According to a recent British Journal of Psychiatry editorial, the absence of biomarkers for any psychiatric disorder has been used to call into doubt, the whole diagnostic enterprise in mental health. But the editorial suggests that the absence of biomarkers in general medicine is commonplace. Whilst a biomarker can indicate a mechanism of dysfunction, it cannot determine whether pathology exists. The determination of pathology cannot be outsourced to biology.
The assessor is an actor in the determination of pathology and a conduit for societal values. It appears that in the very act of trying to gauge pathology, what is the focus is being changed. The situation seems akin to in physics, that the more that one determines the position of an atomic particle the more uncertainty there is as to its’ velocity and vice versa (the Heisenberg Uncertainty Principle). It appears that for the foreseeable future, it’s likely to be a matter of clinicians muddling along with diagnostic categories, that may not be carved into nature, in the absence of a better way of categorising difficulties and corresponding treatment options. A great deal of humility is called for, not the strong suit of many psychiatrists or psychologists.
NHS Talking Therapies operates a free for all, its’ clinicians ascribe a diagnosis based on ‘ICD-codes’ and not on any standardised diagnostic interview. Making for highly questionable reliability. Nonetheless luminaries of ‘critical psychology’ have used NHS Talking Therapies data to substantiate the very significant withdrawal effects from antidepressants.Whilst I don’t doubt that this is a very real issue, they don’t at all raise the issue of the reliability of NHS Talking Therapies data. One is reminded of certain President’s inability to criticise other Presidents.
Dr Mike Scott