Psychiatry’s Incurable Hubris
[I]By virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain. In this sense, the attempt to work out the biology of mental illness is different from the attempt to work out the biology of cancer or cardiovascular disease. The fact that the brain is necessary to consciousness, added to the fact that the brain is a chunk of meat bathing in a chemical broth, does not yield the fact that conscious suffering is purely biological, or even that this is the best way to approach mental illness.[/I]
https://www.theatlantic.com/magazine/archive/2019/04/mind-fixers-anne-harrington/583228/
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Then there is the idea that an entity as 'mental illness' exists. Hard to grasp. Like the flu?
That some things are not mentally healthy is obviously a completely different matter.
The pharmaceutical industry has been pumping money in the education of doctors and psychiatrists alike, and with success. My guess is that it will stop at some point. Who will pay for all of that? The iatrogenic burden will simply become too great.
https://www.theatlantic.com/magazine/archive/2019/04/mind-fixers-anne-harrington/583228/
*****************
Then there is the idea that an entity as 'mental illness' exists. Hard to grasp. Like the flu?
That some things are not mentally healthy is obviously a completely different matter.
The pharmaceutical industry has been pumping money in the education of doctors and psychiatrists alike, and with success. My guess is that it will stop at some point. Who will pay for all of that? The iatrogenic burden will simply become too great.
Comments (200)
"One's relationship to an organism is different from one's relationship to a person. One's description of the other as organism is as different from one's description of the other as person as the description of side of vase is from profile of face; similarly, one's theory of the other as organism is remote from any theory of the other as person. One acts towards an organism differently from the way one acts towards a person. The science of persons is the study of human beings that begins from a relationship with the other as person and proceeds to an account of the other still as person."
"The other as person is seen by me as responsible, as capable of choice, in short, as a self-acting agent. Seen as an organism, all that goes on in that organism can be conceptualized at any level of complexity - atomic, molecular, cellular, systemic, or organismic. Whereas behaviour seen as personal is seen in terms of that person's experience and of his intentions, behaviour seen organismically can only be seen as the contraction or relaxation of certain muscles, etc. Instead of the experience of sequence, one is concerned with a sequence of processes. In man seen as an organism, therefore, there is no place for his desires, fears, hope or despair as such. The ultimates of our explanations are not his intentions to his world but quanta of energy in an energy system.
Seen as an organism, man cannot be anything else but a complex of things, of its, and the processes that ultimately comprise an organism are it-processes. There is a common illusion that one somehow increases one's understanding of a person if one can translate a personal understanding of him into the impersonal terms of a sequence or system of it-processes. Even in the absence of theoretical justifications, there remains a tendency to translate our personal experience of the other as a person into an account of him that is depersonalized. We do this in some measure whether we use a machine analogy or a biological analogy in our 'explanation'. It should be noted that I am not here objecting to the use of mechanical or biological analogies as such, nor indeed to the intentional act of seeing man as a complex machine or as an animal. My thesis is limited to the contention that the theory of man as person loses its way if it falls into an account of man as a machine or man as an organismic system of it-processes. The converse is also true.
It seems extraordinary that whereas the physical and biological sciences of it-processes have generally won the day against tendencies to personalize the world of things or to read human intentions into the animal world, an authentic science of persons has hardly got started by reason of the inveterate tendency to depersonalize or reify persons."
Also, it is unfortunate that "depression" has become as vague a term as "fever", and that far from advancing in our knowledge of our mental states, we are reversing into ignorance. The contemporary refusal to acknowledge unconscious conflicts and a tendency to speak vaguely of "stress" and "genetics" leave us with a reduced vocabulary. What we are suffering from (among other things) is a lack of words and better ideas. Empiricism can only take us so far; it is the hidden — our unreachable secrets, which generate puzzling symptoms — that is doing the damage.
All these various miserable people end up on psychiatry's doorstep. They might all be diagnosed as "depressed" and treated with the same medication. What's a good doctor to do? Give them a pill that might help them feel better.
I believe there are actually D-E-P-R-E-S-S-E-D people. People who are bi-polar, for instance, really do swing back and forth between mania and depression. There are people whose whole affect, mental functioning, appetite, libido, etc. are suppressed. They are properly "depressed". These people are part of the 1 in 10 people who will experience mental illness at some point in their lives. One in Ten seems about right. Most of these people will get better and do fine in the long run. Even the bi-polar, schizophrenic, and psychotic people will feel fine and will function normally at least some of the time. They need drugs. Sometimes they need a padded cell in an hospital; sometimes they just need a protective institution / mental hospital in which to live.
It's all the other wretched refuse of a crazy society that I worry about. They aren't mentally ill, per se, they are just very unhappy, and they don't seem to know what to do about it. Hey, I didn't either.
I have been depressed, properly defined. But, I also have ended up in that depression sink, when what I really needed was not an antidepressant, but a clearer vision of reality, an attitude readjustment, or a major change of scenery, or something. Looking back over the last 72 years of my life, it's hard to sort it all out.
So I've taken antidepressants of several kinds and benzodiazepines over the last 30 years. The period of actual depression was fairly short (and followed a bad injury while jogging in the winter). The rest of the time I was just part of that wretched refuse blowing around in the streets. I was employed, properly housed, in relationships, had friends, was never alcoholic or addicted, etc. I was just chronically dissatisfied and unhappy.
Was there an intervention that professional could have delivered? I really don't know. What really improved things was a major change in scenery brought about by unemployment and early social security, and the death of my mate, now 10 years ago. Leaving the workforce certainly helped, and the end of my partner's suffering from cancer was, inadvertently, the shock treatment that made the difference.
The upshot? I've regained full mental functioning. I'm not chronically unhappy and dissatisfied. My mind is again firing on all 8 cylinders again, (yeah, yeah, I know; most cars don't have 8 cylinders any more). Life is not perfect of course. I'm not living in la la land. Like millions of other 72 year olds, there are challenges today and more ahead. But I feel balanced, centered, focussed, and all that.
Thyroid dysfunction can be pretty serious, I agree, but how common is undiagnosed thyroid deficiency?
As a person that professionally works in the psychiatric field, I have to disagree. I don't like to use the phrase of "telling people what to do." rather, I'd like to educate the client that their understanding of reality is maladaptive and that my job is to redirect them to a course that is least harmful.
Quoting Chisholm
How so?
Quoting Chisholm
This is speculation. How did you come to this?
Seems like this is the rant of someone who had a bad experience
As an example, there is no direct evidence that other people feel, we aren't themselves to know that they feel, all we can say really is that we believe they feel because we feel and because they behave in a way similar to us. Yet someone claiming that he has no reason to believe other people feel anything would be quick to be labeled with some mental illness, simply because his distinction between what he considers real and not would not be the same as that of the psychiatrists.
The likelihood of being labelled as mentally sick is correlated with how distant or incompatible your beliefs are with that of psychiatry. A big part of what psychiatry does is pushing one world view and shaping people to adhere to that world view, and it isn't clear that's the best way to make many people feel better. Some people would feel much better simply if they felt loved and supported and understood, than if they were told there is something wrong in their brain and they need to take some drug regularly to mask the disease.
When it comes to internet forums, I find personal accounts of mental struggles to be more credible (because the writer usually only has sympathy to gain) than:
1) Medical pronouncements lacking citation(s) to relevant research. And,
2) Claims like:
a) "As a person that professionally works in the psychiatric field..." Or,
b) "My background is in neuroscience."
Because the latter are usually only a prelude to Argument from Authority fallacies.
2a could be a janitor at a pharmaceutical institution, and 2b could be a popular science writer.
Wrong. Psychiatry/Psychology rest on the foundation of behaviors that are adaptive and maladaptive which the latter and the behaviors surrounding it, are used as classifications to make the correct diagnosis.
Quoting leo
But this is not psychiatry. Psychiatry/Psychology base its principles off science and what can be tested. Psychiatry/Psychology does not deal with the metaphysics much when it comes to defining what is real and not real.
Quoting leo
I didn't understand this at all.
Quoting leo
You really have no grasp on how psychiatrists/psychologist conduct their assessments do you? If someone is doing PCP or methamphetamine and the result is delusion, sure, we clinicians may call it a delusion because what they're experiencing is not independent of any substance that may manipulate areas of their brain (i.e. drugs). If someone is on drugs and they see peter pan and believe they can fly to never never land, most likely their behavior is the result of the meth and/or PCP usage. If their body is absent of hard drugs then of course we may think they are suffering from visual hallucinations, because seeing things that are a part of storytelling and folklore are not come images people see.
That is not to say people who see things are crazy but a lot of times people who see things behave in an atypical way which becomes maladaptive and eventually can lead into destructive behaviors.
In the adverts, the road is smooth, and sinuously winding through wonderful scenery. The man is master of his fate, enjoying the freedom of the road, and going places in his penis extension. That is the fantasy.
The reality of being stuck in traffic in a concrete jungle, potholed and blocked by roadworks and other people's penis extensions with the kids screaming in the back and everyone looking at you as if you're the one in their way. You're supposed to be somewhere already and you're going nowhere, breathing the toxic fumes.
The conflict between fantasy and reality cannot be resolved, and this results in frustration. Let the frustration out, and you are suffering from road rage. Keep it under control and you are suffering from chronic stress.
Everyone is insane, and everyone is on drugs - the car is just another drug we are addicted to, though it makes us sick.
[quote=J.Krishnamurti] It is no measure of health to be well adjusted to a profoundly sick society.[/quote]
Psychiatry offers pills as palliatives, when the sickness of society requires a revolution.
I could have used the fantasy of the 'social network' and the reality of social isolation, or many other addictions as my example. Slaves used often to suffer from Quoting Anaxagoras
It was called drapetomania. We found a cure for that - the abolition of slavery.
hmm interesting...I'm curious to know where you got this information from if you could provide a link please thank you.
Quoting unenlightened
If you say so.
Quoting unenlightened
This made absolutely no sense. Especially since drapetomania's terminology largely was reference to African slaves which in the Psychological community has been debunked as pseudoscience and its largely considered racist.
If someone is suffering from a maladaptive disorder which is causing them to ruin their job, relationships, and is affecting their way of life sometimes medication is necessary to mitigate this problem. For example look at the following story:
Mom, Teen Daughter Accused of Killing 5 Family Members Spoke of ‘Demons Being All Around’: Relative
"Damon Decree, Sr., the ex-husband of suspect Shana Decree, 45, and the father of suspect Dominique Decree, 19, told WPVI that both women had been “talking about demons being all around themthis link opens in a new tab.”
Decree said he believes the mother and daughter — charged Monday with murdering Shana’s two children, Naa’Irah Smith, 25, and Damon Decree Jr., 13, along with her sister, Jamilla Campbell, 42, and Campbell’s 9-year-old twin daughters, Imani and Erika Allen — may have been indoctrinated into an unspecified online religious group.
“Apparently, they had dissected into some type of cult that they materialized online,” he said. “I don’t know how or what kind of cult.”
Destiny Harris, the half-sister of the twin victims, also told WPVI the family had been “going through something religiously and they decided to drag the kids into it.”
See more: https://people.com/crime/mom-teen-daughter-accused-killing-5-family-members-spoke-of-demons/
Now, I understand cults and what not but what perplexes me is not that they were influenced by the cult but by the following statement in the article:
"Initially, investigators allege Shana and Dominique Decree denied having any involvement in the killings, telling cops Campbell’s boyfriend and two other men broke into the apartment and slaughtered the five victims."
Now you tell me are they simply just cult followers or are there some underlined psychological issues?
D'you know I think I made it up! At any rate I cannot remember whence it came. However Over here if you add to the 5% in sales, a reasonable fraction of others involved with marketing as business managers, spin doctors, web designers, and then divide out those jobs that only use the statistical skills and not the psychological skills, then my invention is not altogether implausible.
