Posted by Scott L. Schofield on April 10, 2000, at 11:17:09
In reply to Re: BIOLOGY or PSYCHOLOGY ?, posted by boB on April 9, 2000, at 16:22:53
I give up.
You win, we lose.
- Scott
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> >> I'm not really sure why we are having this discourse.
>
> Because your post seemed to address issues I had posted over several days. Once i responded, we were engaged more or less in a one on one dialogue. We must both be interested in testing the limits of our understanding.
>
> SLS> What is your thesis?
>
> reply> I'll get to that....
>
> boB > DSM-IV diagnoses are a nomenclature for groups of symptoms.
>
> SLS> No. I don't think so. My unschooled perception of the DSM is that it is a listing of the clinical diagnoses of specific named medical conditions for which each is prescribed a precise algorithm of symptom identification and inclusion based upon observational statistics. That's what it looks like to me, anyway.
>
> Reply - the definition you offer of DSM-IV diagnosis is weak because it is a string of prepositional phrases. My statement that “DSM-IV is a nomenclature” is a statement to which opposing attorneys often stipulate when qualifying expert testimony. The phrase “specific medical conditions” is actually quite vague, referring basically to the consensus of included practitioners. But your reference to “each is prescribed a precise algorithm of symptom identification and inclusion based upon observational statistics,” is accurate, except for the “precise” part. Obeervation that a subject does not have telephone is a component of the “precise algorithm” by which clinicians are encouraged to derive a diagnosis of “schizoid personality.” (At least it was in an earlier DSM - don’t have the latest version in front of me) Anyway, such subjective measures, and subjective tests like Rorshac and draw a person are also impricise, and widely criticized as measureing the test giver as much as the test taker.
> Once a practitioner reaches a verdict (sorry) based on DSM, pharmaceutal suggestions often follow. Lost in the process is an understanding by the subject (patient) that the subjective tests used to derive the diagnosis relate only vaguely to precise neurochemical conditions.
>
>
>
> boB> Of the diagnoses you have listed, the observation of the clinical practitioner is the causative agent.
>
> SLS> This is witty, but shallow and meaningless rhetoric. Of course, I'm supposed to append a IMHO.
>
> reply: In your humble opinion indeed, but actually my analysis is a precise analysis of the process. To understand my thesis, my response (which you apparently don’t yet recognize), and finally the complex causation of conditions classified in DSM-IV, one needs to obey such precise rules of language.
>
> To say a general feeling of meaninglessness and malaise is “the biology of depression” is not precise use of language - it is rather a lay understanding, and contains the elements of a medical folklore.
>
> SLS> I would still be interested to see your response to at least one of these questions.
>
> reply> you have seen it, but apparently do not yet recognize it. You called it shallow and meaningess rhetoric.
> boB > The practitioner's preference for a common nomenclature,
>
> SLS> I should hope a practitioner would be in favor of the use of a common (standardized) nomenclature. Don't you?
>
> Reply: more or less, but I would hope practitioners continue to be scientists, and as such seek to advance the collective understanding while realizing limitations of the present understanding, rather than become authoritarians who insist on the correctness of their present understanding.
>
> boB > in this case DSM-IV, causes the practitioner to form an opinion based upon the practitioner's observation of symptoms.
>
> SLS> I prefer the word "encourages" to "causes". It just sounds better to me.
>
> reply: Granted. Attribution of motive is a fundamental error in any public discourse. I actually noticed the same error, once I had posted. We are shooting from the hip in this dialogue and I am posting scantily edited, complex and wide-ranging replies that stretch the limits of my ability. I am not conducting research, siting sources, or even spending a day away from my text, and the second opinion I seek is the one you offer.
>
> boB > The practitioner's opinion is known as a diagnosis.
>
> SLS> The practitioner's choice of a particular diagnosis is his opinion.
>
> reply If a=b and b=c then a=c. Or more simply, in this case, if a=b then b=a.
>
> boB > The diagnostic methods inferred by DSM-IV's inventory of diagnoses include
> subjective and projective tests, but not as often chemical tests or biological
> measurements. The nomenclature of DSM-IV was derived from the review of
> collected data, which included data derived by subjective tests, objective tests
> and neurobiological research.
