Mental Disorders and Religious Sentiment...

[stamenflicker]

I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

 

[blutoski]

I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

I'm sure you're aware that there are certainly skeptics who are exasperated by this position. I've discussed it before in other threads, but skeptics shelve this under 'psychiatry denial'. My impression is that nothing that can be said will convince a PDer that the DSM-IV has medical value.

So, let me start this way: what would you be looking for to accept that a psychiatric condition is 'real'?

 

[Avita]

Thanks, Stamenflicker, for starting this thread. As you and I were both responsible for "corrupting" the other thread, I would like my questions from there answered before I try to formulate an answer to your OP in this thread. To quote:

I would like to know what you mean by an "empirical disease." You say that there are no clear lines of demarkation for depression, and contrast it with diabetes. However, many, many diseases are not entirely clear-cut, either. For example, this description of the usual first symptoms of hypothyroidism is taken from the Merck Manual -

The symptoms and signs of primary hypothyroidism are generally in striking contrast to those of hyperthyroidism and may be quite subtle and insidious in onset. The facial expression is dull; the voice is hoarse and speech is slow; facial puffiness and periorbital swelling occur due to infiltration with the mucopolysaccharides hyaluronic acid and chondroitin sulfate; cold intolerance may be prominent; eyelids droop because of decreased adrenergic drive; hair is sparse, coarse, and dry; and the skin is coarse, dry, scaly, and thick. Weight gain is modest and is largely the result of decreased metabolism of food and fluid retention. Patients are forgetful and show other evidence of intellectual impairment, with a gradual change in personality. Some appear depressed. There may be frank psychosis (myxedema madness).

The manual goes on to list a few more things, but all of them are in the same vein - they might or might not occur, and practically all of them could occur in a perfectly healthy person, or at the least, in a person suffering from something other than hypothyroidism. There is no line of demarkation between a healthy person's dry skin and a hypothyroid person's dry skin. You may say that we have very specific tests for the levels of thyroid hormones in the body, and indeed, we do. But before the doctor orders those tests, it has to occur to him/her to do so. And that decision is made on the basis of the above symptoms. Similarly, there are some tests for things like depression (not very specific yet, and usually extremely expensive, which is why they are rarely used in diagnosis), but everyday diagnoses are made on the basis of what we know about the likely experiences of people with mental disturbances.

And:

You also equate mental illness with religious sentiment. Considering that you say that religious sentiment is primarily due to trusting God (whether or not there's any evidence for God), I am curious to know more about what you mean by this comparison. Do you mean, for instance, that mental illness is due to some sort of conviction?

Now, I am off to bed to try, yet again, to fall asleep. The insomnia appears to be caused by both physical and psychological factors. Some of the physical things I am experiencing are caused by my mental state. And vice versa. How, I ask, can this be, if mental diseases are subjective?

 

[blutoski]

And vice versa. How, I ask, can this be, if mental diseases are subjective?

I'd also like to ask: what's wrong with subjective? Most organic 'diseases' are, too. You brought up hyperthyroidism, but I'd like to add:

• back pain
• headaches, including migraines
• any type of pain-based illness, actually (there are 'fibro deniers')
• cholesterol levels (what's 'too high'? - there are 'cholesterol deniers')
• blood pressure (what's 'too high'? - there are 'blood pressure deniers')
• sodium levels (see 'blood pressure deniers')
• addictions (how 'serious' is an addiction to caffeine? Is there such a thing as addiction? there are 'addiction deniers')
• obesity (notice a pattern: there is an 'obesity denial' movement, too)
• dangerous tumours (when to remove? when to monitor?)
• epidemics (what's an 'epidemic'? - see 'epidemic deniers')

Other arbitrary things in medical science:

• confidence intervals of p<=.05 (ie: almost all medical research is based on an arbitrary confidence intervale - there are 'confidence interval deniers')
• clinical trials have three phases (there are people who debate the need for three, there are people who think we should have more phases)

'arbitrary' is not a bad thing, even in science. Wherefore species? Completely arbitrary classifications, and most people are fine with that. Classifications usually are.