Quoting Anaxagoras
Dude, I have not denied it. I bring up psychology's pseudoscience and racist past in order to encourage you and others to have a little less hubris, a little more humility, and a more careful use of language.
Have a little think about 'maladaptive disorder'. At some stage, a failure to adapt is not a disorder of the organism, but a disorder of the environment. Indeed I would suggest that at almost every stage there are both aspects in play. One might say that in the case you cite it is the successful adaptation to the cult that constitutes a maladaptive disorder wrt society in general, although there are no doubt other factors, because it is not usual even for cult victims to behave thus. But bear in mind that 'maladaptive' is necessarily relative to a particular society and being maladapted to some societies might be a sign of good mental health. If your job is torturing the enemies of the state, or indoctrinating people into a belief in demons, then losing one's job is on the road to recovery.
Huh? Where did I display hubris? I'm a clinician and this is my professional job.
Quoting unenlightened
Do you even know what maladaptive means?
"Maladaptive daydreaming is a disordered form of dissociative absorption associated with vivid and excessive fantasy activity that often involves elaborate and fanciful scenarios.It can result in distress, can replace human interaction and may interfere with normal functioning such as social life or work."
On another note I'm kinda done as I don't think you and I are having a serious discussion.
You seem to be stating that that's not the complete picture and the gaps are big enough to discredit the profession. You may be right you know.
What alternative do you have to psychiatry?
Not only do I know what maladaptive is, I also know that
Quoting Anaxagoras
...is not the same as...
Quoting Anaxagoras
...or...
Quoting Anaxagoras
Quoting Anaxagoras
Well right there in your appeal to your own authority, amusingly, and more generally in your non engagement with any of the critical thinking on offer, and response to it instead as if it were a personal attack.
But let me ask you a question for a change. Over all, given the huge growth in psychological knowledge and training, and all the research and advances in the field, would you say that the mental health of the world is improving?
Then you must be psychologically damaged, because you obviously didn't read the article linked in the OP (or subsequent posts), and that kind of thing isn't done here without incurring the disapproval of others. Take your medication, please!
Could there be other explanations for that kind of behaviour?
That heedless refusal has played out here rather clearly. Every suggestion I have made that there is a social component has been taken by our resident professional not as a contribution to consider, but as an attack to be defended against, to the ridiculous extreme that "maladaptive" is somehow redefined to not be a term of relation of organism to environment, of individual to society.
One way to see it is that the hubris of psychology is to make every disagreement an ad hominem, not realising that there is a society of psychologists that is the legitimate subject of sociologists just as there are sociologists with psyches.
Well, you're right. I didn't read the article. My sincere apologies. However I did get the main point that psychiatric theories based on neurochemistry may be inadequate or wrong.
To that I respond with the simple observation that pscyhotropic medications work and their pharmacology is understood even if it's only basic.
What is the alternative to pscyhopharmacology? Do you have any ideas?
Read the quote in this post carefully.
What is interesting about the OP's claim is that it rejects a paradigm (neurochemistry-based pscyhology) without offering an alternative. What do you think we should do then?
If you ask me the criticism reveals to us that the picture psychiatrists have is incomplete. A person getting tortured everyday will soon be depressed. A psychiatrist would do nothing more than prescribe some antidepressants to the poor fellow. Is this what's wrong with psychiatry? I know mine is a caricature of the discipline of psychiatry but it gets to the point doesn't it?
I think we can get even more to the point. Without dismantling mental health facilities or banning drug treatment there are many steps that can be taken to make societies less stressful and traumatic and more supportive and inclusive. For example 'Let the train take the strain' used to be a slogan; a really good public transport system would be hugely beneficial and incidentally far cheaper than the current every man his tin box arrangement.
Reduce stress, reduce isolation, foster cooperation, minimise trauma. These simple principles should guide social policy in housing, transport, community services education. In this regard, mental health is no different from the rest of medicine, where the greatest improvements in health have come from social and environmental factors such as clean water and sewage treatment systems, health and safety and food standards legislation and so on.
One of the things psychology has been quite good at is identifying social risk factors for mental illness. Unfortunately, it has never been seen as its business to mitigate them.
Sure it does, you just haven't realized it. If your patient sees or hears things that you don't, either you will find an explanation within the range of phenomena that you deem to be real, or you will deem the patient to have delusions that cannot be explained by anything that you deem to be real other than it being some brain disorder. The diagnostic of delusion is based on your own preconceived beliefs (based in great part on your training) about what is real and what is not.
Quoting Anaxagoras
I know. Do you believe other people feel? Sure you do, it's obvious to you, so much that you don't even see it as a belief but as a fact, as truth. Yet how have you come to the truth that other people feel? You are you and they are them, how would you know what it is like to be them?
Either you imagine what they feel based on what they look like and how they sound like, and you deem it to be real, so you believe that something you imagine is real, which by psychiatry's definitions makes you delusional. Or you believe you have some supernatural sense that allows you to read their minds and know what they feel, that you have telepathy, which psychiatry deems to be not real, which again makes you delusional.
So in any case according to psychiatry, you believing fiercely that other people feel means you suffer from delusions. But psychiatrists won't say that, because they're the ones implicitly deciding what is real and what is not, telling people what to believe and what not to believe, forcing their own world view onto others.
A lot of things work, exercising, eating healthily, feeling loved, supported, understood, feeling free, feeling having one's own future in one's hands, not feeling threatened, which all could be attained in various ways without having to ingest drugs, but some of it would require rethinking society and education as a whole.
I think this thread matches with an issue raised in this thread: Complexities of suicide
Psychiatry seems to exclude an important aspect, the external reality like socio-economic factors and other things you guys mentioned, which have causal import to mental health and focuses, unduly, on the inner world/self of a person.
However, a thing to note is that given any set of situations no two people will react in the sameway. Look at the holocaust. Some went into severe depression but many pulled out of it sanity intact. Doesn't this mean that psychiatrists many not be completely wrong in their outlook that mental illness is a personal issue?
Of course they are not completely wrong, or even half wrong. But at the same time they are not only completely factually wrong but completely morally wrong. Imagine the insult of rocking up to the concentration camp and offering pills or CBT to help the inmates "adapt". No, close the damn camps, food and freedom first, surely? And then we can talk about mitigating the effects of the trauma.
This is partly the case, but does it mean we should consider that people who can't adapt to being tortured in concentration camps are mentally ill and ought to be medicated so they become well-adapted to the concentration camp? Do we have to be machines that always put into question the individual rather than the system the individual is in, only trying to change the individual and not the system we impose on the individual? That seems like a good road to mayhem.
No worries.
Hopefully, you understood my post to be ironic for emphatic effect.
Well yes this is called an assessment, but I'm referring to actually giving credence to auditory/visual hallucinations.
Quoting leo
Exactly.
You made an assumption upon the profession of psychiatry. To think this is a clever discussion by using anecdotes and philosophical jargon and word play is meaningless to actually validating to what you're saying.
No it doesn't. This is not how assessments work. We take into account all external as well as internal factors that could contribute to a persons dysfunction. I'm seeing a lot of you guys make assumptions here without any real support. When I evaluate my clients I take into account all factors.
If you were a psychiatrist trained in a system where you are taught that concentration camps are normal, and that mentally healthy people are well-adapted to concentration camps, if your career and social status depended on you accepting that concentration camps are normal, would you look at the concentration camp itself as an external factor that could contribute to a person's dysfunction, or would you see the concentration camp as an essential part of reality that the person ought to adapt to? Would you then look for other causes behind the person's dysfunction, such as hypothesized brain defects, and then attempt to treat them by making the person ingest some drugs? If these drugs made the person's behavior appear less dysfunctional in the concentration camp, would you then consider these drugs to be an effective medication to treat the mentally ill?
These were more rhetorical questions rather than a personal attack, I only phrased them that way to provoke thought. Probably many german people back then didn't see anything wrong with concentration camps. What might we see as the concentration camps of today's society, infrastructures and ways of doing things that lead many people to suffer but that we see as normal?
Humans tend not to be consciously aware of many of their beliefs. Scientists and professions that rely on science work within a system of beliefs they often are not consciously aware of. They believe they take all factors into account, because they omit to take into account the factors that depend on the truth of their beliefs. They think they are looking at all the factors that could be responsible for why one individual suffers, without looking at what they take for granted or what they see as normal.
In an earlier post you mentioned the reality of being stuck in traffic. That's one example where many people might have come to see it as a normal part of life that one has to adapt to. Like sitting in an office looking at a screen for 9 hours a day doing some repetitive task, while being occasionally pressured by some other individuals who get to decide whether you can keep doing this every day, so that you can get at the end of the month some pieces of paper or some numbers in an account that give you the right to sleep in a place you can temporarily call your own. Taking part in all this is the normal thing to do these days, and not adapting well to it is being mentally sick.
Possibly one of the dumbest things the scientific community did was to allow businesses like Pharma to use science as a marketing tool, hide their data and then sell billions of dollars of drugs whose efficacy was exaggerated and risks were downplayed. Great job shooting yourself in the foot. The fact that most keep their mouth shut about this is a travesty.
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020138
I can understand if research is not replicable due to honest mistakes — science is hard — but to allow it to be exploited for profit at the expense of sick people trying to get better is a deep betrayal.
Here is another article which explains exactly why a large portion of the "scientific" literature is BS.
https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12147
I believe psychiatry as it now functions is a menace and should disappear.... There is a need for medical doctors with special additional training regarding mental and behavioral problems, psychoactive drugs, medical diseases presenting with psychological and behavioral symptoms, et cetera to work with other professionals and non-professionals but should never be anything but [b]equal members of a team.[/B]
You're a professional psychiatrist so I can't completely reject your claims but it is quite odd to blame and treat a person who's depressed with medication because people treat him/her badly. You see the problem is not with him. It's the people who mistreat him. The pills don't treat that significant part of the problem do they?
You're using a play on words and hypotheticals here because this would be utterly ridiculous. If you expect a serious answer can you use a less ridiculous hypothetical example?
Again, the kneejerk reaction is not to assess someone and medicate them immediately, but more importantly why would you assume someone who has psychiatric distressed is "blamed" by the psychiatrist? This is ridiculous and it is harmful. We would do a disservice to clients by blaming them for their psychiatric distress.
The thing is, if someone has issues with coping with stress and/or are having a psychotic breakdown some clinicians may use a combination of psychiatric medication as well as behavioral modification techniques to aid the individual. Some clinicians use medication primarily, some don't. All psychiatrists aren't one size fits all.
Quoting TheMadFool
Are you referring to someone specifically or is this a general opinion? Someone who is for example expressing the idea that demons are trying to kill them and are going to use physical means to absolve their situation, can indeed become dangerous. Sometimes therapy alone may not help and unfortunately chemical intervention is necessary to regain a mental balance on the situation.
You definitely sound like someone who had a bad experience,.
That is beneath your usual level, and rather disappointing. Such a statement is an insulting grab for the moral high ground and bears no relevance to anything that had been written earlier.
If you've had a bad experience with psychiatry, or someone close to you has, then bring it out so it can be discussed openly, fairly and constructively. Making unsupported slurs, disguised as wisdom and impartiality by the use of poetic language (poetry being something for which, as all regulars here know, you have a gift) is unfair and unhelpful.
Quoting unenlightened Just like ambulance officers don't see it as their business to stop people driving so fast. Should ambulance officers all quit attending road accidents and take up jobs as highway patrol police until we reach that utopian ideal when nobody drives dangerously any more?
This just shows that you don't understand what depression is. Many people with depression are not that way as a result of being treated badly at all. Many people in unfortunate circumstances are not depressed.
And nobody with an ounce of understanding of psychology blames people who are depressed.
Quoting andrewk
And the medical profession doesn't campaign against smoking, over eating, poor sanitation, or poor air quality? I seem to remember a story of doctors stopping a cholera epidemic by removing the handle of a pump.
