Comment by natnat | Hacker News Reader

Comment by natnat | Hacker News Reader

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I've become really disillusioned with clinical psychology because of things like this. There are certainly people with specific personality types. In this instance, we have brilliant people who don't like to follow other people's arbitrary rules, and are attracted to new information. There are also certain people who will stay up for a week at a time, binging on cocaine and meth and driving to Mexico without sleeping and then becoming nearly suicidal for a few weeks after that.

The first person has a lisp-like personality. The second person has bipolar disorder. The two sort of resemble one another, but in the lisp programmer's case, they aren't doing anything really harmful to themselves or anyone else. They aren't hurting anyone, they aren't hurting themselves seriously; they're just acting a little quirkily. They might be bipolar-like, but they don't have a disease like the person who goes on cocaine binges and then tries to kill himself does.

The same principle applies with ADHD. Some people literally cannot sit still for a minute, and will disrupt every class they're in because they simply cannot pay attention to the work. This behavior is a problem for themselves and others. However, most people have some trouble concentrating on things they find boring. It's practically tautological.

The problem is, when we start using medical disorders to describe personalities, we conflate the two. Suddenly, everyone has a disease. This isn't a problem in itself, but we tend to try to fix these diseases with medication. If we try to give every lisp programmer some lithium to cure his bipolar behavior, he's going to become substantially less brilliant (lithium taken early on tends to knock off a few IQ points). If we give him adderall to treat his supposed ADHD, he might end up getting addicted to amphetamine.

I think we really need to accept the fact that some brilliant people are going to have problems no matter what, and they are fundamentally part of their personality. I don't think teaching a lisp programmer Python is going to make him write code more consistently and still write code that's just as beautiful. I don't think we can slice the "tortured" part of "tortured genius" off without cutting off some of the "genius" with it.

>"I've become really disillusioned with clinical psychology because of things like this."

I agree with your points about people using diagnostic jargon in conversation in a way that distorts its meaning. I'm sure that happens in other fields also, but speaking as a psychiatrist one thing that I have noticed is that it tends to make people feel like experts on mental health when that conclusion is not justified. There are, however, relatively specific technical definitions for terms like Bipolar Disorder and ADHD. This article doesn't use them, but it's not being published in a peer-reviewed journal.

Don't let this article disillusion you, because it's not about clinical psychology or by a clinical psychologist. It's by someone with some interesting observations who is mis-applying technical terms.

I wasn't really referring to the article in particular; I was more just ranting about something that I was thinking about before that the article reminded me of.

I think the problem runs a bit deeper than people thinking they're experts when they're not, though. I think when most people try to diagnose themselves, they look online for symptoms and such. If they already have some conviction in their diagnosis, they might think that they should also have other symptoms when they don't, or start noticing borderline things that they otherwise would easily ignore. Then, when they finally go to the doctor, their list of self-reported symptoms is no longer a list of what they independently noticed but a laundry list of whatever they read on webmd.

I'd be interested in hearing if you think this is actually the case, since you definitely have more experience and knowledge in it than I do. I'm basing most of this off of the personal experience of a few of my friends and the modicum of knowledge I have from a few clinical psychology classes I took in college.

>"Then, when they finally go to the doctor, their list of self-reported symptoms is no longer a list of what they independently noticed but a laundry list of whatever they read on webmd."

Sure, it happens all the time, in all areas of medicine. Not just psychiatry. The key here is that when someone says "I'm depressed," or "I have 5 of 9 criteria of a Major Depressive Episode," or "I have gout," that does not mean that the diagnostic evaluation is over. It's important to get clear examples of what people have noticed. Despite their conclusion, is this better explained by cancer, or anxiety, or a thyroid problem, or substance abuse? Like migraine, psychiatric illness is evaluated clinically rather than by imaging or lab tests, but there can be important overlaps that sometimes make these tests helpful to rule out other causes.

A patient's own conclusion is an important piece of the puzzle, but it's still just one piece.

The DSM-IV criteria have never impressed me as particularly specific or technical; especially for milder (more common) diagnoses like hypomania, ADHD, bipolar II, etc...

It's important to check the back of the manual for definitions of all of the terms in the criteria. Reading the criteria, you may be interpreting them through their conversational meanings. It also underscores the need for doing observed interviews during training, to make sure that you are applying the terms correctly. However, you are right in saying there's always room for improvement.

What's lacking from the psychiatric process is any sort of objectivity in the choice of thresholds distinguishing "normal" from "atypical". The criteria for most disorders apply to huge swaths of the population. They're not symptoms of disease, but symptoms of being human. In order to separate the diseased from the healthy, the psychiatrist must then twiddle nobs to find a distinguishing threshold.

"If you're only annoyed at the shape of your nose, well that's normal. You have a somewhat ugly nose. But, this other chap is really preoccupied with his nose. It's impairing his life quality--- he must be suffering from body dysmorphic disorder. Antidepressants might do the trick!"

My wife, who actually is a Clinical Psychologist has a motto.

"A problem is not a problem, unless it is a problem"

She agrees with you. It is the pop-sci nuts who do not.

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