normative preconditions for psychopathological diagnosis. Finally, we address the issue of subjectivity, which, together with the related aspect of the subject’s relational context, appears to be crucial to any scientific theorizing about mental disorders, despite DSM’s attempt to exclude it. Our defense of a non-reductionist view of mental disorders, however, does not imply that we endorse any sort of metaphysical dualism, or anti-diagnostic or anti-psychiatric positions. On the contrary, we argue that the adoption of a reductionist position actually undermines the theoretical and clinical accuracy in explaining depressive disorders…

But I don’t really buy my it’s too cold to think about it excuse for having nothing to say about this paper. I thought of some lines from my oft-quoted poet:

… And so each venture
Is a new beginning, a raid on the inarticulate
With shabby equipment always deteriorating
In the general mess of imprecision of feeling,
Undisciplined squads of emotion. And what there is to conquer
By strength and submission, has already been discovered
Once or twice, or several times, by men whom one cannot hope
To emulate — but there is no competition —
There is only the fight to recover what has been lost
And found and lost again and again: and now, under conditions
That seem unpropitious.
T.S. Eliot, East Coker 1939

It has all already been said "Once or twice, or several times, by men whom one cannot hope to emulate." I’ve thought all of the things in this paper in one form or another for twenty-plus years. But it’s more than that, because I’ve worked up a full head of steam about these matters many times in the last several years. I hope my torpor reflects something more general. The DSM-5, for all the hoopla, was a non-event. It’s not even a DSM-IV on steroids. It’s a DSM-IV with some quirky changes. Maybe [fingers crossed] it’s back to being a code book where it belongs [and a not-very-good code book at that]. Now they’re publishing a version for patients and the lay public [maybe an attempt to stir up some interest somewhere? amywhere?]. But other than that, it’s not much mentioned.

So I hope my lassitude about the DSM-5 is a barometer to a general lack of interest. But we’ll have to wait until Spring to be sure it’s not the cold when the Sun comes back our way…
    Steve Lucas
    February 20, 2015 | 7:55 AM

    Many years ago I was taught a system called management by exception. The concept is you only look at those situations that are out of the ordinary. This was backed up by the accounting concept of a statement of change, where only major changes to accounts were reviewed.

    I was often criticized by people for not “managing.” My take was if people are doing their job and they do not have a problem, I do not have a problem. I was not interested in bolstering my position by harassing people and pointing out the obvious.

    My niece, who lives in the south, wrote a frantic email about how it was going to snow and they may have ice. I checked the weather and there was going to be no accumulation and the following day it was going to be 44. Where I live anything less than six inches of snow is flurries and we are only interested when the temperature falls below zero.

    It may be time to look at the DSM-V in terms of change and realize the bulk of the manual remains the same and those exceptions may not be such a big deal. This is not my field, but in reading and speaking with people I have to believe that Mickey is correct in regulating this manual to the position of a code reference and recognizing it really is not a big deal worthy of all the time and effort spent on review.

    One of the strongest emotions is not hate, but ignoring a person or a concept. The DSM-V may be a concept that needs to be ignored as doctors and patients manage their conditions.

    Steve Lucas

    February 20, 2015 | 3:29 PM

    Re: The cold and snow. In Boston we have something called The French Toast Alert. Whenever a storm is forecast people run out to buy milk, eggs and bread (all the ingredients of French Toast). We are stuck with bad temperatures even by our standards, and when it gets warmer, i.e. just below freezing, we get more snow. Northern New England can handle this; we can’t.

    berit bryn jensen
    February 21, 2015 | 10:34 AM



    Indeed! “There is only the fight to recover what has been lost and found and lost again and again, and now under conditions that seem unpropitious.”

    We have been warned by the police to stay indoors in freezing weather and record braking storms several times this winter. Roads were closed, roofs flew off, some houses near the shoreline crashed under the waves. But no citizen succumbed. We were warned by people who did not mince their words.

    Courageous civilians and some health professionals are also issuing warnings. The conditions are unpropitious. We stand to lose much more.

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