Ahahah I know what you did here.

While I agree that DSM is likely a bunch of nonsense:

> As long as they don’t provide physical mechanisms for disorders, it’s worthless

This reasoning will dismiss too many things.

We don't know the physics of almost anything, it's all progressive levels of approximation.

For the longest time we knew nothing about the physical mechanisms of anesthetics, or how a plane wing works.

Science doesn't need the mechanism. It needs predictive power. Observations, hypotheses, tests and thesis.

Yep. Quantum mechanics, for example, works, even though we don't understand the underlying thing that the model describes.

> it’s worthless

Hundreds of millions of people whose lives have been saved or improved thanks to broader recognition and treatment of their disorder would disagree.

Can you provide evidence-based numbers of how many people's lives have been saved or improved vs how many have been ruined or ended in part due to the guidelines DSM? Or what the outcomes would have been had psychiatry not continued to rely on it as the gold standard? Without a comparison, a vague, unsubstantiated claim such as that is worthless.

I'm not familiar with every diagnosis in the DSM-5, but I'm very familiar with ADHD. The DSM lays down the diagnostic criteria, brain scans of people diagnosed according to those criteria have confirmed structural and functional differences, and even more extensive studies have confirmed the overwhelming efficacy of the medication used to treat the disorder. Is that worthless?

Claiming that DSM-5 is "worthless" simply because it doesn't provide physical mechanisms that cause the disorders is an extraordinary claim that requires extraordinary evidence, not the other way around.

> how many have been ruined or ended in part due to the guidelines DSM

You tell us, how many have been ruined? What "guidelines" are you referring to?

Homosexuality was in the DSM. As was hysteria.

Because they looked at clusters of symptoms, rather than actual causes.

Precisely my point.

As for ADHD etc; you do realise they changed the treatments and clustering precisely because of insight in physical processes?!

Those things make it flawed, not worthless. Your "precise" point was that the DSM-5 is worthless, please don't move the goalposts now.

Now you are moving the goalpost. I said that the DSM when not providing the underlying physical processes is worthless.

I stand by that. In fact, historically whenever they did this they caused a lot of harm.

> Now you are moving the goalpost

I would beg to disagree: "The DSM is a bunch of nonsense. As long as [...], it’s worthless."

> DSM when not providing the underlying physical processes is worthless.

And when does the DSM ever provide the "underlying physical process"? It certainly doesn't for ADHD or any other chapters I happen to have read, which would make them worthless according to your criteria despite overwhelming evidence to the contrary.

And while I haven't read all 1000 pages of the DSM because it's not exactly my idea of a good time, I don't think it provides that kind of information in any chapter because we simply don't understand these disorders to that extent, as your original comment correctly observed.

It clusters symptoms "without underlying cause" because we don't know the underlying cause. If we wanted to go for a fully "physical mechanism" approach to mental health, we could just end any treatment attempts and say "come back in a few decades or perhaps centuries".

But we do know that certain symptoms tend to show up in clusters, and that patients in certain clusters tend to respond to certain drugs with an above-placebo level of effectiveness.

The same is true for a runny nose: It can be caused by any number of viruses (there is no such a thing as "the" influenza virus or "the" common cold virus), or allergies, or irritants like pepper spray, or a problem with the body's ability to regulate itself, or something else entirely – but going through the effort to test for every virus, allergen, irritant, and whatnot is wasteful, if all the patient needs at that moment is some nasal spray to breathe properly again. Incidentally, a runny nose is (or perhaps: was) not a common symptom of Covid, so unless other symptoms more indicative of it show, there may not a good reason to test for it, or prescribe medication specific to it.

If more symptoms accumulate over time, or the symptoms don't go away, you then probably can go back to your doctor, will get a different diagnosis and possibly a different prescription. The same is (or at least: should be) true for mental issues, where you might switch treatment over and over until something is found which actually helps your symptoms. Is this a flawed process? Frustrating? Absolutely. But is it "worthless"? I don't think so.

You are wrong. Medicine does not need physical mechanisms for any diagnosis or therapy. It is preferable but not obligatory. A mere grouping of a symptom cluster forms a diagnosis as well as a therapeutic target.

Then I sure hope somebody with HIV never goes to the doctor with a runny nose, since I’m pretty sure staying in bed a week doesn’t solve the underlying issue.

In clinical medicine you follow correlations. A positive HIV test and a running nose mean red alarm. If you know that from sole past observations or by reading about immunosuppression plays no role in giving the indicative treatment. In research mechanisms are, of course, mandatory everywhere.