Notable Links and Miscellanea - May 31, 2023
#1 Nancy Potter and I wrote about 30 years of Philosophy, Psychiatry, & Psychology for Daily Nous, offering an overview of some major areas of development in philosophy of psychiatry.
Both Robert Chapman and Judy Singer (accurately) pointed out on twitter that the use of the word “normal” in our discussion of neurodiversity was problematic: “neurodiversity is far less about arguing certain variations are within the normal range and far more about challenging how we think about normality, especially naturalist accounts, in the first place.” (Chapman) and “Great piece but for use of the word #normal. There's no place for it in the Neurodiversity paradigm.” (Singer)
#2. Aidan G. C. Wright, editor in chief of the Journal of Psychopathology and Clinical Science, was interviewed by Highlights in Psychological Research. His discussion of editorial priorities offers a great summary of current directions in research.
“The field of psychopathology is in the midst of several paradigm shifts. First, it is now widely recognized that traditional diagnoses do a poor job of organizing thinking about psychopathology and that a shift to basic mechanisms that are unlikely to be discretely and categorically distributed is needed. Second, psychopathology theory and research lack temporal specificity. That is, the timescales on which psychopathology plays out, either in the short term or across development, are not well understood. Acknowledging this situation means longitudinal work across multiple timescales needs to be prioritized. Third, theoretical models are poorly integrated across methods and levels of inquiry, and method variance seems to far outweigh substantive variance in studies. How psychopathology is understood should not depend so much on how it is studied if the goal is to find ecumenical truths. Tackling the challenge of multimethod inquiry is essential. Fourth, the science is too limited by who is doing it, who is being studied, and where it is being conducted. More and diverse perspectives need to contribute and be included. Again, if the goal is to discover fundamental insights, researchers need to broaden the lens and be more inclusive. Finally, psychopathology research needs to be more open and transparent. To that end, open science principles contribute to stronger, more replicable, and more trustworthy results.”
#3. “Borderline personality disorder: a spurious condition unsupported by science that should be abandoned” by Roger Mulder and Peter Tyrer in the Journal of the Royal Society of Medicine
“The only accurate aspect of borderline is its title, a word that correctly signifies its complete lack of specificity. It emerged over 60 years ago to describe patients on the border between neurosis and psychosis who might be amenable to treatment with psychoanalysis. Not surprisingly, its diagnostic criteria are not longstanding personality dispositions, but oscillating symptoms and behaviour. The triad of unstable mood, erratic relationships and disturbed behaviour may be readily identifiable but that does not make it a personality disorder...
Both recently accepted classifications of personality disorder, ICD-11 (World Health Organization) and the American DSM-5 Alternative Model of Personality Disorder have trait domains that link well with the commonly described Big Five domains of normal personality. All attempts to find a borderline factor have failed. If borderline was a true personality disorder, it would not be outside this system. Many clinicians and patients attune to the diagnostic descriptions of borderline features, as their features are easy to detect and very common from adolescence onwards and the diagnosis seems to give a reassuring degree of certainty to otherwise intangible complex symptoms and behaviour. But any positive aspects are overcome by its contradictions and the confusion created by overlap. It is a mushy blancmange diagnosis that simply embraces too much pathology to be of any real value.”
#4.- Mythbusting Suicide: The Ages of Suicide, Statistics fail to demonstrate that suicide is “more common in kids and the elderly”
#5. Scott Alexander aton effect sizes in pharmacology — “All Medications Are Insignificant In The Eyes Of God And Traditional Effect Size Criteria”
See also my comment on the post
#7. Dominic Murphy reviewed “Are Mental Disorders Brain Disorders?” by Anneli Jefferson for the British Society for the Philosophy of Science (and ends the discussion with a rather startling comment)
“… I am on the other side of what Jefferson thinks of as a very profound intellectual divide (p. 44), separating her from proponents of the over-inclusive view. That view, she thinks, makes no empirical claims and is just (wrongly) supposed by its proponents to be a straightforward derivation from physicalism.
I think this is almost entirely correct and I am grateful to Jefferson for putting the issue so starkly. I would put it like this: What she calls the over-inclusive does little more than commit us to studying mental disorders as continuous with the other sciences of the mind, in that they all aim ultimately at mechanistic explanations of properties of intelligent systems, since we have learned that treating the world—including its human components—as unedifying collections of machines is the right way to do natural philosophy. This is sort of an empirical claim, in that it claims legitimacy based on the history of modern inquiry into nature. But it doesn’t make any particular predictions and it has no independent non-contingent foundations.
The appeal of this picture in psychiatry has always been its affiliation with the sciences of the nervous system. A somewhat jaded view is that this just shows the desire of psychiatry to look like proper science. But there really is a kind of methodological promise on offer if we try to copy sciences that seem to get it right. Perhaps it is simply that the label of ‘brain disease’ is more of a philosophical commitment to a materialist and biologicist picture of humans than a basis for a method, but I think that’s satisfactory, since the point of a research programme is in part to confer a shared identity on the community it defines. I think philosophers like Jefferson worry that this approach lacks the foundations that a proper metaphysical discussion would provide. But some of us don’t care about foundations.”
#8. Peter Kramer in Stat News: “I want to make a strange, speculative prediction: that the need for resolution will soon be behind us. We won’t have to rely on doctors to diagnose public figures. Bots will do that job.”
“I treated psychiatric patients for well over 40 years. I found distinctions between personality disorders — the sorts of conditions that Trump was tagged with in the 2016 campaign — to be of limited value. For one thing, the diagnoses are unstable. Patients called narcissistic on one visit may soon qualify for the label sociopathic. To the therapist, the patient will seem the same person throughout… Psychiatry’s best function is explaining the meaning and limitations of our various labels and the range of expected behaviors that they predict.”
#9. Dialogues on Disability: Shelley Tremain interviews T. Virgil Murthy about philosophy of statistics, addiction and the dynamics of oppression around it, and creating “a hermeneutics of addict interiority”
“I can’t help but wonder if there is something about the EBM paradigm that either attracts contrarians or facilitates those predisposed to contrarianism to descend further into it.”
#11. Hane Maung reviews Jonathan Tsou’s Philosophy of Psychiatry for Philosophy of Medicine
“The strength of Tsou’s book lies in its negative thesis that mental disorders do not necessarily involve failures of evolutionarily selected mechanisms. Indeed, I would contend that mental healthcare is justified by the presence of suffering that could be alleviated by a mental healthcare intervention, regardless of the evolutionary history of the affected system. However, the positive thesis that mental disorders are biological kinds is less successful. Such privileging of the biological over the social seems somewhat outdated and unwarranted in view of some key features of the contemporary research landscape. These include (1) the relative successes of projectable inferences based on social and psychological mechanisms, as exemplified respectively by the aforementioned research in psychiatric epidemiology and network analysis; (2) the failure, which is not for a want of trying, to find mechanistic biomarkers that reveal the causal structures of mental disorders; and (3) the increasing knowledge of the dynamic and recursive interactions between biological, psychological, and social processes. In light of the above, philosophers of psychiatry have been turning increasingly to ecological and pluralist approaches to mental disorder…”