Why we need to get better at critiquing psychiatric diagnosis

Why and when I was reading this

I was doing a deep dive into the nature of psychiatric disorders.

Key takeaways

  • We should treat psychaitric disorders as tools, not ideologies
  • There are many myths surrounding psychaitric disorders and critique often misses the point.
  • If used correctly, psychiatric disorders have adequate Reliability and Validity

Why we need to get better at critiquing psychiatric diagnosis

Why we need to get better at critiquing psychiatric diagnosis

Summary & Comments

“There are no biological tests for psychiatric diagnoses”

  • Not true, in very few diagnoses are biological tests entirely irrelevant. One such example is BDD.
  • The most common way to use biological tests is to exclude other causes (attributable to the physiological effects of substance or other medical condition)
  • Very specific tests are sometimes recommended: Test serum calcium levels to exclude hyperparathyroidism when diagnosing panic disorder
  • Anorexia requires BMI < 17

“Psychiatric diagnoses label distress”

The critique is that the DSM (and ICD) describe people’s distress in terms of medical diagnosis.

  • Common criterion is that the symptoms cause clinical significant distress or impairment, but not for all diagnoses
  • Tic disorders does not need clinically significant distress

“Psychiatric diagnoses are not reliable”

  • Only if we use unstrucutred tests like an open interview
  • With structured assessments like SCID and MINI, the reliability is high and often better compared to other parts of medicine

“Psychiatric diagnoses are not valid because they are decided by a committee”

  • Well, all medical diagnoses are decided by committee
  • They are not perfect though, and the pitfalls include susceptibility to fads and influence from big pharma

Having a diagnosis decided by committee doesn’t make it invalid. Actually, on balance, it’s probably the least worst way of doing it.

General comment

Does psychiatric diagnosis medicalise distress arising from social hardship? Hard to see how this applies to stuttering and Tourette’s syndrome. Is psychiatric diagnosis used to oppress people who behave differently? If this applies to sleep apnea, I must have missed the protests. Does psychiatric diagnosis privilege biomedical explanations? I’m not sure this applies to PTSD.

Finally, I think we’d be better off if we treated diagnoses more like tools, and less like ideologies. They may be more or less helpful in different situations, and at different times, and for different people, and we should strive to ensure a range of options are available to people who need them, both diagnostic and non-diagnostic. Each tested and refined with science, meaning, lived experience, and ethics.