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-   -   Request info on definitive study (http://www.behavior.net/bolforums/showthread.php?t=286)

joe_pilot January 5th, 2005 12:59 PM

Request info on definitive study
 
No one here denies that psych is an inexact science,bBut one thing is for certain: the field is rife with studies of one sort or another -- countless zillions of studies. For example, psychologists want to study some things about schizophrenia, its symptoms and/or causes and/or effective treatments, so they do an assiduous study, using real patients who've (already) been diagnosed as schizoid.

Psychologists and psychiatrists (for brevity I'll sometimes use the term "shrinks") usually diagnose their patients using a combination of elements. Primary of course are records forwarded by previous shrinks; but also of direct use are interviews of the patient, anecdotal contributions by those who have had significant contact with the patient, and observation of the patient's behavior in a controlled setting.

If a patient steadfastly refuses to release records or any information whatsoever about his previous psych consultations, then his current therapist will most likely offer to diagnose the patient by observing him/her over time in a controlled setting, possibly an institution.

So here finally is my inquiry: can anyone cite a study that has ever been done to determine the efficacy of psychiatric diagnosis?? I am talking about a double blind controlled experiment. Let's say you took a couple dozen various individuals, a small undisclosed number of whom have been diagnosed as suffering from one or another psych malady, and put all these individuals into a controlled setting where they can be observed and interviewed (maybe videotaped?). And then let's say ten different shrinks are independently shown the videotapes and asked to identify which of the individuals are sick, and in what way.

I'm sorry if my wording of all this is imprecise, but I am sure you get the idea. In the patient interviews, certain questions would have to be off limits, such as (obviously) if they've ever seen a shrink or been diagnosed. More interview content constraints would have to be imposed as well, obviously. The whole idea behind such a study is whether or not shrinks, working independently from one another, could arrive at matching conclusions about which of the study subjects is psychologically afflicted, and in what manner, based solely on observations and interviews. Of course, the study subjects would (in one variant of the study anyway) be permitted or even encouraged to employ some deceptions.

I would be extremely interested to read all about the results of such a carefully blinded study and see what if any concurrence manifests among the shrinks.

Obviously, this study would have vital implications to Law and Ethics, since it would demonstrate the degree of confidence one can presume in psychiatric diagnosis, when cheat sheets are unavailable... "cheat sheet" meaning the patient's prior records.

William Reid January 16th, 2005 10:19 AM

Re: Request info on definitive study
 
You are quite right that accurate diagnosis is very important to the care and treatment of any condition. Sometimes it is useful to treat symptoms alone (as with most kinds of headache or mild anxiety); much of the time, especially when the disorder is serious or the symptoms are a harbinger of such a disorder, misdiagnosis can be a real problem. Current diagnostic knowledge isn't perfect, nor is its application by all practitioners (in psychiatry or anything else), but it is extremely useful.

There have been a great many studies of psychiatric diagnosis, of diagnosing specific disorders, of the validity and reliability of various diagnoses in various settings, and of the methods used in diagnosis. The studies have involved many, many thousands of both diagnosed and previously undiagnosed patients over the years, and thousands of clinicians, statisticians, and related researchers and staff.

For summaries of such studies, in a clinical "textbook" context, consult any general psychiatry or psychiatric diagnosis textbook (there are many), or pick up a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR), at a local bookstore or Amazon.com. They make fascinating reading. :-)

For primary sources of such studies, consider searching three specific areas:

(1) The reference material for the DSM-IV and prior editions. You want the reference support information, which is in volumes separate from the DSM-IV-TR itself, and available from American Psychiatric Publishing, Inc., and maybe at places like Amazon.com. Every edition of the DSM since DSM-II, at least, has such written support material.

(2) The reference material for the APA's Practice Guideline series. These references are included in the Practice Guidelines for each disorder or group of disorders, each of which has several hundred pages. The texts are available at the same places as the DSM texts.

