neurosciencenews.comPosted Jul 8, 2019, 10:21 PM UTC
I find the title somewhat disingenuous here. This is a publication, and it is research, but it is not the kind of quantitative, systematic research that one usually thinks of. I think this falls under the heading of so-called qualitative research, although what that means is as fuzzy as what it often is. Allsopp and Kinderman, at least, are covering fairly familiar ground at more length.
And "scientifically meaningless" is scientifically meaningless. These are entities that have been defined, have studied inter-rater reliability for various diagnostic tools, and yes, have been studied scientifically. Perhaps the intent is to say that they are clinically worthless? But it seems fairly self-evident that they are clinically useful even if they are as fuzzy as the authors say.
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It´s still the best thing we´ve got to do the job. Cheers budy
Psychiatry is discipline still very much in its infancy and nobody is pretending that we have all the answers or that our current conceptions map all that meaningfully on to the complexities of the brain and its various maladies.
Now I'm all for some good faith criticism of the DSM, or even the field as a whole, but there are a few red flags for me about this particular study, with some tone and language stuff in what little I read which strikes me as a little suspect.
For one thing, there's a repeated emphasis on the importance of trauma here, where they seem to deviate from their central negative claim, that psychiatric diagnoses are meaningless, to positive claims about what is actually relevant.
As something as an aside, I'd say that if anything there is far too much emphasis on the causative role of trauma in psychiatry, both in theory and in practice. The human psyche is generally far less fragile than I think it's often given credit for.
It boggles my mind, for example, that psychodynamic psychotherapy continues to exist to the extent that it does, with trained professionals routinely insisting that someone's personality issues stem from unresolved issues with their mother.
Psychodynamic psychotherapy is more than dealing with unresolved issues with their mother. It might be more accurate to say that it deals with unresolved issues from development.
However, it’s more closer to define Psychodynamic psychotherapy as an examination of the interplay between unconscious and conscious mental activity.
And it can be very effective for neurotic disorders if the patient is willing to invest time and effort into their recovery.
Thanks for the reply.
I'm a long way from being an expert on the subject, more an interested observer really, but I am closer to the current state of relevant sciences here and terms like ‘unresolved issues’, ‘defense mechanisms’, ‘transference’, or the idea of the conscious and unconscious as these separate entities battling it out - the best that I can tell, these are essentially meaningless ideas in the context of what we now know about how the brain works.
The core idea at the heart of psychodynamics, that our early life experiences set in motion personality processes that will affect us for years to come, just doesn’t map on to reality. The weight of the evidence right now strongly supports the idea that parenting has no effect on things like personality development, intelligence and a number of other significant outcomes. As it turns out, what makes you you comes from your genes, the noise inherent to neurodevelopment, and then environmental factors outside of the home.
Your relationship with your parents simply doesn’t play a role.
You’re way off the mark.
How can you say an idea is ‘meaningless’. Psychodynamic concepts are clearly defined and very usable. They can help understand why a person might be exhibiting a particular behaviour.
Your claim that early life experiences doesn’t affect personality development couldn’t be more wrong. I’d be interested to see any research that supports this claim.
Childhood experiences absolutely influences personality development. It’s true that it’s filtered through genetics but what happens in childhood drives adulthood. Have you done any reading into the effects of childhood trauma/abuse on personality development?
It’s laughable to suggest that childhood abuse won’t affect the adult. Parents are the noise of development.
Sorry for the delay in replying. Felt the need to write something a bit more considered if I'm going to have any hope of “red pilling” you on this.
I totally understand how radical the idea sounds if you haven’t come across it before. We have incredibly strong intuitions that push against this. I may as well be claiming that up is down or that water isn't wet.
And while it doesn't particularly surprise me that as an psych trainee you haven’t come across this already, to be clear, this isn’t some out-there fringe view. This is very much a recognised idea within academia with an increasing body of work to support it. It just hasn’t filtered down to the professions yet.
