psychiatry

I was reviewing two books on child psychiatry in the 90s, one on psychosis in chldren.

One covered pre and post DSMIII surveys.

There was an increase post DSMIII in the frequency of diagnosis, around 1/4 to 1/2 increase.

Nonetheless, in all reported surveys in the books the prevalence was less than 1 in a 1,000, around 1 in 3,000-5,000, even 1 in 10,000 in several places of the western world, including the US, UK and Canada, since the 60s to the 90s. Most likely, I think, such variation in frequency reflects the irreproducibility of the whole definition and assesment of minors at least back then, i.e. such diagnosis are mostly in the mind of the practitioners.

Most of the minors diagnosed had autism, between 1/3 to 2/3 or 1/2.

The second most common group had brain disease, brain damage, and developmental disorders I think.

Primary psychosis was less common, I think around 1/10th of cases or less.

Nowadays, according to this study 1 per every 333 minors was prescribed an antipsychotic in Australia, a 10 fold increase at least, apparently, compared presumably to before the 90s. Although more than half now, 55% for non-psychotic disorders, apparently.

But speculative, psychosis in children was not diagnosed then on the basis of hallucinations and delusions, but on isolation, language and interaction with family/peers, etc. And the "symptoms" were more related, at least to me, to abuse: they could very well have been the expression of abuse, perhaps severe on the minors with such behaviours, like withdrawal, avoidance and isolation.

And in fact, studies made a restrospective diagnosis of psychosis TO childhood when diagnosed as adults with psychosis if as children there were reports of such child behaviours in the case in question, no direct obsevation there.

So, those behaviours do seem to be caused by abuse in childhood, perhaps severe, not only because of it's appearance in persons abused, normally without "disease", but because abuse does increase the likelihood of being labeled/diagnosed with psychosis as adult.

One thing standing out to me, and transparent to the ridiculousness of the psychosis frabrication, specially in childhood as a "disease", is that those books spoke of "deviant" behaviour as manifestation of psychosis in childhood, literaly, "deviant behaviour" was pepered.

Nowadays they don't say deviant, but it made me think that they are still using deviancy in the statistical sense*, not moral nor moralistic: all minors, even adults are labeled because they fall outside a norm, an expectation of "normality".

And that expectation has no basis in reality of the human brain, it has no basis as meassuring weight, height, blood pressure, blood sugar, etc**. It is still based on moral, social, educational, political and ideological expectations of society and it's torturers. And it doubly punishes minors who probably have been already severely abused, but their parents, family and community do not report their own abuse against minors, and the pros don't even document it, let alone report it to the authorities***, they just push a pill that makes the minor more "manageable" and less likely to complain enough to be put in a safer place.

It conceals and perpetuates the abuse, despite that by their own "deviant", pun intended, then rhetoric, "psychotic" children were more likely to be abused. "Deviant behaviour" was the cause of child abuse!. Pfuff...

Not investigating, documenting AND reporting to the authorities sounds to me like an atrocious possibility, inexcusable for a psychiatrist, and doubly inexcusable for a GP,  who should have a more communitary integrated approach.

* But it still requires an expectation of normal, more correctly stated "acceptable" behaviour in minors. What is the basis of calling it unacceptable and therefore expression of a disease/disorder?. None: the same DSM claims that there is no pathological process explaining any symptom of mental disorders, therefore no explanation of why it is considered a symptom, and ALSO, undertandably, the inability to distinguish normal from pathological psychiatric symptoms. So no basis for labeling psychosis, let alone in children WITHOUT hallucations and delusions, and it is an authoritative, by top experts, claim that invalidates ALSO any alternative way of labeling/diagnosing psychosis: otherwise it would be in the DSM...

** Like Schizophrenia, that 1% around the world "prevalence", without scientific theory behind it, could be precisely a reflection of culling the 1% that appears "deviant" in a moral, laboral, familial and social sense, prejudice, hate, anger, violence and fear against a minority. A possible crime of persecution...

*** I believe it is a common misconception that crimes comited against a child will not be prosecutable when reaching adulthood. Not entirely correct, in some jurisdictions, I am not a lawyer, when is part of a related secuences of presumed crimes, like a different form of the same: family violence, it does not expire, it's prosecutable period is actualized up to the latest offense, like now violence as adult children, say narcissistic. And the law, as far I understand, does not give practitioners the faculty, attribution nor capacity to judge alone wheter it is prosecutable or not, even if it happend 50yrs ago, that's up to district attorneys/judges not practitioners, so I expect that they should report ALL abuse, including from decades ago.



The linked article seems to be a handwave that pretends to be authoritative.

Does not explore alternative explanations and why they have not been researched or why they are discarded.

It does not explain the normal process, the how it works, the imagination, the seeing of the future, particularly the place in it for oneself.

That is, it gives no beyond doubt facts to be used for reasoning and experimenting, interpreting correlations about seeing oneself in the future: none. Then, even just reasoning about it is false, fallacious, since it does not start with premises that are true, and as science, real science not dogma,ideology, pseudoscience or, least worse humanities, demand.

