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DSM 5 Diagnosis: Psychiatric Institution Lockdown
Psychiatric Diagnosis and DSM 5: Maps to Nowhere
February 13, 2010CorePsych Updates: Crossroads
March 15, 2010Must see!
Even if you are only slightly interested in the DSM 5 validity flap, you must absolutely listen to this piece by Clay Shirky from TED Talks
The issues that arise with change and continuity over time:
1. Institutions vs Collaborative models
2. Economics of Institutional Challenges the 80-20 Rule
3. The Negative Impact of Institutions with Collaborative Change
4. The Challenge with Collaboration
Take a look, and then do drop your comment – 20.46 min, goes very fast – tighten your seat belts!
So what do you think… which is your perspective? Are you a journalist? This is interesting…
cp
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This post was mentioned on Twitter by drcharlesparker: New post: DSM 5 Diagnosis: Psychiatric Institution Lockdown http://goo.gl/fb/cXrb…
You were right to warn people that this video moves fast. I had to stop it several times and jot down some notes.
What is not addressed in this video is the issue of quality. In the open source world (he refers to Linux) we have the case where a programmer may contribute a patch that, perhaps, may address a significant problem…and that constitutes the entire contribution of that programmer. We can judge the quality of that patch by the way it has solved a particular problem. But things become muddier once we move into the world of information in general, be it in the form of “amateur” journalism (the bloggers) or Wikipedia, where measuring quality is, to some degree, subjective, yet there is certainly an objective component to measuring quality. We are all familiar with the pseudo-journalistic websites that promote rumor as news, yet this “rumor” has often turned into “news” and has shaped dialog about the world. What an institution provides is a vetting process for information. I have more faith in something that comes out of an institution (interesting that he selected Judith Miller who was doing little reporting and more retelling of the Bush/Cheney/Iraq War talking points). Miller actually is a case of two problems with, as far as I’m concerned, the Shield laws being the less important issue. The MORE important issue is that we depended on the institution to assure the quality of the information and, in the case of Miller (and there have already been a few others), it has failed. But without an institution to vet the information, who am I to believe? And how do I judge one source of “news/facts” when compared to another? One more point concerning quality. I’ve used Wikipedia many times but I’ve used it to verify what I ALREADY KNOW to be true. When I want something that I can trust, I’ll turn to a recognized online encyclopedia or other authoritative source.
Now, there is the very important issue of how does an institution incorporate the insights of that solitary person who contributes that one “patch” that, perhaps, solves a major problem with DSM V. It’s a question mark as to whether institutions, in their current form, can adapt/evolve to be able to take advantage of this possibility. That’s the real problem to be solved. My worry, though, is that without an institution, be it the APA or the NY Times, I have no way to really know if the information provided is any good and I also have no recourse, no place to go to to complain when I believe such information is erroneous.
Finally, what is ignored is the issue of power. We have fooled ourselves into believing that because millions of us have access to the Internet, have access to blogging software, etc., that that somehow constitutes power and, through the miracle of sheer numbers, the “truth” will win out in the end. Where power is concerned, it is so widely distributed and thereby so diluted that all we really have is an illusion of power. The best example of that? The current administration in the White House. Millions and millions of people thought that they were contributing to real change when they harnessed the power of the Internet to get behind Obama. But what have we seen? The institutions, in the form of Wall Street (Goldman Sachs, etc.), the banks (Citibank, etc.) and so far, it seems, the health insurance companies (Wellpoint, etc.), are the ones calling the shots. You can only fight institutions with something equally powerful…namely…an institution. As for truth, well, we have a few websites that started out as amateur operations and have become quite impressive in the quality of the information (Talking Points Memo, for example), but we also have MANY websites that put forth junk information and which thereby promotes bogus information. My favorite example of this is the website http://jewwatch.com/ .
Final, final point. I don’t know what the future holds. My fear, though, is that as institutions that cannot remain profitable, like the NY Times, whither away, what will take its place is amateur, junk journalism. I fear that we will have the junk news and junk science (“let’s use crystals to cure your cancer!”) and no way to separate the wheat from the chaff. I can probably tell if a Linux patch has failed (and maybe I cannot). But how will I be able to determine whether crystals will cure my ills? I need an institution to perform those studies, those double-blind tests.
Jeff,
Thanks for your thoughtful comments, and I almost completely agree… except for one point – a point that you are making throughout this piece: peer reviewed references are valuable, and can add to/further validate the discussion on the Internet. Discussions will ultimately change institutions, as change frequently comes up from the people when science is stuck on itself.
And from my perch, I believe that diagnostic coding can change in our lifetimes if we simply listen to the extant science, and stop dreaming of better descriptions.
cp
Dr Parker,
I don’t disagree with you on this point. In retrospect I realize that in what I had written, and in the video itself, there seems to be no clear qualitative delineation between peer reviewed scientific work, the creations of Linux developers, the photographic output on Flicker and Matt Drudge-like news reporting. Different criteria are used to measure the quality of the output. So in my comment I realize now that these types of works need to be differentiated from one another.
Jeff
Jeff,
Yep, evidence is evidence, speculation is speculation – and labels inhibit even speculation about the actual underlying problems.
cp
[…] morning as I was catching up on email I got a post from a blog I follow. This blog addresses current information on brain functioning, with a strong emphasis on […]
I first heard of Clay Shirky last fall on a rebroadcast of the this excellent CBC radio interview: Clay Shirky Audio Program on Cognitive Surplus;. I am huge believer in the power of context. Right away I was struck by his great term "cognitive surplus" and went to view some of his other videos. It provides context for what you, me, Gina and others are involved in here. I also can see that participation provides something of a channel for my own cognitive abundance and fulfilling my driving needs (which I identified a couple of years back after some intense processing) – contribution, connection and recognition. As for the DSM V, I am not sure, except it sure gives me pause to cede authority to that group.
David,
The guy is definitely on to something regarding the evolution and trimming of ideas. Thanks for your link, he is great fun to listen to, – and I encourage our readers to take a listen!
cp