Quoting andrewk
A large part of my argument is precisely to deprive the profession of its automatic presumption of the moral high ground by showing as a matter of historical fact that they are not entitled to that presumption. And one of the disqualifying factors is just such personal attacks as you have mounted. You cannot dispute the facts, so you impugn my motives. And present fatuous suggestions that the emergency services should be speed cops. Yeah- I'm saying that, aren't I? C'mon man play the ball not the man!
Quoting Chisholm
As I brought up earlier in a casual way, psychology is heavily implicated and has great impact and influence on the advertising industry, and it is no mistake.
To put it very simply, a contented person does not spend money. The way advertising works, therefore, is to make people discontented, to make them anxious about their body hair, or how clean their work surfaces are, or whether Johnny Foreigner is coming to steal their children, or all their friends are secretly laughing at them because they have last year's suit. Psychologists are very good at this, because when you treat people as objects in the name of objectivity, then you learn how to manipulate them like objects.
Psychologists set out to create the anxiety; psychiatrists try to cure the anxiety. This is no foolish mistake, but central to the functioning of capitalism and economic growth. This is why the profession does not protest and this is why mental health is deteriorating despite all the professionals working to improve it.
1) This is correct.
The Joe Camel and Joe Chemo campaigns provide good examples of the Elaboration Likelihood Model of Persuasion proposed by Petty & Cacioppo (Social Psychologists) in 1986. (Petty, Richard E.; Cacioppo, John Terrence. 1986. "The Elaboration Likelihood Model of Persuasion". Advances in Experimental Social Psychology. 19: 123–181.)
2) However, it is also irrelevant (i.e., off-topic).
The OP is concerned with Psychiatry, not Psychology. Psychiatry is a regulated profession in most western jurisdictions, which requires a medical qualification. And the title "Psychiatrist" is legally protected.
Whereas, Psychology is an extensive field, and its clinical practitioners generally do not have a medical qualification, hence; they cannot legally prescribe medications.
It is my understanding that with regard to practise, Clinical Psychology is the only branch of Psychology associated with Psychiatry (although other branches may contribute to Psychiatric research).
That said, the OP raises a very good point concerning treatment scope and method which is conducive to philosophical discussion (i.e., that the treatment of neuro-behavioural atypicality should be a multi-discipline enterprise).
[*]Exactly what mental illnesses can be said to exist?
Quoting Galuchat
Medicine is supposed to be science based, so one would not, I hope, claim that biochemistry is irrelevant. But as it is exactly the scientific base as opposed to the socio-political base that is in question, the science of psychology should certainly inform the practice of psychiatry. It seems very odd to suggest otherwise, and also historically untrue.
Quoting Hanover
This is likewise nonsensical. One can devise an effective treatment for homosexuality, and be as empirical as an empire about it, but the successful treatment of something that is not an illness is bad medicine at best, and a serious violation of human rights if imposed against an individual's will as in the case of Alan Turing.
Quoting Hanover
But that isn't all psychiatry does. Alone of the branches of medicine, it frequently and systematically imposes treatment on those not seeking assistance against their expressed will.
Treatment that is for illnesses listed in the DSM that get voted on and off from time to time in a manner closer identified with social attitudes than any kind of science, and that even researchers have decided to more or less ignore.
You have quoted me out of context, and misrepresented my further comments; cheap tricks. So we are done here.
Medicine is a practice, and in so saying I'm not knocking it. Ditto for psychiatry. Ditto for dentistry. On their way to practice, students study science (like, major in molecular biology), then take more classes, and rotate through clinics. Along the way a good deal of solid science is encountered and (we hope) absorbed. But let us face a fact: The various sciences behind medicine, and all their content, is way too voluminous for the brightest doctor to carry around in his or her head.
Students mostly learn how to be doctors and dentists (and psychiatrists) by practicing on patients. Once they get good at it, they keep 'practicing'. They go with what works, what makes patients happier, or at least not dead.
@Hanover, lawyers used to prepare for the bar just by reading and practicing. Abe Lincoln became a lawyer that way. Worked for him. The Mayo brothers weren't master scientists, they were very good organizers.
So, a psychiatrist is presented with two different patients, The first is clearly out of his mind -- screaming incoherently, flailing about, totally nuts. The other patient is unhappy, is doing poorly in life, but is functional. What to do?
In the first case, administer Thorazine, put him in a padded cell, and wait for the drugs to work. Then out of the cell into a locked ward, then into an unlocked ward, and eventually, home with an Rx for lithium. The psychiatrist doesn't need to know (and doesn't, in fact know) how Thorazine and lithium work, just that they do what they do. Patient gets better.
The unhappy patient doing poorly in life, but who is behaving more or less 'appropriately' presents a lot more difficulty in a way, because there is no particular drug or intervention that will dramatically change his behavior. From his practical experience, the psychiatrist knows that soothing words help, some drug or placebo will help; encouragement, helping the patient develop some insight, and so on may all be helpful--or not.
Where psychiatrists really earn their status is in dealing with major mental illness, where life and death issues are at hand. Their waiting room full of merely unhappy, dissatisfied, pissed off, worried sick patients will mostly get better on their own, as they always have, but he gets paid to help them, so...
But what I said was:
Quoting Hanover
This would require that those being assisted are those who want to be assisted. I've not suggested that any branch of medicine impose itself on unwilling patients, and I don't know that anyone was suggesting that the fundamental rules requiring informed consent be changed.
Quoting unenlightened
There are fairly strict laws regulating the imposition of unwanted treatment, requiring judicial intervention. http://brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/INVOLUNTARY%20TREATMENT.pdf
The state often has an interest in seeing that certain people are treated and not left to their own devices, especially when they pose a risk to themselves or others. Even in those instances, there are strict standards and limitations imposed on the treatment.
You're attempting to define the medical profession by the rare instances of extreme examples where a responsible society can't just stand idly by under some over-reaching theory of self autonomy and allow people to self destruct or destroy others.
What you're referencing has less to do with medical ethics and the proper role of medical professionals in treating patients than it does the proper role of police powers vested in the state and the state's right to promote the public welfare. Such is the purview of law enforcement and the judicial system more than doctors, but to the extent you have an over-zealous doctor trying to impose treatment on an unwilling patient, his power will be checked by the law and judges.
The unfortunate reality is that there are more people in need of treatment sleeping in the street than there are people not in need of treatment forced into hospital beds.
Most people are psychologically healthy enough that they can function with or without any form of therapy. Since there's minimally wrong with them, they invest at most a few hours a month going to their therapist, and sort of like getting a massage from time, it feels good, but you're no better or worse off long term from it. Your back is going to hurt sometimes and it's going to stop hurting sometimes regardless of what you do, but a massage might help you through the worst of times.
I've been to a therapist before and it did offer some insight. Whether it was a life changer, not really, but I wasn't in need of a life changer. I also didn't leave embittered, with the feeling the process was bullshit and a money grab. It had its value and I'm not ready to jettison the whole profession as a scam, or worse yet, a destructive, controlling cancer on our society.
Up until the late 60s and early 70s, it was possible for a family or a state agency to commit a problematic person to a psychiatric hospital without much concern about civil rights. As bad as that was, it was just as bad that most state hospitals were not really doing much to effectively treat patients. They were, for all practical purposes, merely custodial.
I've seen psychiatrists and three different therapists. The best one was finishing her therapy doctorate at St. Thomas University. We met weekly for a year; her approach was non-directive psychotherapy. That year actually produced significant progress. 6 or 8 week workbook based counseling programs aren't much. If you could solve a psychological problem with a workbook, you didn't have much of a problem to begin with.
Isn't it strange. I entirely agree with you. I offer some criticism, I make some connections between psychology and psychiatry, but I have actually been confronted with an axe wielding schizophrenic, and I have no doubt whatsoever that something needed to be done quick smart. I say, along with the article from the op, that it is largely hubris for anyone to claim to know causes or cures, but I have a huge respect for folks who take on that problem and do their best. And getting rid of some of the hubris would I suggest result in more humane, more responsive, more personal, and probably better treatment. This would be especially so if one could discuss openly the limitations of a scientific approach to such things and the heavy influence of social conditions on both the patient and the therapist and their theories and practices.
And you're still crazy as shit, so I guess I'll have to concede the point that psychiatrists and psychologists are useless. Well played sir.
I went to a therapist who just sat there and made me talk. I didn't like the awkward silence, so I kept talking. I'm not sure it accomplished anything, but I didn't want to object that it was bullshit because I have this tendency to do that and impose whatever the hell I want on things. I thought it'd be ironic for me to do to her what I do to others, so I fought the urge.
I eventually quit going, saying I had other shit to do.
What I noticed about myself is that I tended toward such introspection that I failed to actually emote. I recognized that as I rambled on and on self-diagnosing, when I noticed the lonely box of Kleenex on the table, realizing that it must be there for a reason, that some people actually cry on that couch where I was sitting. I thought to myself that was an astute observation I just made about myself as I sat there, further self-diagnosing and self-treating. Sort of like I'm doing now.
Nice chat.
And psychiatrists campaign against conditions that contribute to psychiatric disorders. For instance they have been foremost in the campaign in Australia against the inhumane treatment of refugees in detention, many of whom are now suffering psychological disorders. So what's your complaint?
Quoting unenlightened Such a plea would have a greater ring of sincerity if you hadn't said:
Quoting unenlightened
I don't know why you launched this bitter, unprovoked attack, but it would be a good idea to reflect on why you have done it, rather than doubling down.
Quoting andrewk
I really would like to know where you see the bitterness in that quote. As to unprovoked, I think I can point you to the several provocations, not particularly directed at me, but It's off topic really, as are your remarks about me.
That will be $150.
Quoting unenlightened
... but you won't identify one of them,
Quoting unenlightened
... and yet you don't.
Quoting unenlightenedIf you are now saying your attack on an individual and a profession was off topic then it's hard to see why you pursued it so vehemently. But if your grudge is spent then let's drop it.
Quoting Hanover
Well, that wasn't all in the same week! It took 25 years to stumble on the last one who was really quite good.
You are supposed to do most of the talking. Only you, after all, know just how fucked up your family life was, the horrible things that happened in the cradle, and so on. The therapist is there as a guide, a mirror, and an echo chamber, in whom you see and hear yourself, and come to understand just how horribly wrong it all went.
Then, after you have finally collapsed in a paroxysm of weeping, wailing, rending your polyester double knit shirt and sprinkling the ash tray's cigarette butts on your head, have really used that box of Kleenex, you're reading for Phase II, where the silent therapist who listened to you for 3 years comes to life and instructs you in detail in how to get your shit reorganized, and to move on to finally become a whole, integrated, and somewhat satisfactory person. That may take another 5 years.
But how is it possible to take these factors into account? What does this analysis consist of? Could an analysis of a patient's cognition, behavior and social welfare by any honest measure be called objectively scientific? Wouldn't you need to observe the patient in situ?
In my personal experience as a psychiatric patient for ADHD and depression, "taking external factors into account" consists of the psychiatrist diagnosing purely on the basis of self-reports that cannot be crosschecked and that are potentially wildly inaccurate, especially considering the political pressure there is on the patient to obtain a supposedly "objective" medical diagnosis for obtaining sick-notes.
Imagine if a dentist operated on teeth purely on the basis of questionnaires and self-reports...
At least in the UK, my experience with the NHS tells me that the cognition and behavior of mental-health patients is not evaluated by clinical psychologists - not even a stroop test - and that psychiatrists only provide superficial consultation services with respect to googleable psychopharmacology.
Back in the early seventies when I was studying philosophy and psychology, specialising in abnormal psychology, there was a deal of criticism of the practice of psychiatry from the libertarian Thomas Szasz, from existentialist Ronald Laing from psychonaut and novelist Ken Kesey, marxist David Cooper. (These were qualified psychiatrists, apart from Ken Kesey.)
