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Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces with… Nothing

The views expressed are those of the author and are not necessarily those of Scientific American.


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What is mental illness? Schizophrenia? Autism? Bipolar disorder? Depression? Since the 1950s, the profession of psychiatry has attempted to provide definitive answers to these questions in the Diagnostic and Statistical Manual of Mental Disorders. Often called The Bible of psychiatry, the DSM serves as the ultimate authority for diagnosis, treatment and insurance coverage of mental illness.

Now, in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.” Thomas Insel’s statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual. Insel writes:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’–each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better.”

Insel said that the NIMH will be replacing the DSM with the “Research Domain Criteria (RDoC),” which define mental disorders based not just on vague symptomology but on more specific genetic, neural and cognitive data. But then, immediately after making this dramatic announcement, Insel added that “we cannot design a system based on biomarkers or cognitive performance because we lack the data.”

Hunh? So the NIMH is replacing the DSM definitions of mental disorders, which virtually everyone agrees are profoundly flawed, with definitions that even he admits don’t exist yet! What more evidence do we need that modern psychiatry is in a profound state of crisis?

Insel’s statement is also an implicit admission that there is no real theoretical basis for drug treatments for mental illness. As I have pointed out previously, drug treatments have surged over the past few decades, while rates of mental illness, far from falling, have risen.

Ironically, some pharmaceutical companies that have enriched themselves by selling psychiatric drugs are now cutting back on further research on mental illness. The “withdrawal” of drug companies from psychiatry, Steven Hyman, a psychiatrist and neuroscientist at Harvard and former NIMH director, wrote last month, “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.” Funny how this view isn’t incorporated into ads for antidepressants and antipsychotics.

NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year. Insel, I suspect, is hoping to form an alliance with neuroscience, which now seems to have more political clout than psychiatry. But as I pointed out in posts here and here on the Brain Initiative, neuroscience still lacks an overarching paradigm; it resembles genetics before the discovery of the double helix.

Since I became a science writer 30 years ago, I have heard countless claims about breakthroughs in our understanding and treatment of mental illness. And yet as the NIMH decision on the DSM indicates, the science of mental illness is still appallingly primitive. Instead of forming fancy new programs and initiatives and alliances, leaders in mental health should perhaps do some humble, honest soul searching before they decide how to proceed. And they should think of what’s best not for their professions or the pharmaceutical industry but for those suffering from mental illness, who deserve better.

Postscript: See two related followup posts: “Why Buddha Isn’t Dead–and Psychology Still Isn’t a Science,” by me; and “Bipolar Writer Comments on ‘Crisis in Psychiatry,” by Jessica Reed.

Photo: http://www.tumblr.com/tagged/dsm-iv-tr.

John Horgan About the Author: Every week, hockey-playing science writer John Horgan takes a puckish, provocative look at breaking science. A teacher at Stevens Institute of Technology, Horgan is the author of four books, including The End of Science (Addison Wesley, 1996) and The End of War (McSweeney's, 2012). Follow on Twitter @Horganism.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. Shecky R. 11:11 am 05/4/2013

    Somewhere, Thomas Szasz (…and also the Church of Scientology) is clapping…

    Link to this
  2. 2. jsweck 12:48 pm 05/4/2013

    A paradigm shift is needed to understand the place of psychology…

    That shift revolves around the concept of software, which people seem to greatly misunderstand. All computing systems have completely separate hardware and software systems. The brain is a piece of hardware only. Software is stored in memory, and governs complex behavior, problem solving, and is in control of the overall system. Software means information in memory. Minds are software systems – there is no other way to make a mind. You can simulate hardware until doomsday, but you won’t spontaneously make a software system. In humans, the mind is always learned after the brain is manufactured. To learn something means to transfer information to memory, in other words, to make software.

    When psychologists think about the conceptual basis of their discipline, they believe that ultimately minds are based on biological hardware like neurons. They believe that if you treat these hardware entities with chemicals you can affect the mind…perhaps, but not in any meaningful way. The mind is a software-only entity, and exists apart from the hardware. Software is not electronic, mechanical, or biological – it’s made of pure information.

    The reason there is a clash between psychology and neuroscience is because few people realize they are dealing with two completely separate systems. Among other things this means that there are separate hardware and software faults in the system. For example, right now psychologists have a hard time explaining a delusion (a belief error) – that’s because it’s a software fault. All the hardware is working fine – the erroneous belief only exists in memory as a software error.

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  3. 3. waltermatera 1:08 pm 05/4/2013

    Sometime back, maybe a decade or so, a Ph.D in California got in trouble with the APA for ‘practicing medicine without a license’. He maintained that he wasn’t practicing medicine at all but acting as a consultant in his specialty, philosophy! Perhaps what we have needed all the time is more consulting philosophers and fewer claims to treat ‘illness’?

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  4. 4. Robert D. Stolorow, PhD 1:22 pm 05/4/2013

    Deconstructing the DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible

    Link to this
  5. 5. Azuaron 1:30 pm 05/4/2013

    jsweck, as a programmer and psychologist, I must say you neither understand the distinction between hardware and software nor the neurochemistry of brains.

    First, hardware and software: software doesn’t exist; everything is actually hardware. Software is an illusion brought about by hardware that can rearrange itself. Every calculation modern computers do can, technically, be accomplished at the circuit level without varying inputs. The power of allowing hardware to rearrange itself (and, in particular, the silicon transistor) is what allows us to create “software” that can run on any similarly configured machine simply by transferring inputs from one machine to another.

    Nothing is “pure information”, and that, as a statement, is fallacious in and of itself; all information is encoded at the binary level in hardware.

    Brains work in a similar fashion; nothing is “pure information” in whatever metaphysical aether one might imagine inside a skull. Rather, information is chemically and structurally encoded within the brain. Neurons are constantly growing, dying, connecting, and disconnecting while sending and absorbing dozens of neurochemicals to each other.

    The problem is not that “some things are hardware and some things are software”; it’s all hardware. But the hardware is often too complex to directly manipulate, or the problem more easily fixed without disrupting the natural inputs.

    It’s like physics and chemistry: chemistry can be entirely explained by physics, if the physicists had ALL the information. But the system’s too complex, so chemists approach it from a different angle. Similarly, biology can be entirely explained by chemistry, if chemists had ALL the information, but they don’t, so biologists come at it from a different angle. Then neuroscience. Then psychology. Then sociology.

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  6. 6. TTLG 2:38 pm 05/4/2013

    I applaud this and think it is long overdue. From what I have read, large amounts of psychology, such as the “big 5″ personality traits were based more on subjective perception and value judgements than the scientific process. The more objective and accurate the information we have, from sources such as brain scans, the more it looks to me like the foundations that have been used have only a passing resemblance to what is really going on inside our heads.

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  7. 7. jsweck 3:49 pm 05/4/2013

    Greetings Azuaron,

    Software definitely exists. Software means information in memory. It’s not some abstract extension of the hardware, like the relationship between physics and chemistry. Software stands completely separate and decoupled from the hardware. Let me give you an example of a simple software system.

    A book is also a hardware/software system – it has memory system that contains information. Note that the memory system, and the information it contains are not the same thing. The hardware of a book consists of paper, glue, and a binding. The story stored in the book is pure information, and has its own internal structure that is completely different from the hardware. The story is not made of any hardware structures. Part of the value of software is that it can make its own structure, because it’s a pool of pure information. No one gets mixed up in the middle of a story and mistakes a story setting for the hardware pulp of the memory container.

    All softwares are by their nature separate from their containing hardware. There is no way to eliminate the software in the system. If you try, the system will not work, because that software is doing something useful. For typical computers, the software solves all of the significant informational problems the system. There is no hardware way of problem solving. When speaking of computers, calculations are not king, software is. Most of the hardware exists in order to run the software system. The software is the information system that handles the back end of all perception – no system analyzes things by sending information to a piece of hardware.

    It doesn’t matter how software is encoded. It doesn’t matter how memories are encoded either. All that matters is that if you have a memory it must be filled with information (aka software). Computing elements don’t matter either – the behavior of your computer is determined by its software – not the logic gates that comprise the hardware, and not the interconnection of those logic gates. For example, electrical engineers are never consulted by software engineers in creating software. These are two completely different disciplines, with no overlap at all. Software people never create low level objects that are 50% device driver, and 50% NAND gates.

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  8. 8. Azuaron 6:05 pm 05/4/2013

    jsweck, you’re missing the point. In a book, it’s all still hardware: the “pure information” is ink on paper. Modify the ink, or hardware, and the information changes. There’s no state of “pure information” where the information is mystically separate and independent of the hardware.

    And, like I said about physicists and chemists before, software people don’t create logic gates because they’re approaching a problem from a different direction, but the notion that there’s no overlap between software engineering and hardware engineering is absurd in the extreme.

    Quick (extremely simplified) example, a software engineer is writing a program and needs to know what 3 * 3 is. What’s the best way to do this? Answer: add 3 + 3 + 3. Computers, at the hardware level, only really know how to add and subtract, so when you tell a computer to multiply, it must first translate the multiplication into addition before performing the calculations. Translation + calculation will always be slower than pure calculation.

    Good software engineers have an intimate knowledge of how their programs run on hardware. Software engineers without this knowledge write code with memory leaks, bloated RAM footprints, and absurd CPU usage. My brother, a software engineer, writes code in a language specifically created for multi-core processors. You don’t think he needs to know how processors work at their most basic level?

    But all of this is getting away from the very simple point I was making: everything is hardware. Like in a book, if you change the ink, you change the information. Computer hardware, unlike a book, is self-mutable. This mutability has tricked you into believing there’s this other entity called software, but at the end of the day everything that happens in a computer is a mechanical process of bits and logic switches.

    And, to that end, if I knew everything about the hardware in a computer, I could pull out your harddrive, etch some very specific bits in a very specific place, and put a text file on your desktop called “Hello World”.

    The point isn’t that this is a better way of doing things, the point is that it’s possible at the hardware level because everything is, at it’s basic level, actually hardware.