And given it's authoritative nature leads me to conclude there is none, and therefore NO causality can be claimed, imputed nor inferred, not even argued, just fantasize about it, even if from "Terrific research".

Which stated thus, seems to me more like terrorificacious, even rephensible, not terrific...



“genetic and personality factors”, which genetic factors,which personality factors?. Meassured how?, by “expert” assesment or bogus personality testing “meassures”. What is the scientific theory behind them?, not the “constructs”/models…

Note: those refered lack a causally scientifically valid, as in beyond doubt basis to be used even to “think” about them, let alone to be claimed as truthfull, or worse, to do experiments with them. They are unscientific, since they are not beyond doubt, as the definition of Scientific Theory demands.

To put a simple imaginary example: Let’s say that saying someone has a tendency for conscientiousness, well, how many behaviours one would need to meassure, observe, whatever to be CONFIDENT, scientifically, that is characteristic of this individual?. Out of the 1,000s per day, millions per year or life,how many, in which circumstances they would have to qualify as conscientious to be labeled characteristic of this individual?. How do they compare to the rest of the population?.

What should the sample size be and what should be the sampling methodology?. To claim: yes, of course, this fellow is overly, too much, conscientious?.

That might seem abstract even ridiculous, but actualy to validate ANY meassure of conscienstiousness would require THAT kind of procedure. A test that meassures that characteristic in a piece of paper requires that validation. Same as height, weight, blood pressure, etc.

Particularly crucial if the measure is not constant as weight and height, but if it’s meassurement is noisy: it requires even more measures and more accurate meassurement apparatuses.

Mere “internal validity” or “agreement” is not enough in real science. Using mere constructs leads to confirmation bias, at least. How many personality “theories” have been discarded?

And if it’s applied with input from “past” behaviour it becomes worse: it’s unobservable in practical terms. It becomes a telling, a story, a memory subject to ALL recall problems. It would be evaluating the MEMORY of conscientiousness. A proxy at best!, which it is not, that would require meassuring directly conscientiouness first as stated to be used as proxy at all…

And the obvious not acknowledged enough serious problem of integrating it as part of being of THIS individual. Which does not have a science behind it either…

“… the standard error of measurement on the particular instrument.” In populations, not in individuals…

***

Psychotherapy could be an active placebo, disprove that one given there is no theory how it works, mere constructs, models and correlations…

***

The page:

https://en.wikipedia.org/wiki/Falsifiability

Gives an example of black swans, that is an example of a problem of “existance”, conscientiousness is a problem of intensity and distinctivenes different from white/black dichotomy, as in: gray swans, from pristine white to almost black ones. And that meaning something, anything to swan mind suffering!.

That requires meassuring grayness, it’s causes and effects, among others…

“where neither confirmation nor refutation is possible, science is not concerned”. confirmation AND refutation seems more accurate to me…

From said wiki:

“Another example from Popper of a non-basic statement is “This human action is ALTRUISTIC.” It is not a basic statement, because no accepted technology allows us to determine whether or not an action is motivated by self-interest. Because NO BASIC STATEMENT FALSIFIES IT, the statement that “All human actions are EGOTISTIC, motivated by self-interest” is thus not falsifiable.[AH]”. Uppercases mine…

Same page, Daubert standard:

“Ordinarily, a key question to be answered in determining whether a theory or technique is scientific knowledge that will assist the trier of fact will be whether it can be (and has been) tested. Scientific methodology today is based on generating hypotheses and testing them to see if they can be falsified; INDEED, THIS METHODOLOGY IS WHAT DISTINGUISHES SCIENCE FROM OTHER FIELDS OF HUMAN INQUIRY. Green 645. See also C. Hempel, Philosophy of Natural Science 49 (1966) ([T]he statements constituting a scientific explanation must be capable of empirical test); K. Popper, Conjectures and Refutations: The Growth of Scientific Knowledge 37 (5th ed. 1989) ([T]he criterion of the scientific status of a theory is its falsifiability, or refutability, or testability) (emphasis deleted).” Uppercase mine.

But, admitedly: “David H. Kaye[AV] said that references to the Daubert majority opinion confused falsifiability and falsification and that “inquiring into the existence of meaningful attempts at falsification is an appropriate and crucial consideration in admissibility determinations.”.So apparently, for the Daubert standard sort of a moot diference…

Crucial for pesonality the section of said wiki on: “Connections between statistical theories and falsifiability”.

Like in: “…he [Popper] was aware that some convention must be adopted to fix what it means to detect or not a neutrino in this PROBABILISTIC CONTEXT.”

Or: ‘”The falsifying hypotheses … necessitate an evidence-TRANSCENDING (INDUCTIVE) STATISTICAL INFERENCE. This is hugely problematic for Popper”‘. Uppercase mine.

So, psychobable is unfalsifiable at least because it does not start from necessarily true premises. That’s why it belongs in the best scenario to the humanities, not to the sciences, properly understood TODAY, not even in the times of the great Popper.

