{"id":39723,"date":"2013-09-06T18:47:35","date_gmt":"2013-09-06T22:47:35","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=39723"},"modified":"2013-09-06T18:54:21","modified_gmt":"2013-09-06T22:54:21","slug":"as-he-wished-it-had-been","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/09\/06\/as-he-wished-it-had-been\/","title":{"rendered":"as he wished it had been…"},"content":{"rendered":"\n
Did you ever notice how quickly resolutions melt in the face of temptation? I had resolved that I wouldn’t lurk in wait for everything Dr. Lieberman writes so I can attack it as a way to protest the way his APA is running these days. I did pretty well until I got to the paragraphs below, then watched as my resolve evaporated into the ether as I clipped them for this post: <\/div>\n
\n
Change, Challenge and Opportunity:
Psychiatry in Age of Reform and Enlightenment
<\/a><\/div>\n
From the President<\/font><\/strong><\/div>\n
Psyciatric News<\/font><\/strong><\/div>\n
by Jeffrey Lieberman, M.D.<\/div>\n
August 29, 2013<\/div>\n

… In 1952, the Diagnostic and Statistical Manual of Mental Disorders<\/em> was created to complement the World Health Organization’s International Classification of Diseases. DSM-I<\/em> and DSM-II<\/em> [1968] had no systematic organization and were both relatively short books. Studies in the 1960s and 1970s showed that diagnostic reliability among clinicians using the DSM<\/em> was poor; the likelihood of any two clinicians agreeing on a particular patient’s diagnosis appeared no better than flipping a coin. <\/p>\n

To remedy the problem, APA radically revised its diagnostic approach and published DSM-III<\/em> in 1980. This edition dramatically expanded the number of disorders and provided detailed descriptions of their defining criteria, with precise lists of symptoms and behaviors. DSM-III<\/em> revolutionized diagnostic precision in mental health care and provided clinicians with a common language to facilitate communication among themselves and with their patients. In the revisions that will follow DSM-5<\/em>, which was released in May, we anticipate that psychiatric diagnoses will move beyond descriptive phenomenologic criteria to measures of pathophysiology and etiology and that they will involve laboratory tests to identify lesions and disturbances in specific anatomic structures, neural circuits, or chemical systems, as well as susceptibility genes—the kinds of tests that routinely inform the diagnosis of infection, cardiovascular disease, cancer, and most neurological disorders. The research that occasions these developments may not just enhance our ability to make diagnoses, but may fundamentally redefine the nosology of mental disorders…<\/div>\n<\/blockquote>\n
He’s still writing about the coming of the DSM-III in 1980 as the moment that lead us from of the wilderness. He starts with reliability:<\/div>\n
<\/div>\n
perhaps forgetting that the reliability of the DSM-5 reported by the Field Trials was lower than<\/u> the dreaded DSM-II that got revised in the first place [humility…<\/a>]. He also seems to have forgotten the outcry surrounding the work of the DSM-5 Task Force that hardly reached the consensus that the DSMs "revolutionized diagnostic precision in mental health care" but rather universally condemned it. But then Dr. Lieberman lapses into his standard cheerleader mode, launching his tired sermon about the coming wonders of research and biomarkers, sounding just like Drs. Kupfer and Regier did in 2002 with their Research Agenda for the DSM-V<\/font><\/strong> [irrational exuberance…<\/a>]. If those things weren’t enough, he makes the fundamental error of continuing to speak as if all mental illness has some biological substrate, something no-one believes, making himself and the rest of the profession a target for articles like Gary Greenberg’s latest in the New Yorker [The Psychiatric Drug Crisis<\/a>]. I extracted these paragraphs from an article that proposes to introduce a series preparing us for a changing future:<\/div>\n
\n
We should prepare ourselves now for our future and how it will be formed. \t\t\t\t\t\t\t\t \t\t\t\t\t\t\t\t\t Toward that end, subsequent articles will preview the health care reform process; how it will affect models of care, professional roles, and methods of reimbursement for psychiatrists; and how we anticipate scientific advances will transform psychiatry’s understanding and treatment of mental disorders. <\/div>\n<\/blockquote>\n
I think Dr. Lieberman would be better placed to open with a realistic picture of the past as it has actually been, rather than as he wishes it had been…<\/div>\n","protected":false},"excerpt":{"rendered":"

Did you ever notice how quickly resolutions melt in the face of temptation? I had resolved that I wouldn’t lurk in wait for everything Dr. Lieberman writes so I can attack it as a way to protest the way his APA is running these days. I did pretty well until I got to the paragraphs […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-39723","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39723","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=39723"}],"version-history":[{"count":16,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39723\/revisions"}],"predecessor-version":[{"id":39739,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39723\/revisions\/39739"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=39723"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=39723"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=39723"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}