So the idea first came from a woman called Judith Rich Harris, who’s got a pretty remarkable story actually, and who you might think of as the John Bowlby of this. Harris wrote a paper on this in the mid 90's, which made shockwaves. She followed it up with a book a couple of years later, The Nurture Assumption, which I’d recommend.
Harris had looked extensively at the research into developmental psychology, and the relationship between parenting and various outcomes. On a basic level, thousands of studies showing good parents having good kids and bad parents having bad kids. What occurred to Harris was that from all those decades of research, all those data actually showed was a correlation. Causation had always just been assumed, but never demonstrated.
It was already known at the time that about 50% of the variance (ie the differences within the population) in personality and intelligence were attributable to genetic differences, with the remaining 50% assumed to have come from parenting. Harris really made two claims. Her first,(and main claim), was that the remaining 50% has nothing or very little to do with the home/parenting (the so-called “shared environment”). Her second claim was that the remaining 50% was better explained in terms of the peer environment (the “non-shared environment”). Harris backed up her claims with evidence from family studies.
While the second claim hasn’t stood up entirely, since Harris there’s been an enormous amount of evidence from various places, particularly behavioral genetics and population studies that seem to confirm the first. Probably the most compelling results come from twin and adoption studies, which provide an elegant and robust way to separate out and measure the relative contributions of the factors involved.
The literature is extensive, but I'll use a couple of examples to illustrate.
First, from adoption studies. In a highly replicated and consistent finding, adoptive siblings raised from infancy in the same home, by the same parents, are no more similar to each other in personality or intelligence than any two random people selected from the population.
Twin studies are particularly helpful since obviously they naturally control for the genetic contribution. We can compare monozygotic twins that were raised together with monozygotic twins who were raised apart. In both cases the genetic effects are the same, acting to make them more similar. So, if the family environment really does have an effect on, say personality, then we should expect that the twins raised in the same home are going to be more similar in personality than the twins that were raised apart.
Allow these words to really sink in and take a moment to process the implications; monozygotic twins who are raised in the same family are no more similar to each other in personality or intelligence than monozygotic twins who are raised apart.
Now, it’s important to note that not all traits show no parental influence. Depending on the specific thing you’re looking at, the contribution of the shared environment ranges from zero to large. These kinds of studies have been repeated countless times, and results remain remarkably consistent; where there is no effect of the shared environment, they consistently come out as showing no effect. Where there’s a moderate effect, it consistently comes out showing the effect to be moderate.
Here’s a big and important meta-analysis from a few years ago looking at 50 years of twin studies (n=30,000,000);
https://www.nature.com/articles/ng.3285
It also has an awesome web tool to play around with where you can look at the various contributions to particular things. It's a bit technical but there’s a basic version and instruction video;
https://match.ctglab.nl/#/home
Now, as for abuse and trauma. What I’ve mentioned so far really concerns the normal range of personality and does not include psychopathology. In terms of trauma, abuse, and neglect, the jury is still out. There just isn’t the data yet.
Personally, I’d be very surprised if severe abuse was found to not to have an effect on personality development. But I am increasingly skeptical about the emphasis in psychiatry on the role of “trauma” in things like Borderline Personality Disorder. It seems to me to be founded on false assumptions and to be every bit as suspectable to the kinds of confounding errors we see in developmental research from the past. Clearly, trauma correlates with BPD, but to my knowledge, a causal role hasn’t been demonstrated.
For one thing, the term “trauma” tends to be used so elastically it ceases to have any real meaning. I’ve seen it used for anything from prolonged sexual abuse all the way to the totally normal developmental experiences like the death of a grandparent. I recently saw a girl diagnosed with BPD, with her documented “trauma history” being simply that she was born in South Africa.