At the time, psychiatry was busy divesting itself of the psychoanalytic tradition, which my psychology course dismissed as 'unscientific' (it was a major target of Popper, who was the leading philosopher of science at the time, and dismissed Freud and co as 'unfalsifiable'). But the criticisms of the psychiatrists mentioned above went much further.
The derogatory term for 'unscientific' here is 'quackery' and it is a very serious charge against any medical practice. So Bell's question from 1886 "Exactly what mental illnesses can be said to exist?"
is a vital one. I have already indicated that historically, a number of illnesses have been said to exist that are now regarded as rationalisations and promotions of social prejudice that have no substance. But the problem is, that there are no mental illnesses that can be diagnosed on any basis other than an assessment of behaviour. There is no bug, no gene, no chemical deficiency, no physical property at all that unequivocally marks out any psychological illness. And after 130 plus years, it's a major embarrassment or ought to be, that the scientific basis of psychiatry remains so weak as to be unworthy of the name - illnesses diagnosed on the basis of an individual's assessment of another individual, and treatments assessed in the same way.
However, while the biological neuro-physical materialist objective approach has not been successful, progress has been made in a direction much closer to the discredited psychoanalytic tradition. In very crude outline, the suggestion is that trauma and stress, and particularly childhood trauma activate psychological defensive responses, that are mediated by all those physical factors that have been discovered to be risk factors but not causes. That is to say, even more crudely, most if not all mental distress is a form of PTSD. For a more sensible exposition, see Gabor Mate, a mere medic, but still worth reading.
And so the environment, the society, and personal history returns to prominence, and this demands of the therapist above all a non-traumatising intervention - a humane and respectful relationship to the patient, even if at a moment of crisis, some vigor is required to remove the axe from the mad axeman.
incidentally, if anyone is interested, critical psychiatry is a thing, it's not just some rubbish I made up because I'm horrible.
At the 161st annual meeting of the American Psychiatric Association in 2008 the APA president Carolyn Rabinowitz told the audience in her opening-day address:
[Quote]”We have come a long way in understanding psychiatric disorders, and our knowledge continues to expand. Our work saves and improves so many lives.”[/quote]
But here is a conundrum. Given this great advance in care, we should expect that the number of disabled mentally ill in the United States, on a per capita basis, would have declined over the past 50 years. We should also expect that the number of disabled mentally ill, on a per capita basis, would have declined since the arrival in 1988 of Prozac and other second-generation psychiatric drugs. We should see a two-step drop in disability rates. Instead, as the psychopharmacology revolution has unfolded, the number of disabled mentally has [U]skyrocketed[/U]. Moreover, this increase in the number of disabled mentally ill has accelerated further since the introduction these second-generation psychiatric drugs.
The disability numbers, in turn, lead to a much larger question. Why are so many Americans today, while they may not be disabled by mental illness, nevertheless plagued by chronic mental problems — by recurrent depression and crippling anxiety? If we have treatments that effectively address these disorders, why has mental illness become an ever-greater health problem in the United States?
This doesn't change the fact that psychology being a branch from philosophy, provides value through the structural reasoning that many researchers and professionals like myself use as a model to understand the foundation of the human mind.
I hope this was sarcasm and I hope there was a method to this madness. I take offense at someone who pokes fun at someone's mental health whether they are going through some form of mental abnormality or not.
Quoting Hanover
Great self-reflection! but it doesn't change the fact that you may not have gotten down to the root cause as to why you were there in the first place, and why you were there is indicative that there exist something that required objective mitigation through therapeutic means.
I like you
Your ability to put words together is interesting enough for me to say, you ought to write a book one day.
Hanover and I have been trading sarcastic broadsides for years.
The statistics might be misleading.
50 years ago, give or take a few, the rate of "mental illness" per se was thought to be around 10%. Several factors could be raising the figure:
Maybe more people feel more comfortable about claiming to be mentally unwell? During the recession which began 12 years ago, people who were unable to find work (and were getting a bit old to change careers) tried salvaging the situation by going on disability related to mental illness. (It's hard to manufacture paralysis; it's much easier to manufacture mental illness.) Maybe there are more ways now than 50 years ago to be diagnosed as mentally ill? Maybe people believe that antidepressants actually work wonders, and were willing to give it a try?
And how do we know how many people actually are mentally ill? There's no registry of certified lunatics, as far as I know. Mental disorders are not reportable illnesses, like syphilis. Who is counting and how?
Quoting Chisholm
One possible reason is that so many Americans are living in a crazy society, and are going mad, in the colloquial sense of the word.
True, and I don't think that genetics is anywhere close to parsing out all the genetic factors that control the behavior of the brain for learning 2 + 2 = 4, let alone somebody who thinks they are Jesus.
I knew a guy who claimed to be Jesus. (This was not in a psychiatric setting,) He was educated, charming, intelligent, funny, apparently grounded in reality, and so forth. There are three possibilities. A) he was pulling my leg. 2) Perhaps he was Jesus. Why not? 3) Perhaps he was a perfectly functional lunatic.
Why should there be some other method of diagnosing a mental illness other than observing behavior? If this guy thought he was Jesus, what more would you want to see in a blood test or MRI? A guy who thinks he is Jesus but is also witty, urbane, intelligent, educated, and an effective employee raises questions that behavior answers, it seems to me: He may be deluded, but he is otherwise behaving normally. So who cares if he thinks he is Jesus? It's more interesting than being a run of the mill bat shit white supremacist, don't you think?
If a patient is delivered to the emergency room of a hospital after being found on the street naked, screaming incoherently, displaying intense agitation, displaying inability to interact with the staff, what more than behavior observation do you need? Severe mania and psychosis produce this kind of behavior. The pt's blood can be checked for hallucinogens. No drugs? It's probably mania.
How long does the mania last? Does the pt. respond to major/minor tranquilizers or anti-seizure drugs? How long does the pt. stay awake in this condition? Doesn't respond to drugs? periodically and suddenly falls asleep wherever he happens to be? Better do a neurological work up.
Medicine -- including psychiatry -- has a very strong element of "practice". After seeing 500 pts. in mania, a pattern probably becomes pretty clear. How many moles does a dermatologist have to look at before than can say at a glance, "malignant" or "nothing to worry about". After a while they know the drill. Untextured red spot on skin? Probably cancer. Textured red spot on skin? Probably benign. Patient is counting the ceiling tiles in the waiting room. Probably OCD. Your friend has to check to make sure the stove is turned off, the refrigerator is closed, and the door is locked 5 times before than can leave. Definitely OCD. No need to see a psychiatrist.
But those are the easy kinds of cases.
Quoting unenlightened
So your complaint is that mental illnesses are not reducible to simple underlying physical causes? That's what makes psychology and psychiatry "unscientific" in your assessment?
Why do you think your one-liner is going to be more clear than my several lengthy posts with references.? What is it about unscientific that requires scare quotes? We say homeopathy is unscientific because there is no evidence that it works, and no evidence for the theory that underpins it.
Perhaps we can talk about 'the medical model' - behaviour understood as illness. Apart from the tradition, which applies also to 'the possession by devils model', what evidence is there that medicine is the right approach as the underlying theory of mental distress?
And why are you talking about 'my assessment' when I have just pointed out a long standing tradition within psychiatry and linked to an ongoing group of critical psychiatrists, along with another well respected expert in the field of addiction, proposing a rather different approach. Why are you even talking about 'my complaint'? I'm only the messenger, stop trying to shoot me.
Quoting unenlightened
Perhaps. That would be an improvement over criticizing "the biological neuro-physical materialist objective approach" because it did not reduce all questions of medicine and psychology to simple, bite-sized physical explanations like bug, gene or chemical deficiency.
I think it was sarcasm. He might in fact be crazy as shit. I'm not a doctor, so can't be sure. It was all in fun though. Many of us have known each other here for a very long time and this was just gentle ribbing. As to calling me out when I am actually offensive, sometimes I care, sometimes not.
Quoting Anaxagoras
I knew exactly why I was there actually and I didn't want to talk about it. I wanted to talk about how introspective I was. Those Kleenex scared me.
I think being logical probably helps in all fields.
So my question for Anaxagoras is this:
What is a psychiatrist without his medications and diagnoses?
What is it exactly that he/she has to offer people in need and our society? What are psychiatrists offering us that we need so badly?
What is the point of that question? You could play that game with any profession: what is a lumberjack without their cutting down of trees, what is Chris Froome without his bicycle, or Serena Williams without her racquet?
What psychiatrists offer to society is that they can eliminate or mitigate the suffering of many people who suffer chronic mental anguish, and in some cases cure them for good.
That psychiatry has been used for terrible things in the past is not in dispute. But so has teaching - just read Nicholas Nickleby, David Copperfield or Tom Brown's Schooldays. Yet we don't blame today's teachers for the sins committed by teachers past. So has nursing, with many nurses involved in forced adoptions from unmarried mothers. But we don't blame today's nurses for that.
Great post!
Perhaps you could elaborate upon anatomical and/or physiological causes of behavioural atypicality (if not per DSM, then per ICD-10, Chapter V), and what psychiatrists do to eliminate these from consideration in arriving at a diagnosis?
Quoting Chisholm
I think this is the point. If the lumberjack's chainsaw turns out not to have a chain, and the trees turn out to be telegraph poles, then one is entitled to question what he is doing.
Quoting andrewk
One can say as much for priests. And personally, I am not against priests either.
What distinguishes the practice of psychiatry from the above, is that the the reason for the practice of psychiatry isn't politically neutral, either on the side of the patient who requests a diagnosis due to failing to conform to the social values of modern society, nor on the side of the psychiatrist who is diagnosing according to an illness ontology that is based on a narrow conception of an individual that serves capitalist interests in endorsing a particular system of moral judgement.
In the criminal justice system and the welfare state , psychiatrists and psychologists play the role of priests who in effect deliver a moral judgement of an individual in the guise of the presence or absence of a mental illness diagnosis, that is largely subjective with respect to unreliable and incomplete proto-scientific evidence. Of course the psychiatrist will claim to be only giving the best possible objective psychological diagnosis, but he is rarely paid for this reason, for his diagnosis is used by other institutions and juries to reward or punish a 'weakly performing' individual in relation to society's values.
It sounds like your concern about psychiatry relates to its practice in the criminal justice system, where the subject is not the doctor's client. That will always be problematic, just as it is with forensic pathologists and police surgeons.
But we can't avoid having that involvement, can we? What would be your preferred model for dealing with someone that is alleged to have committed a brutal crime and who pleads insanity or is suspected to be suffering from severe mental illness?
Your apparent reticence (no answer to this question) causes me to suspect that you're not actually familiar with the practise of Psychiatry.
So, @Chisholm's complaint is valid, to wit:
Quoting Chisholm
Absent such information, the only conclusion I can come to is that psychiatric practise is inexplicable and/or indefensible.
First off I am participating in several other threads so whatever you said in quotes was pushed way down the line as I had 20 other responses. Two, I'm not a practicing psychiatrist. Although I have my doctorate, I'm not a medical doctor and although we use the DSM-V in much of our assessments we do not prescribe medication at least here in the state of California. Three, I work for a living so I'm in and out of this place. Four, to reiterate point two, I don't do private practice, as I'm a clinician and work in a hospital setting and deal with a different demographic.
So, you don't "professionally work in the psychiatric field".
In fact, according to this post, you have a doctorate in Clinical Psychology, but work "professionally as a Social Worker", because you are not licensed to practise Clinical Psychology in your State.
No wonder you can't provide specific information on the practise of Psychiatry. That's fine, as long as we are all clear on the point that you cannot be considered an authority on Psychiatry.
For all I know, maybe you shouldn't "be allowed to live in the community".
Britain's Care in the Community policy has not been an unmitigated success.
That’s a huge potential assumption. Where do you get off saying something like that?
Google Care in the Community.