There is a logical fallacy called 'corruption of the continuum', which takes place when somebody expects a demarcation in a situation where one does not exist, or denies the endpoint categories because there is no clear differentiation among their intermediates. eg:

[-young----------------------------------------------------------------------old-]

My granmother was young when she was two, and old when she was ninety-six. When, exactly, (to the second, please) did she stop being young and start being old?

If we don't know, are the concepts of young and old 'meaningless'?

ETA: Corrupt Continuum

 

[Dancing David]

I've made the claim before that I do not "believe" in mental disorders. With only a few exceptions, most of the DSMIV labels are just that-- labels. The notion that they represent real conditions is absurd to me. I think the only thing we can safely say is that the linguistic title of "disorder X" merely indicates the presence of some subjective state, which may or may not be reflective of an "actual" disorder.

That somehow psychological pursuits can be deemed as science any more than religious sentiment is illogical. The reality that they (mental illnesses) in our time and place are more illuminating is reflective of our value structure than any real sense of what is or is not real.

In other words, gathering statistical data on how many Americans attend church (or experience the subjective feelings of God) is meaningless in demonstrating whether or not there is such a reality as unconditional love. Yet, by the same hand, statistical data is gathered on subjective feelings of depression which may or may not hold true for its adherents and still is treated magically as if they exist as a collective disorder.

I promised to start another thread after corrupting another one below.

UH-huh,
and so are you saying that people who do hear voices aren't 'people living with schizophrenia', or are you saying that people who never sleep and think they are the president aren't 'people living with bipolar disorder', or are you saying that people who are hopeless, helpless, hate themselves are not 'people living with depression'?

There are people who suffer from things than can be benefitted from conventional medical treatment. are you saying that we should use terms like' person with symptoms which would indicate a psychosis'? Instead of the doctor using the label scfhizophrenia?

I can understand that the labels may seem rather large to those who don't worj in the mental health fireld and certainly there is room for refining the nomenclature but as someone who has to assess people everyday who try to kill themselves, I hope that you are not disputing the existance of mental disorders. Some people can be grossly misdiagnosed, some people use substances that alter thier behavior, some people are unedr stress, but it appears to me that the mental disorders do exist.

Unless you think it is okay for some person to kill themselves due to depression or murder thier family because of psychosis?

 

[Dancing David]

Thanks, Stamenflicker, for starting this thread. As you and I were both responsible for "corrupting" the other thread, I would like my questions from there answered before I try to formulate an answer to your OP in this thread. To quote:



And:


Now, I am off to bed to try, yet again, to fall asleep. The insomnia appears to be caused by both physical and psychological factors. Some of the physical things I am experiencing are caused by my mental state. And vice versa. How, I ask, can this be, if mental diseases are subjective?

OOOPS


I misread the quoted quote and thought something I shouldn't,

the comment below is addressed solely to

Stamenfilicker!

Sorry this is silly , experience is experinece, there is a biological basis for the human body, unless you are an immaterialist.

Are you saying that diabetes doesn't exist or that it exists because you can do a glucose level?

Pharmaceutical companies may not be the best way to determine if psychiatric conditions exist. I suggest you make a trip to your local state operated facility and talk to someone who hears voices.

Obviously it is up to individuals who have an experince to determine if it distresses them enough that they would like help.

But you statement that 'mental diseases are subjective' is like saying doctors should not use anesthesia bacuase 'pain is subjective'.

A pwerson in a full blown panic attack has discernable sysmptoms, doctors will often treat infections on the basis of observed subjective report and in fact that is how most treatment occurs, there is not always a test for all conditions.

Are some condtions more accurately diagnosed sure, but you are saying that alcoholism doesn't exist because it is 'subjective', but it is an accurate term to say that a person who looses jobs, relationships, can't function in life and is dying from iver failure has 'alcohol dependance'.

