I continue being not well but because I yesterday
wrote - in effect - on the irrationality of psychiatry in the US, I
could not refrain myself today from listing an interesting piece by
Neuroskeptic, who has
a nice blog on neuroscience, entitled 'Normal?
You're weird - Psychiatrists', that starts of thus:
Almost everyone is pretty screwed up. That's not my opinion, that's
official - according to
a new paper in the latest
British Journal of Psychiatry.
Make sure you're sitting down for this. No less than
48% of the population have
"personality difficulties", and on top of that 21% have a full blown
"personality disorder", and another 7% have it even worse with "complex"
or "severe" personality disorders.
That's quite a lot of people. Indeed it only leaves an elite 22.5% with
no personality disturbances whatsoever. You're as likely to have a
"simple PD" as you are to have a normal personality, and fully half the
population fall into the "difficulties" category.
Neuroskeptic also makes clear what's wrong with that paper (in his and my
opinion, to be sure) and fields some comments quite well.
I do want to make two somewhat critical remarks, of which the first is
First, the new DSM, unlike the previous ones, is numbered by an
Arabic not a Roman number. It confused me too, initially, but the
correct - even trademarked - name is "DSM-5", or so I have read on the
internet in prose of people who should know.
Second, he writes
They suggest that in the upcoming
revision of psychiatric diagnosis, it would be useful to formally
incorporate the severity spectrum in some way - unlike the current
DSM-IV, there everything is either/or.
Here his given link is to an interesting site, from which I quoted some that
underlines why I wrote about the DSM-5 yesterday:
"The publication of the fifth edition of Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) is one of the most highly anticipated
events in the mental health field," explains Managing Editor Daniel
Falatko. "This is the first major rewrite of DSM in 16 years and history
has warned us that even small changes to this manual can have
extraordinary repercussions in the diagnosis and treatment of mental
Quite so, indeed - and this also explains why this elderly
psychologist only got (somewhat) acquainted with DSM-III, that
incidentally also did not much impress him, but which he could and can
see the need for, namely for the eminently rational and scientific purpose
to have similar symptoms at least labelled in the same way.
To return to the last quote by Neuroskeptic, who reports that the authors
of the paper according to which, if you happen to be British, there is
a chance higher than 3 in 4 that a British psychiatrist will diagnose you
with a personality disorder, suggest that in
"it would be useful to formally incorporate the severity spectrum in some
way - unlike the current DSM-IV, there everything is either/or."
Not so, I think, being also a philosopher of science: A main
part of the original reasons for setting up the DSM was to have similar
symptomatology - for psychiatrists usually do NOT have a
neurologically based explanation for psychiatric conditions, but only
a set of interrelated labels - possibly held together by some vague
verbal psychiatric theorizing (**) - that in its turn is connected
with a set of possible therapies or medicines that may alleviate the
symptoms or the conditions that lead to them - judged in similar terms
and treated in similar ways.
Now this was a fine scientific end: To understand things, the first thing
necessary is to mostly agree on the terms to discuss them, and to be
consistent and uniform in that, so that a GP may know what a psychiatrist
means, rather than - as was more or less the case before the DSM - having
to look into some library to find out what a psychiatrist of a certain
school might mean by "neurosis" or "personality disorder", and also with
the end in view that similar symptoms get similar treatments in different
hospitals and from different doctors, not because that treatment would
necessarily be the right or a helpful treatment, but to be able to
establish empirically whether that treatment would help.
Therefore, if the DSM-5 will insist on limbering up precise
terminological divisions, and return to vague qualitative judgments of
severity or seriousness, or the lack thereof, most of the basic
justification for having a DSM - a Diagnostic and
Statistical Manual of Mental Disorders - will have been left,
effectively, and real objective empirically based mathematical statistics
will have little to do with it anymore.
That is an important enough conclusion to write out, and here is a
related point, that in fact is simultaneously moral, logical,
methodological and statistical, which I again give in Neuroskeptic's
words, in a comment of his to a comment to his post:
Even if everyone in the world became really fat, we would still be
unusually fat, because we would be fatter than people from previous
However this survey isn't comparing people to any real healthy baseline.
It's comparing people to the ideal baseline of "not answering yes
to any of these questions". What the data show is that it is normal not
to meet that ideal.
That either means we're all screwed up, or it means the ideal is
unrealistic. Given that the ideal is something dreamed up by a bunch of
psychiatrists who wrote DSM-IV (and even they didn't intend personality
disorder criteria to be used in this way) I suspect it's the latter.
In fact it's not just that the theory that informed the symptomatology
that can be found in DSM-IV and was used by the authors of the paper
that implied 78% of the British is not really mentally sane should be
considered as refuted by these data (if there are no methodological
or statistical errors, to be sure), but also that the paper in the
Brit. Jn. of Psychiatry shows a not very sane confusion of the menu and
the diner, that is, a confusion of the terms for the facts and the facts
themselves, for the authors argue as if the DSM-IV must be correct if
the data they found contradict it, namely in the form of implying that 4
out of 5 British persons are not mentally sane.
P.S. This in fact continues
yesterday's piece about the DSM-5, that today had some typos
removed and also got some better formatting. (Ms. Chapman's text wasn't
properly displayed in Microsoft IE because my Frontpage doesn't do tables
uniformly for both Firefox and Microsoft IE. It should be OK now.)
There also turns out to be today an interesting piece by
tries to unravel some of the XMRV-story. Here is the link:
Primer. This is quite helpful, also in explaining Dr. Judy
Judy Mikovits reacts to the Lo/Alter paper (video),