Posted by Simon Sobo, M.D. on September 15, 2010, at 14:51:22
In reply to Re: hrguru - Re: Anti-psychotics not mood stabilizers? » Simon Sobo, M.D., posted by SLS on September 15, 2010, at 12:42:06
> Thanks for attending to my comments and providing information.
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> > Don't know if you read my article. I would appreciate your telling me whether you have.
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> I did the best I could.
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> > I did not do a scientific study
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> That's all I'm saying.
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> > but rather wrote it when all of a sudden half the patients being discharged from inpatient units were suddenly being discharged with a bipolar diagnosis.
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> Perhaps a change in the rate of diagnosis of BP reflects greater accuracy in diagnostics. How would we go about testing this hypothesis?
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> > When I called the doctors about their diagnosis they cited "mood swings" as the reason.
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> All of them? I find the use of the term "mood swings" as a diagnostic descriptor offered by professionals in the mental health field to be quite disappointing. The only time I heard one of my doctors use the term "mood swing" was in describing the title of Ronald R. Fieve's book "Mood Swing - Fieve". Otherwise, I have never heard any professional use the term in front of me. I guess I have been lucky in this regard.
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> > I don't get your reasoning regarding Dr. Frances' opinion that there is a pseudoepidemic
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> Again, you are offering only the opinions of others. Where is the evidence you would present to validate these opinions? What evidence do these people use to substantiate their opinions? To me, it looks like Zimmerman's work offers the kind of methodology that would help resolve these questions. Perhaps you can comment on this.
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> In my opinion, the fad of overdiagnosing bipolar disorder has been in decline over the last 10 years. I can't prove this, though. My opinion is the result of observing the prescribing habits of doctors in a partial hospitalization program. Of course, this is far from being scientific evidence.
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> - Scott
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I see we are coming from very different places but I will try to throw my views across the the bridge and enter your paradigm.I love science when it delivers the goods. I love it as a method of trying to find solid answers to questions through well thought out experiments. We must never abandon this ideal for the generation of possible hypotheses and data that will "prove" or "disprove" a bit of knowledge,
However, unfortunately, we may be asked questions that we need answers to now and simply don't have the scientific information to answer the questions. It may be decades away.
You seem to be saying, the only thing worthy of discussion in that case is that which has been shown to be statistically valid. Everything else is wild speculation by do-dos who would rather speculate than cite evidence. If we turn to that kind of discussion we have the chaos of opinionated people and anyone can be right or wrong.
I say we have to do the best we can when science can't help us. There are better reasoned and worse reasoned, better observed and worse observed phenomena. Not being open to discussion that isn't based on solid science is a perversion of science's purpose, a one dimensional restraint on formulating the best answers you can come up with. As an example of this I don't understand what you don't understand when you say Dr. Frances is not citing evidence, is merely expressing an opinion.
>Perhaps a change in the rate of diagnosis of BP reflects greater accuracy in diagnostics. How would we go about testing this hypothesis?The "greater accuracy in diagnosis" is based on criteria his committee proposed! He's saying those criteria were mistaken and warning the creators of DSM V to not make the same mistake. Sure his DSM IV committees could have blundered into better criteria so that now we are discovering new and very real bipolar patients, but the burden of proof is on those refuting him. And it ain't gonna be answered by statistics..
Any way, the main point is you are depriving yourself of a rich source of important information and perspectives if you only considered statistically valid information. If we are talking about scientifically known information (e.g. penicillin treats a strept throat because it kills stretococcus) some one else' theory about Karma can be ignored. But if we are talking about the vast array of unanswered questions in psychiatry, the criteria is sensible or not sensible. Claiming the prestige of science is a false statement of validity and value when very little is scientifically known,
Put another way (quoting one of my articles) "Equally questionable is the use of DSM IV to dictate evidence based treatment, which implies unwarranted scientific validity. Given the choice between what is understood and proven through scientific method and what is, in essence , opinion or formulation, science should command absolute loyalty. But that doesnt mean that using a scientific format, or waving its banner, adds validity to those who speak as scientists. Its virtues can act as a smokescreen. The language, the prestige, the trappings of science can be so distracting that sciences core value is overshadowed, absolute clarity about what is known and not known."Those using the science paradigm to exclude interesting, (or possibly the best formulation for now) because it is unproven by strict statistical criteria are not speaking in the modesty of our shared ignorance. They are shouting down reasonable alternatives and claiming to be"experts" (a favorite self description and a term I find ludicrous given our state of knowledge)
Scientific curiosity and its method of validating ideas is a wonderful tool that has served us well. It is silly when used to stifle discussion and formulations
poster:Simon Sobo, M.D.
thread:960844
URL: http://www.dr-bob.org/babble/20100908/msgs/962481.html