We had a discussion/disagreement recently about the validity or otherwise of psychiatric diagnoses or labels, designer drugs, and the DSM [see Comments on the N&C ‘Opinion’ on 26 August if you’re interested]. I was browsing my disorderly collection of printed-out articles this morning and so re-read this article by Carol Tavris that I posted in News last March. What she says is highly pertinent to the discussion/disagreement. In fact, it raises a whole set of questions that are very much B and W territory: what is science and what isn’t, what is pseudoscience, what kind of evidence is reliable and what isn’t and why, what kind of harm can be done by taking shaky evidence as more reliable than it is. And perhaps above all, the strange way the less reliable, well-founded, evidence-based branch of a discipline has become dominant in the public realm while the more cautious, skeptical, research-based branch is comparatively ignored.

Yet while the public assumes, vaguely, that therapists must be “scientists” of some sort, many of the widely accepted claims promulgated by therapists are based on subjective clinical opinions and have been resoundingly disproved by empirical research conducted by psychological scientists…Indeed, the split between the research and practice wings of psychology has grown so wide that many psychologists now speak glumly of the “scientist-practitioner gap”…Unfortunately, the numbers of scientifically trained clinicians have been shrinking. More and more therapists are getting their degrees from “free-standing” schools, so called because they are independent of research institutions or academic psychology departments. In these schools, students are trained only to do therapy, and they do not necessarily even learn which kinds of therapy have been shown to be most effective for particular problems.

And so we come to the DSM – the Diagnostic and Statistical Manual, that is, the ‘bible’ of US psychiatrists. The DSM is a product of the clinician side rather than the research side of this debate. There is a review-article here that discusses the same issues Tavris does while reviewing Science and Pseudoscience in Clinical Psychology (which has a foreword by Tavris). The differences (in all senses) between clinical psychologists and research psychologists, what kind of evidence they rely on, which treatment techniques are effective, which are ineffective, and which are actually harmful, the importance of distinguishing between science and pseudoscience. The book also discuss the controveries that can erupt over these issues. And the DSM.

These two drastically divergent conclusions demonstrate not only how varying standards of evidence can result in vastly different perceptions of treatment effectiveness, but also how some standards, such as clinical-anecdotal literature and clinical acceptance, are inappropriate measures. These conclusions also raise concern about relying on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is also based on practitioner consensus rather than empiricism (American Psychiatric Association [APA], 1994). This concern is reinforced in the chapter titled, “The Science and Pseudoscience of Expert Testimony,” by Joseph T. McCann, Kelley L. Shindler, and Tammy R. Hammond, which observes that the APA acknowledges that DSM-IV diagnoses do not rise to the standard of legal evidence (APA, 1994).

Well there you have it. All those syndromes and disorders in the DSM rely on practitioner consensus (sounds like what Susan Haack calls ‘vulgar Rortyism’) rather than empiricism, and the diagnoses do not rise to the standard of legal evidence. Just what I’ve long thought, so it’s good to see it said so explicitly. And the Candace Newmaker case is discussed too, not surprisingly.

Tavris is not alone among the contributors in suggesting that these practices are not only unscientific, but harmful; at worst, they can lead to inappropriate custody decisions and jury verdicts. Lilienfeld and his coeditors expand upon this concept in their opening chapter, identifying varying degrees of harm that may result from pseudoscientific techniques. Some treatments are truly dangerous, such as the “rebirthing” techniques that gained attention only after the suffocation death of Candace Newmaker; “memory recovery,” which caused many innocent people to be accused-and some convicted-of heinous crimes; and “critical incident stress debriefing,” which exacerbates the trauma it is purported to mitigate.

This is a large subject, and one we’ll be turning our attention to.