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  9. 9. karenalcott 6:30 pm 05/4/2013

    On a subjective level I must agree with jsweck. The problem with treating mental illness is that it is very time consuming and therefor expensive. Antipsychotics and Antidepressants are invaluable when they are required, but they cannot treat anything on their own. I know from experience that you cannot “pop” your way out of a lifelong mind set. You also have to get out in the fresh air and sunlight, get some exercise and a psychologist. Counseling is too expensive for most people as it can take many years, cost a hundred dollars an hour or more and is rarely covered by insurance. But without it most patients won’t get any benefit from medication. It’s as if the software was learn enabled and has learned to run, however badly, on damaged hardware. The medication can fix the hardware, but the software needs to reboot and relearn, which it cannot do on it’s own. I think the analogy is valid.

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  10. 10. softwarematters 7:11 pm 05/4/2013

    jsweck is right, Azuaron is wrong. I am also going to give an example that illustrates very well the reason why the analogy applies and why the DSM model was doomed very early on. The real shame is that this pseudoscientific endeavor was ever given any credence at all.

    To see why software exists independently and is different from hardware one has to think about how software problems are fixed vs how hardware problems are fixed. To fix a hardware problem, now you basically replace the faulty part (memory, CPU, etc) because they are so complex that hardware problems cannot be possible fixed otherwise. Long gone are the days when one could open a personal computer and fix the individual transistors/resistors. In software, the way you fix problems is by reprogramming. A good example that illustrates this difference is a so called “memory leak”, which is one of the most insidious problems a programmer can face. This problem results when a program keeps memory that does not need anymore and refuses to give it back tot he computer’s operating system. On the surface the symptoms are deceptive. The computer takes increasingly more memory without doing much. Some times it might take all the memory available to the point of making the computer non responsive. The “hardware” approach to solve the problem would say, OK, add more memory. And that might mask the issue for sometime until, the program becomes so dysfunctional that even the extra memory is completely taken, at which point the “hardware” oriented guy might be tempted to “ECT” the RAM while the system is still powered on and, by a matter of chance, change the behavior of the software in a way that makes the system stop taking more memory. Nonetheless, the most likely result of that ECT is that the RAM is going to be inflicted irreparable damage. Here comes the software engineer. He realizes that it is a memory leak and after some back an forth with the source code (which is the set of instructions that the computer executes, only the computer has them codified as a set of on/off positions), once the problem is fixed, you put the new software in that on/off form (by a process known as compilation) and install it on the computer. While hardware is needed as a physical support of the software to encode those on/off positions, the software exists independently in the form of the source code and, more importantly, in the mind of the software engineer that coded the source code. From the software point of view, hardware only provides a physical support to the software. While you arguably can change the behavior of the computer by altering the individual on/off positions, that is not how software is designed. With today’s complex software systems, altering the individual transistors is infeasible, so a practice analogous to psychiatric interventions (ECT to a hard disk, altering the conductivity of all the pins of a CPU chip, etc) are more likely to result in irreparable damage of the computer even if sometimes such interventions leave the illusion that something significant has been accomplished.

    What the DSM model has been doing is analogous to those random hardware interventions to fix problems of living. They might have masked symptoms with a bit of luck for some time, but because they were clueless about the root cause of the malfunction not only they did not provide a long lasting solution but, in the long run, repeated usage of antidepressants, antipsychotics, anxiolytic, mood stabilizers, ECT and other hardware interventions ended up doing more damage than good. All that was built on a sloppy DSM model. Time to move on and to recognize that many lives have been ruined in the name of a pseudoscientific discipline.

    The concern that I have of course, is that the new wizard apprentices at the NIMH develop something that is even worse than the DSM. But for now, it’s time to celebrate that psychiatry’s latest scam has been defeated. Thomas Szasz must be smiling in heaven.

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  11. 11. Azuaron 8:14 pm 05/4/2013

    softwarematters: I’m not wrong, you’re just paying attention to what you think I mean instead of what I actually said.

    Link to this
  12. 12. softwarematters 8:21 pm 05/4/2013

    Azuaron,

    You are wrong because you keep defending random hardware interventions, under the excuse that it is “theoretically possible” to write “Hello World” by etching a specific CPU that would do so, to fix software problems all while you ignore that software is not designed that way by any stretch of the imagination. In fact it never was. Even during the time (like in the 1950s/60s before assembler was even commonly used) when writing those on/offs were the way software was actually written, software was a different animal altogether, it’s the “intelligence”. In that regard, the example of the memory leak illustrates very well how a “hardware” approach to a genuine “software” problem not only does not fix the root cause, but has the potential of causing irreparable damage to the system. That’s what the current DSM/drugging approach has been doing to psychiatric patients for decades.

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  13. 13. juandegringo 10:39 pm 05/4/2013

    If nuerological disorders cannot be defined with measurable numbers, they must not exist and the wasted entitlement money given to these freeloaders who claim they have them must be eliminated. The government has no business getting involved in individual citizen issues. The market will self-regulate and these people will fall in line or go to prison, like everyone else.

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  14. 14. juandegringo 10:41 pm 05/4/2013

    You see, I can think like one of these Tea Party bozos. Pretty horrifying isn’t it?

    Link to this
  15. 15. jayjacobus 11:00 pm 05/4/2013

    The issue may relate to perspective. A paranoid person has a different perspective than a normal person. Find the therapy that switches the person’s perspective away from paranoia and back to normal and his paranoia will vanish. Does perspective relate to chemistry, neurons, illness, brain structure and thought patterns? Perhaps it is not necessary to diagnose the underlying mistake if a pill will switch the perspective back to normal.

    This is indeed treating the symptom but without knowing the technical process that creates the mind, one cannot treat the process. Only the symptoms can be treated.

    Poor diagnostic skills may be cause of mis-treatment but we don’t know because we only have the doctor’s word for the diagnosis. If the treatment fails it could be that the treatment is not effective or it could be that the diagnosis is wrong.

    It seems imperative to examine the creation of the mind to be able to describe erroneous processes. Until then treating symptoms is all there is.

    Link to this
  16. 16. vapur 5:03 am 05/5/2013

    “Feeling Good: The New Mood Therapy” by Dr. Burns worked for me. Many people do not understand the power of the mind and how focus on negative thinking can affect your health. The Black Bile must be memories to dwell on, being recalled as a depressive trigger.

    Link to this
  17. 17. Rock Dude 7:02 am 05/5/2013

    Psychiatry is a primitive wierd science. Although I have always thought that people are too eager to follow the so called experts with blind faith. How can any one person grasp the complexity of the human brain. Let alone write a DIY biological manual dating from the 1950′s.We need fresh thinking and a fresh approach to this unfathomable science.

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  18. 18. dbtinc 8:48 am 05/5/2013

    He’s nuts … is that in the Manual?

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  19. 19. alan6302 9:07 am 05/5/2013

    I wonder what illness Adam Lanza has. He is ,after all, a fantasy made up by the government.

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  20. 20. jayjacobus 9:47 am 05/5/2013

    A person who has been abused or has gone through any traumatic experience might not be thinking in a way that will resolve his / her underlying thoughts. Trying to get the sufferer to think differently will be particularly difficult if the toxic environment continues to exist or can return without notice.

    The first, preliminary step is to remove the threat (or actuality) of a toxic situation.

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  21. 21. Bernard Carroll 10:37 am 05/5/2013

    This episode reminds me of a beloved physiology teacher during my preclinical education: On hearing about some new administrative scheme dressed as an innovation, he gruffly retorted, You’re not conducting an experiment, you’re just shuffling expediencies. It is ironic that NIMH made this announcement right when we learned there has been a major increase in suicide rates among middle aged males: their approach so far hasn’t been working very well, as John Horgan points out.

    Is RDoC the answer? No. The RDoC initiative exposes the intellectual poverty within NIMH. Science bureaucrats have no business messing in the steering of original science. Here they are being presumptuous and supererogatory. RDoC is a top-down solution to a bottom-up problem. Moreover, these same bureaucrats contributed greatly to the problem by allying themselves with the American Psychiatric Association through previous iterations of the DSM. They even threw good money at the APA to help develop the DSMs.

    RDoC would never have solved the problem of cerebral syphilis – dementia paralytica – with its pleomorphic symptomatic presentations. The 5 big domains of RDoC are metaphysical, scholastic constructs, which we can expect will devolve into something like the eccentrics and epicycles of 16th century astronomy. The cross-cutting notion (yawn) is a recycling of old ideas from the 1970s. Absent a clue about pathophysiology, the slick talk now about cross-cutting biomarkers is just biobabble, to use the term David Healy coined. I commented not long ago to Shitij Kapur and Thomas Insel that their approach would lump together Cushing disease, juvenile diabetes, pregnancy, anorexia nervosa, and adult onset metabolic syndrome because each of these displays abnormal glucose tolerance tests. I never heard back from them.

    I commented a while ago that American psychiatry is irrelevant: http://hcrenewal.blogspot.com/2012/11/does-american-psychiatry-matter.html. Under its current leadership, NIMH also is irrelevant.

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  22. 22. mudphud 11:35 am 05/5/2013

    I feel for psychiatrists. Unlike cardiologists or surgeons, they have few measures that are not subjective, both from the physician’s observations and the patient describing how they feel. Hindsight is 20/20, today it’s clear the DSM is a mistake, and now so entwined with the profession, research methods and reimbursement it will be very hard to undo. At the start though, something similar was needed to at least start to standardize, categorize, and define psychiatric diseases. Like cancer, no one thought it would turn out to be so complicated.

    As far as hardware vs software, I don’t think such analogies make much sense in the realm of psychiatry. Neurology I think is very much about specific nerve pathways and transmitters. Consciousness, mood, memories are a much different interaction between how your genes created and continue to maintain your particular brain (along with a large dose of random variation) and the environment and experiences. There is no clean separation between hardware, code, and input and output.

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  23. 23. softwarematters 3:03 pm 05/5/2013

    mudphud, I don’t feel for psychiatrists. In fact, the real outrage is that they have been given powers that in the past were reserved for the Inquisition based on “a consensus about clusters of clinical symptoms”. Thanks God these people do not think that being highly creative and eccentric, such as Einstein or many other were/are, is a “disease”, otherwise, we would have been deprived of their contribution. Or do they? Maybe the false epidemic of ADHD, that DSM-IV started and denounced by the DSM-IV’s own chief editor, has deprived us of many of these people but we don’t know yet.

