Grasp the Nettle

NYTimes has an interesting article on Asperger’s and psychiatric classification:

THE Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the bible of diagnosis in psychiatry, and is used not just by doctors around the world but also by health insurers.

Changing any such central document is complicated. It should therefore come as no surprise that a committee of experts charged with revising the manual has caused consternation by considering removing Asperger syndrome from the next edition, scheduled to appear in 2012. The committee argues that the syndrome should be deleted because there is no clear separation between it and its close neighbor, autism.

So Aspie diagnoses have no content? Who knew?
Also, it is humorous the writer sets up this document as their Bible and then discusses the changes they are considering to it …

The question of whether Asperger syndrome should be included or excluded is the latest example of dramatic changes in history of the diagnostic manual. The first manual, published in 1952, listed 106 “mental disorders.” The second (1968), listed 182, and famously removed homosexuality as a disorder in a later printing. The third (1980) listed 265 disorders, taking out “neurosis.” The revised third version (1987) listed 292 disorders, while the current fourth version cut the list of disorders back to 283.

So what a mental disorder is changes according to fashion and societal values? Again, who knew?

This history reminds us that psychiatric diagnoses are not set in stone. They are “manmade,” and different generations of doctors sit around the committee table and change how we think about “mental disorders.”

This in turn reminds us to set aside any assumption that the diagnostic manual is a taxonomic system. Maybe one day it will achieve this scientific value, but a classification system that can be changed so freely and so frequently can’t be close to following Plato’s recommendation of “carving nature at its joints.”

Urgh.

First, a good shake of the fist at Plato and his wretched Essentialism (capital E for irony). Nature has no joints. The taxonomic systems in biology are unavoidably arbitrary to a degree, and have changed over time, though they are useful for certain purposes.

The main issue is not that psychiatry isn’t carving nature at the joints, but that what it seeks to classify is itself dubious. The author is on to something: the fact that the classifications shift so often is an indicator of something. But it’s not an indicator of psychiatry not having gotten down the right methodology yet — it’s that what they’re trying to classify mostly isn’t there. Imagine some superstitious Dark Ages “scientist” being criticized due to his classifications of Demons shifting around all the time; it’d be far better, it is said, far more scientific, if he just adopted some objective principles, like number of horns or tails. This would be missing the point, to put it mildly.

While I’m not quite willing to rule out that some people have something which we might reasonably call mental illness, a lot of the “mental illness” which we medicalize is either caused by really bad ideas (suicidal depression), or is merely a classification foisted on people who are outside of the mainstream (homosexuality as a mental illness, or Asperger’s, or ADHD). Maybe I should reject the whole kit-and-kaboodle, I dunno. But I’m certainly willing to junk most of it. The author, though:

… science hasn’t had a proper chance to test if there is a biological difference between Asperger syndrome and classic autism. My colleagues and I recently published the first candidate gene study of Asperger syndrome, which identified 14 genes associated with the condition.

We don’t yet know if Asperger syndrome is genetically identical or distinct from classic autism, but surely it makes scientific sense to wait until these two subgroups have been thoroughly tested before lumping them together in the diagnostic manual. I am the first to agree with the concept of an autistic spectrum, but there may be important differences between subgroups that the psychiatric association should not blur too hastily.

In counterargument to the argument that the distinction doesn’t make sense, he wants to maintain the distinction so he can do tests to see if the distinction makes sense? Is that how it normally works?
If there’s some objectively measurable criteria of Aspieness (say high IQ plus low Emotional Intelligence or whatever), there’s nothing to stop him from doing tests to find what he thinks are Aspies and then doing his research studies. If there’s not, and he needs the diagnosis to exist so that psychiatrists can unscientifically create a pool of candidates for him to do his studies on via their off-the-cuff diagnoses, well, he shouldn’t want to do that research anyways.