(3) The National Library of Medicine's online search service, called PubMed. PubMed is a huge listing of articles in peer-reviewed journals (research, clinical, etc.) in virtually all medical and medically-related fields (including psychiatry/psychology/mental health) which indexes only journals which have passed their test for scientific merit (there are hundreds, maybe thousands, of different journals. The URL for a PubMed search is www.ncbi.nlm.nih.gov/entrez/query.fcgi. It takes a little investigation to learn how to do a good search and interpret the results, but there are plenty of help links. If you don't learn how to do it, you are very likely to end up either with very little useful information or with thousands of irrelevant articles to sift through -- sort of like a complicated GOOGLE.

joe_pilot January 17th, 2005 03:58 PM

Re: Request info on definitive study
 
#3 Search psychological disorder diagnosis methodology reliability
#8 Search blind study mental health
#7 Search blind validation studies mental health diagnosis
#5 Search blind study mental health diagnosis

I have yet to scratch the surface of the recommended citations, but using the above phrasing, PubMED has so far found none, no blind study that validates the distinguishing of healthy individuals from psychotic individuals.

I found one study correlating clinical diagnosis with diagnosis per a certain patient questionnaire. [And those Phds called .34 to .56 a "moderate to high correlation" - Ha!]

No: I want a *written* test that can be administered then graded and assessed by ANY certified INDEPENDENT scientific facility/lab -- a test that will VOUCH UNEQUIVOCALLY that the person (depending on which variant test(s) are performed) can distinguish Right from Wrong, and/or has unimpaired mental acuity, knowledge, wits. But of course such a test cannot necessarily identify disorders and is not intended to... but it can be used for an *objective* measure as to whether a full-blooded American has the right to publicly defend himself before a jury of his peers against heedless and unfounded allegations. We can ill afford to allow the shrinks' PERSONAL biases & vendettas to taint that process, as they INEVITABLY would (NOT to mention the psychotherapists' SEXUAL leanings)!

Anyone who deigns to argue against the word "inevitably" in that last sentence is, I swear, on a fool's mission. Tell it to Catholic choir boys!

[edit] Shrinks owe it ALL to Darkness. If they ever had to prove their allegations of mental illness to a jury, in the light of hard evidence, they'd be hard pressed to make a case and have it stick. Shrinks's so-called 'success'? they owe it 100% to Darkness, to black-balling, to a single sheet of paper, withered from decades of aging, but revered nevertheless -- revered above all else and revered beyond all rationality. The CHEAT-SHEET: that's the entire ball game.

William Reid January 17th, 2005 08:13 PM

Re: Request info on definitive study
 
1. Sounds as if you have a bit of an ax to grind.

2. RE: Your demand that "I want an (sic) *written* test that can be administered then graded and assessed by ANY certified INDEPENDENT scientific facility/lab -- a test that will VOUCH UNEQUIVOCALLY that the person (depending on which variant test(s) are performed) can distinguish Right from Wrong, and/or has unimpaired mental acuity, knowledge, wits."

Gee, you're right; there isn't one. If that makes your point, fine.

PS: I also haven't found such a test -- or any test -- for various forms of heart disease, dementia, dizziness, and back problems. I guess that kind of ambiguity is what separates medicine from, say, basic arithmetic and Mister Spock's computer-esque logic. But that doesn't mean I'm going to cancel my next cardiology appointment or stop taking my Zocor.

3. One of my professors was an excellent evaluator of research methodology. In his process of mercilessly critiquing papers for grants and publications, he also gave credit to the thousands of clinicians and researchers who at least try to tackle hard-to-define questions (and sometimes devote large chunks of their careers to them), but who almost never accomplish a "perfect" study or find a "final" answer. His point, for professionals and armchair critics alike when they heap sophomoric criticism on someone else's honest work, was often to tell the critic to go and do a better study.

Have at it.

4. Finally, this is the Law & Ethics forum. If you want to argue diagnostic research, you might want to try a different venue.

joe_pilot January 17th, 2005 11:20 PM

Re: Request info on definitive study
 
Quote:

Originally Posted by William Reid
2. RE: Your demand that "I want an (sic) *written* test .."

You added the "n" where I had none, making it 'sic'. It's all there in black & white. Tsk tsk! ((YOU ARE CORRECT; MY ERROR -- WHR))
Quote:

Originally Posted by William Reid
".. that can be administered then graded and assessed by ANY certified INDEPENDENT scientific facility/lab -- a test that will VOUCH UNEQUIVOCALLY that the person (depending on which variant test(s) are performed) can distinguish Right from Wrong, and/or has unimpaired mental acuity, knowledge, wits."
Gee, you're right; there isn't one. If that makes your point, fine.

