Will: I'm not trying to undermine the entire filed of psychiatry. That would be silly, but I'm wondering if they are on the receiving end of what I'm going to call 'sufficient skepticism'. Psychiatrists say and are are treated as though any of their diagnosis as equivalent in reliability to that of any medical doctor. You say it's justified, I'm not so sure. I think it's important to recognize that psychiatrists have a vested interest you believing that their ideas are beyond reproach (this is true of any professional field).
It's the research itself that solidifies an idea as beyond reproach (at least as much any theory can be). The number of people who agree or disagree with the research have no bearing on it's truthfulness. Not to mention the individual biases or lack of knowledge of the voters. When you become a member of the APA you get a vote and you can exercise that vote whether you are knowledgeable about research in an area or not. Let's be honest, it isn't possible to be on the cutting edge of all psychiatry research, but you still get to vote as if you are. I fail to see how voting is the key step that solidifies and idea as beyond reproach.
I'll take evolution to use for an example, since it is so highly politicized and you brought it up. Suppose we were going to to vote on whether or not evolution is a valid explanation for the existence of diverse species on the planet earth. All the research is there, it's been played out to book length hundreds of times. We let everyone vote regardless of qualification. Does the vote matter? No. Does the qualification of the individuals matter? If we make everyone watch an hour long tv special presenting all the evidence, does that make the vote more impacting upon the truth? What if we required everyone to attend 8 years of specialized training before they could vote? Does the vote affect the truth now? That's why it bothers me so much. The vote ought to be irrelevant, the research is what's relevant.
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Originally Posted by dippin
I'm going to go on a different direction here: why is the fact that they vote on it so disturbing to you?
More importantly, why do you think the rest of medicine is so much more certain and less subject to arbitrary boundaries between health and disease?
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A distinct lack of diagnostics, or biomarkers to use the language of the APA. This is from a press release from the APA September 26, 2003. You can read the full text
Here. (Warning: PDF).
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Originally Posted by APA
Research has shown that serious neurobiological disorders such as schizophrenia reveal reproducible abnormalities of brain structure (such as ventricular enlargement) and function. Compelling evidence exists that disorders including schizophrenia, bipolar disorder, and autism to name a few have a strong genetic component. Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. Ultimately, no gross anatomical lesion such as a tumor may ever be found; rather, mental disorders will likely be proven to represent disorders of intercellular communication; or of disrupted neural circuitry. Research already has elucidated some of the mechanisms of action of medications that are effective for depression, schizophrenia, anxiety, attention deficit, and cognitive disorders such as Alzheimer’s disease. These medications clearly exert influence on specific neurotransmitters, naturally occurring brain chemicals that effect, or regulate, communication between neurons in regions of the brain that control mood, complex reasoning, anxiety, and cognition. In 1970, The Nobel Prize was awarded to Julius Axelrod, Ph.D., of the National Institute of Mental Health, for his discovery of how anti-depressant medications regulate the availability of neurotransmitters such as norepinephrine in the synapses, or gaps, between nerve cells.
In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by a person who has a mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population-based norms for cognitive processes, mood regulation, or other indices of thought, emotion, and behavior.
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It's all well and good to say that it's very likely that mental disorders will be proven to be disorders of intracellular communication, but it hasn't been yet. What has been proven is the action of some antidepressant medications, which modulate intracellular communication. Nobody knows what a normal serotonin release levels are, not in and individual or in the population at large. Nobody knows the extent to which serotonin release is modulated by a given dosage in a given individual. These are important facts which are not noted nearly enough.
Later in the release they go on to compare diagnosing mental disorders to high cholesterol. Cholesterol can be monitored in individuals, it's levels are known in the population at large, and a certain levels correlation with increased risk of heart disease is known. After medication is prescribed the effect of the medication can be closely monitored by blood test, and adjustments made. To compare the rest of mental disorder diagnostics to high cholesterol screenings is disingenuous if not outright deceitful.