Speaker unverified: belief

Transcript context

…Nevertheless history Psychotherapy Example Subfields Human Mind Complicated All Factors Say Anything Helpful Have Simplify Freud famously simplified Lot Towards Particular View Human mind Mm-hmm That simplification Actually Talk about Its Correct Deeper Sense Productive yes in fact whenever you’re trying to deal with a very complicated set of issues you have to simplify you have to make heuristic decisions about what you’re going to neglect and what you’re gonna emphasize but what im trying to say well you asked me about the crisis in psychiatry and the simplest way for me to encapsulate the issue and the problem as i see it that’s arisen —one of the problems—is a quote by Leon Eisenberg who had a very long career at Harvard and Eisenberg said towards the end of his career He Said When Entered Psychiatry Was Brainless Psychiatry Leaving It mindless Psychiatry Yeah sums Up Way Field Large Degree Moved Process Insights Lost Though Ways Other Being Gained Freudians tended Neglect Biological Suggest Brain as a biological organism was not something we needed to worry about. We worried at the level of a psychological model of how our minds work. And all too often, not exclusively because some of the psychiatrists I’m friends with are very sophisticated men and women and do grasp that you can’t move in these bipolar directions. You’ve got to meet somewhere in the middle. But that sort of got lost, I think, in all the enthusiasm for neuroscience. I mean, when antipsychotic drugs were discovered in the early 1950s, we had no clue of how they worked. And one of the things that they helped us spawn as people began to say, “Well, why did these drugs work? What did they do?” Was to begin to understand that the brain wasn’t just a set of electrical signals, as had been thought in the first half of the 20th century and before. But rather there was this very interesting chemical soup running around in our brains with neurotransmitters that help the brain work the way it did and perhaps explained why it went awry. So it was one of the many factors that gave rise to neuroscience. The first neuroscience conventions were in the 1970s, and they attracted a few hundred people. Now it’s tens of thousands of neuroscientists. It’s a huge enterprise. So diagnosis has come under threat. The categories that we have all become familiar with, that we’re told are real diseases like bipolar disorder, schizophrenia, major depression, are beginning to falter, and we’re beginning to worry about whether those diagnoses are real ways of thinking about the world and may in fact mislead us. Because if we think there’s something called schizophrenia or the schizophrenias, as the inventor of that term put it, if we think there’s something like that and we try to research where it comes from, but that’s not really what’s going on, obviously we’re probably gonna not make the progress we could be making if we had a better diagnostic system. And that’s what DSM-V thought it was gonna be able to do and discovered it couldn’t. So it stayed basically with the symptomatic approach. If we can just really brief – … I would love to talk a little bit more about the DSM, but just to give a history here, looking it up on Perplexity, DSM One in 1952 was a 32 page pamphlet- ..with 106 diagnoses heavily influenced by psychodynamic concepts- ….and etiology using broad, often vague categories like reactions. DSM Two in 1968 expanded to 185 diagnoses, still psychodynamically flavored and reliability poor, but added more attention to childhood disorders and later removed homosexuality as a disorder in 1974 printing. Then to the revolution, as you mentioned, the DSM Three in 1980 introduced explicit symptom-based diagnostic criteria, a multi axial assessment system, and an officially atheoretical stance about causes aiming to improve reliability and research utility. And then DSM Three R in 1987 revised criterion expanded to around two 97 diagnoses. DSM Four in ’94 and DSM Four TR in 2000 focused on literature driven empirical revisions,- …..added and deleted some disorders, increased coordination with ICD ten and goes on. And then finally in 2013 DSM Five came out which eliminated the multiaxial system, integrated most information into a single nonaxial diagnostic list than separate notations for psychological and medical factors. It reorganized chapters, e.g., neurodevelopmental, obsessive compulsive related, trauma and stress related disorders, introduced new and refined entities, and so on. But big picture trajectory conceptually, the DSM moved from cause focused and psychoanalytical to symptom based, theoretical, and reliability driven over time. There has been growth in the number of granularity of categories, closer alignment with ICD, ongoing controversy over medicalization validity and the balance between categorical and dimensional approaches. Yes, it feels like that description doesn’t necessarily fully get to the core of why the DSM five doesn’t quite get the full scope of the problem.…

Stored transcript either side of the excerpt. The highlighted words are the published quote; the surrounding text is unedited source, never generated.