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Who determines mental disorders?

DSM V Future Manual

We are expecting the latest word about whether we are mentally well or ill -  DSM V.  A preview version will appear tomorrow. I am talking about the fifth edition of the  Diagnostic and Statistical Manual of Mental Disorders created and published by the American Psychiatric Association. I am a member of the American Psychological Association so I am biased. Psychiatry and psychology represent two different perspectives on human behaviour and the mind. Psychiatry favours a biological model while psychology favours a multiperspectival model. The authors of the DSM hold to a disease model. This "medical model" has its strengths especially when there is consensus as to what is a "problem" in simple cause-effect relationships.

Which model should we use - the medical?

However, the "medical model" has many limitations. Some of the more obvious ones are:

  • relying on "categories", "ideals", and "objectivity"
  • not recognising sufficiently internal (subjective) experiences
  • insufficient importance given to the role individuals play in their own development
  • lack of recognition for the contribution of culture or context in behaviour.

Or the psychological?

Psychology, on the contrary proposes many models of human behaviour that attempt to consider multiple influences from genetics, development, psychodynamics, cognition, culture and society, just to name a few. The resulting perspective is much more fluid and does not consider behaviours as normal or diseased. Human behaviour seems to be too complex to contain in one simple model.

Hope and trepidation

Because of the importance that the DSM has in the psychiatric and pharmaceutical fields, I await the publication tomorrow with hope and trepidation.


Scientists communicate with man in coma

Seeing into our Minds

Scans of Mental Imagery TasksScientists can now see into the mind and 'thoughts' of a brain-damaged man. By using new brain scanning technology they were able to determine that a patient in a vegetative state could understand and respond to their requests.

Brain Activity in Disorders of Consciousness

The study which, appeared in the New England Journal of Medicine, demonstrates that with the help of brain scans it can be determined if someone, thought to be unaware of the external world, is aware or not. The study showed that some of those apparently in a coma, are actually awake, but without self-awareness, due to their brain damage. The above study reported that,

"One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside."

Published at www.nejm.org February 3, 2010 (10.1056/NEJMoa0905370)


The Black Boxes of our minds

Even to Ourselves

The stories we tell about our mental processes are logically appealing but fatally flawed more often than not.

We all have our own theories about how our minds work. Unfortunately evidence based psychology demonstrates that our theories are often wrong. The differences between how we think our minds work and how they actually work can be quite startling, especially when we try to judge others. What we think are important factors in others often are not at all, while what we think is unimportant can make all the difference.The black box of our mind

Social Psychology Study

In their classic study Nisbett and Bellows (1977) asked 128 women to judge if a person called Jill matched the requirements to work in a crisis centre. 'Jill', was a creation of the investigators, consisting of 3 pages of information: an interview transcript, answers to a questionnaire and a letter of recommendation.

The information presented to the women about Jill was the same except for 5 crucial factors which changed amongst the participants. The women were told that:

  • Jill has an attractive appearance or nothing about her looks
  • Jill's academic qualifcations are good or nothing about her studies
  • Jill had had a car accident before or not
  • Jill spilled coffee on the interviewer's desk or not
  • Jill would meet the women subjects soon or not

This meant that each woman saw a different combination of items in Jill's profile.They were then asked to judge Jill on how much:

  • sympathy she would have for others,
  • the women would like her,
  • flexibility she would have in problem solving,
  • intelligence she had.

The women were then asked to rate how much each of the above factors influenced  their rating on a scale of 1 to 7. The experimenters wanted to see whether the womens' judgements were controlled by factors they thought influenced them. In other words, do people know how their own minds work?

Poor judgement

The women turned out to be surprisingly poor at predicting the ratings of sympathy, likeability and flexibility and the effect of each on their own judgements. For example the women thought if Jill was good-looking she would be more sympathetic to others. But, it had the opposite effect; if Jill was described as good-looking the women thought others would find her less sympathetic.

They thought that the car accident would make Jill more likeable, but it made her less likeable. They thought the coffee-spilling would make her seem less flexible in problem solving; but those same women rated Jill as more flexible. And so on.

The interesting thing

All the women were wrong to the same degree. All the women probably used similar 'common sense' theories about how the mind works, which were mostly wrong. The results suggest that most of us have similar 'theories' about the way the mind works, from our culture or we worked it out from 'common sense'. The only area in which the women were accurate was intelligence. The women thought they could rely on the academic records to judge Jill's intelligence and, they could.

The weakness of introspection

This study shows how poor we are at understanding what will affect our judgement of another's personality, besides intelligence. People might know what they like, but they usually don't know why they like it. Similar results are repeated in other studies showing our lack of understanding of who we're attracted to, how we solve problems and where our ideas come from.

These results are a real challenge to psychologists like myself. The most important decisions in our lives, like choosing how we spend our time and with whom we spend it, are challenged. The stories we believe about ourselves are appealing, but are wrong more often than not.