    Psychiatry is not a legitimate branch of medicine, it’s a replacement for the Inquisition that uses the language of medicine to justify itself. Which other branches of medicine have legally sanctioned ways of imposing their more scientifically valid treatments to people against their will? Last time that I checked, if you are HIV positive and don’t want to take antiretrovirals, despite the real dangers for the public when said individuals refuse to do so, the drugs cannot be “forced” into you. Same thing with cancer patients/chemotherapy. Now, you behave in ways considered “not normal” by a bunch of people seating in a DSM committee -who made their decisions based on “a consensus about clusters of clinical symptoms”-, and all kinds of toxic drugs can be imposed onto you to make you “normal” despite the fact that there is no evidence that these drugs do nothing more than masking symptoms at best or are just active placebos at worst.

    The “bible” nickname for the DSM seems right to me for like in previous darker times, those who behave in ways their “bible” declares “not normal” are given the same treatment that the Inquisition gave to those who behaved in ways considered “not normal” by the actual Bible.

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  24. 24. softwarematters 3:28 pm 05/5/2013

    Something else, this contention that psychiatry is a replacement for the Inquisition or similar religiously motivated institutions is historically accurate. Psychiatry rose as an attempt to invalidate the role of religious institutions in defining “normal”. The problem? Psychiatry became no better than these religious institutions at it. Religious biases were replaced by the biases of the day, which is why Drapetomania (an alleged mental illness present in black slaves who wanted freedom during the XIX-the century), Hysteria (an alleged mental illness that inflicted women during the Victorian era who didn’t behave according to their husbands’ desires) and Homosexuality (considered a mental illness until very recently) were considered at different times valid mental diagnoses.

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  25. 25. singing flea 3:35 pm 05/5/2013

    Give a person a degree in psychiatry or psychology and by some miraculous gift from their God they are suddenly empowered to play with their patients brains as if they were God. The fact of the matter is, they are all actors on a stage trying to make a living on other people’s differences. Yes, I said differences, because in the end all these attempts to quantify and define mental health are based on the observation of billions of different people that are all fundamentally as unique as their DNA.

    The field of psychiatry and psychology is a farce. Anyone with a lick of common sense would know that a clerical specialist like a priest, rabbi, imam or monk has a better success rate at controlling the masses then a medical professional. All one needs to do is take a look around to see that the generation of pill popping ADS diagnosed young adults has produce the highest incidence of drug dependency in history.

    People who buy into this big-pharma myth that drugs are a cure for mental variations in society are as delusional as their patients and peers.

    Society’s greatest ill these days is not gun wackos or terrorists or the Mexican mafia, it is the very companies that make these drugs and alcoholic beverages and them pedal them like candy to the youngest adults.

    Case in point: Just yesterday I was at the liquor of my local grocery store and right in front was a display of readymade sugary shots by Twisted Shotz with names like Buttery Nipple, Sex on the Beach and Hot Licks. Now, who do you suppose that is targeted for? Grandma and Grandpa?

    The mental health industry (yes, it is an industry as opposed to a practice) would have a whole lot more success if they took the profit out of it and concentrated on helping those whose lives have been all but destroyed by the drug industry and the voodoo-psychiatry they have hired lobbyists to influence lawmakers into legitimizing their products.

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  26. 26. yourkidding 3:55 pm 05/5/2013

    I believe from my experience with a loved one with mental illness that the following formula is correct:

    Medication+Therapy+DSM+FamilySupport=Better Life

    There can be a great debate on how to assign numerical values of importance to each category but to completely eliminate one category jeopardizes the validity of the entire equation.

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  27. 27. softwarematters 4:01 pm 05/5/2013

    yourkidding,

    And I believe from my own experience that

    Medication+Therapy+DSM+FamilySupport = My own life being ruined.

    If only my parents and ex-wife would have minded their own business instead of “trying to help”. I stand by General Patton’s quote: “God deliver, us from our friends, we can handle the enemy”.

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  28. 28. yourkidding 4:17 pm 05/5/2013

    softwarematters

    I offer this in good faith that you did not have “support ” from your family. Ironically family can help ONLY when asked.

    I still stick by the formula.

    P.S. No need for senseless debate.

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  29. 29. softwarematters 4:29 pm 05/5/2013

    yourkidding,

    Of course I had. Your loved one would have been probably better off without “your help” as well. Continued usage of psychotropic medications has been shown to cause all kinds of physiological side effects that result in lives being cut, on average, by 25 years.

    Family can be a curse, as in my case, and probably your loved one as well. As I said, I stand by General Patton’s quote: “God deliver us from our friends, we can handle the enemy”.

    I have been off drugs, off family, off psychiatrists for a long time and my life has never been better. The only problem is that because psychiatry was “forced” on me, there are many things that I cannot do, such as holding certain government/private jobs for which there is a security clearance requirement. That’s where I speak of my life having been ruined (in addition to the divorce, etc). But boy, would I have been better without any of my family’s “help”.

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  30. 30. softwarematters 4:54 pm 05/5/2013

    yourkidding,

    Continuous usage of neuroleptics has also been linked to brain shrinkage:

    http://archpsyc.jamanetwork.com/article.aspx?articleid=211084

    Results During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.

    Conclusions Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.

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  31. 31. Christian Spiritist 7:16 pm 05/5/2013

    The key to this answers relies on the fact that we are immortal spirits. Unfortunately, Science has persistently denied this fact for the past two centuries. Men like Allan Kardec, Oliver Lodge, Frederic Myers, Lord Rayleigh and William Crookes had already demonstrated it at XIX and XX century and, even more recently, Ian Stevenson approached this fact through the reality of reincarnation. But the materialism simply ignored and mocked it and that is the result. But, sooner or later, everything will come up and everything will be clear. Here in Brazil, realities like mediumship, reincarnation, pre-existence and survival of the soul and many other related ideas are like common sense to many Brazilians. See the story of Chico Xavier, for example. Hugs from Brazil!

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  32. 32. Nuschler 11:31 pm 05/5/2013

    While you all are arguing and sniping at each other over the analogy of software/hardware vs cognitive functions/synapses…the suicide rate of women ages 60-64 and men in their fifties has risen 40-50% in the last two years.

    People are dying NOW! And with our gun culture and continued unemployment of many over the age of 50, this percentage is only going to get higher. Without universal single payer health care, mental health care budgets being slashed in all states, this percentage will continue to grow.

    So quit arguing about such silly things and start figuring out a way to stop this horrific epidemic in America! If 30,000 people (approx. number suicides/year) died of food poisoning each year the FDA would catch holy hell. And despite medications and therapy 15% of clinically depressed patients WILL complete suicide.

    Get off your butts people and discuss something that matters! And we can have a new DSM manual every year…but it means NOTHING if we are losing people!

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  33. 33. thomasR 12:45 am 05/6/2013

    Nuschler — yes, people do die and it’s a real problem. However, it is precisely because of this that we need to develop theories. It’s the lack of scientific explanation that is holding up progress and the taking of action. We still don’t really know how to think about ‘mental health’. We need to produce fundamental new ideas and to criticise them. And that entails debate and controversy.

    The neuroscientist Daniel Bor has suggested that so-called mental illnesses may be reframed as *disorders of consciousness*. Since there is a great deal of research interest in consciousness and artificial intelligence at present then there may be implications for psychiatry in the not-too-distant future.

    Anyway, I’m glad we’re giving up with the DSM manual (assuming we truly are). Progress has always depended upon rejecting authority, including the authority of official texts.

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  34. 34. softwarematters 1:14 am 05/6/2013

    Nuschler,

    People die sure, but did you know that antidepressants are known to increase the risk of suicide in people (read the black box warning of any of them). What about the organ damages caused by neuroleptics and benzodiazepines? The DSM approach, because of its lack of scientific validity, is responsible for more people’s deaths than if there was no DSM at all. Here is another fact: all the recent mass killers were or had been under psychiatric meds because some DSM committee decided, with absolutely no evidence to back it up, that some behavior was “evidence” of “mental illness” that could be treated by taking drug “X”. That’s what the DSM approach brought: emotional pain and death (and big paychecks for psychiatrists and Big Pharma executives). Time to move on, I think.

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  35. 35. TMarshmallow 8:17 am 05/6/2013

    jsweck:

    Pretty much everything you have written about software vs. hardware is wrong. You appear to be completely ignorant of the history of computers and this lacuna appears to be the source of you bizarre ideas regarding computers and computing.

    The earliest computers were not reprogrammable, their program was literally hardwired into them. There was no software, the concept of “software” did not even exist. There only was _hardware_ and this was patent. It was not until the idea of the _stored-program computer_ (eg. the Von Neumann architecture was an implementation of this idea) that the idea of software emerged. The stored-program computer made computers reprogrammable but it did not change the fundamental nature of computers beyond this improvement. The idea of the stored-program is not essential to the design of a computer — a computer with no software, with no ability to be reprogrammed via loadable instructions is nevertheless a computer. The program instructions that software consists of can — in theory — be implemented entirely in hardware, i.e. hardwired into the device. I say “in theory” because software today is many orders of magnitude larger and more complicated than the software of the 1940s so hardwiring something like Microsoft Word would be an onerous task. The point is that there is really only hardware (as you have already been told). Hardware reduces to (many, many) electronic switches that are typically implemented using diodes and transistors. These switches serve as logical gates which enable the implementation of all of the operations of Boolean logic. In these terms, the difference between a hardwired computer and a stored-program computer (i.e. one with distinguishable software) is that some of the switches that are hardwired in the former are set by program code (i.e. the software) in the latter. Here is the design for a digital circuit that simulates the throw of a six-side die: http://download.ni.com/pub/devzone/tut/lab11_digital_dice.pdf Observe that there is no software. This sort of digital design can be scaled up to produce increasingly complicated computing devices — with no “software” — such as a tic-tac-toe game or an adding machine or a prime number generator. Thus your claim that “[a]ll computing systems have completely separate hardware and software systems” is incorrect.
    With the exception of self-modifying code every algorithm that can be implemented in software can also be implemented in hardware.