 

[Katana]

You can no more will depression away than you can will away diabetes.

If ignorance is bliss, stamenflicker must be euphoric.

 

[stamenflicker]

How, I ask, can this be, if mental diseases are subjective?

As to hyper-thyroidism, I'm not an MD. However, if we have tests available (and apparently we do) which can measure literal levels of substances associated with the thyroid, and then conclusively determine that the substance X is causing a physical symptom, then it seems real enough to me.

The problem enters when we have two specimens with exactly the same measurement of substance X, yet one does not manifest any symptoms. To certain degree, pain itself is a subjective experience... and our best empiricism isn't going to answer why that it is after its finest hours.

So let's take Blutoski's excellent example of cholesterol. If Blutoski and I go get our cholesterol checked and have identical results, yet I am suffering from fatigue, high blood pressure, etc. and he is not, then with what degree of confidence can we assume my cholesterol is the problem? Supposing that we were identical twins, thereby ruling out genetic history problems, what would we do?

My body is manifesting symptoms that his is not. What we have is then is merely a symptom-- one that is understood only by encapsulating it in vectors that we deem to be relevant to the cause. So surrounding my fatigue and high blood pressure, we have determined scientifically that cholesterol is one of these vectors. Again, I'm no doctor, but I imagine that it has been scientifically proven that exercise is another one of these vectors. Both cholesterol and exercise are measurable. And while high blood pressure is a measurable symptom, fatigue is not. So we begin to get a picture of something that we can name, as we name the vectors that encapsulate the symptom(s).

Contrast that with depression:

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Note that an individual needs only three or more of the symptoms to be considered "depressed." Notice that 3,4,5 are the only vectors that are truly biologically accessible. The others are indicative of subjective states. And really we are left with only #3 when looking for something truly measurable since baseline measurements likely are not available prior to diagnosis in the others. So it is possible to receive the diagnosis of depression without any real evidence that there is such a thing at all.

If Blutoski choses to point to his back or his head and say it hurts-- he actually is pointing at a literal something, not a mood he may or may not be in.

Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

 

[stamenflicker]

Are you saying that diabetes doesn't exist or that it exists because you can do a glucose level?

I'm not saying "they" don't exist at all. Certainly as a category of subjective experiences "they" are a real something. But a real what?

More specifically, I am saying that "depression" as a set of subjective descriptors are of no more or less importance than the set of subjective descriptors which comprise a kundalini awakening, divine bliss, or whatever else a person chose to build a category around.

 

[stamenflicker]

so are you saying that people who do hear voices aren't 'people living with schizophrenia'

I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

 

[slingblade]

I've long felt that many disorders are probably the same disorder, manifesting in an individual way within a particular individual.

This is not meant to be a sweeping statement. And I can't tell you specifically which ones I mean. But ADD and OCD are strongly related, I would think (this is not my area of expertise in the slightest, except as a patient ). What if they weren't just related, but were the same "problem," whatever we call that problem, which manifests differently, depending on the person.

People are different, she said simplistically, so why wouldn't manifestations of a brain disorder naturally differ among them?

I also think folks just get tired of the "31 Flavors" air of mental diagnosis, whether they should or shouldn't. I'm talking, for instance, about that recent article this summer about a "new kind" of anger disorder, a road-rage sort of thing. Can't recall the specifics just now...

I was, oddly enough, taking a basic sociology class at that time, and we discussed it: is this really a "new" disorder, or just a new label for something we already recognize? Did we really need this new label, if so?

How many perfectly "normal" but socially unacceptable behaviors are we medicalizing, maybe when they don't deserve to be such? Are we feeding a health-care/drug manufacturer's monster, or are we helping people?

How many "disorders" are simply products, results, of living in a hostile society? I don't always like to be around people much, but then, people often treat me like crap. Knowing I have to go around people sometimes makes me very anxious. Disorder or learned response? If learned response, can you really give someone a pill that will help?

