Just finished my keynote at @conference_2021 on "Mental health: studying systems instead of syndromes". You can find slides & new preprint here: osf.io/bm6r5/. Really enjoyed making a completely new presentation from scratch.
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The first barrier to progress I talk about is diagnostic literalism and its consequences: while many of us don't believe in MDD or schizophrenia as "natural disease units" in the world, case-control research in our field is often carried out in that way.
I discuss some historical evidence on how arbitrary many of the categories and thresholds we have today in DSM-5 were, and that DSM-5 may look quite different today if minor things had gone differently.
This means diagnostic categories are not natural kinds.
But our field is not alone in having failed its ambitious mission to identify natural kinds: many nosologies are somewhat arbitrary (e.g. biological species, emotions, threshold for high blood pressure). That doesn't make these things less "real" or important.
The second barrier I talk about is reductionism, using the prominent example of biological reductionism. Reductionism is a useful heuristic tool, but has limited value in complex systems such as mental disorders.
Both barriers interact with each other in a vicious cycle: somewhat arbitrary diagnostic categories are reified because we identify (e.g. biological) correlates.
Moving forward, conceptualizing and studying mental disorders as complex systems offer many new opportunities because there is a rich field of complexity science with many theories and methods that may prove to be useful for mental research.
I discuss some features we can study from this perspective, such as emergence, early warning systems, phase transitions, stable states, and so on.
Dutch universities are making a move to abandon the impact factor in recognition and reward considerations. A group of 170 Dutch academics posted a critical response to this initiative. I summarize why these responses fail to convince me. 🧵
First, for context, here the initiative by @UniUtrecht we are talking about: changing rewards and recognitions. Other universities have similar initiatives.
Here the rebuttal by 171 academics in the Netherlands, most of whom appear to be full professors. It's in NL, but google translate works well for Dutch websites.
1/ National Institute for Health & Care Excellence does not recommend #esketamine to treat #depression bc effectiveness unclear (low quality trials), problematic economic model (short-term treatment, depression lasts long). Cost/benefit not sufficient to recommend treatment.
3/ Agreed that published literature is low quality. Samples are generally too small to draw inferences from the samples to the population; there are recent studies without placebo groups (how does that even get funded in 2020); when placebo groups exist, they are often not >>
"Hans-Ulrich Wittchen .. is under fire after an investigation into one of his studies found evidence of manipulation—and elaborate efforts to cover up the misdeed. The investigation report .. also shows Wittchen intimidated whistleblowers"
1/ A test helps to determine whether you have a feature or not.
Good tests are precise: they predict a feature well, have high sensitivity/specificity, & low false positives/negatives.
2/ Precise biological tests do not exist for the most common mental disorders. There are some weak biological correlates for depression, but a weak correlate is not a test, the same way that a weak correlate of COVID (coughing) is not a test for COVID.
Happy to share our new preprint with Edwin de Beurs, in which we recommend to solve the current dilemma "So-Many-Scales-For-The-Same-Construct" (e.g. for depression) by mandating a common metric, not by mandating a common measure.🧵
We introduce the problem of scale proliferation, and how it impacts not only science, but also communication (between researchers & policy makers; between clinicians; between clinicians & clients; etc).