Professionally I deal with psychiatric patients and yes I make assessments based on the DSM-V categories and professionally I have the authority to hold patients based on whether they have homicidal or suicidal tendencies. My research background plus being a member of the APA very much makes me an authority. As far as shedding light on atypical behaviors as per expressed in the DSM-V versus the International Classification of Diseases again, psychiatrists use ICD-10 as well as DSM but the thing is as far as what I do professionally I mainly make assessments by using DSM however ICD codes and DSM codes are basically the same.
I know in the UK they primarily use ICD-10 as opposed to DSM-V.....
Quoting Galuchat
Yes, I do actually....I literally work in the emergency room which has a behavioral unit.
Quoting Galuchat
This is true.
Quoting Galuchat
Because Psychiatrists are medical doctors and I'm a psychologist as per my education, although not currently practicing nor making attempts to gain licensure, I am still at least academically qualified to shed light on mental disorders.
APA?
Aberdeen Performing Arts?
American Psychological Association
I'm starting to get that feeling. Work is very slow right now and I'm literally at work giving this the time of day.
Quoting Galuchat
Quoting Anaxagoras
And that makes you an authority on Psychiatry, not.
Sorry.
Google Argument from Authority.
We use the same Diagnostic Statistical Manual. Based on the axis models in the DSM I can make assessments on behavioral disorders and in fact know common medications that are used to treat mental disorders. I literally speak with doctors all the time and they literally always ask me recommendations on the best medications that I recommend (for example whether someone who has recurring panic attacks ought to be given lorazepam commonly known as Ativan, or Zyprexa).
I'm not saying I'm an authority of psychiatric medicine because again, like I said, I'm not a medical doctor. If you want my academic as well as professional opinion on behavioral disorders and their causes and treatment, I can give my professional opinion. If YOU wanted me to diagnose you, I couldn't make a professional opinion online because we aren't face to face. Sure I can make a general assessment but it would only be general and not something professional.
But as far as authority is concerned of course I have no authority in psychiatry I'm not arguing that but this is not how this thread developed.
Finally! Thanks for admitting that.
It feels like I'm becoming an authority on pulling teeth. But just for the record: I'm not a qualified dentist.
So what was your point in all this?
Google Argument from Authority.
I know what it is, and your point?
Thanks. There is literally no difference between a psychologist and a psychiatrist except that one goes to medical school and the other one doesn't. One is research based, and the other deals with medicine. One can write scripts, the other one doesn't. I just don't understand what the issue is here.
I thought you were a psychiatric patient, not a Psychiatrist.
I think I'll leave you two authorities to have at it.
Cheers!
Gotcha...Yeah this happens a lot where I work
Only when the Lakers lose
I had a lot of bizarre perceptions but I don't think there was any "reality" to them beyond the contents of some subconscious part of my brain. Like dreams. I know many people who still think their eg hallucinations were some kind of "gift". I thought so at the time. It's my opinion that the reason so many psychotic individuals use religious language is that our society lacks a vocabulary to talk about extreme mental states. Which is maybe for the better, because we don't take mystics very seriously.
I also want to point out that most of the institutionalized people I have met are very self-absorbed, inconsiderate, and frequently reality-denying, not to the point of delusions but just...refusing....to pick up social cues, eg. I do think at some point the lack of "honesty", more or less, is a moral problem and not a psychiatric problem.
The thing is that society always finds some way to remove, marginalize, or isolate undesirables. We used to be more honest and just stone people to death. Now we warehouse them in prisons and institutions.
But let’s put aside the subject of psychotropic medications and consider for a moment what has become the dominant and most popular treatment of mental disorders over the past 30 years or so — Cognitive Behavioral Therapy (CBT)
CBT is based on the idea that our emotions and moods are influenced by our patterns of thinking. The aim of therapy was to "correct" these processes, "to think and act more realistically". It would allow the patient to avoid the misconstruction of reality that had led to their problems. Rather than focus on the patient's history -- say their childhood and early experiences -- like most other psychotherapies, CBT is mostly directed to the here and now.
Ok, I am not convinced by this or by the current behavior-based descriptions of depression, diagnosed according to a check-list of factors that drugs can shift (appetite, mood, and sleep patterns) or by the cures. People are both much more complicated and far more interesting! Depression is not just a set of pre-ordained symptoms, but as multiple and varied as those who are told they suffer from it... Its source can lie deeply buried in an individual's history and far from present awareness, though the trigger may well be a separation or crisis. At its core is the experience of loss: engaging in the difficult process of mourning is what allows us to come through. CBT can certainly be helpful for some people. But it is crucial to distinguish the question of whether a therapy works and HOW it works. For any therapy to get started, unconscious belief systems need to be mobilised. Human belief is a very powerful thing and no external authority can tell us what to believe in. Just to be clear: I don't think CBT is completely without value. It can definitely help some people to become aware of and to correct one's irrational biases in thinking or with anger issues. But I think it's impossible for CBT theory to take into account the complexity and contradiction and detail in human life. It also has no place for the realities of sexuality or violence that lie at the heart of human life.
With CBT the psyche has become like a muscle that needs to be developed and trained. There is no place for complexity and contradiction here: the modern subject is represented as one-dimensional, searching for fulfilment. The possibility that human life is aimed at both success and failure and never simply at wealth, power or happiness no longer makes sense. Suddenly the world of human relations described by novelists, poets and playwrights for the past few centuries can just be written off. Self-sabotage, masochism and despair are now faults to be corrected, rather than forming the very core of the self. In today's outcome-obsessed society, people must become countable, quantifiable, transparent. And this leads to a grotesque new misunderstanding of psychotherapy. Therapy is now conceived as a set of techniques that can be applied to a human being. This makes sense if we see it as a business transaction with a buyer, a seller and a product. But it totally ignores the most basic fact: that therapy is not like a plaster that can be applied to a wound, but is a property of a human relationship. Therapy is about the encounter of two people, and the real work is done not by the therapist but by the patient. As the psychoanalyst Donald Winnicott observed, the therapist provides a space in which the patient can construct and create something. The therapist encourages and facilitates, but whether a therapy takes place or not depends entirely on the patient.
The patient's own reality has to be taken very seriously by the therapist. To explore it, to define it, to elaborate it and to see where it will go. No outcome can be predicted in advance. With CBT the divided self has vanished, along with the recognition that grief, despair and frustration strike at the heart of our image of self-possession and fulfilment.
However, I agree that CBT is unhelpful for many (myself included).
The problem I have with therapy is that I know what the therapist wants to hear, but it is nearly impossible for me to control my thoughts from moment to moment. I know how I should think, but I CANNOT change my erratic thoughts throughout the day no matter the effort involved.
I also have had a much greater than average share of trauma in my life, and CBT doesn’t seem suited to address my issues.
I used to be, like, completely insane. Don't make excuses for yourself. Tyrannize your brain and only allow it to entertain what a psychiatrist would find kosher.
If you have no idea how to achieve such discipline, take CBT seriously.
One of the biggest problems with mental health is that, in general, nobody can force anybody to change. It's such a problem that most people think a psychiatric diagnosis is permanent. Lazy comparisons to diabetes abound.
If you want to change yourself bad enough, if you don't allow yourself to fail, you'll succeed. Otherwise you won't respect yourself.
It seems to me that the best thing for bipolar people (and lots of others, as a matter of fact) is to do what you are doing: take your medication consistently, make your appointments, and monitor yourself so that you can access emergency intervention before your stability deteriorates too far.
I've experienced depression, but nothing worth a journal write-up. Pedestrian, ho hum. My partner was bi-polar, and managed it for a good 40 years. He did have some hospitalizations along the way after going into pretty severe mania. He found support groups (not therapy groups) helpful -- he learned about manic depression/bipolar disease, made some good friends, and a couple of times got some very good leads on better psychiatrists. (He died of cancer a few years back.)
So, good luck in your care. Mental illness is a tough challenge.
Schizoaffective disorder, which is like a little bipolar, a little schizophrenia.
I started a thread here, so some of you can continue to bitch a moan under a proper subject. I say "bitch and moan" because apparently a couple of you perceive to act like you know more about the realm of mental health, and considering that I've spent almost ten years of my academic life in its study not to mention this is what my current profession entails.
Sorry for your loss...
https://www.npr.org/sections/health-shots/2019/04/11/712295937/ketamine-may-relieve-depression-by-repairing-damaged-brain-circuits
[I]“have found hints”
“In mice”
“appears to”
“scientists have known relatively little about how ketamine and similar drugs affect brain circuits”
“there are still many remaining questions”
“appears to”
“region of the brain we think is important”
“seemed to be repairing”
“finding suggested”
“could be relieving”
“research suggests”
“somehow coaxes”
“One possibility”
“study suggests”
“What we can imagine”
“if that’s true”[/I]
*************************
In other words, these researchers don’t know jack sh*t about what this new drug does.
:roll:
If we accept that individuals are not self-causing agents, and therefore if we understand the concept of guilt pragmatically, in other words we define a person's guilt in terms of the social benefits of sentencing the individual, then we certainly need much more than mere analysis of the subject's brain, and in many instances the status of the subject's brain is irrelevant.
And exactly the same logic applies when diagnosing the average depression.
If psychiatry is a science which t accepts that individuals are not self-causing agents, then I cannot see how psychiatric evaluation as currently practiced is particularly relevant to establishing guilt.
I don't know a great deal about how it is used in the criminal justice system, but my impression is that the involvement of psychiatry is mostly related to determining the best method of dealing with the situation, rather than the assignment of guilt which is, in my opinion, purely a matter of opinion.
I imagine that, if a claim is made that the accused was suffering mental disturbance at the time of the alleged crime, the value of psychiatry would be in assessing whether the frame of mind the person had at the time was likely to recur. If it was, and the crime was very grave, it may be necessary to restrain the person for longer than the range of criminal sentences allows. On the other hand, if it was a psychiatric event that was unlikely to recur, it may be considered appropriate to have a shorter period of incarceration, or none. These considerations could be made based on the principles of public protection and deterrence, rather than retribution, which is all that the notion of 'guilt' relates to.
I also imagine this varies between cultures. In the US, which seems to have a retributive focus, 'guilt' may be seen as important. I don't think retribution plays much of a role in Scandinavian countries.
If you review this thread, please consider the possibility that you are cherry picking (selection bias) engagement with only the most extreme anti-psychiatry position, which I am not even sure are as extreme as you think.
As a "mental health professional" your usage of the words "bitch and moan" to minimize your opposition is incredibly typical of people in positions of authority who have no real argument justifying that authority.
Your responses are on par for abrasiveness and some areas I would say exceed, for instance in the category of deflection, your opponents in this debate. In the vernacular, I would say you have been "triggered", far more than your counter-parties that openly admit to a history of mental illness whereas you claim to be, of one degree or another, an authority on mental illness.
You also seem to have problems perceiving the reality here. No one has claimed to "know more about the realm of mental health, and considering that I've spent almost ten years of my academic life in its study not to mention this is what my current profession entails".
Your interlocutors have pointed out philosophical problems in the construction of what "mental health" is, that it is as much a social construction as a scientific construction. The component that is a socio-political construction cannot by definition be professionalized, and naming experts of the socio-political component of mental health is for the purpose of imposing order ... an order that can be challenged on political grounds.
Now, I will admit there is also a scientific component to mental health and that the various mental health professions do help people in this category.
However, the socio-political component is incredibly dangerous to society, and not simply people misdiagnosed or "had bad service" that one can claim are bad apples the profession is always working to remove.
Leo has provided a really good thought experiment that puts this issue in to perspective ... that you dismissed off hand in a thread entitled "Psychiatry’s Incurable Hubris".
Quoting leo
Your reply was:
Quoting Anaxagoras
Leo's example is not a play on words, I don't see where you get that from. It's also not a hypothetical. The concentration camps actually happened, psychiatrists managed inmates with chemicals to increase compliance, and psychologists and psychiatrists made and applied criteria of what mental illnesses are "undesirable" and weakening German society.