>
> SLS> Sounds pretty good. I am particularly fond of your use of the word "method". It
> reminds me a bit of the word "algorithm".
>
> reply I think we are reading the same book on this one. My point, which approaches my thesis, is that in this case a does not equal b, but is similar to b. “A” would be the collected data used to compile the DSM-IV nomenclature, and “B” would be the diagnoses rendered in clinical settings based on the nomenclature.
>
> My thesis is that the necessities of practice and of specialization dilute the ability of practitioners and specialists to fully understand the complex genetic, experiential, cultural, neurochemical relationships they define as disorder. Disorder is a definition, not an exact condition. An understanding of the arbitrariness and ambiguity of diagnosis leaves room for more complex understanding of contributing circumstance. My thesis, since you asked, is that our current medical culture is more oriented toward changing the biological condition of the subject ( i.e. patient) rather than explaining and effecting specific and systematic conditions that effect the individual subject and groups of subjects.
>
> boB > Biology is the STUDY OF biological relationships and conditions.
>
> SLS> I know I can be a stickler for words. The definition of biology is both simpler and broader.
>
> BIOLOGY:
>
> The science of life and of living organisms, including their structure, function,
> growth, origin, evolution, and distribution.
>
> * biology \Bi*ol"o*gy\, n. [Gr. ? life + -logy: cf. F. biologie.] The science of
> life; that branch of knowledge which treats of living matter as distinct from
> matter which is not living; the STUDY OF living tissue. It has to do with the origin,
> structure, development, function, and distribution of animals and plants.
> Source: Webster's Revised Unabridged Dictionary, © 1996, 1998 MICRA,
> Inc.
>
> Reply> You offer a better definition, compiled by dictionary editors.
> My point was that biology is a STUDY, a point to which we both referred.
> My response to your query “Of the diagnoses I have listed, are there any for which you believe that biology is the causative agent?” is that the study does indeed lead to the diagnoses, and the conditions to which the diagnoses refer do indeed involve living tissue. But that is not the equivalent of saying “low serotonin levels cause depression.”
>
> My point is that the convenience (and profitability) of medications, and our present fascination with laboratory discoveries is contributing to a bit of ignorance (not paying attention to) circumstances that can contribute to the biological conditions we define, classify and often treat with neurotropic pharmaceuticals. Contributing to this particular area of ignorance is the role of pharmaceutical sales forces in developing the language whereby we understand conditions diagnosed as disorders. The pharmaceutical sales force has a vested interest in maintaining a certain cultural direction, and has little reason to suggest that people might be to hard by those cultural forces.
>
> As a collectivity, the pharmaceutical industry contributes to research that advances its market share, but does not contribute nearly as much, or at all, to research that might explain our growing fascination with human fabrications. This dichotomy is occurring at a time when human fabrications are becoming increasingly dangerous to the broader biological web of living organisms.
>
>
>
> SLS> (in reference to his initial post) I stated an opinion that it is important
> that we treat both the biological and the psychological. Additionally, I don't see
> that I have specified any biological treatments. Drugs would be included, but
> not exclusive.
>
> boB> I recognize that. I am responding to the weight given to pharmaceuticals, which enjoy the advantage of “hard” research, at the expense of psychology, which includes social psychology and is stunted by being informed by “soft” research. My thesis, is that the “soft” sciences desperately need to be informed by the “hard” research that is driven by market forces to contribute more to pharmaceutical than experiential treatment of personal, social and mental difficulties.
>
> I hope it is clear I am not out to prove Steve wrong, but to implore, at a time when this summer is likely to be hotter than last summer, when CO2 levels are likely to be higher this year than last, when more species will be rendered extinct, when a greater portion of the American population will be in prison this year than last, (among other indicators of sociopathology) that research and clinical psychiatry look closely at our relationships within natural world and within human society and share with us the “hard” science that will encourage us to seek less, not more, and to be more satisfied with who we are rather than constantly pursuing happiness.
>
> (J-Criminy that’s a long sentence)
poster:Scott L. Schofield
thread:29296
URL: http://www.dr-bob.org/babble/20000401/msgs/29512.html