    That notwithstanding, the comparison between the brain and computers is a disanalogy and not worth pursuing. But you, equipped with your misunderstanding of the relationship between hardware and software push this disanalogy into absurdity.

    You opine:

    “The mind is a software-only entity, and exists apart from the hardware.”

    So are you suggesting that minds exist independetly of brains and hence bodies? Are you claiming that you have experience of disembodied minds?

    You add:

    “Software is not electronic, mechanical, or biological – it’s made of pure information.”

    There is no such thing as “pure information”, information can not exist independent of its method of encoding and representation. If you disagree then show me where “pure information” is to be found. Even ideas in our heads have a specific encoding and representation (which is only partially understood but that doesn’t diminish the truth of the point).

    You wrote:

    “For example, right now psychologists have a hard time explaining a delusion (a belief error) – that’s because it’s a software fault. All the hardware is working fine – the erroneous belief only exists in memory as a software error.”

    A delusion is not merely “a belief error” or an “erroneous belief”. If I forgot to turn on the heating and retire to my bedroom with the mistaken belief that the heating is on that is not an instance of a delusion — it is just a mistake. The erroneous belief isn’t even the significant component of a delusion (as understood by psychiatrists and psychologists). The DSM-IV-TR glossary defines a delusion as:

    “A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitues incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious faith.” (p.821)

    In reply to Azuaron you wrote:

    “Software definitely exists. Software means information in memory.”

    Well, yes software does exist but it doesn’t mean “information in memory”. Software can be — and usually is — represented outside of memory, it can be printed on paper, encoded as a series of punch cards, written to magnetic media as a series of patterns of magnetisation, written to optical media as a series of pits and lands or encoded in some other yet to be conceived method. Software is a series of machine-readable instructions, it needn’t be “in memory” to be considered software.

    You then proceed to make an issue of information versus its form of representation but you do so in a confused and confusing manner, furthermore this issue is entirely irrelevant to mental illness and the brain or the mind. You then proceed to conflate the idea of information with the idea of software. Software is a type of information but not all information is software.

    You wrote:

    “All softwares are by their nature separate from their containing hardware. There is no way to eliminate the software in the system.”

    I already addressed this but I will repeat myself. Software is not essential to a computer system. It remains possible to create computers with no software, with their program hardwired into their design.

    You wrote:

    “For example, electrical engineers are never consulted by software engineers in creating software. These are two completely different disciplines, with no overlap at all.”

    I think you mean _electronics_ engineers not electrical engineers. I find this completely wrong in relation to my education in IT and in my career in IT. Only a subset of software can be authored with _complete_ disregard for the hardware of execution. Any software in which the memory footprint or the execution speed (or both) is/are critical must be written with reference to the hardware. This is the case with much of systems programming, as opposed to application programming. But as recently as thirty years ago even applications programmers had to resort to inline assembly language in programming languages such as COBOL to speed up “inner loops”. It is not possible to write assempbly language without knowing anything about the hardware. With regard to overlap between electronics engineering and software engineering, device driver writers straddle both fields, as do compiler writers. It is patently untrue that there is no overlap between electronics engineering and software/programming.

    But all of this is ultimately irrelevant because there is no useful analogy to be found between computers and brains.

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  36. 36. ronwagn 9:16 am 05/6/2013

    Glad to see the DSM series being played down.Its main use is in getting payments from insurance companies and the government. It is an impediment to seeing the individual and his behavior. The behavior is what needs to be described and dealt with. Individualized behavior records and problems need to be addressed. We are all individuals that are best described by our actual behaviors over time.

    Cognitive therapy is sadly underused, and should be considered as important as medication. Functioning independently and with others is the main goal.

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  37. 37. TMarshmallow 9:23 am 05/6/2013

    softwarematters:

    Do you really see an analogy between adding more memory to a computer system and using psychotropic drugs? Really? You also throw ECT in there but at that point you seem to abandon even any pretence that there is any analogy to be made. How does the hardware person ‘”ECT” the RAM’? Hasn’t the disanalogy been made plain by this point?

    You wrote:

    “What the DSM model has been doing is analogous to those random hardware interventions to fix problems of living.”

    Well no it isn’t analogous and your attempt to draw an analogy illustrates the disanalogy. The DSM doesn’t advise any treatment or intervention, it’s just a work of nosology. There is nothing about pharmacology or ECT in the DSM.

    Whenever I read the phrase “problems of living” I know I am just reading a paraphrase of junk that was sourced from some nutty anti-psychiatry web site. Also, when I read that phrase I realise I am likely reading the ravings of someone that was diagnosed with a psychotic disorder. I am lifelong sufferer of chronic major depression and I haven’t met any fellow depressives that would reduce their condition to being caused by “problems of living”. Those with psychotic disorders — which I conjecture you are one — typically don’t experience melancholia and experience their psychosis in an oscillating pattern i.e. the condition becomes acute then over time remits. This makes it possible to just conceptualise the illness as due to “problems of living”. The idea that depression that is so painful it leads to suicide is due merely to “problems of living” is idiotic and offensive.

    You wrote:

    “They might have masked symptoms with a bit of luck for some time, but because they were clueless about the root cause of the malfunction not only they did not provide a long lasting solution but, in the long run, repeated usage of antidepressants, antipsychotics, anxiolytic, mood stabilizers, ECT and other hardware interventions ended up doing more damage than good.”

    So is mental illness due to “problems of living” or some as yet undiscovered biological cause? So what exactly are you contending here? If the DSM ceases to exist will my mood magically improve? Before I started taking antidepressants I was suicidally depressed; when I stop taking antidepressants I fall back into suicidal depression. How do you reconcile that with your jaundiced worldview? I have been on antidepressants of all classes over the last twenty years and I have experienced no lasting adverse effects. Any ill-effects have been relatively minor (relative to the suicidal depression) and temporary. Again, how do you reconcile this with your warped view of the world. I agree that psychotropic drugs are very far from perfect but that is far removed from your spewing of bile and vitriol. The antidepressants that I take do not “cure” the depression nor do they even provide complete symptomatic relief BUT they provide temporary and partial relief and that is better than _no_ relief. The worst symptoms — the constant crying, the total loss of appetite and the urge to commit suicide — are relieved and for that I am grateful. I am left with a low-level chronic depression but I can cope with this, at least most of the time.

    I have read dozens of research papers concerning the SRIs, SSRIs, SNRI and tricyclics and there is no evidence that they cause any permanent damage to any organ or system of organs.

    Since the brain is the most complex organ in the body it stands to reason that understanding and successfully treating this organ will take longer to achieve than it has the other internal organs. Neurology is not fairing much better than psychiatry in terms of treating disease, consider Alzheimers and Motor Neuron Disease.

    Szasz — at best — provided only critique, he failed to come up with anything substantive in relation to relieving the suffering of those with mood disorders and anxiety disorders (which are the bulk of those with mental illness) that could serve as an alternative to psychiatry. Unfortunately it is not possible to define suicidal depression and paralysing anxiety out of existence. Declaring that there is no such thing as mental illness doesn’t magically elevate moods or calm anxieties. Does it?

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  38. 38. TMarshmallow 9:34 am 05/6/2013

    softwarematters:

    You wrote:

    “People die sure, but did you know that antidepressants are known to increase the risk of suicide in people (read the black box warning of any of them). ”

    Besides dismissing the fact that depression causes people to commit suicide — for the sake of a cheap anti-psychiatry point — you are misrepresenting the FDA black box warning. Here is the actual warning:

    http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM173233.pdf

    Notice that the increased risk of suicide pertains _only_ to young people.

    You wrote:

    “The DSM approach, because of its lack of scientific validity, is responsible for more people’s deaths than if there was no DSM”

    Do you have any evidence for this extraordinary claim?

    You wrote:

    “Here is another fact: all the recent mass killers were or had been under psychiatric meds”

    Here is a fact for you: correlation is not causation.

    I’m sure “recent mass killers” also wore underarm deodorant, are we then to conclude that underarm deodorant causes mass murder. Given that there are literally millions of people worldwide that are or have been on psychotropic drugs it would be reasonable to assume that if there were a causal connection between these drugs and acts of mass murder then incidents of mass murder would be much more frequent than they actually are.

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  39. 39. N a g n o s t i c 9:37 am 05/6/2013

    There’s rationality afoot!

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  40. 40. N a g n o s t i c 9:40 am 05/6/2013

    The good ol’ DSM is the psychiatric profession’s biggest tool for drumming up business. Is the government going to put these charlatans on the dole? Oh, they already are…

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  41. 41. N a g n o s t i c 10:02 am 05/6/2013

    “…Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year. Insel, I suspect, is hoping to form an alliance with neuroscience, which now seems to have more political clout than psychiatry.”

    Sure bet.

    I wonder how the Brain Initiative meshes with the 23 year old ongoing Decade Of The Brain?

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  42. 42. N a g n o s t i c 10:11 am 05/6/2013

    I’m falling all over myself trying to pile on.

    “As I have pointed out previously, drug treatments have surged over the past few decades, while rates of mental illness, far from falling, have risen.”

    Rates of fabrication, application and inclusion in the DSM is more like it. There’s not more crazy people running about today than 500 years ago. The average peasant of 500 years ago would be a grab-bag of mental maladies if examined by today’s psychs. Psychiatry wants to make a buck, and has had no shortage of help during the past 120 years. High time they’re recognized as witch-doctors.

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  43. 43. msgates1964 10:42 am 05/6/2013

    The DSM has its flaws. However, the one major complaint is that so many of its descriptions are subjective. It’s very difficult to be objective with such a subjective organ such as the brain.

    Psychiatry has many of the same problems of quantum physics–poking around trying to find out what’s going on skews the data.

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  44. 44. TMarshmallow 10:44 am 05/6/2013

    Nagnostic:

    You wrote:

    “There’s not more crazy people running about today than 500 years ago.”

    I agree that some of the conditions in the DSM are indeed nonsense (eg. Dissociative identity disorder) but I would contend that mental illness is more prevalent today compared with 50 years ago. Life has become more uncertain, more pressured and hence more stressful. Chronic mild stress is sufficient to cause mental illness in those that are vulnerable.