 

[Katana]

Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

Funny. I wasn't aware that being a "born again" Christian was a condition that responded to medications. If so, can we put one of them in the water supply?

 

[Starrman]

I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

I would say that we can't measure the chemicals or mis-wiring that causes audio hallucinations in schizophrenia like we do cholesteral because those are occurring inside the brain. We can, however, take CAT scans - which do show physical abnormalities (http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=3154505&dopt=Abstract). We can conclude that these abnormalities were the cause by the fact that specific medicine makes it go away.

 

[Katana]

Yes. I agree that we have begun to over-pathologize common symptoms and complaints. I am concerned that too many people now have names for their symptoms, an excuse to wear them on their sleeves, and spend the rest of their lives defined by their "condition." I also believe that some physicians are over-diagnosing and over-prescribing for mental illnesses.

However, don't discount the legitimacy of mental illness when properly diagnosed and treated. I don't like the loss of personal responsibility rampant in our society any more than the next person, but there are people out there genuinely impaired by issues like depression and bilpolar disorder. They're not happy about it, and they really only want to get better. Unfortunately, on top of their illness, they have to confront the societal bias against "believing in" mental illness that some have demonstrated in this thread.

 

[blutoski]

The problem enters when we have two specimens with exactly the same measurement of substance X, yet one does not manifest any symptoms. To certain degree, pain itself is a subjective experience... and our best empiricism isn't going to answer why that it is after its finest hours.

You totally missed the point of my examples. I'll modify your example for illustration: we get our cholesterol tested. Your results are 5.9. My results are 6.0. I'm above the arbitrary threshold that says I should be on statins. You are below the arbitrary threshold that says you should be on statins. I have "a medical diagnosis"; you do not.

Medicine is like that.

Back to my prior examples:
Blood pressure (medicate above level x); pain (analgesics after point x, narcotics after point y, anaesthetize after point z, sedate after point z2)

Futhermore, there is no real reason that this list of 9 things should be deemed of any more scientific value than say any nine subjective reports of a kundalini awakening, or the experience of nirvana, of the experience of being "born again" in the Christian faith.

Sure it is: they describe depression. As opposed to, say, the amount of fish particles in the atmosphere, which is an objective measurement, but does not pertain to depression, and is not considered in the diagnosis.

Use common sense, man! Look at that list of diagnostic criteria. Are you saying that a patient with a fistful of those attributes is not likely to be more depressed than somebody with none of them? One of the appeals of skepticism is its grounding in science, which is basically organized common-sense. Fru-fru metaphysical arguments have little place in scientific discusisons.

I think you're conflating two issues:
1) standards/classification/identification/diagnostics and
2) thresholds for medicalization.

The value of diagnostics is that we have research that shows certain treatments work with certain problems; it behooves us to identify the correct underlying problem. Slingblade made this point, and it's the underlying principle of medicine: diagnostics are the key to proper treatment.



As for the relation to religous beliefs: the key difference is that religious people don't say things like: "Believing in Jesus has made my life a living hell. Ever since I started, my life has gone downhill. I wish I could stop, but I just can't. I wish there was something I could do to make this end."

Basically, if it's not having a negative impact on the patient's quality of life, it's not in the DSMIVR.

 

[blutoski]

I've long felt that many disorders are probably the same disorder, manifesting in an individual way within a particular individual.

The trend has been toward more splitting, rather than more lumping, I'm afraid. However, there have been cases of reclassifications where distinct conditions got rejigged with one as a special case of the other.

This is what we should expect, though, as it follows the trend of medicine through the ages. We no longer talk about diseases with such vagueries as "he has the fever" - we now know which of the 3,000 *kinds* of illnesses are causing the fever, and that's what we name it.

This is not meant to be a sweeping statement. And I can't tell you specifically which ones I mean. But ADD and OCD are strongly related, I would think (this is not my area of expertise in the slightest, except as a patient ). What if they weren't just related, but were the same "problem," whatever we call that problem, which manifests differently, depending on the person.