Now as it happens, just the other day came across a new study looking specifically at Borderline Personality. It shows a heritability of around 50%, which is no great surprise, but very much in keeping with what's been said above, it shows that none of the remaining variance comes from the family environment. Now, this doesn't exclude the role of trauma overall, but does mean that if traumatic events are playing a causative role, then these must routinely be occurring independently from the home (ie as part of the “non-shared environment”).
https://www.nature.com/articles/s41380-019-0442-0
For a very good summary of where we’re up to with all this right now, I’d strongly recommend the recently released book Innate by Prof Kevin Mitchell, a neurogeneticist at Trinity College, Dublin.
Lastly, I’d recommend giving the following podcast a listen. The show is called The Very Bad Wizards, it’s a very popular psychology/philosophy podcast. This episode they have Paul Bloom, professor of psychology at Yale University on to talk about this stuff. It’s a very good primer.
https://verybadwizards.fireside.fm/162 (the relevant part starts at 39 minutes in).
Not the person you were responding to, but here are two twin studies, one on the heritability of Cluster A PDs, and one on the heritability of cluster B PDs.
The results are pretty striking, this is a quote from the abstract of the second paper (emphasis mine):
the heritability of the convergent latent factor, including information from both interview and self-report questionnaire was .69 for APD, .67 for BPD, .71 for NPD, and .63 for HPD. As is usually found for personality, the effect of shared-in families (familial) environment was zero.
Stepping outside of the realm of psychological pathology, here is another twin study that looks at the heritability of the Big 5 Personality Traits. Again, the abstract (and again, emphasis mine):
Broad genetic influence on the five dimensions of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness was estimated at 41%, 53%, 61%, 41%, and 44%, respectively... The influence of the environment was consistent across all dimensions and facets. Shared environmental influences accounted for a negligible proportion of the variance in most scales, whereas nonshared environmental influences accounted for the majority of the environmental variance in all scales."
I was of similar intuitions - that family influence should have a very significant effect on development, but it's hard to escape the fact that study after study in personality psychology suggests that the shared environment, at least for the average individual, has a negligible effect on personality.
What books would you suggest for further reading into the effects of childhood trauma/abuse on personality development?
Would you share the papers that show that parents have no role?
I'm very critical of the love psychiatry still has for Psychoanalysis/Psychodynamic ideas but saying that parenting has no effect on those things while environmental factors outside of home do doesn't sound right.
ideas but saying that parenting has no effect on those things while environmental factors outside of home do doesn't sound right.
I wrote a response to u/gandalfsgreypubes below that is responsive to this point - you might find it interesting.
I really disagree with you on this as well! I don't have time to type out a long response to give this justice, but I've found conceptualizations such as attachment theory very intuitive and clinically useful to improving the lives of so many patients with "depression," "anxiety," and trauma related disorders.
So many people suffer by walking around with constant secondary emotions and defensive habits that developed because their early-in-life caregivers and overall environment were not conducive to processing core emotions properly. I love psychopharmacology, but it's very limited in many scenarios in providing significant change if utilized alone.
Attachment seems to me to be an extremely useful and well-evidenced tool, but from my reading of things, that’s really only in terms of describing the relationships in front of you.
It seems to me that we're on far shakier ground when trying to use it to either make predictions about the future, or more commonly, to retrospectively explain current psychological issues in the adult. That's when I fear we're getting more into tea-leaf reading territory.
What's become clear quite recently though, is that infant attachment correlates very poorly with adult attachment. There have been a few recent meta-analyses on this, and the best numbers from those, the best numbers mind you, show a correlation coefficient of 0.14 (from memory). That's not zero, but its significantly less than what we'd perhaps expect if we are working from the idea that infant attachment is a super important indicator of future relationships.
One obvious problem I see with psychoanalysis/psychodynamics is that while there isn’t a shred of evidence for any of it, it remains largely internally coherent, meaning that from the inside it’s self-justifying and appears to make a great deal of sense.