    “Craziness” isn’t really the issue, the most common mental illnesses are anxiety disorders and depression. According to the WHO, currently unipolar depression is the largest cause of DALYs (Disease Adjusted Life Years) in middle and high income countries, 5.1% and 8.2% respectively. The forecast is that by 2030 unipolar depression will be the number one cause of DALYs _worldwide_ (6.2%) (see http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part4.pdf).

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  45. 45. TTLG 11:10 am 05/6/2013

    The hardware/software discussion here is interesting in that it is similar to the the disagreements about brain function. My computer can be reconfigured to do vastly different things very quickly simply by changing the electrical states of the hardware. Also, if it “gets sick” with a computer virus it can also be “cured” very quickly. On the other hand, if something physical goes wrong, such as a burnt-out microprocessor or damaged motherboard, the repairs are more difficult.

    In the case of the brain, the question is to what extent our mental illness require physical changes to fix them. Can we, like some people seem to be saying, just do some quick attitude change and the problem will disappear like a software virus? Or are most mental problems caused by underlying physical problems that require things like drugs to help us rewire ourselves to become what we want to be? If, as the latest information seems to indicate, many mental problems are based on physical wiring as well as chemical states created by our experience, these may require a combination of approaches, or at least a long-term change in environment before they can be changed.

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  46. 46. Drivmeinsane 11:55 am 05/6/2013

    Psychiatry is in it’s infancy in regards to making diagnostic decisions. It is a mistake for the mental health director to throw out the DSM and replace it with nothing.

    The pier review process works for all scientific processes.

    Only the growth of information in a system will enable for better diagnostics. If the addition of brain scans will aid in the diagnostics of mental illness I welcome any light they can shine on the the problem.

    The treatment of medical maladies has, until very recent in history, been a series of trial and errors. To say that the psychiatric profession should not be allowed to proceed along the same lines as other professions is disingenuous.

    In my opinion when they get to the 500th edition of the DSM, and they haven’t learned anything more, then throw it out.

    As for the pharmacology industry taking advantage of the ignorance and greed of a few individuals. We will always have crooks. They should be exposed and punished for the cretins they are. Better yet they should be forced to see a psychiatrist so that we may better understand why they would prey upon the sick and mentally disturbed.

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  47. 47. pinetree 12:27 pm 05/6/2013

    “Hunh? So the NIMH is replacing the DSM definitions of mental disorders, which virtually everyone agrees are profoundly flawed, with definitions that even he admits don’t exist yet!” Some might call that crazy, clinically speaking…

    DNA was the breakthrough of the 20th century within the context of the science understood at the time (largely organic chemistry), and clearly has extended into the start of this century. Coming to grips with the mechanism, architecture, and function of the brain is beyond any theoretical foundation we have today. It may come in the next generation, or artificial intelligence may render it moot in the long haul. We can only poke at the edges for now.

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  48. 48. esurma7 1:03 pm 05/6/2013

    Much of this appears to me as the nature/nurture debate: what is “physical” and what is shaped by experience. As Azuaron points out, “information is chemically and structurally encoded within the brain”. Nature component. The question is “What information?” I believe many of the respondents are saying experience, learning, and the like. Nurture. My personal opinion is that regarding mental illness, we rely too much on the physical solution — there are physical components, but not just physical components. Through this we try to objectify the subjective, as that makes diagnoses of pathology (and many other things) much easier, and lends to communications through common terms, as many have pointed out. Yet we lose sight of the subjective component while doing so, or we randomly ignore the subjective in order to keep our objective paradigms strong. In hard sciences, 2 H2 + O2 = 2 H2O. In psychological sciences, the same experience may have many different effects, which cannot be traced to “brain structure” alone. We (and I am studying psychology) seem to fear bringing the subjective into our “science,” which makes me think of “proving” that the Mona Lisa is the greatest painting ever because of the chemical composition of the paint.

    Forgive me for sharing a trivial example: every morning I feed the squirrels and birds. I go out to my deck, I say “Good Morning, Come Get Breakfast.” And within a couple minutes, squirrels, blue jays, cardinals, etc. are on my deck having a snack. An outside observer may think me “mentally ill” for talking to the animals and may challenge my behavior. I can think of two possible answers (and there are many): (1) Having studied psychology, I know about conditioning: man’s voice, food appears, wildlife comes. Yes, there is the common (admittedly childish) human trait of anthropomorphizing our environment; I could repeat a set of random sounds every day and get the same effect. I prefer to say “Good Morning.” (2) I believe myself to be the incarnation of the (fictional) god Bruwuuwuu who has the ability to communicate with animals and sometime in the year 2014 the animals are going to revolt and kill all humans, etc., etc. I think we all can agree there’s a difference in mental paradigm here. If we look at this from the superficial level, talking to animals = mental illness, regardless of the motive, understanding, etc. of the subject. If we find a “talking to the animals” circuit in the brain, we can treat both of these examples with drugs, electricity, etc. and “cure” the person. Yet, are both in need of treatment? This is where subjectivity plays such an important part in my view, and that even if all behavior can ultimately be traced to “hardware”, looking at the hardware from purely objective criteria will not “solve” mental illness. It may in fact lead to many more diagnoses!

    That the DSM is subjective, I feel is completely true – it’s simply a consensus. I agree with Drivmeinsane that much more work needs to be done, and should be. The DSM debate may be a “throwing the baby out with the bath water.” At the same time, “religious” texts can lead to dogmatism, blind faith, etc. That includes the dogmatism that science can explain everything. Maybe the solution is holistic, where we take the knowledge we have, realize that knowledge’s limitations, and keep an open mind as we strive for greater understanding. Maybe we have encountered a limit to science, the scientific method, etc. I don’t mean to throw out the science; I mean to add to it the subjective aspects that plague the diagnosis and treatment of mental illness.

    A second note I feel that I must add: after the death of my fiancé, I was diagnosed with moderate to extreme depression and PTSD. I received NO physical treatment (drugs, EST, etc.), yet two credentialed psychologists (one MS, one PhD) have both declared me symptom free. If there was no physical intervention, what made the circuitry of my brain change?

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  49. 49. jsweck 2:32 pm 05/6/2013

    Azuaron,

    “There’s no state of “pure information” where the information is mystically separate and independent of the hardware.”

    All memory systems are specifically designed to create the separation of hardware and software – that’s just part of making a good memory. For example, a book that reads as random literature is useless. Yes, the software has a physical basis that connects the software and hardware systems together.

    Software is information in memory. Information is the structure or arrangement of things in our universe. Information is a fundamental quantity in physics, like charge or space-time. When you make a pool of information you are really making a pool of structure separate from the structures of the universe. When software engineers create a system they create their own structure out of pure information. By “pure” I mean to emphasize that there’s no hardware components in the system, whether it’s a story, a computer program, or a genome. Most of what really matters in these systems is the software system. This universe-creating capability of software is why game companies use software to build their game worlds, and also how a virtual earth was created in The Matrix.

    “ the notion that there’s no overlap between software engineering and hardware engineering is absurd in the extreme.”

    This is the plain truth. I’ve done both, and I can tell you that all hardware and software concepts are completely separate. If you think otherwise, then give me an example. I can give an example of incongruence right at the core of electrical engineering – EE’s call one of their hardware implementations of a bit, a flip-flop, the software people call their “atoms” a bit. A flip-flop and a bit are two separate things. With varying hardware, the bit is implemented with all sorts of things like magnetic domains, paper tapes, mechanical switches, etc. A bit is the information that is stored in the hardware memory system, not the memory system itself. The structural hierarchy of the software typically is bits, variables, functions, objects, applications, etc. The hardware is particles, molecules, analog devices, logic gates, memory systems, etc. These concepts are completely different from one another.

    Hardware people see hardware structures only – gates, processors, memory system, etc. Software people see bits, variables, objects, applications, etc. These are completely different worlds. In publishing, the same differences exist between the paper and binding specialists (hardware) and the writers (software). This is why I think that psychology is so different from biology.

    “Translation + calculation will always be slower than pure calculation.”
    Why does this matter?

    “Good software engineers have an intimate knowledge of how their programs run on hardware”

    Good software people can have intimate knowledge of anything. The point is that they don’t need to know, because they are not going to be making any hardware. Yes, someone that deals with complicated hardware needs to be aware of how it functions, but being aware does not mean they are creating hardware – they are still creating 100% software systems. If you switch the hardware to, say a photonic system, the software remains the same. Sometimes the software is changed to accommodate new hardware – but the change is a 100% software change, it’s not some hardware effect trickling up through the software (which can happen with faulty hardware). Software engineers don’t go into the lab and start cranking out electrical designs instead of software.

    I hope I’ve answered your questions.

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  50. 50. softwarematters 3:12 pm 05/6/2013

    TMarshmallow,

    So many strawmen in your comment that it is difficult to address all of them. Let’s being by the most obvious, no I was not given a “psychotic disorder” label. There are 400 different made up so call “disorders” than can screw your life for the rest of your life. This is the last time I address the issue of what ruined my life. The point is that my life was ruined by an arbitrary label. Now the NIMH is on record that indeed, the labels that come from the DSM process are arbitrary. In addition, DSM-5 field testing showed that they are even less reliable than the DSM-IV labels. So!

    On the issue of correlation doesn’t imply causation. I never said otherwise. However, high correlation (and the high correlation of psychotropic drug use – violence has been scientifically established) is a piece of evidence that adds to the overall case against the current “drug everybody labelled as mentally ill” paradigm. A few years ago, Oxford psychiatrists published a study that debunked the notion that people labelled schizophrenic are more prone to violence http://www.ox.ac.uk/media/news_releases_for_journalists/090520.html “Small risk of violence in schizophrenia unless drugs and alcohol are involved”. Ie, it’s drugs and alchool that mediate violence, not psychiatric labeling.

    With respect to the FDA and the antidepressant black box warning, the label applies to young people because that is as far as they are willing to go. Nonetheless, the link violence-SSRIs was known even before Prozac was approved. http://edition.cnn.com/2005/HEALTH/01/03/prozac.documents/ “An internal document purportedly from Eli Lilly and Co. made public Monday appears to show that the drug maker had data more than 15 years ago showing that patients on its antidepressant Prozac were far more likely to attempt suicide and show hostility than were patients on other antidepressants and that the company attempted to minimize public awareness of the side effects.”

