Society’s critical response to DSM-5
Work on the latest, fifth version of psychiatry’s diagnostic code (DSM-5: see www.dsm5.org), due for publication by the American Psychiatric Association in 2013, has already suffered from resignations and accusations of vested interest. Now the British Psychological Society has had its say by publishing a highly critical response to the planned revisions (access the full document at tinyurl.com/67wygp7).
The Society says it is ‘concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation’. The statement was made public in June, signed off by Dr Carole Allan, chair of the Professional Practice Board, and prepared by Professor Peter Kinderman, chair of the Division of Clinical Psychology.
The statement criticises the DSM-5 for being based on social norms and subjective judgement, and for locating problems within individuals, rather than recognising the role of social causes, such as poverty. The Society also has concerns with specific conditions found in DSM-5, including the proposed new conditions of ‘attenuated psychosis syndrome’ (the presence of psychotic-like symptoms without a full disconnect from reality) and ‘disruptive mood dysregulation disorder’ (excessive temper tantrums). The former ‘is very worrying’ the Society statement says, ‘it could be seen as an opportunity to stigmatise eccentric people, and to lower the threshold for achieving a diagnosis of psychosis’.
The only aspect of the DSM-5 welcomed by the Society is the plan to rate symptom severity over the preceding month, because to do so focuses on specific problems and ‘introduces the concept of variability into the system’.
The Society concludes by calling for a revision to the way mental distress is thought about, including recognition that mental disorder is on a spectrum with normal experience, and recognition of the role played by social factors. ‘Rather than applying preordained diagnostic categories to clinical populations,’ the Society says, ‘we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or “symptoms” or “complaints”’. The statement ends with the Society offering to help in any exercise to develop an alternative approach to the DSM.
The Vice-Chair of the DSM-5 task force, Dr Darrel Regier is robust in his defence of the DSM (see www.bps.org.uk/dsm5news). In an e-mail to The Psychologist he says that he and his colleagues agree that there is an overlap between normal responses and disease states, but that ‘psychiatry also recognises that there are real and discrete disorders of the brain that cause mental disorders and that can benefit from treatment’.
Regier says that experts working on DSM-5 have attempted to approach this issue by adding more dimensional approaches to describing psychological symptoms and opportunities to assess both disorder severity and associated disability levels. ‘The problem’, he says, ‘is that the psychologists quoted here think we shouldn’t consider any mental disorder, including individuals whose psychosis renders them mentally incompetent, to have a brain-based illness. The group also wishes to emphasize the relational context of mental disorders and wants to exclude the possibility of mental disorders being independently present in the person – the way that cancer or heart disease may be affected by social and psychological realities but nevertheless exist within individuals as discrete states. What seems to be missing is an appreciation of mental disorders as the result of gene–environmental interactions that would trigger abnormal neuronal function in the brain. Why the brain should be exempt from pathology when every other organ system is subject to malfunction is left unaddressed.’
Regier further explains that DSM-5 will recognise that boundaries between conditions like schizophrenia and bipolar disorder are not clear cut and better thought of as ‘central tendencies’, which can be modified by high-level psychological domains, such as anxiety or addictions. ‘However, the complexity of psychiatric disorders in no way abrogates the psychiatrist’s obligation to provide treatments, including talk therapies and medications, that succeed in ameliorating symptoms and reducing suffering,’ he says.
In conclusion Regier reminds us that psychiatric disorders have existed since the beginning of recorded history, but that tremendous progress has been made in recent decades in our ability to treat them. ‘The DSM strives to be a living document that will continue to draw upon research and clinical experience as we endeavour to relieve the suffering of the millions of people worldwide who suffer the devastating effects of mental illness,’ he says.
Looking ahead, Professor Kinderman notes that many psychologists continue to work in healthcare contexts that use diagnoses, including helping people with physical and neurological problems where he considers diagnosis to be valid. ‘So we have to strike a balance and offer pragmatic advice,’ he says. ‘We base our advice on evidence, and will continue to develop our position in the light of research. We are currently developing practical guidelines for psychologists in their day-to-day work. We will also continue to make a constructive contribution to the debate by promoting a positive way forwards in developing alternative paradigms rooted in psychological models.’ Christian Jarrett
- For background on the development of DSM-5, see April 2010 News and August 2009 Forum.