The German psychiatrists and psychologists had all sorts of "science based" theories on why some people needed to be put in concentration camps, developed the criteria for putting people in camps and, once in camps, criteria for distinguishing "good laborers" from the bad. They also experimented on and found chemicals to help people adapt to the conditions in the camp without challenging authority as much.
Now, a lot of this is just bad science (some science specific to Naziism and some more or less global beliefs of the discipline at the time) and if you claim "well, we've learned since then", I'll accept that answer on the science component of mental health (in this debate).
However, part of this practice stemmed from the values of Nazi society and was an entirely logical follow through of those values. "Getting rid of undesirables" is a logically consistent value system and many societies have shared this value, and "deficiencies in mental health" is a logical category of "undesirable". In this case, psychiatrists are charged with identifying, trying to "fix" and if that fails labeling "for extermination" mentally ill people. (They also had theories for why entire ethnicities were mentally ill and performed experiments to see if anything could be done to fix these people and concluded that no; however, to simplify the discussion I want to focus on the Germans identified as mentally ill).
So considering this actually happened and as a university student of the subject for 10 years you are certainly aware, claiming it is a "hypothetical" is deflection at best and disingenuous at worst.
Now, the practice of psychiatry in the West today is not as extreme as in Nazism, but there are parallels.
The danger today (in the West) is not exterminating people, but a displacement of ethical and political dialogue, society must engage in to resolve new political challenges, to psychiatric expertise. For instance, in the past if working conditions became intolerable, the reaction to these conditions was political action; this is how 40 hour work week, for instance, came into being. Today, there is another option available: working conditions are fine, it's individual people who have problems that are "maladapted". So, if the truth is that working conditions are not fine, then the situation is a direct analogue of the concentration camp example: society as a whole is the (granted not as bad) concentration camp and psychiatrists direct their efforts to the people who find conditions intolerable and improve their adaptability; and this can be tracked by science (even if we disregard self-reporting of moods, we can track "people getting back to work" and other objective behavioral metrics; and conclude that psychiatry is "helping people and society").
However, the justification of mental health interventions rests on the justification of the government policies, both in the specific systems that deploy mental health but also in the general good governing sense. If government is oppressive, then the natural reaction is to be angry, anxious, depressed about it (if you are in an oppressed class, of course) and it is these feelings that motivate political change. To lower these feelings with chemicals is to participate not in the assistance of the individual, but in the sedation of society as a whole for adaptation to further oppression.
An extreme example today is the Chinese "re-education camps" of Muslims. Professionally trained to a western standard, psychiatrists and psychologists help build the systems to identify who needs "re-education" and how to "re-educate" them to be adapted to Chinese state management of their land, economy and culture.
Yet the mental health profession in the West has nothing to say about this, and any professional from China involved in the above system could easily move to the West, have degrees recognized and complete any remaining licensing condition, and practice professionally in the West. If they were an effective technician at enforcing state policies in China, there is no reason to question their effectiveness would change in the West. There has been little to no discussion (by the mental health professional community in the West) about the abuse of the science of mind to enforce compliance of an entire culture using large integrated AI systems, re-education camps, manipulating children to give information on their parents, and every other method available, all informed by the behavioral sciences. For instance, there has been no attempt to identify and blacklist participants in this oppressive system.
It's not as extreme in the West, but is there really no analogous issues? And as Leo points out, would you be able to know just in virtue of having a psychiatrist degree?
In the West, psychiatrists and psychologist are an integral part of the enforcement of compliance in school, the work force, public spaces, prisons and the home.
Take school for example. Western schools are to a significant, but a lesser degree than China, also filled with propaganda. Lot's of things in textbooks are verifiably false, misleading or simply absent (for propaganda purposes and not simply time constraint purposes). On top of this, teachers can be prejudiced themselves. If a student evaluates the direction of society as "bad" and so makes the logical conclusion of needing to resist conditioning and "wakeup" his or her peers, what will be the result? An arms-wide welcoming of a critical thinker out to improve society, and a sit down with the student body to put on trial alleged state propaganda? ... Or, will that student be labeled a trouble maker and enter various pipelines to be "fixed", and after the failure of a few disciplinary measures, will find themselves quickly diagnosed with a mental health issue.
Now, if the reality is there is not state propaganda in curriculum, no teacher prejudices in this student's case, and the general direction of society is morally justified, then indeed the student is living either "outside reality" or then the agitation, anxiety and disruptive behavior is due to brain chemical and wiring and the rational of "resisting conditioning" is simply a childish excuse to retroactively justify inappropriate behavior due to an unfortunate underlying physiological and mental condition the student does not have the skills to identify. If chemicals fix the emotions and disruption, it can be considered a win.
However, if the evaluation of the student is correct, then the resistance is justified and diagnosis of a the reasonable response of the student becomes not medicine but an organ of state oppression, to fix the problem at the behavioral level: whether it means sedating political actions or as a form of mental harm to increase the cost of resistance beyond what the student is willing to accept, both mechanisms will have the desired behavioural outcome and contribute to the statistics showing the treatment is effective.
Likewise, if legal working conditions are simply not acceptable, a psychiatrist employed by a company or even sought out by the worker to increase productivity by suppressing natural mental reactions to intolerable living and working conditions, is again a tool of state oppression. If working conditions are fine, then it's just helping the outliers have a normal and productive life. Again, a big difference as to the nature of what's happening.
If a justice and prison system is maintaining oppressive and racist policies and the conditions in prison are inhumane and closer to a concentration camp of forced labour than to anything resembling justice and rehabilitation, then it is justified to resist such conditions. Again, any mental health intervention to enforce compliance of prisoners with prison conditions is a tool of state oppression. If the justice system is great, rehabilitation as effective as it can be, then helping prisoners with mental health issues is part of a good rehabilitation system. Again, big difference.
Now, in all these cases, genuine mental health problems will be mixed in with reasonable methods to resist oppression, so the practitioners will always have clear cases of a mental problem to point at and say: look, no one can deny this persons hallucinating or can't function at a basic level. But this is a red herring used to justify and enable state oppression as whole, which is far more dangerous and damaging to society as a whole than fixing the genuinely mentally ill along with the politically disruptive.
Now, to be clear, this is not a personal attack on you. I don't know what system you are in, and, even in a bad system, being aware of these issues, an individual psychiatrist could try to do more help than harm by allying with the oppressed and either minimizing harm or helping them to "get through the cracks" and advance their cause without being caught by the mental health machine.
However, based on your responses you seem to believe there is no issue, that psychiatry deals with "reality" and never dabbles in enforcing compliance of government policies.
To be doubly clear, I am not asking for a justification of your system visavis the above issues, but response on the principles level. Are the Chinese mental health professional that are helping to track and predict using integrated surveillance and AI systems to minimize disruptive Muslim behaviour doing good work (are they potential terrorists with the mental culturally wide health conditions the Chinese government claims, or legitimate political actors seeking self-determination, as most other nations did at some point)? If they aren't doing good work, are they bad behavioral scientists, or just bad people? If they are bad people, would behavioral science tell them this, if, so, what papers and studies? If there's nothing in behavioral science that would point to an ethical problem, are they not then good behavioral scientist but simply with ethical and political beliefs you disagree with? Likewise, are the examples of the student, worker and prisoner simply impossible? If they are possible would you argue that psychiatrists are trained to identify and "leave alone" legitimate political grievances in the situations I described, in, for instance, the US?
To preempt one potential response, I am aware that these issues have been written about and some professionals maybe aware of them; however, my rebuttal would be only a just society trains to understand and employs people who apply such considerations: an oppressive state will train for and select for effectiveness in achieving the policies.
Really great post, thank you, you explained it better than I could.
I would give it as compulsory reading to all psychiatrists and would-be psychiatrists, so they might ponder and be more self-aware about how much what they're doing actually heals people, and how much of it is nothing more than forcing people to adapt or shaping them to conform to oppressive social norms and policies. It's not easy to uncover a social norm as oppressive when one grows and is conditioned in a system where such a norm is taught as a normal part of reality, and to see people who refuse to bend to this norm or who suffer from conforming to it as legitimately oppressed rather than as mentally ill.
This is all I need to know....
Really? Someone takes the trouble to write a long, detailed post teasing out some of the controversies and philosophical issues, and this is the best you can manage?
You place a tremendous amount of responsibility on the mental health community for the enforcement of community values and propaganda on the citizens. That governments are often oppressive and horrific is undisputed, and their employment of any means possible for their ends is a historical fact, but blame rests more on the government leadership than their puppets. Mengele was a physician I suppose, but I can't blame medical science for the horrible experiments on human beings, often children, that the Nazis performed.
As another historical fact (which is why I cited that quote of you above) the 1970s marked a departure from using psychiatric diagnosis and psychiatric treatment on inmates, leading to a far more punitive approach to corrections than previously. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762476/
Many see this departure from the rehabilitative approach as the cause for current prison population surges. That is to say, while psychiatric approaches might be oppressive, so might be it be to ignore such approaches.
No and yes.
No, I avoided using the term "community values", because an oppressive state generally doesn't reflect "community values. I'm sure you're aware that every oppressive and/or totalitarian state claims to be representing "community values".
If community values are indeed reflected in an effective democratic system where no one is disenfranchised and everyone has equal say and political dialogue is open without parties with disproportional external or internal manipulative or obstructionist force, then I would expect mental health professionals to be in constructive dialogue with society to manage the issues outlined above without any fear of career repercussions of criticizing current policies as potentially unethical.
Yes, if mental health professionals are engaged in creating and/or enforcing state propaganda, directly or through all sorts of subtle ways their profession in organized, I place a tremendous amount of moral responsibility on them for their participation.
Quoting Hanover
This is exactly my point. There was no incompatibility between the Nazi value system and the science of mental or physical health. Being an expert in mental health therefore is not grounds to argue "we're helping more people than we're harming: trust me, I'm an expert"; Nazi scientists who participated could successfully argue they were top experts in their field. Nazi scientific expertise has no relation to the moral argument of what purpose it served in Nazi society. The point of this is to show that more evidence than "10 years of academic study in psychiatry" is required to argue the function of psychiatry in a given society is doing more good than harm.
Quoting Hanover
This is deflection without any relation to the points I bring up.
First, it's a false dichotomy, "punitive" measures, longer sentences, and worse conditions for inmates known to damage mental health, isn't the only alternative to relying on over diagnosis of the terrible psychiatric framework of the 70s. If you are accepting the premise that the US justice system is oppressive, then and now (something I'm not arguing here, but what principles would apply if it was; so substitute China or Saudi Arabia or then if no oppressive state exists, imagine one hypothetical), then government deciding to make it even more oppressive isn't a good argument for a previous "less bad" oppressive system.
Second, the "departure from using psychiatric diagnosis and psychiatric treatment on inmates" was precisely because the profession entered the exact moral-political crisis that people in this thread are referring to. The state was happy when psychiatry as a whole would diagnose anyone making problems for the state as "mentally ill"; whether it be "all the blacks" are prone to more violence (especially in the sight of beautiful white women) and segregation is scientifically sound, that marijuana leads to mania and should be illegal, why homosexuality is a deviance and thus a crime and a disease, or to just paint any disruptive political behavior as mental illness whenever the need arises; it's a convenient synergy where the state doesn't even have to pretend there's an ethical argument for any given policy and psychiatrists and pharmacology producers make bank and can power-trip without state interfering with nuanced ethical questions: the opposition are all mentally ill! and questioning the profession is the worst mental illness of all (they are "experts in reality" after all, they should therefore know their profession is good in reality).