    With respect to the “problems of living”, that’s what they are. And now no other than the NIMH director is on record saying that the DSM labels are just “consensus” about what are the “problems of living” of the day. You might feel better with being labelled “clinically depressed” vs admitting that this world is too tough for you, but that’s your problem. People having “problems of living” have existed as long as there have been people on this planet. Only people used to deal with those issues with their support networks. Now everybody wants to have their “problem of living” being considered “scientific” in spite of the evil the DSM has caused during the last decades. We are talking about people taking their own lives, of mass shooter like those who did the Virginia Tech, Aurora and Newtown massacres, all that so that people like you can “feel better”. Pathetic, indeed.

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  51. 51. cmvvmd 4:20 pm 05/6/2013

    On the contrary, predicting drug response is easy. Depression responds to antidepressants, psychosis responds to antipsychotics, anxiety responds to anxiolytics, unstable mood responds to mood stabilizers, attention felt to be inadequate responds alarmingly well to amphetamines, just as pain responds to opiates. . . no matter what other names we give all those symptoms.

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  52. 52. Azuaron 4:38 pm 05/6/2013

    softwarematters, I’m not wrong because I never “defend[ed] random hardware interventions, under the excuse that it is “theoretically possible” to write “Hello World” by etching a specific CPU that would do so.” I said that software is a myth perpetuated by self-mutable hardware, and there was no such thing as “pure information” that existed in some strange aether away from hardware.

    I also said that hardware interventions into a programmatic problem, while theoretically possible, were not the best or appropriate approach.

    The last paragraph of my previous comment:

    “The point isn’t that [direct hardware manipulation] is a better way of doing things, the point is that it’s possible at the hardware level because everything is, at it’s basic level, actually hardware.”

    You are extrapolating my statements into defending something I’m not; I’m making a very specific point about information storage and representation regarding someone’s incorrect analogy, not making a treatment recommendation of any kind. For God’s sake, do you think I’d advocate attaching magnets to a hard drive to fix a computer virus? Just because something is possible doesn’t mean it’s practical, reliable, or recommended.

    jsweck, you’re completely missing my point, and the only thing you’ve answered is your inability to understand the words coming out of my keyboard; I didn’t have any questions.

    Everything in a computer is hardware. The hardware is self-mutable, which allows the modification and storage of inputs which can then be arranged into algorithms and functions with relation to various logic gates. These stored inputs can be easily transferred from computer to computer via networking hardware or physical media. Nothing about these statements is open to debate; they are fact.

    I’m saying the gravitational force exists and people are pointing at a helium balloon and trying to tell me it doesn’t.

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  53. 53. Christopher Springer 5:02 pm 05/6/2013

    Dear Sirs,

    I really like the “Read full article” shown below:

    Read full article Continue reading page |1 |2

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    Link to this
  54. 54. softwarematters 9:11 pm 05/6/2013

    cmvvmd,

    Actually long term outcomes in people under psychiatric medications are no better than people on placebo,

    http://www.amazon.com/Emperors-New-Drugs-Exploding-Antidepressant/dp/046502016X

    Psychiatric drugs alter the brain chemistry, there is no question about that, however they do not “treat” the DSM invented diseases. It has been shown many times that long term these drugs are just active placebos that have severe side effects. Something that puzzled many psychiatrists is that outcomes were better in those poor countries where people did not have access to drugs. The statement by Tom Insel is just an acknowledgement of something that has been known for years.

    Link to this
  55. 55. TMarshmallow 11:03 pm 05/6/2013

    Softwarematters wrote:

    “It has been shown many times that long term these drugs are just active placebos that have severe side effects.”

    No, this has not been demonstrated. The Cochrane group produced a review on the matter of antidepressants versus active placebos. The review found an effect size of 0.39 in favour of the antidepressants. Admittedly this is not great but it contradicts the claim that antidepressants are “just active placebos”.

    Refer
    http://www.ncbi.nlm.nih.gov/pubmed/14974002
    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003012.pub2/abstract

    Link to this
  56. 56. TMarshmallow 11:27 pm 05/6/2013

    esurma7 you wrote:

    “If we look at this from the superficial level, talking to animals = mental illness, regardless of the motive, understanding, etc. of the subject. If we find a “talking to the animals” circuit in the brain, we can treat both of these examples with drugs, electricity, etc. and “cure” the person. Yet, are both in need of treatment?”

    It appears that in your psychological studies you are unit to complete any units on psychopathology. Please don’t offer examples of what we would consider eccentricity as cases on which to form conclusions about the nature of mental illness. Psychiatric hospitals are not filled with eccentrics that talk to plants and animals rather they are largely filled with those with anxiety and mood disorders that are experiencing great anguish, many times to the point of being driven to try and end their lives.

    If you want to reason about the nature of mental illness then do so using realistic examples not silly ideas. Clearly if a person is so racked with feelings of guilt, shame, worthlessness, hopelessness and meaninglessness that they don’t want to go on living they need some form of help. Very often — usually in those cases where all hope has not been extinguished — the person will ask for relief.

    You wrote:

    “This is where subjectivity plays such an important part in my view, and that even if all behavior can ultimately be traced to “hardware”, looking at the hardware from purely objective criteria will not “solve” mental illness.”

    In what sense is the suffering of those with severe anxiety or depression “subjective”? As far as I can determine, the welfare of a sentient creature is an objective measure. Certainly the diagnosis — at this point in history — is based on a subjective report but if suffering is reported (or apparent from signs such as constant crying) there is no room for interpretation. Why is that cases of purely physical pain don’t ever receive this sort of pseudointellectual theorising about subjectivity but cases of mental anguish are oversupplied in this regard?

    Link to this
  57. 57. TMarshmallow 12:45 am 05/7/2013

    jsweck:

    You wrote:

    “Software is information in memory.”

    Software is still deemed software regardless of its location or form of encoding. When MS Office is on a DVD it is still considered to be software. Further, software is a special type of information in that it consists of algorithms and data structures, it is essentially instructions to the hardware. If I were to summarise software in line I would say “Software is instruction to the hardware” NOT “Software is information in memory”.

    You wrote:

    “When software engineers create a system they create their own structure out of pure information. By “pure” I mean to emphasize that there’s no hardware components in the system”

    You seem to be confusing high level languages (HLLs) such as C++, C#, Ruby, Perl etc. with what computers actually load and execute, viz. machine language. The high level constructs in HLLs are essentially useful fictions, there are no such things as functions, subroutines, objects or even data types in machine language. Compiled code — i.e. a blob of machine language — is software and its elements consist entirely of referents to hardware. Machine language is incomprehensible in the absence of its target hardware.

    You wrote:

    “This universe-creating capability of software is why game companies use software to build their game worlds”

    No they use software because that is how you get a stored-program computer to do things. It is entirely possible in a hypothetical world — call it AW1 — in which practicality and efficiency are no concern that users purchase a complete computer system for every function they require (this is actually how computers were in the distant past). In AW1 there is no software, all program code is hardwired into the hardware. If you want a wordprocessor you buy a word processing computer, if you want a spreadsheet you buy a spreadsheet computer, if you want the game Gods of War you buy the Gods of War computer and so on. Computers don’t need software. In AW1 there are no software defects because there is no software. If the wordprocessing computer is misbehaving its hardware is altered to correct that problem. The stored-program computer and its reprogrammability via loadable software is a great design feature but it is not in any way essential to computing.

    You wrote:

    “I’ve done both, and I can tell you that all hardware and software concepts are completely separate. If you think otherwise, then give me an example.”

    Writing a device driver; writing a compiler; writing an operating system; writing an application that diagnoses hardware faults; writing a program that defragments a harddisk drive; writing a program that emulates hardware (such as VMWare); writing an assembler; programming graphics and sound by accessing the video card and sound cards directly (as per MS-DOS and Windows 3.1 and Windows 95); etc. etc.

    You wrote:

    “A flip-flop and a bit are two separate things. With varying hardware, the bit is implemented with all sorts of things like magnetic domains, paper tapes, mechanical switches, etc.”

    No, a bit is an _abstraction_ of a flip-flop circuit. The idea of an abstraction appears to be missing from your conceptual vocabulary. There really is only the underlying hardware and the manner in which it represents binary states. The bit — as conceived in relation to programming — is just an abstraction, a useful fiction.

    You wrote:

    “The structural hierarchy of the software typically is bits, variables, functions, objects, applications, etc. ”

    Bits, variables, functions and objects are just abstractions, i.e. useful fictions, they have no existence outside of the text file of source code. When the source code is translated into machine language they cease to exist even as abstractions.

    Responding to Azuaron you wrote:

    ‘“Translation + calculation will always be slower than pure calculation.”
    Why does this matter?’

    Azuarons point is that compilers, interpreters and macro assemblers give programmers the (useful) ability to pretend that computers can do things which in actuality they can’t do. You seem to believe that CPUs can in fact do the things that HLLs allow to be expressed with ease, eg. insertion of a substring into a string.

    You wrote:

    “Good software people can have intimate knowledge of anything. The point is that they don’t need to know, because they are not going to be making any hardware.”

    Yes they are not “making any hardware”, that is a stupid point that is not worth making. The central point is that many types of software, to be written, require an intimate understanding of the underlying hardware. For example, it is not possible to write a C compiler and standard library without having any knowledge of the target platform — it is literally impossible.

    You wrote:

    “If you switch the hardware to, say a photonic system, the software remains the same. Sometimes the software is changed to accommodate new hardware – but the change is a 100% software change, it’s not some hardware effect trickling up through the software…”

    The example of changing to a photonic system doesn’t properly capture the relationship between hardware and software. You can not take the version of MS Office for Intel/Windows and run it on PowerPC/OS X and this fact completely contradicts your bizarre claim that software is “pure information”.

    Further, software has to be “ported” to other platforms largely because of the underlying differences in hardware. A piece of machine language, i.e. an executable file, is CPU and OS specific.