The requirement of necessarily true, beyond doubt, to me deals with the whole Popper rhetoric that scientific reasoning WAS informal, that was yesterday, not today…



From:

https://en.wikipedia.org/wiki/Daubert_standard

"4. Whether it has a KNOWN error rate; and...", uppercase mine.

Error rate in the conscientuossness and depression context would mean how many overly conscientious individuals are NOT depressed, and how many depressed individuals are NOT overly conscientious.

Do we know that Les?. :)

I don't think we know how many are overly conscientious and how many are really, as in reality not on "constructive" minds, depressed...

Same wiki:

"In Daubert, the court ruled that nothing in the Federal Rules of Evidence governing expert evidence [refering to Rule 702 governing expert testimony] "gives any indication that 'general acceptance'[*] is a necessary precondition to the admissibility of scientific evidence."

General acceptance* of clinical psychology models/constructs is not a necessary condition for admissibility as "scientific evidence".

From same wiki:

"1. Has the technique been tested in actual field conditions (and not just in a laboratory)?". Field conditions would be direct observation of a persons life, not just in the "laboratory" or the office of the practitioner...

And some Judges at least in the US are reluctanct and sometimes hostile to accept forensic psychiatry/psychology testimony, even as "opinion"...

Same wiki:

"While Daubert has superseded Frye, the standard of Daubert is not substantially different. While the focus of the inquiry has changed, the result rarely does. Accordingly, the Daubert standard has been described as "Frye in drag." That means to me in practice judges and justices are not much better now, perhaps because for the most part they are not scientifically literate enough, not even researchers with PhDs are, in my personal biased opinion, AND they must follow precedent...

* "General acceptance" seems to refer to a superseeded standard in federal courts, the Frye standard: "... the thing from which the deduction is made  must be sufficiently established to have gained general acceptance in the particular field in which it belongs."

As an example of why General acceptance is not enough is bite marks: it's bogus, fake and led to many wrong convictions. Strictly speaking ALL of them based on that.

Which was somewhat covered and therefore not off topic by an interview, at least here at MIA about a book that covered it extensively a few months back. Written by one of the founders, I think, of the Innocence Project.


Even as biographical stuff:

Refering to "Irving v Penguin Books and Lipstadt"...

From https://en.wikipedia.org/wiki/Historian#Objectivity :

1. The historian must treat sources with appropriate reservations;

2. The historian must not dismiss counter-evidence without scholarly consideration;

3. The historian must be even-handed in treatment of evidence and eschew "cherry-picking";

4. The historian must clearly indicate any speculation;

5. The historian must not mistranslate documents or mislead by omitting parts of documents;

6. The historian must weigh the authenticity of all accounts, not merely those that contradict their favored view; and

7. The historian must take the motives of historical actors into consideration.

Replacing the word historian with practitioner/assesor/evaluator, since the evidence presented at least rhetorically, the testimony of past behaviour, is essentially historic*:

Do psychotherapists/psychiatrist DO any of that?, let alone effectively?.

And even if, same wiki:

"Schneider uses the concept of the "objective historian" to suggest that this could be an aid in assessing WHAT MAKES A HISTORIAN SUITABLE AS EXPERT WITNESSES UNDER THE DAUBERT STANDARD in the United States. Schneider proposed this, because, in her opinion, IRVING COULD NOT HAVE PASSED THE STANDARD DAUBERT TESTS unless a court was given "a great deal of ASSISTANCE FROM HISTORIANS"."

Which in the case of clinical psychology/psychotherapy/psychiatry would more properly be of CRITICS, SKEPTICS of such pseudosciences, as my opinion.

Imagine ALL historians being not objective at a particular time...

I seriously doubt, respectfully, clinical psychologists AND psychiatrists actually have and show effective knowledge of "objective historian", or the Daubert/Frye standards... even with PhDs...

Take an example: do they consider, really, let's get serious, the motives of people, point 7, with whom the patient interacts?. How could they?, most of the time ALL they have is the patient's testimony!. Sometimes not even that as in child/adolescent psychiatry, a second hand testimony...

* "History is the systematic study and documentation of the human past." So, strictly speaking it would become historic when the practitioner WRITES about it, and not before, before it's prehistoric, no writting... so those pseudosciences when not properly written are prehistoric, like Dinosaurs... :)



AND!, the use of such words with loaded meaning as innatentive, concientious, depressed, anxious, callous, etc., ALL the descriptors of clinical/psychological disorders/disease cause harm to self perception, and that is to me IS a clear violation of human rights.

Specially if not clearly stated BEFORE psychiatric/psychological evaluation: This procedure might cause at least a diminution in the apreciation of your self-worth, self-identity, self-expression, self-determination and the like. Patient, beware.

Do any clinical psychologists/psychiatrists does that?.

That's sounds illegal to me, I am not a lawyer and I am aware the Law has not caught up to that. I think they are severely wrong by not admitting clearly that: such diagnoses and labels attack, impinge and restrict, sometimes destroy such human rights. Sometimes permanently.

It's not a moral nor scientific issue, it's a legal one not properly framed, appreciated or evaluated thus.