The DSM counts you as being schizophrenic if you have 2 or more of the following for more than 2 months:
1) Delusional beliefs (Oxford Dictionary: "a false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions") Bryan's objection: what counts as "incont…
The DSM counts you as being schizophrenic if you have 2 or more of the following for more than 2 months:
1) Delusional beliefs (Oxford Dictionary: "a false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions") Bryan's objection: what counts as "incontrovertible evidence to the contrary?" If the standard is "certainty," there isn't incontrovertible evidence that we aren't brains in vats, so it must be something more like "really really good evidence to the contrary." But what about religion? Many (most?) religious folks are happy to acknowledge that their beliefs are taken on faith, in full knowledge of the lack of evidence. Maybe Bryan's objection fails because religious beliefs are not subject to incontrovertible evidence *to the contrary,* just lacking in positive support.
Bryan also objects that incentive programs at psych wards have caused people to stop attesting to their delusions. I don't find this convincing because it's too easy for a patient to simply lie about their beliefs for rewards.
2) Hallucinations (usually auditory). Problem: most people have an internal monologue. You could say it has to be a voice heard from the outside, but the DSM considers a voice which can only be heard "on the inside" to count, assuming one does not identify with or control the voice. I'm not sure what to make of that either, though, because many of my thoughts are spontaneous and uncontrolled (just try to control what your next thought will be, and notice how often it comes to you unbidden), and I don't necessarily identify with my thoughts either. (I'm not entirely sure what it even means to "identify" with a thought. To think the thought is you? I am more than any thought I have. Does it mean "to think the thought is a part of me?" Why wouldn't hallucinations be "a part of" a schizophrenic?)
3) Disorganized speech (incoherence, frequent derailment). I don't know if Bryan has an objection to this, and Scott says in his experience this doesn't respond to incentives. That is, he will offer a patient who wants to be released the opportunity to be discharged if they can just string together an even slightly coherent sentence without their medication, and even still they cannot do it.
4) Grossly disorganized or catatonic behavior: IDK what Bryan says about this criterion either, maybe there's a study somewhere where this responds to extreme incentives too.
The takeaway: you could plausibly meet the criteria for schizophrenia despite being mentally healthy if you fit items 1 and 2 for more than two months (by being religious and having an internal monologue). But maybe the solution isn't to jettison the concept of schizophrenia as a disease, but to refine the diagnostic criteria?
Yeh thats why diagnosticians are taught to use clinical judgement and not use the diagnostic criteria as a checkbox.
Hence the years of training on interview technique (assuming the symtpom , open ended etc) and thousands of patient encounters.
You dont fill out a dsm form and send it to the dsm police when you diagnose someone , you do an in depth interview and take into account the entire case and the patient as a whole. You get collateral. You examine if subjective and objective line up and if its causing dysfunction or damage to the persons well being.
No ones out their trying to "gotcha" people into a diagnosis if the treatment would be of no utility.
A broken medical system with poor incentives isnt psychiatrys fault , they use the same criteria in countries that sont have for profit healthcare systems, the criteria werent designed to buttress US inpatient hospital numbers , insurance companies and governments dont want to pay for that and have a lot more money and power than all thr psychiatrists combined.
The DSM counts you as being schizophrenic if you have 2 or more of the following for more than 2 months:
1) Delusional beliefs (Oxford Dictionary: "a false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions") Bryan's objection: what counts as "incontrovertible evidence to the contrary?" If the standard is "certainty," there isn't incontrovertible evidence that we aren't brains in vats, so it must be something more like "really really good evidence to the contrary." But what about religion? Many (most?) religious folks are happy to acknowledge that their beliefs are taken on faith, in full knowledge of the lack of evidence. Maybe Bryan's objection fails because religious beliefs are not subject to incontrovertible evidence *to the contrary,* just lacking in positive support.
Bryan also objects that incentive programs at psych wards have caused people to stop attesting to their delusions. I don't find this convincing because it's too easy for a patient to simply lie about their beliefs for rewards.
2) Hallucinations (usually auditory). Problem: most people have an internal monologue. You could say it has to be a voice heard from the outside, but the DSM considers a voice which can only be heard "on the inside" to count, assuming one does not identify with or control the voice. I'm not sure what to make of that either, though, because many of my thoughts are spontaneous and uncontrolled (just try to control what your next thought will be, and notice how often it comes to you unbidden), and I don't necessarily identify with my thoughts either. (I'm not entirely sure what it even means to "identify" with a thought. To think the thought is you? I am more than any thought I have. Does it mean "to think the thought is a part of me?" Why wouldn't hallucinations be "a part of" a schizophrenic?)
3) Disorganized speech (incoherence, frequent derailment). I don't know if Bryan has an objection to this, and Scott says in his experience this doesn't respond to incentives. That is, he will offer a patient who wants to be released the opportunity to be discharged if they can just string together an even slightly coherent sentence without their medication, and even still they cannot do it.
4) Grossly disorganized or catatonic behavior: IDK what Bryan says about this criterion either, maybe there's a study somewhere where this responds to extreme incentives too.
The takeaway: you could plausibly meet the criteria for schizophrenia despite being mentally healthy if you fit items 1 and 2 for more than two months (by being religious and having an internal monologue). But maybe the solution isn't to jettison the concept of schizophrenia as a disease, but to refine the diagnostic criteria?
Yeh thats why diagnosticians are taught to use clinical judgement and not use the diagnostic criteria as a checkbox.
Hence the years of training on interview technique (assuming the symtpom , open ended etc) and thousands of patient encounters.
You dont fill out a dsm form and send it to the dsm police when you diagnose someone , you do an in depth interview and take into account the entire case and the patient as a whole. You get collateral. You examine if subjective and objective line up and if its causing dysfunction or damage to the persons well being.
No ones out their trying to "gotcha" people into a diagnosis if the treatment would be of no utility.
A broken medical system with poor incentives isnt psychiatrys fault , they use the same criteria in countries that sont have for profit healthcare systems, the criteria werent designed to buttress US inpatient hospital numbers , insurance companies and governments dont want to pay for that and have a lot more money and power than all thr psychiatrists combined.
> Grossly disorganized ...behavior
Anti-ideological Pragmatism, eg, US domestic politics and foreign policy