    Link to this
  58. 58. Seth K. 3:04 am 05/7/2013

    Re: “Leaders in mental health…should think of what’s best not for their professions or the pharmaceutical industry but for those suffering from mental illness, who deserve better.” I think I should win the lottery – and that the odds of that happening are better than the odds that John Horgan will get his wish. For a sobering look at how these sausages are made one could do worse than to read Stuart Kirk and Herbert Kutchins’ “The Selling of DSM.”

    Link to this
  59. 59. jayjacobus 9:43 am 05/7/2013

    Computers don’t think like humans. If there is an error in the computer’s results, the computer program is debugged. So far the human brain can’t be debugged.

    Computers don’t have a natural perspective. Whatever perspective they seem to have is programmed in.

    A depressed computer doesn’t exist. Computers can’t feel depressed. If the computer acts depressed it is faking it as a result of a “faking it” program.

    Studying computers won’t solve mental health illness.

    The treatment for mental illness sufferers has come from years of trial and error and is sometimes based on anecdotal evidence. Is it completely off track? Or is it better than 50 years ago?

    A complete change in direction does not seem feasible. No one here has suggested a different approach.

    Link to this
  60. 60. jsweck 2:07 pm 05/7/2013

    Greetings TMarshmallow,
    You are correct about software existing in different forms, but all of those forms are just varying memory systems. This is what I mean by Information in Memory. It doesn’t matter that we load machine language as part of our software systems. No matter what we load, it’s still software because its information in memory.
    Software is not some sort of option in computers. It is at the core of all problem solving. There are no hardware problem solvers that I know of. The same applies to world-building. If you attempt to make an artificial world with hardware, you’ll get something like DisneyLand, not World of Warcraft.
    In all of your examples of hardware/software concepts you are specifying a software system only. This only requires cognizance of hardware to make better software. No hardware was created at all. At meetings, people speak of hardware, or software, but not both at the same time. In manuals, there are software chapters and there are hardware chapters. The electrical engineers ignore the software parts completely, and the software engineers ignore the electrical engineering parts completely.
    Bits are the core of current software engineering, because they anchor the entire software system. Bits are a real thing composed of pure information. The flip-flop is just one of many hardware ways of bringing a bit into existence.
    Software is not merely some abstraction. Information is a real thing, and memories are real too. With software you can build software structures, processes, and with them an entire world.
    Computers never pretend they can do things – they either do it, or they don’t. CPU’s are irrelevant to problem solving. Only the software solves problems. For the most part, the hardware exists to run the software system.
    Many of your comments are overly specific about the software you are personally familiar with. Try think about software as information in memory instead. You can use as an example, a book, which is also a hardware/software system. This will allow you to think about softwares that are more alien, like genomes.
    “Further, software has to be “ported” to other platforms largely because of the underlying differences in hardware.”
    This is not relevant. Hardware is not being developed by the software people. The software people almost never develop the hardware, and when a single person does both, they are doing two completely different jobs. This is nothing like having a physicist and a chemist talk to one another.
    Software is made of pure information, and is utterly different from any of these disciplines. Current computer software has far more in common with writing than electrical engineering.

    I hope I’ve answered your questions.

    Link to this
  61. 61. TMarshmallow 12:49 am 05/8/2013

    jayjacobus:

    I agree 100% with your comments re computers. Studying computers will neither contribute towards treating mental illness nor understanding the brain.

    “Is it completely off track? Or is it better than 50 years ago?”

    Psychiatry (and neurology) are lagging behind other branches of medicine but it is unclear whether this is due to the brain being the most complicated organ in the body or whether there is something fundamentally wrong with the foundational assumptions of psychiatry. General medicine was ineffectual (and dangerous) before microbes and antibiotics were discovered and at one point in the history of medicine there was no objective means of diagnosing diabetes. It would have been a grave error if it were rashly concluded that general medicince was completely off-track in the 17th C. and the existing work and approach was discarded. Perhaps psychiatry is now where general medicine was in the 17th C.?

    I think psychiatry is more effective now than it was 50 years ago. I have chronic MDD and if I were in my position 50 years ago I think I would have ended my life. To be clear, I don’t think the psychiatric pharmacopoeia is great but it is better than nothing. I achieve partial relief from the symptoms of MDD, the very worst symptoms subside and that is sufficient for me to at least shelve the idea of suicide. But I acknowledge the limitations of the drugs. In an earlier post I cited a Cochrane review of antidepressants vs. active placebos which found an effect size of 0.39 in favour of the antidepressants. This isn’t anything to brag about but it does show that antidepressant medications are better than placebo (even active placebo).

    Psychotherapy — i.e. the talking therapies — have shown only modest results in relation to anxiety and mood disorders and poor results in relation to psychoses. The psychotherapies have been developing in parallel with the pharmacological therapies and they too haven’t really delivered much either.

    A point in defence of psychiatry vis-a-vis other branches of medicince is that psychitary lost much valuable time as a consequence of the influence of Freud. Psychoanalysis (and the other offshoot psychodynamic therapies) is/are junk and decades were lost on wild goose chases and dead ends.

    Finally, it will take many years for the decision of the NIMH to filter down to clinicians. The NIMH is one research granting organisation.

    “A complete change in direction does not seem feasible. No one here has suggested a different approach.”

    Indeed. There are people here cutting and pasting stuff that they have collected from the various anti-psychiatry websites on the www, some of it (poorly) paraphrasing Szasz. Szasz — in his 50 or so years of anti-psychiatry critique and rhetoric — failed to offer an alternative. He offered only platitudes such as that those with (what psychiatry deems to be) mental illness need support and that (what psychiatry deems to be) mental illness is due to “problems in living” (someone here actually used that phrase). Szasz failed to explain how “problems in living” can cause someone to experience the symptoms of schizophrenia whereas others experiencing “problems in living” will instead experience anxiety and depression. On the face of it it does seem reasonable that “problems in living” would contribute to anxiety and depression but how — in specific terms — do they contribute to schizophrenia and other psychoses? Szasz didn’t tell us.

    jsweck:

    Computers are completely irrelevant to the matter of mental illness and the brain so even if you were correct about the nature of hardware vs. software (which you aren’t) then you would still have no point. We will learn more about the brain by studying the brain not by studying computers.

    The above not withstanding your ideas about software vs. hardware remain incorrect and your dialogue remains evasive.

    “Software is not some sort of option in computers.”

    Software is an option. Prior to the stored-program computer there was no such thing as software, program code was hardwired into the hardware, it was part of the hardware.

    “There are no hardware problem solvers that I know of.”

    Now there aren’t but that is because now almost all computers have the Von Neuman architecture which is a type of stored-program computer. The key point is that non-stored-program computers are still computers and they have no discernible software.

    “The same applies to world-building. If you attempt to make an artificial world with hardware, you’ll get something like DisneyLand, not World of Warcraft.”

    It is (theoretically) possible to create a World of Warcraft computer, i.e. a non-reprogrammable computer with World of Warcraft implemented entirely in hardware.

    “In all of your examples of hardware/software concepts you are specifying a software system only. This only requires cognizance of hardware to make better software. No hardware was created at all.”

    No, you are being evasive. It is not possible to write a device driver, a compiler or an operating system without referencing the hardware and its peculiarities. Producing the back-end of a compiler requires that you understand the CPU instruction set, the CPU registers, the endianess of the CPU and the word size amongst other things. This shows that your claim that “software is pure information” is false as a generalisation about software. If software were “pure information” then it would somehow be possible to write a compiler (including the back-end) that is able to produce executable files for _all_ computers. No such compiler exists.

    “At meetings, people speak of hardware, or software, but not both at the same time. In manuals, there are software chapters and there are hardware chapters. The electrical engineers ignore the software parts completely, and the software engineers ignore the electrical engineering parts completely.”

    Again this is a false generalisation. This is true only of a subset of software. Writing a compiler, device driver, hardware emulator (such as VMWare), disk defragger, Anti-Virus requires simultaneous concern with both software and hardware. Yes I could write a bash script that sorts the lines in a text file into alphabetical order and I will not need to refer to the underlying hardware to create such a script but such a bash script is not definitive of the entire universe of software. You are drawing an unjustified conclusion on the basis of considering only a subset of software types.

    “Software is not merely some abstraction.”

    Software is entirely an abstraction. One popular CS textobook defines computer science as _the mechanization of abstraction_ (see http://infolab.stanford.edu/~ullman/focs/ch01.pdf). C++ source code — for example — is nothing but an abstraction, there are no such things as objects, trees, graphs, linked lists, structures, and templates in the real-world, those are just abstractions of things that exist in the real-world devised to make problems in the real world tractable by computers and computation. Further, these abstractions vanish when the source code is translated into executable code. The CPU has no “understanding” of objects, there is no such thing as object-oriented programming as far as the CPU is “concerned”. To the CPU all code is entirely procedural.

    “With software you can build software structures, processes, and with them an entire world.”

    You can build _virtual_ worlds and that is all. The World of Warcraft is a virtual world and it is a virtual _world_ only because of our imaginations.

    “Computers never pretend they can do things – they either do it, or they don’t.”

    That is egregiously false. Computer graphics is an illusion. An apparently 3D cube that is rotating on your monitor is just an illusion — it must be because your monitor can represent only two dimensions. A compiler for a HLL (High-Level Language) creates the illusion that your computer can “understand” such things as complicated algebraic expression, matrices and declarative statements. It can do none of those things. Languages such as Perl, Ruby, Python and LabView are translated into machine language which consists of very simple instructions to the CPU. HLLs are (very useful) fictions.

    “CPU’s are irrelevant to problem solving.”

    That depends entirely on what language you are programming in and what sort of software you are writing. If you are writing a compiler then the CPU is central to the task (of writing the back-end of the compiler). If you need to optimise an inner loops then the CPU again becomes central to the task.

    What if your programming language of choice is assembly language? There are many people that write Win32 applications in Microsoft Macro Assembler (see http://www.masm32.com/). The CPU and its instruction set are central to the task of programming in assembly language. An assembly language program is software. So again your generalisation is shown to be false.

    “Only the software solves problems. For the most part, the hardware exists to run the software system.”