Yes, that makes my point.
Quote:

Originally Posted by William Reid
PS: I also haven't found such a test -- or any test -- for various forms of heart disease, dementia, dizziness, and back problems. I guess that kind of ambiguity is what separates medicine from, say, basic arithmetic and Mister Spock's computer-esque logic. But that doesn't mean I'm going to cancel my next cardiology appointment or stop taking my Zocor.

There are fairly reliable lab tests to identify most (the Lion's Share of) impairments of the human physique.
Quote:

Originally Posted by William Reid
3. One of my professors was an excellent evaluator of research methodology. In his process of mercilessly critiquing papers for grants and publications, he also gave credit to the thousands of clinicians and researchers who at least try to tackle hard-to-define questions (and sometimes devote large chunks of their careers to them), but who almost never accomplish a "perfect" study or find a "final" answer. His point, for professionals and armchair critics alike when they heap sophomoric criticism on someone else's honest work, was often to tell the critic to go and do a better study.

I don't profess to slander honest diligent work, but when you have a situation where an upstanding blameless human soul can get labelled, villified, incarcerated and ever alienated from basic constitutional due process, you had best rein in your precious egoes and see to it that no one is victimized by unfounded or unsubstantiable allegations!

joe_pilot January 17th, 2005 11:52 PM

Re: Request info on definitive study
 
Quote:

Originally Posted by William Reid
Finally, this is the Law & Ethics forum. If you want to argue diagnostic research, you might want to try a different venue.

Nay, this here thread is quintessential to Law & Ethics for the reasons stated. Our forefathers endowed us with the privilege to opt to defend ourselves publicly before a jury of our peers, in the light of the evidence, against any State accusations. But that right can be summarily recinded if a shrink says the individual is 'incompetent'. My objections are concise, and they are twofold. (1) If you can morally try a person in absentia, which is sometimes done, then you can morally try a person who is incompetent. (2) If the accused individual can prove by a comprehensive written exam that he/she can distinuguish Right from Wrong, and that he/she possesses consummate mental acuity, knowledge and wits; then there is NO reason whatsoever to interlope further, injecting some mortal's subjective evaluations, which may be biased. I am INDIGNANT that you would have me barter for my US.Constitutional right to due process, with some shameless self-important pseudoscientist. That IS tyranny, IS despotism.

edit: If you had to evaluate this individual ((PHOTO OF MAN IN MUSCLE SHIRT DELETED -- WHR)) for fitness to stand trial for some stupid (trumped up?) misdemeanor harrassment charge; would you tend to see him as some loose cannon Hell's Angels wannabe, or would you recognize him as one the nation's leading authorities on Cosmology, hmmm?

Da Friendly Puter Tech January 18th, 2005 05:40 AM

Re: Request info on definitive study
 
Ok Joe_pilot,

So what exactly is it you need? Do you need to tell us that the system we currently have build the psychological industry up around is fallible? I will be happy to acknowledge for you that it is.

Or do you just need to spew your anger somewhere? Well, consider the anger spewed.

Or do you want to change things in our system? Got any good ideas that you want to see happen to make the system better? Ok, I am listening.

But really - better make your ideas realistic, cause enough people has been helped by the psychology industry and they dont want to see it not be there for them.

Da Friendly Puter Tech

joe_pilot January 24th, 2005 05:56 PM

Here is the clincher
 
Speaking of Law and Ethics...
You hear all the time about convicts that are released from prison or from Death Row because new evidence has come to light that exonerates them. So lawyers and judges and politicians have the courage to admit when they're wrong. But psychotherapists are just the opposite. You never hear about shrinks exonerating a person who was wrongfully diagnosed, villified and blackballed without foundation or substantiation. No, you never ever hear of that occuring. Shrinks know that their's is not an exact science, but they go ahead and condemn people for life anyway, never ONCE reversing a call... never ever having the courage to admit when they're wrong.

So I dare the American Psychiatric Association to fund the study that I've proposed herein; a study that would lay to rest ONCE AND FOR ALL any question of the uniform validity of psychiatric diagnosis. Do I see someone trembling in his boots, hmmm??

joe_pilot January 25th, 2005 06:11 AM

Re: Request info on definitive study
 
Quote:

Originally Posted by William Reid
Sounds as if you have a bit of an ax to grind.