The policy change from relying on diagnosis and psychiatric treatment of criminals was not because "we might be criticized for enforcing compliance, let's err on the side of safety" but because the discipline couldn't withstand scientific scrutiny. Experts couldn't come to the same diagnosis for the same people, and, famously, a healthy scientists pretending to be "a bit weird" was misdiagnosed and their explanation that it's an experiment to test accuracy of mental diagnosis was itself categorized as even worse mental illness (the scientist couldn't escape, no one knew where he was, and he had to pretend to accept the prescribed "reality" and pretend to get better in order to eventually get released and publish his findings).
At the heart of the problem, there was no scientific basis for evaluating states of mind, but all diagnosis was based on the psychiatrist imagining the state of mind of the patient.
So I don't see what you're suggesting, that it was some voluntary shift of a system that "worked" (to avoid uncomfortable but ultimately unfounded criticism?) to the sad only alternative of increasing punishment, decreasing all forms of rehabilitation (which, again, is a false equivalence with psychiatry and mental health to begin with), and increasing the prison population as a whole?
... Or, was increasing the prison population and increasing punishments a response from embattled institutions to turn the oppressive nobs up where they could on the black community, since the moral justification of the time honored tradition of segregation was falling apart?
But whatever your answer, I don't see the link with the topic at hand.
As for psychiatry, the whole crisis in the 70s emerged precisely because American society was resisting oppression and psychiatry was correctly identified as an integral part of justifying and enforcing those oppressive policies (segregation, homosexuality, female opportunity-gap and "female hysteria", etc.), so dissident scientists set out to test these claims using the scientific method rather than just "some expert said so". In some cases, best practices, under scientific scrutiny, turned out to be literally torture to maintain a disincentive for bad behaviour. In other-words, the entire "science of mind" was under the mass psychosis of believing they could imagine correctly what other people thought and perceived and could predict correctly how their interventions corrected the thoughts and perceptions, and a further mass-psychosis of believing that actual science, starting with basic scientific principles, could and did support this belief. There may have been a period that followed the crisis of more caution, more discussion of the difficult ethical and political questions, but I would say that period has ended since a while now: there's too much money to be had in making society believe it's normal to be mentally ill, which is more or less the point we're at. There's an even larger portion of money to be had making society believe false things are true. Everyone involved has been selected for efficiency in attaining these goals, and benign parts of the profession are selected based on not asking uncomfortable questions. The danger to society, as I mentioned, is mentally healthy people believing that poor performance in adverse conditions are a "you problem" and not a "how society is organized problem" and that luckily you can be fixes! or at least feel less bad about being broken; the other danger is a large portion of people believing total nonsense is fact.
The rest of your post is duly noted.
Since you're continuing to participate, I'll assume you're serious about your proposed moral standard of "not as extreme as the Nazi's".
Please educate me, is this a mainstream view in psychiatry that the moral standard to clear is Nazism? Are there papers, from which you derive the content of your expertise, that explain how this ethical standard follows from sound scientific principles in understanding reality and how it is to be applied in psychiatry practice?
Furthermore, there are good psychiatrists and bad psychiatrists. When I was at the UW psych ward, I was told by the head psychiatrist that he couldn’t change the world, but he could help me feel better. In my opinion, he was a good psychiatrist.
Dr. Israelstam of Madison, Wisconsin, told me after I told him that I was suicidal that he hoped he’d never see me again after he suggested that I might want to try heroin. He ended up going to prison on child pornography charges. He was a bad psychiatrist.
Perhaps it should be a rule that any thread gets automatically closed after one hundred posts, to head off the inevitable Nazi comparisons.
At least as much as anyone else.
Quoting Noah Te Stroete
This is one of the central issues. To what extent is "feeling bad" a mental health issue, and to what extent it is a good reaction to bad circumstances (that can be changed through political action). In what circumstances is government intervention in how people "feel" about society, morally justifiable, to what extent it a tool of oppression.
Quoting Noah Te Stroete
In my responses, I pointed out that even in a oppressive system, a given psychiatrist could be helping more than harming. The general issues here are not reducible to "bad psychiatrists and good ones", and so the only ethical issue is "bad apples" that are progressively being removed with best practices discovered over time.
I also point out that I believe mental health does exist and a valid science can exist addressing it, and the practice of psychiatry today, under most if not all systems in the world, can point to successes.
But pointing to some successes, this does not establish that more good than harm is taking place, neither in a given system nor if we consider psychiatrists as a global community.
My intention here is not to prove this is the case, and to what degree, but to discuss the relevant principles.
To offer a simplification that can synthesize my points so far and where I am going with them, mental health professionals become the agents of state oppression in an oppressive state, simply because an oppressive state will set things up to achieve it's oppressive policies. So, mental health becomes in the same category as the police and military. Of course, policemen and soldiers of an oppressive state can too point to instances where they are "helping people", but ultimately they are enforcing oppressive control that does more harm than good. The roll of psychology and psychiatrists is less obvious in the maintenance of control but, I would argue today is actually more effective. Keep in mind that an oppressive state uses an excess of propaganda and educates people from a young age with that propaganda, and so if and when an individual starts to "feel something is wrong" they have not been provided the opportunity to study the history of philosophy and so cannot immediately articulate "why they feel things are wrong". In an oppressive state, mental health practitioners main function in the state system is to intervene in this process of become socially conscious and convince the would-be-political-active person that they have a mental health issue, that they are not adapted to society and they will feel better if they are fixed and able to adapt. Adaptability of presupposes it is a worthwhile objective to adapt to society as it is. The claim psychiatry is helping people more than harming them, is thus reducible to the claim that society is justly organized, and so people that "don't feel good" have a mental health issue and they should be convinced, and in some cases forced, to adapt to government mandated expectations of behaviour. If society is not justly organized but oppressive, then people who "don't feel good" are having, most of the time, a healthy reaction to intolerable social conditions. Now, what is "a just organization of society" is of course the central question, one discussed on this forum tirelessly, but if my argument follows, the point is that psychiatry cannot refer to a scientific standard to justify it's roll in society.
Now, if all this is established, I of course don't expect many psychiatrists in an oppressive system to care or do anything; they are selected for training and elevated to positions of authority precisely because they either agree with the social engineering program of the state or don't view it as their business to care or comment on. The purpose of my argument is first to simply to establish the truth of what basis psychiatry can be be said to doing more good than bad, and, a second less important point, that understanding the roll of psychiatry and psychology in state oppression is essential to resisting it, just as understanding the roll of police and the military are prerequisites to resisting oppressive power. Now, in such a struggle against oppression, the agents of oppression are both an obstacle and a potential ally; most large political changes occur when the agents of the state abandon state propaganda and side with the resistance.
Of course, in an effective democratic society where everyone has equal say and neither the political process nor social organization in general cannot be argued to be lowering the say or marginalizing any would-be-oppressed group, there is no need for "resistance" but simply participating in the political process if one has concerns about government mental health policies.
Great attempt at deflection, but in this conversation your point isn't even factually correct. I cited Leo's mention of Nazism and explained why it had good points that merited a response. The entire purpose of my post was to recast what I viewed as salient philosophical points into less extreme circumstances.
How could I be first, if I'm citing someone else and trying to explain the philosophical merits of their comment?
Quoting andrewk
No one here is calling anyone else a Nazi, so you're not even using Godwin's law correctly to begin with. Furthermore, any academic course of medical ethics will bring up the Nazi's, but you seem to think it's irrelevant, is my understanding of your comment correct? Should we just ignore this period in history or at least cut off any attempt to learn from the evils and mistakes committed at 100 posts?
So, yes, I decided that it is best not to rock the boat too much because I was a target of the authorities at one time. I decided that I cannot change the world. Most psychiatrists are no different, and the good ones want to help people out of compassion. I decided I want to feel better as the world is. I suggest you give up your idealism and just let society evolve as it is wont to do.
This...
I rather like to back away with the discussion on Nazism trope
This is another issue, certainly warranting debate. However, in this discussion I'm only interested in establishing that an oppressive state will naturally use mental health sciences as a tool to further oppression. And evaluating whether a state is oppressive or not is outside the domain of psychiatry.
That we should expect to find psychiatrists, on the whole, agents of and beneficiaries of state oppression, rather than other jobs like agriculture and factory work where we would expect to find the oppressed (assuming an oppressive state, of course). Now to what extent is each psychiatrists personally morally responsible and to what extent "just plodding along and following orders" is again another debate.
Quoting Noah Te Stroete
To answer your first question, I don't live in the US; I moved to a country (from a country other than the US) where I have even less fear of "rocking the boat" and becoming "a target of the authorities" then from whence I came.
Quoting Noah Te Stroete
Not even a little?
But even if your statement is true for you and for me, I am largely an adherent to stoic formulation of ethics where the intention and "giving a good ol' try" is what matters.
Quoting Noah Te Stroete
Because most people are like you? Or because psychiatrists are selected based on having a similar outlook? Though, at no point did I morally condemn any psychiatrist; for me it's largely irrelevant part of the debate. Just like condemning individual police or soldiers for their roll in state oppression. However, there are exceptions to this general rule, but simply being in the category is not such an exception in my view; more particulars would be needed about what someone knows, what actions were participated in, opportunity to do otherwise, degree of coercion etc. I have pointed out twice now that an individual psychiatrist can still be doing more good than harm even in a system that does more harm than good.
Quoting Noah Te Stroete
Society's evolution is not independent of my actions, so what you say is simply not logically coherent: it is not an exterior system I can choose to leave alone. If I choose to maintain the status quo, I would be contributing to that evolution not letting it "evolve as it is wont to do".
It seems like you think you can have an impact on societal affairs. If so, that sounds an awful lot like delusions of grandeur. In reality, you have very little to no effect on society. State oppression? Welcome to the world as it’s been since the formation of communities. No one will ever change that. Now, if you live in Saudi Arabia, then it does very well need drastic changes. Just don’t stick your neck out too far lest your head get cut off.
You can say that about any powerful first world society.
Quoting boethius
Which is what I've done during my residency yet according to you, psychiatrists/psychologists are agents of oppression.
Quoting boethius
pray tell what system do you refer?
Really? That's what you understood from my comments.
I say "But even if your statement is true for you and for me [that we cannot change the world at all], I am largely an adherent to stoic formulation of ethics where the intention and "giving a good ol' try" is what matters." And you deduce I have delusions of grandeur?
Quoting Noah Te Stroete
Democracy doesn't exist? The transatlantic slave trade is still humming along? Segregation never ended? Or are none of these things changes to the oppressive nature of all human communities?
Quoting Noah Te Stroete
So trying to make the world a better place would be reasonable in Saudi Arabia in your view, as long as you don't get caught? But elsewhere your recommendation is to just feel as good as you can about the world and let it evolve as it wont to do? Or are you also recommending that to people in Saudi Arabia, just pointing out they got a bad lot?
How so?
Quoting Anaxagoras
Please read my comments, I am pretty clear that my view is psychiatrists/psychologists are agents of oppression in an oppressive state, and that my view is effective democracy solves the problems of the dangers of behavioral sciences used to manipulate society; just as effective democracy solves the problem of the dangers of police and military institutions.
If you want to argue no states on earth are oppressive that would be another debate; if true (that there are no oppressive states) then my points here would be hypothetical. If you want to argue your particular government is not oppressive, that would be another debate. Both debates would be relevant, but it is not the issue I am addressing here.
I am not arguing a just society should not have police or soldiers or psychiatrists/psychologists, and that these would not be agents of justice in a just society.
Quoting Anaxagoras
My arguments are on the level of principle. If we agreed in principle then it would make sense to start discussing particulars. The principle I am arguing in the instance you cite is "even in a system that does more harm than good, an individual psychiatrist can be doing more good than harm". I'm not referring to a particular system.
Which individuals? Please point them out.
[Edit] to make my point perfectly clear: are you referring to individuals such as you and me specifically, or individuals in the general sense?
Yes, I am interested in what principles, if any, would be true in all circumstances.