    No, the software and hardware together solve problems. Either alone is impotent. The source code for an accounts receivable system will not help you manage your debtors nor will the executable code.

    “Many of your comments are overly specific about the software you are personally familiar with. Try think about software as information in memory instead.”

    LOL! The problem is that you are making generalisations about software completely divorced from the real world. The purpose of my specific examples is to show that you generalisations are false. I am familiar with a broad range of software both as a consumer and as an author and I have a rudimentary grasp of Information Theory. Your conceptualisation of software as “pure information” is idealised, fictional and entirely divorced from reality. I think the way that I conceptualise software is just fine.

    “This will allow you to think about softwares that are more alien, like genomes.”

    DNA is not software. An analogy could be made between DNA and software but that analogy is crude and imprecise. There is nothing to be gained by smashing everything you find (brains, DNA, what else?) into the model hardware/software. Yes, DNA does encode information using sets of three nucleotides, but that doesn’t make DNA software. A useful analogy requires that the two things you are relating have many elements in common. We don’t treat a dining table like a cat just because both have four legs.

    ‘“Further, software has to be “ported” to other platforms largely because of the underlying differences in hardware.” This is not relevant.’

    It is relevant because it demonstrates that software is not “pure information”. If software were pure information then software would not need to be ported, it would just run on any platform that you cared to deploy it on. Software can not be “pure information” because there are no such things as interpreters and executors of “pure information”. Every machine that is capable to decoding and acting on decoded information expects a particular type of encoding and representation. “Pure information” and the machines that understand it exist only in your imagination.

    “I hope I’ve answered your questions.”

    No you haven’t answered any of them. You haven’t even attempted to answer my points. You just ignore whatever you don’t have an answer for and just repeat yourself.

    Link to this
  62. 62. jayjacobus 11:55 am 05/10/2013

    Software and hardware create instructions on how to process information. I was taught that software could always be turned into hardware. The switches in hardware are tangible. The switches in software utilize the hard switches to create code.

    Information could be a record. A record is not hardware or software.

    Link to this
  63. 63. American Muse 4:17 am 05/11/2013

    The DSM-5 manual is a conceit. Why not just use the ICD manual (International Classification of Disease) like all other medical specialties do? We do not need an American diagnostic manual for psychiatry alone.

    Link to this
  64. 64. jsweck 9:35 am 05/11/2013

    Greetings TMarshmallow,
    ” We will learn more about the brain by studying the brain not by studying computers”
    In order to understand difficult systems that you don’t understand, it helps to use a system you do understand.
    “ …program code was hardwired into the hardware, it was part of the hardware.”
    Software is never part of the hardware – they are always separate systems. Older systems simply stored their software in different ways – they still had information stored in memory, aka software, in their systems. It doesn’t matter that they may have used different names for it.
    “…Von Neuman architecture which is a type of stored-program computer. The key point is that non-stored-program computers are still computers and they have no discernible software.”
    Computer architecture is irrelevant – it’s more hardware. Software is the stuff in the memories, the stuff they leave out of the hardware diagrams. All computers of any architecture use software. The only way to eliminate the software is to eliminate the memories. If you get rid of the software, you are getting rid of the problem solvers, and the system will act like it’s in a coma. You cannot build a hardware version of World of Warcraft – not even a tiny piece of it. In the same vein, you can’t build a mind out of neurons – it’s a software-only concept.
    “…It is not possible to write a device driver, a compiler or an operating system without referencing the hardware and its peculiarities…”
    Actually it is, but you would write a pretty bad driver. When people design software, they may have many areas of knowledge in their head – this doesn’t tie that knowledge to the nature of software. For instance, what is the nature of the crocolisks in World of Warcraft? They are software entities only. The person responsible for crocolisk behavior may have a degree in zoology when he programmed its behaviors, but that doesn’t mean that zoology is somehow the basis of software systems.
    “…abstractions …”
    Software is a real thing. It is the information in memory. It doesn’t matter how you make it, or stir the pot, or how you arrange it. All that matters is information and the memory system hardware that contains it. It is not your cpu, or memory hardware, or logic gates, or whatever, that control the system – it’s the software. Only software understands things, experiences things, perceives things, and learns things. The hardware guys would give you a blank stare at any of these concepts.
    “You can build _virtual_ worlds and that is all…”
    Virtual means software. Our imaginations come from our minds, but mind is yet another software system.
    …illusions…HLLs are (very useful) fictions”
    These are not illusions at all. I know exactly what I’m getting with computer languages and graphics systems. At no time is anyone “fooled” in any way. Yes, they are useful tools, but they are not fictions.
    The reason that CPU’s are irrelevant to problem solving is because all of the hardware is irrelevant to problem solving. There is no special hardware that solves problems – no hardware solves problems. The reason software is in the system at all is to solve problems. The job of the software engineer is to generate the behavior of the system. He accomplishes that using a 100% software solution. All device drivers are 100% software entities.
    “The CPU and its instruction set are central to the task of programming in assembly language. An assembly language program is software”
    Exactly. It’s not a CPU at all. Software is information only.
    “No, the software and hardware together solve problems. Either alone is impotent…”
    Correct they do, as two completely different systems. What does each system do? Roughly speaking, the software is the problem solving machine, and the hardware contains the software system. That software is why people use computers. Books work the same way, no one cares about the paper and binding (the hardware memory system) – they care about the story (the software system).
    “The problem is that you are making generalisations about software completely divorced from the real world.”
    Have you ever seen a software system that didn’t exist inside a memory? Do you really think that books contains no software, or that genomes aren’t’ software systems?

    Link to this
  65. 65. jayjacobus 9:56 am 05/13/2013

    There is often a master – serf relationship between psychiatrist and patient. But the psychiatrist doesn’t know how the patient feels and may continue a treatment / medication that doesn’t work.

    Patients may have insights into their own suffering and some patients may understand the needs of other patients better than the psychiatrist. In my opinion patients should be more involved in research and treatments.

    In other words, patients can be more than passive participants in mental health.

    Link to this
  66. 66. Delicia 1:23 am 05/15/2013

    The United States truly amazes {and disappoints me} in so many ways.It seems they are almost always changing something but almost never have another SOLIDlY WORKING set of plans to set in place. I suffer from Depression and Anxiety. I have two sons who suffer Schizophrenia, one really bad and another who doesn’t suffer it as extremely as his brother. I can only imagine what a torture it is to hear voices and see “beings” almost every waking moment of ones life. Still, despite my best efforts on behalf of my sons such as one on one with their doctor I didn’t get anywhere with helping my sons getting their meds tweeked to suit their needs.They got what the doctor “thought” would be best for them because all the “nuts” are the same to them. One time my oldest literally looked, acted, and talked like Lurch from the Addams Family because of the drugs given him. He also at that time swallowed batteries.Did the doctors and therapists listen. No.Not until he swallowed the batteries and even then they didn’t give him what was best for him.Just what Medicare and Medicaid would allow {he’s on Social Security}. And just recently when he was in court and the judge stood up for him demanding that his medications be conformed to his needs after which he was sentenced to a year to 3 in a low security prison. And what else gets me is this country doesn’t like alternative forms of healing AND even backs insurance companies {including Medicare and Medicaid} from allowing insurance to pay for these alternatives that in many cases get to the core problem of an illness and not just glossing it over with medications. In my opinion, West needs to meet East badly as well as other forms of healing such as subliminal messaging, chakra healing, Reiki, Healing Touch, and others.We are a pill popping country and the government likes it that way. But until we take all the knowledge we have and all the other knowledge that is known in other countries and put it together, analyze it,and actually do something positive with that knowledge we will keep having Newtown incidents that are blamed on gun owners. We will keep having suicides, serial killings, rapes. The human psyche needs studying and understanding. It needs all positive health practices and support through insurance companies. Health care professionals need to care-whether Medicaid or Medicare {or an insurance that isn’t very good}is being used.Also professionals need to understand that though a disease has a certain name its effects are different on everyone as each one of us are individuals. If our fingerprints are unique; why not the rest of our body?

    Link to this
  67. 67. newzbug 1:47 pm 05/22/2013

    So with all this arguing about who is right, who is wrong and what is what, where does that leave someone like me. Without psychotherapy and subsequent medication I would have died. God knows I have tried. Since when are medical books a how-to be a doctor exactly that? If that were so, you just read a book and become a doctor. Can’t the books themselves be guides where one uses logic, information available, incoming science. Does anyone really think about us, the people who are suffering with the crap? I suppose you could just throw is into the mental hospitals that all the government closed and lock us away. Experiment on us as you once did and then write your journals and call your self “scientists”. I guess that would make you feel better wouldn’t it?!!

    Link to this
  68. 68. jayjacobus 10:13 am 05/23/2013

    I had a tumor in my right adrenal gland. The doctors were treating me for hypertension ( a symptom). Their treatment wasn’t working. My wife read a book about the reasons for hypertension and concluded that all my symptoms taken together pointed to a tumor in my adrenal gland. She insisted that the doctor give me two simple tests. The testing led to MRI which showed the tumor.

    The doctors were unaware of all my symptoms because they saw high blood pressure and stopped there. Thank God for my wife’s involvement.

    Doctors are the best chance for effective treatments and cures but doctors can be wrong. Let the patient be aware that treatments / medications that aren’t working should get checked by the most experienced / knowledgeable source.

    Link to this
  69. 69. endrun 12:01 pm 12/31/2013

    While you are arguing over hardware and software, trillions of dollars(not thousands, not millions, not billions–but trillions) more will be wasted through insurance in procedures which destroy civil, constitutional, and human rights called involuntary commitments, practiced by Psychiatrists, in processes that disallow the same level of procedural protection afforded accused criminals. In the United States, this means not only thwarting the federal constitution and often enough state laws(the mental health system never pays any attention to any provision in those built in to protect the patient), but also thwarting its international treaty obligations on the issue of human rights. What this equals is a level of hypocrisy on the issue of human rights by the United States as presented to the rest of the world. So the next time you think about Psychiatry, try to think about these abuses which happen regularly and constantly. Thank you.

    Link to this
  70. 70. allintheasylum 11:46 am 11/10/2014

    Love the way you got “soul” and “science” in the same sentence!

    Link to this

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