I don't think there's a good case for that. OCD is obviously an anxiety disorder, whereas ADD is a concentration problem. Stimulants make OCD worse, but make ADD better. The underlying organic is almost certainly different.

Watch for the 'axes' and 'clusters'. This is how you find the diagnoses with shared underlying causes, although some axes and clusters are catchalls.

People are different, she said simplistically, so why wouldn't manifestations of a brain disorder naturally differ among them?

I also think folks just get tired of the "31 Flavors" air of mental diagnosis, whether they should or shouldn't. I'm talking, for instance, about that recent article this summer about a "new kind" of anger disorder, a road-rage sort of thing. Can't recall the specifics just now...

I was, oddly enough, taking a basic sociology class at that time, and we discussed it: is this really a "new" disorder, or just a new label for something we already recognize? Did we really need this new label, if so?

Well, the point of diagnostic categorization is to identify appropriate treatment. This disorder is different than others, and its treatment needs to be specialized. That was the thrust of the publication.

Previously, these people have been misdiagnosed as narcissistic personality disorder, but the usual treatment for this condition (cbt) is not effective. In order to return these rage-outburst patients to some sense of control, they need medication. It's a newly-discovered variation on Tourette's tic, and not at all a personality disorder.

How many perfectly "normal" but socially unacceptable behaviors are we medicalizing, maybe when they don't deserve to be such? Are we feeding a health-care/drug manufacturer's monster, or are we helping people?

It should be noted that again, diagnosis is not the same thing as medicalization. Psychology categorizes people all the time: introverts, communicative, fantasy-prone, innovative, &c. The DSMIVR is a tool that focuses on only a small segment of these categories - the ones that cause negative lifestyle impacts. Most diagnoses are treated with non-medical therapy in short timespans.

How many "disorders" are simply products, results, of living in a hostile society? I don't always like to be around people much, but then, people often treat me like crap. Knowing I have to go around people sometimes makes me very anxious. Disorder or learned response? If learned response, can you really give someone a pill that will help?

This is also a myth, though: that non-western, preindustrial, or primitive societies do not see mental problems. The reality is that they just don't have the infrastructure to recognize them as such, and deal with them as they see fit.

For example, my wife was literally half of "psychiatry" in Tobago for about 3 months earlier this year. She said the sad thing about it was that the people down there with mental problems are just as abundant as here, but the difference is that they do not get an iota of compassion. Narcissists are chopped up with machetes by angry neighbours, the depressed are allowed to kill themselves, and the schizophrenic get gunned down by police in a blind panic when they finally do their "I hear voices!" thing in the middle of downtown.



One of the other benefits of classification is predictability. We can predict a person's future behavior, given enough information to understand their diagnostic classification. In the example of the road-rage problem, this is debilitating, and these people now face the legal restriction against having a driver's licence. Just as if they were declared legally blind (an arbitrary legal threshold on a subjective medical diagnosis), the public can assess their risk of causing accidents, and protect ourselves accordingly.

Bipolars often lose their driver's licences, too (not to mention, being institutionalized).

 

[stamenflicker]

Funny. I wasn't aware that being a "born again" Christian was a condition that responded to medications.

Have you ever seen one on crack?

 

[stamenflicker]

I would say that we can't measure the chemicals or mis-wiring that causes audio hallucinations in schizophrenia like we do cholesteral because those are occurring inside the brain. We can, however, take CAT scans - which do show physical abnormalities (http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=3154505&dopt=Abstract). We can conclude that these abnormalities were the cause by the fact that specific medicine makes it go away.

I've stated before in other posts that schizophrenia might be one of only a handful of exceptions. The reason I might be willing to make one there? Is there is empirical evidence which can be pointed to with the human biology.

Look at some other dissociative disorders-- fugue states, multiple personality, whatever. Rarely if ever is there any tangible evidence of a true empirical disorder.

 

[blutoski]

I'm saying just what a comedian I heard once said...