The response was coordinated by the Society’s Consultation Response Team.
To get involved with future responses, see www.bps.org.uk/consult. For other recent activity, see p.608.
Working memory side effects
Each brain hemisphere has its own discrete visual working memory store. At least that’s what a new study with two rhesus monkeys suggests (PNAS: tinyurl.com/62wz4jx). The monkeys had to look at an array of coloured squares, there was an 800 to 1000ms delay, then a second array appeared, the same as the first except one of the squares had changed colour. The monkeys’ task was to look at the square that had changed colour. The more squares there were in the arrays, the more difficult the task became. Whilst the monkeys performed the task, Timothy Buschman at MIT and his colleagues used electrodes to record from individual neurons in the parietal and frontal cortices of the monkeys’ brains.
The monkeys’ performance suggested a memory capacity of 3.88 squares (human capacity is typically around 4 squares). Beyond that number their performance accuracy dropped off abruptly. Most intriguing, adding extra squares to one side of the screen didn’t affect performance for the other side, suggesting that each hemisphere has its own independent capacity. This independence was also confirmed at a neuronal level.
Whilst memory capacity was divided separately between the hemispheres, another finding was that memory capacity within each hemisphere was divided in a graded fashion – each extra item diminished the memory for all items, rather than memory slots being filled in an all-or-nothing fashion.
By comparing frontal and posterior brain activity for when there were fewer versus more squares, the researchers further showed that memory capacity was limited by a ‘bottom up’ failure to encode more squares, rather than by a ‘top down’ failure, in the prefrontal cortex, to store already encoded information.
‘Our results suggest that visual capacity limits result from competition for encoding within independent, but limited pools of neural information that can each be divided among multiple objects,’ the researchers wrote. In a university press release Buschman said the new findings have practical applications: ‘For example, heads-up displays [of the kind used by drivers or pilots] show a lot of data. Our results suggest that you want to put that information evenly on both sides of the visual field to maximize the amount of information that gets into the brain.’ Christian Jarrett
Queen’s birthday honours
It was a bumper year for psychologists in the 2011 Queen’s Birthday Honours list. The Psychologist offers its congratulations to them all.
Gisli Gudjonsson, professor of forensic psychology at the Institute of Psychiatry, and a Fellow of the British Psychological Society, has been awarded the CBE for services to clinical psychology.
Peter Hulme, an Associate Fellow of the British Psychological Society, and until recently Principal Clinical Psychologist and Head of Profession for Psychology, Herefordshire Primary Care Trust, has been awarded an OBE for services to mental health care.
Society Fellow Professor Judy Hutchings, Director of the Centre for Evidence Based Early Intervention at Bangor University, gets an OBE for services to special educational needs.
Society member and basketball star John Amaechi has been awarded an OBE for services to sport and the voluntary sector.
Society member Lynne Babbington has been awarded an MBE, for services to educational psychology in the London Borough of Harrow.
Finally, Sheffield University psychology graduate Jessica Ennis, the current World and European heptathlon champion and world indoor pentathlon champion, has been awarded an MBE for services to athletics.
Challenging the scepticism of psychology
A US psychologist has urged the psychological community to do more to challenge the public’s scepticism of our science. Writing in American Psychologist, Scott Lilienfeld, a clinical psychologist and professor of psychology at Emory University, outlines the evidence that this scepticism exists, explores the possible causes, and offers some recommendations for how to rectify the situation. His article includes a valuable series of rebuttals to common criticisms of psychology, such as that ‘it’s all common sense’ (tinyurl.com/5smwwgq).