In that way, I think psychodynamics has far more in common with theology than it does with science; If you already believe in God, you’ll see evidence for him everywhere.
I wish we would just say problems rather than give diagnoses: psychosis, mood, anxiety, substance use, complex trauma etc... I’d also take the word, “personality,” out of personality disorders. These changes would generally be more accurate ways of talking about psychiatric illness. Getting rid of the word “personality,” would make those diagnoses less stigmatizing and more acceptable (now people get tons of other diagnoses first because it’s hard to give and accept that there is something wrong with your personality).
Haven't read the article yet but thought you might find it interesting.
I thought it would be good to hear everyone here out before r/psychology explodes in exaggeration.
Wow, I am glad that the psychiatry community is finally acknowledging that psychiatric diagnosis is scientifically meaningless.
Not going to read through a 350 page manuscript to give a one-liner conclusion like the author of this article, but;
- Is the claim that subcategories of, for example, depressive illnesses do not correlate with outcomes and causes, or that there is no meaningful difference between a diagnosis of a schizophreniform illness and a depressive illness?Because as far as I am aware, a diagnosis of melancholic depression versus atypical depression versus major depressive episode has only ever been a way to simplify the language used to describe patient's ailment when communicating with patients and healthcare providers, rather than having to specify how exactly how their sleep is affected, how their appetite is affected and what their level of functionality is etc. I don't think any psychiatrist thinks there is a strong biological basis (as opposed to a social/historical one) for why one person becomes anorexic in response to a major depressive episode and one person overeats.
- The neurobiology of schizophreniform illnesses is as distinct from the neurobiology of anxiety disorders as the physiology of COPD is from that of lung cancer. It doesn't matter that they can both be precipitated by the same insults, whether that be a traumatic experience or long-term cigarette use.
- The point that individual experiences aren't accounted for in the medical description of psychiatric diseases is an invalid one. No (credible) psychiatrist dismisses developmental psychology, nor the fact that the sea of causes and effects that constitute a human life is much too complex to synthesise in a short letter - that doesn't make the larger categories 'meaningless'. All categories at a fundamental level are arbitrary and contingent on available knowledge. Medicine used to call all forms of mental fatigue 'neurasthenia'. In modern day, that category would include multiple sclerosis, the effects of previous strokes, autoimmune encephalitis, chronic traumatic brain injuries, depression, metabolic disorders, and even the cognitive effects of many cancerous states. This was therefore a 'meaningless' category because immunosupression doesn't fix a stroke but it sure fixes autoimmune brain disease. But categorising these changes as 'neurasthenia' provided a common lexicon for further categorisation and research which eventually lead to our understanding of how the nervous system works and the plethora of ways in which it can be affected.
- All this seems like is a roundabout way of saying that psychology and psychiatry are young sciences, and who doesn't already know that? The fact is, the mind is an emergent property of neurology, which is an emergent property of physiology, so a mature understanding of the mind is always going to come last. This reads like a physicist saying that cardiology is scientifically meaningless because you can't calculate exactly what any given person's heart rate will be after walking up a flight of stairs.
- Thematic analysis is a far less scientifically validated method of describing a systems error than the DSM-V. This a pot calling the kettle black.
Ooo this is a good and even handed comment on the issue. Doesn't throw the baby out with the bath water, but shines appropriate light on where the field is at.
Spot on. This is what we were taught about Thomas Szasz early on in Counseling school. The science is improving, but a healthy skepticism is always helpful.
Great response.
Two things:
I think I love you right now, I really do.
I always say that right now we're linnaean in our taxonomy of mental illness, but we're slowly becoming phylogenetic.
This part makes no sense. The expression of 'emergent properties' is used to talk about properties that can't be deduced from analysing the parts, they emerge at a higher level order. Nothing assures us that a better understanding of the underlying physiology will lead to a mature understanding of our psychological states. This just amounts to saying: 'later on we will get there, just continue along this path; hold on and we will solve it.'