When little Susie hears her dolls inviting her to a tea party, we think its cute.
When Grandma starts hearing these invitations, its a tragedy.

It's all about what we choose to categorize, what we deem to be of value, that sets the stages for what we call a "mental disorder." Again, there are some exceptions, but not so many as the APA wants to believe.

Right, but again, common sense: children are big at pretend. They don't need a motive. It's natural. Psychiatrists are sensitive to this, and assessing whether a symptom is pathological is the point of the interview process.

For example, my wife had a patient who came into the hospital with concerns that he may be having a schizophrenic episode (his mother was schizophrenic). The patient wasn't hearing voices, but had delusions of persecution: he thought somebody was 'out to get him,' and was concerned he was losing it.

Story went like this: he went into work and there was no padlock on his locker. Had he taken it home with him yesterday? Had somebody cut it off? Then, for four days in a row, one of his car tires was flat when he came out of work. Different tire every day. No punctures. Just flat. Dead birds on his doorstep for a week. What are the odds that they're all just dying overhead and landing on his steps?

After a little bit of Q&A, my wife concluded that actually, somebody was out to get him, and his next stop should be the police. Three months later, he came back to thank her, and the complete story was that the patient was trying to unionize his workplace, so his employer had been hiring goons to intimidate him. A police stakeout had photographed them putting dead birds on his lawn, vandalizing his car, and charges had been laid.


Point is: psychiatry involves knowing what's normal. My wife can spot a schizophrenic at 100 paces.

 

[stamenflicker]

You totally missed the point of my examples. I'll modify your example for illustration: we get our cholesterol tested. Your results are 5.9. My results are 6.0. I'm above the arbitrary threshold that says I should be on statins. You are below the arbitrary threshold that says you should be on statins. I have "a medical diagnosis"; you do not.

And while I recognize that we have to create somewhat arbitary lines of demarcation, it sounds more like you are agreeing with me than disagreeing. It still does not alter the fact that with medicines targeting specific empricial diseases we have things we can actually measure.

Sure it is: they describe depression. As opposed to, say, the amount of fish particles in the atmosphere, which is an objective measurement, but does not pertain to depression, and is not considered in the diagnosis.

And yet if we deemed fish particles in the atmosphere to be of any scientific value, we'd have vectors for determining them as well. That "depression" is considered scientific as opposed to say the affect of Beatles tunes in local elevators, is one of preference and practicality-- not scientific truth.

Look at that list of diagnostic criteria. Are you saying that a patient with a fistful of those attributes is not likely to be more depressed than somebody with none of them?

I'm saying that a person with a fist full of those attributes has a fist full of those attributes. I think that's all we can really say about it.

One of the appeals of skepticism is its grounding in science, which is basically organized common-sense. Fru-fru metaphysical arguments have little place in scientific discusisons.

And yet you are telling me that a person feelings of lonliness are of more scientific value than their feelings of oneness with nature. I'm just saying that I don't believe it, or have any method of determining which subjective state is worthy of statistical pursuit for the purpose of creating an false "condition" which attempts to pass itself off as an empirical reality.

The value of diagnostics is that we have research that shows certain treatments work with certain problems;

And things like pot work on almost all of us. That medication may or may not work on certain subjective states really does tell us anything about why we treat one set as scientific and the other as non-scientific.

As for the relation to religous beliefs: the key difference is that religious people don't say things like: "Believing in Jesus has made my life a living hell. Ever since I started, my life has gone downhill. I wish I could stop, but I just can't. I wish there was something I could do to make this end."

You are right they don't. But they may have some set of subject states they have in common with the experience of "born again;" states which when compiled an examined create a statistical "condition" to be named.

Basically, if it's not having a negative impact on the patient's quality of life, it's not in the DSMIVR.

Don't get me wrong, I'm not arguing that religious sentiment belongs in the DSMIV. I'm arguing that the DSMIV is treated as science by imposters, and accepted as science by the gullible. And worse still, used by lawyers to condone any number of activities-- be they religious or otherwise.