🚀 go-pugleaf

Hi, everybody on the PSYCGRAD listserv.

I'd like to respond to the forwarded email that Jason Washburn just sent
on the Practice Guideline Coalition.

Count me out.

I am saddened by the helplessness portrayed by the authors of the
message when they say:

"Practice guidelines are coming, whether we are comfortable
with that idea or not; the PGC effort is designed to bring everyone to
the table to try to develop a consensus about the core material they
should contain."

There is nothing so sad as someone saying, "Well, we're going to be
shackled anyway, so we may as well take an active role in picking the
types of shackles used." No one has a gun to our heads. The idea that we
aid or not protest the very premise of universal guidelines for DSM
categories, as if this has anything to do with the personal realities of
real individuals who are suffering is preposterous to me.

Empirical research deals with sample-wide characteristics and yields
sample-wide attributes of effects. Probabilities yielded by
null-hypothesis testing are not predictors of good clinical work for
individual people.

People are not "actuarial" as insurance companies would like to treat
us. The notion of taking general research findings as guidelines for
individual treatment is absurd considering the obvious problems of
publication bias of positive effects, biases generated by differential
research budgets for different treatment models, etc.

Even those who treat the more clearly definable physical disorders take
into account individual histories, environmental variables, etc. in
generating treatment plans.

You can't give every diabetic the same form of treatment. Some don't
need insulin, they need nutritional counseling. You can't give every
insomniac Klonapin, simply because it's empirically validated.

No clinician in their right mind, medical, psychological, or otherwise,
could subscribe to such a ridiculous program. Saying that we should help
construct it because it will happen whether we want it or not is totally
irresponsible. To the extent that we allow it to develop without
protesting these basically unethical premises, we deserve what we reap
from our assent.

Feel free to forward this message.

-Jason Seidel
University of Denver