So, what’s the scale of the problem? Unfortunately, surveys of students and the wider public continue to reveal a sizeable minority of people who doubt the scientific status of psychology. Among the papers Lilienfeld cites is a 1997 survey of British students, which found on average, across disciplines, that students tended to view psychology as a social science, but not a genuine science.
Perhaps most worrying, Lilienfeld says, is the public’s ignorance of the contribution psychology has made to confronting social problems. For example, the most recent large-scale survey – the APA Benchmark Study – sampled 1000 adults across the USA and found that just 1 per cent of respondents selected psychologists as the profession best suited to confronting the problems posed by climate change, versus 44 per cent who chose engineers, and 11 per cent economists. As we know, and as Lilienfeld points out, psychology has in fact contributed to many applied fields: for example, in aptitude tests, eye-witness testimony, human memory and economics.
Lilienfeld outlines several sources of the public’s persistent scepticism, including: a failure of the field to police itself; the problematic face of public psychology; the illusion of understanding; and people’s failure to distinguish basic from applied research (see the paper for a full list).
The first of these refers to the persistence of unscientific practices, such as facilitated communication for autism. ‘Our field has been slow to police its own questionable practices,’ Lilienfeld says. The second concerns the prominent media profile (in the USA) of people like Dr Phillip McGraw (‘Dr Phil’), who has a record of making unscientific pronouncements, such as that the polygraph is reliable. The third relates to people’s general over-confidence in their understanding of psychological concepts, a bias that emerges in childhood (as reported on the BPS Research Digest: tinyurl.com/yfbcnw9). Finally, the failure to distinguish basic from applied science refers to people not appreciating that psychologists often study particular phenomena (e.g. Japanese quails in a classic work published in 1986: tinyurl.com/64y3m4p), not because they’re interested in quails per se, but because they’re interested in the underlying mechanisms, in this case the mechanisms of classical conditioning in sexual behaviour in general.
Lilienfeld also tackles head-on six common criticisms of the scientific basis of psychology, including that it’s all common sense and uses unscientific methods (this section is a great read for arming yourself against such criticisms). His recent book 50 Great Myths of Popular Psychology in fact features a list of over 300 findings that violate popular wisdom. Lilienfeld also explains in his new article how psychology uses scientific methods as rigorously as other fields, including ‘randomised controlled trials, placebo control groups, and blinded designs… [and] sophisticated statistical methods, including correlational, multiple regression and structural equation modeling techniques’. And he rebuts the claims that psychological generalisations lack meaning because each person is unique (unique attributes often do not interact with powerful main effects), and that psychological findings are not replicable (an analysis by Larry Hedges in 1987 found the replicability of many psychology findings matched those in particle physics).
So what to do about psychology’s public reputation? Lilienfeld calls on individual psychologists to do more to communicate the value of psychological science to the public, and he urges institutions to play their part: to help psychological scientists and practitioners engage with the media; to educate the public about professional distinctions between psychology and other less scientific professions; and for institutions like the BPS to be much clearer about what they’re against, not just what they’re for, ‘…to play a more active public role in distancing themselves from the plethora of therapeutic and assessment fads that are poorly supported by scientific evidence or that blatantly contradict such evidence’.
But in conclusion, Lilienfeld says we should view public scepticism as an ally. A better understanding of this scepticism can help reveal the ‘deep-seated misconceptions’ people have about human nature. ‘Finally,’ he says, ‘public skepticism of psychology may provide us with a much needed impetus toward getting our clinical house in order and winnowing out the elements of our profession that are scientifically dubious, some of which have tarnished our hard-fought credibility. In this respect, public skepticism may be an imperfect but nonetheless informative barometer of our field’s scientific status.’ Christian Jarrett
Einstein data discrepancies?
Make sure you back up your data files. That’s one lesson to come from a long-running saga involving one of the co-founders of the Baby Einstein DVD series (now owned by Disney). In the latest twist, William Clark now claims there are inconsistencies in the psychology research data that tarnished the reputation of the product he created with his wife. The data in question are from a 2007 paper published in Pediatrics (tinyurl.com/5vw9xr9), which reported that 8- to 16-month-old infants who spent more time watching baby DVDs (including Baby Einstein) tended to have smaller vocabularies (see News, March 2010).
