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The SkepDoc

Who’s Crazy Now?: DSM-5 and the Classification of Mental Disorders

WHAT DOES IT MEAN TO BE CRAZY? WE use the word loosely. In casual conversation we might say “He’s crazy” or “That’s insane!” but that doesn’t mean we really think the person is certifiable. Sometimes all it means is “He doesn’t agree with me.” What does it take to be formally diagnosed with a mental illness?

Medical diagnoses like broken bones and diabetes are pretty straightforward. They depend on objective findings from diagnostic tests, but diagnosis of mental disorders is mostly subjective. There’s no blood test for schizophrenia. Psychiatry is arguably the least evidence-based of all the medical specialties.

Mental health diagnosis is guided by rules. The problem is that the rules keep changing. A person who’s crazy now might not be considered crazy in 2050. A person who’s considered sane today might have been locked up in an insane asylum in 1850. So, who’s crazy now, and how do we decide?

Even psychiatrists are not very good at knowing whether a patient is crazy. In 1973, Robert Rosenhan published the study called “On Being Sane in Insane Places” that became an instant classic in psychiatry lore (http://bit.ly/1JMX6D0). Fake patients got themselves admitted to 12 different psychiatric hospitals by briefly claiming to have auditory hallucinations; once admitted, they acted normally and said they no longer heard voices. Every one of them was diagnosed with schizophrenia and they were kept in the hospital an average of 19 days. In order to get released, they were forced to admit to having a mental illness, and forced to take antipsychotic drugs.

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CONFIDENCE SCAMS EXCERPT: The Confidence Game: Why We Fall for it Every Time; ARTICLES: America’s Stonehenge: Did Highly Developed Europeans Build a Sophisticated Astronomical and Religious Monument on the American East Coast More than 3000 Years Ago?; Is It ET?: Is Star KIC 8462852 a Sign of an Extraterrestrial Civilization?; Hurricane Strikes as Divine Retribution—An Empirical Test; Ruins of Empires: Thomas Jefferson, Constantin-Francois Volney, and the Separation of Church and State; Winning the Vaccination War in California; Prophet Without Honor: Francis Galton and the Birth of Behavioral Genetics; When Cops Kill: An Insider’s Perspective; Guns and Games: The Relationship Between Violent Video Games and Gun Crimes in America; More on Morals: On Science and Morality (1) Deontologists are Covert Consequentialists, (2) Expanding Science to Include Morals, (3) Clarifying Confusions; Alligators in the Sewers! COLUMNS: Who’s Crazy Now?: DSM-5 and the Classification of Mental Disorders; The Delicate Dilemma of Defining Rape; REVIEW: Red Team: How To Succeed by Thinking Like the Enemy by Micah Zenko reviewed by David Priess; JUNIOR SKEPTIC: Haunted Houses; Earliest Ghost Stories; Ghostly Evolution
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