No, not any more. Now that I've had my say, I am finally at peace with the World. THANK YOU for providing this forum for me to voice my thoughts and clear the air!!! I hold no grudges against anyone.

I am a fellow of impossibly high principles, and just like the vortex that forms at the base of a category-5 tornado, some things are hellish yet perfectly natural. Find my ultimate manifesto (canned tirade) at http://www.monertia.com.

joe_pilot February 26th, 2005 11:39 AM

Re: Request info on definitive study
 
Quote:

Originally Posted by Da Friendly Puter Tech
..Ok, I am listening. But really - better make your ideas realistic, cause enough people has been helped by the psychology industry...

Ahh, but has psych helped more people than it has harmed? And if your answer is "yes", then let's see the proof.

Da Friendly Puter Tech February 26th, 2005 08:30 PM

Re: Request info on definitive study
 
*sigh*, not quite done grinding yer ax are ya?

I dont know if the psychology industry has caused more harm than good for a majority of those involved with it. I know it has caused a lot of good for me personally, and not much - if any - harm.

I know quite a few people who have had the same experience with the industry. Although granted - most of us will agree with you that finding a professional that is a good fit for us individuals can be difficult. Especially if you dont have unlimited funds are your disposal.

I also know some people that has felt harmed by the psychology industry, although for most of them they have continued searching for healing within the industry after the bad experience - and found it.

I agree that the people within the psychology industry should honestly look for weaknesses (or should I call it possible negative side effects) in their treatment forms, and do their best to guard against those.

I agree that most people working within the psychology industry spend very little time thinking about and working with possible negative side effects of current treatment models - and that is not a good thing.

I agree that there should be more emphasis on certain ethical aspects of therapy that is difficult to make laws around. IE there are good laws in effect to protect clients and therapists both, but certain things cant be legalized, and the ethics of some of those things should still be *discussed*, and they are often not.

I agree that in some ways psychology is not really a science, although in other ways it is.

My proposed solution is to work within the system. To use the good parts, and to hopefully put my own little stamp on the industry in the long run. I guess *g*, I am arrogant enough to think that I could affect some positive influences of my own.

Warm regards
Da Friendly Puter Tech

joe_pilot February 27th, 2005 12:12 AM

Re: Request info on definitive study
 
Yeah okay --thanks for your answer. But just like the baby bird, once touched by humans and placed back in the nest, will NEVER AGAIN be embraced by the parent bird... just EXACTLY analogous: any person touched by shrinks will NEVER AGAIN be embraced by society or their peer group. It's a LIFELONG ostracision, literally a condemnation of one's soul to eternal damnation. ["Psyche" is a precise synonym of "soul", according to Websters.] Now, try and sleep tonight!

I detest this life and will be glad when it's over. It's entirely about hero worship... it's entirely unprincipled... it's entirely about despotism, shamanism, tyranny and demagoguery. First your hero is Adolf; then it's someone else; then it's UBL... always follow the leader. It's always a hero worship thing, worship some beast and his image; principles are left behind in the dust.

Da Friendly Puter Tech February 27th, 2005 06:16 AM

Re: Request info on definitive study
 
Joe,

I am sorry you feel that way. I am sorry that is your life experience, it sounds like a painful one.

I have certainly been a therapy consumer myself, and have never felt negatively branded for it. But that probably doesnt set you at ease any.

It sounds like you are pretty far down right now, so maybe its time to go back to basics and see if it is possible to find just one good thing you can do for yourself today?

Warm regards,
Da Friendly Puter Tech

joe_pilot February 27th, 2005 04:25 PM

Re: Request info on definitive study
 
As I stated in an earlier post, I don't actually hold a grudge against shrinks, or blame them personally for the World they were born in to -- and I am very grateful for this forum to air my views. And, I won't ever find fault with diligent honest work. In fact, I am extremely pleased that shrinks' ethics have (seemingly) bettered and bettered over the years. They no longer harangue me continually or beg obsequious gestures of me.


In reality, there's only one true "mental illness"... and that's choosing Psych for a major.


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