Much has hinged on that 2007 paper. The findings were immediately seized on by the media, and in a damage-limitation exercise Disney responded by offering refunds to parents who bought the DVDs between 2004 and 2009 – a gesture that reportedly cost them an estimated $100 million. The 2007 findings, along with others, will also doubtless have informed the official advice from the American Academy of Pedatrics, which discourages children aged under two from watching any television.
Clark previously sought full access to the data to check the claims, but the University of Washington, the host institution of the study authors, declined on the basis of participant confidentiality. They provided him with paper files with key data redacted. However, at the end of June a new legal settlement granted Clark far greater access to the raw data, in electronic form, plus $175,000 towards his legal fees. Clark’s now claiming that the new digital data files don’t match up with redacted paper files he was shown earlier.
‘My goal from the beginning has been to have the raw data re-analysed to confirm the published results,’ said Clark. ‘That goal is now problematic. I have two raw datasets in my possession that don’t match. I also discovered during litigation that the principal investigator [Frederick Zimmerman] ordered the data destroyed in 2008, less than one year after publication of the study and three months before the study was officially closed by the university’s Institutional Review Board.’
The University of Washington has blamed the inconsistency on a technical glitch to do with converting the data into PDFs. ‘Those records were secure. None of the data files were altered. The underlying file was not changed,’ a spokesperson told Associated Press.
Professor of psychology Andrew Meltzoff, co-director of the Institute of Learning and Brain Sciences at the University of Washington, and a co-author on that 2007 paper, told us that he and his colleagues stand by their research findings. ‘The original scientific paper bears reading,’ he said. ‘There’s accumulating research published by other labs as well on the topic of baby DVD/video viewing and its effect on language development.’ Christian Jarrett
The longlist for this year’s Royal Society Winton Prize for Science Books has been announced and it includes several titles that may be of special interest to psychologists: Through the Language Glass: How Words Colour Your World by Guy Deutscher; The Price of Altruism by Oran Harman; and Packing for Mars: The Curious Science of Life in the Void by Mary Roach. The shortlist will be announced in September, the winner in November.
Clinical psychologist Professor Geoff Shepherd, who works as policy adviser tothe Centre for Mental Health, was among the contributors to a new work and mental health website launched by the Royal College of Psychiatrists in June (tinyurl.com/6znvwks). The site provides advice for clinicians, carers, employers and workers on the task of returning to work after mental illness.
A new publication, the fourth in a series showcasing the impact of social science, outlines how research findings have helped combat crime and the causes of crime (tinyurl.com/6bbqkw7). The pamphlet, a joint effort of the British Psychological Society, the Academy of Social Sciences, and the British Society of Criminology, was launched at an event in Westminster. Among the presenters was BPS Fellow, Professor David Farrington, who spoke about crime risk factors and preventative measures (read more and access Farrington’s slides at tinyurl.com/3qhzpdb).
In June, I’m a Scientist Get Me Out of Here, a Wellcome Trust funded project, invited 115 scientists and over 7000 school pupils to interact online, with the pupils choosing which scientists should proceed to the next round in an X-Factor-style competition. Psychology graduate Suzi Gage, currently studying for a PhD at the University of Bristol, won the Brain Zone. And BPS member Helen O’Connor, who works in sports psychology, won the Sports Science Zone. Both receive £500 to spend on science communication.
It’s not just babies who like to be rocked to sleep. A new study led by Laurence Bayer at the University of Geneva involved 12 men taking two 45-minute afternoon naps, one on a static bed and another on a bed that rocked gently. The rocking bed was preferred and the men fell asleep on it more quickly, transitioning to N2 (second stage) sleep sooner and staying in that stage for longer (Current Biology: tinyurl.com/66u44xv). Bayer’s team said the soporific effects of rocking are likely to arise from vestibular sensations enhancing synchronous activity in thalamo-cortical networks. Christian Jarrett
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