I am not so interested in morally evaluating you, Dr. Israelstam, or the head psychiatrist at UW. As I mention in a post above, morally evaluating the actions of specific individuals is a very lengthy task.
I am of course interested in evaluating my own actions; though I would agree I am highly unlikely to single handedly change the world and vanquish all the oppressors out there, I believe I am able to make a contribution to a community that may, some day, if not eliminate, at least significantly reduce oppressive circumstances in the world.
Are you sure that was your first reference to it? According to the site's search function you were the first user. It's possible that it's malfunctioning or I am using it wrong.
Quoting boethius Godwin's law is about the probability of a comparison to the Nazis. That is what you did above when you said there were parallels.
The point is that if you had a rational argument you wouldn't need to play the Nazi card, which is always rhetorical. If something is wrong, it can be argued to be wrong on its merits. The rational basis for the argument is in no way helped by saying that the Nazis did it - like listening to Wagner, dressing up and in some cases, being vegetarian. :scream:
The United States have used race to oppress people. Portugal more specifically King Leopold II used religion (in addition to race) to oppress.
Quoting boethius
That remains to be seen. I never experienced what effective democracy looks like, and considering that any political system that stems from a human is flawed so I look at your worldview with much skepticism. The problem with your view is that you lack understanding to the nature of various psychological illnesses and conditions. Your so-called explanation does not address the generations of psychological/physiological disorders and diseases people of have contracted, nor does it explain how the removal of the systems of oppression will prevent future mental distress and the necessary removal of psychiatrists/psychologists.
How does effective democracy answer for ADHD, Down Syndrome, Anti-Social Personality Disorders (which research has indicated that some children have experienced behaviors associated with it)?
Quoting boethius
If not a system then what is effective democracy then?
And you would say this of all first world nations?
Quoting Anaxagoras
Please revisit my points. I do not say an effective democracy is without flaws and humans would be perfect within it; I say democracy can solve the issue of dangerous state organs, as with the police and military.
Quoting Anaxagoras
This is not my view at all. I do not say removing oppression would remove mental illness, nor that removing psychiatrists/psychologists would remove oppression. Where do you get that from?
I also say that even in an oppressive system, successes could be pointed to of effective mental health treatment.
I do not deny mental health is a thing and people can be mentally ill, my point is that under an oppressive state, dissidents, mentally healthy people subject to intolerable conditions (i.e. the oppressed), and the mentally ill, are all grouped together and the state does not employ (or tolerate the employment of such people by others) people interested in distinguishing these categories.
Quoting Anaxagoras
Again, this is not my position and I don't see which of my statements would lead you to believe I am advocating that under an effective democracy all mental illness would disappear.
However, the difference with a oppressive state is that an effective democracy would consider and debate all aspects of these issues and try to tease out ethical nuances as well as allow different opinions from both professionals and laypersons to be voiced as to the causes due to environment and social organization that better government policy can do something about.
A fully totalitarian oppressive state will not allow for any discussion that challenges state policy, much less have people vote on anything, and will likely (being oppressive) have terrible conditions contributing immensely to genuine mental health issues as well as, mentioned above, group all dissidents and "disruptive elements" into the same mentally ill category. If treatments reduce disruption then they are successful and there is good empirical evidence that the "treatments work".
Of course, there's a large spectrum between complete totalitarianism and what I call an effective democracy, and a mix of democratic elements and oppressive elements can exist in which case things can be more complicated than the above examples.
We don't have to live in a Utopian state in order to allow psychologists (or anyone for that matter) to provide input into the democratic process. Psychologists are but one voice among many, and their power is checked by the multitude of other interests in society.Quoting boethius
The Nazi example does not stand for the proposition that psychiatry is bunk or that it is only a weapon for the corrupt. The Nazis believed Jews (and many others) non-human and devoid of any value. That determination was not made by the Nazi version of the American Psychological Association. The Nazis used everything in their power to destroy Jews. The propaganda advanced by psychologists against Jews, whatever it might have been, was the least of the Jews' worry at that time.
But to the point of whether a government can misapply science in all its forms (including psychology) to advance evil, of course. There's no limit to human evil.Quoting boethius
The primary theory of why someone needed to be put into a concentration camp was that they were Jewish. Often the decision of where they'd be sent was made by a Nazi soldier who simply pointed which direction they would go. You make it sound like the Nazis kept charts by each person's bed and they reviewed each case closely and made careful deliberate decisions, thinking they had to justify each patient's case on a case by case basis.
Nazi Germany can be used to show the depravity of mankind no doubt. I'm just curious why you think it has special application to psychology as science. I can't imagine that Nazi dentists, for example, treated Jews very well. Why don't you discuss how we should therefore now be highly suspicious of dentistry?Quoting boethius
Mental health intervention occurs only with judicial oversight and its not a matter of a psychiatrist just forcing people into institutions. The likelihood of someone being forced unwillingly into a bed is far lower than someone in need of a bed not finding one.
Quoting boethius
The point is that the psychologists themselves, who you are suggesting are drunk with power to control society, arrived at the conclusion that forced psychiatric treatment was ineffective in resolving criminal propensities. The findings of psychologists resulted in turning the system into one more retributive than rehabilitative and therefore reduced their own influence.Quoting boethius
I'm not in favor of anyone who violates basic human rights, tortures, brainwashes, or does generally terrible things. That would be the case whether they were psychologists, physicians, plumbers, or philosophers.
No, I'm just saying that first world nations have used these tactics to oppress people therefore implying that being a part of a first world nation does not mean its success wasn't realized without oppressing people.
Quoting boethius
I have revisited your argument and it is flawed. I live in a so-called democratic republic called the United States, and so far I don't see any difference from what you're saying and what I'm currently living in.
Quoting boethius
This is what you've seem to imply, at least to me.
Quoting boethius
Yes you did, but if the system is oppressive how is there success? since we are discussing the United States, if we are looking at oppressive systems it takes a certain amount of gall, to fight against the system to establish equity. So far again nothing what you've said is substantial enough to where it would distinguish itself from the current state of affairs in the U.S. or elsewhere.
Quoting boethius
This is your problem is that going back and reading you're very vague and not too descriptive on how something is oppressive yet allude to the state of affairs concerning perhaps the pharmaceutical industry. What I'm saying is regardless whether you change society, mental illness will always be a byproduct of human existence. Much research has indicated our environment playing a factor. So regardless whether you change the government, change the way people think, change the way people eat, drink, and live, mental illness will always be a factor and you need specialists to mitigate those behaviors with coping mechanisms to modify them which is where therapists come in.
Quoting boethius
THIS IS WHAT WE DO IN GRADUATE SCHOOL!!!!!!!!!!
This is what the APA do annually with meetings concerning different therapeutic models that work. This is the problem with you people who have never been to a graduate program or what you think you know about psychology/psychiatry. You sit there at your computer and theorize and have no stepped one foot on campus to actually see exactly this is the shit we do. It really pisses me off online that a bunch of nobodies on a chat forum who have never actually written research can sit there and try to make dialectical arguments to destroy something we've built online as if we aren't making a difference in the world.
Here is a suggestion for you.....
Have the balls to apply to a doctoral program as I did, make sure you have the grades, the letters of recommendation, as well as the background to support your excellent character. Get in, complete the program as well as residency. Get on the APA board and change the game from within. Getting on an online philosophy forum does shit to change the system. I at least put in the work to try and make a difference in the system and yes there is plenty to debate and disagree with, but for certain I've seen an excellent group of board members who are listening to people in psychiatric distress and we are evolving better methods of producing a better way in treating the human condition.
Right, I read into that and it pissed me off. I have fucking taken my work home with me in hoping how to better help people and their conditions.
In response to this ad hom diversion, I'll present my own:
I really fail to see why you take such challenge to the posters on this board, constantly feeling the need to prove your credentials and authority on such matters. It doesn't sway any opinions and it just makes you look pissed off for not being taken as seriously as you demand. I'm just suggesting that the tact of explaining what it is that psychiatrists do in helping the world is a better approach than telling people they're dumbasses for criticizing that which they don't understand.
Did I say anything remotely like this: that only in a utopian state can psychologists (or anyone have input) into the democratic process?
Quoting Hanover
Yes, we agree. If democracy is working effectively everyone can have a voice; both psychologists/psychiatrists can voice their ethical concerns about mental health policy, as well as anyone else. I go to some lengths to explain why the danger of mental health workers acting as enforcement of oppressive state policies is significantly less dangerous in a an effective democracy.
The questions then boils down to what is effective democracy. I think it's clear most posters here are only thinking about the US; however, I have written here mostly about principles (as well as noting a global perspective where there are places like China with "re-education" camps right now).
If one is not convinced one is living in an effective democracy, then my argument is psychology/psychiatry play an important roll (are a powerful tool) in achieving a wide range of state policy objectives; both in relation to passifying individuals who may otherwise become politically active, a roll in punishing people who become politically active, as well as a roll in forming public discourse (i.e. justifying the policies to begin with, by appeals to "expertise").
Now, as for the US, the question of whether the US is an effective democracy where the power of powerful individuals or groups, like psychiatry or pharmacology interests (not to say they are the "most powerful"), is actually checked by the multitude of other interests, is another debate, one which I am sure is suitable for thrphilosophyforum.
My point here, is that all the issues discussed in this thread very much depend on one's opinion of the government in question. If one finds the government sufficiently just and fair, then it's reasonable to trust that the rules and norms being expressed through psychology/psychiatry ("helping people adapt to society") are just and fair. If one feels one's government is not sufficiently just and fair, then one should expect such a government to use the tools of psychology/psychiatry and mental health sphere to maintain the power relations, where ever possible.
Quoting Hanover
No, this is not my point. No where did I say psychologists are drunk with power to control society. What I say was that an oppressive government is going to have oppressive policy objectives and will train for and select for psychologists and psychiatrists that are effective at achieving those objectives, just as with the police and military (which doesn't imply "all police are bad" or "the science of criminology doesn't exist" or that the only solution is a "utopia, and until we have utopia we must get rid of police, soldiers or psychologists").
Quoting Hanover
Again, no where did I say it was psychologists dictating justice system policy. You seemed to present the thesis that there was a link between abandoning the policy of relying heavily on mental health diagnosis in dealing with and "rehabilitating" criminals (that turned out to be based a lot of unrepeatable "science") and the next policy to increase punishment, decrease all methods of rehabilitation, and increase the prison population. The implication seemed to be that "criticism" of psychology/psychiatry roll in the justice system at that time led to a worse system.
My rebuttal is that, first of all, there is no logical link between these events; presented as you did, your argument is a false dichotomy. Whatever problems in the academic literature (what was widely considered fact ... but turns out it wasn't) as well as in the structure of mental health for prisoners could have been solved, improving mental health services for inmates, while employing all sorts of other policy changes that increase rehabilitation rates, as well as policy changes that lower the prison population (i.e. abandoning the "war on drugs").
My secondary point, tangentially related to the main issues of the debate, is that I view a direct link between the civil rights movement, the dissident scientists challenging the status quo of psychiatry (it was certainly not the psychology/psychiatry community as a whole that suddenly abandoned pseudo-scientific theories justifying segregation and other social injustices), and a direct link with features of American society that are part of what I would call effective democracy (freedom of speech, independent press, etc.). However, the struggle against oppression is ongoing; today, I would say a new problem has arisen, in particular in pharmacology, where it is possible to influence the scientific review process (i.e. vast webs of conflicts of interest, revolving door, captured regulators) and also influence society's view of what mental health is and what needs treatment. For instance, in the 70s, a lot of the dissident scientists challenging the status quo could perform very cheap experiments (for instance, walking into an asylum and seeing what happens, is a cheap experiment to do); today, a lot of the studies are extremely expensive to repeat, and so a scientist without conflicts of interest that wants to do repeat studies needs government funding (in an effective democracy, I would expect the government to be like "yes, we definitely want to give a lot of money to those guys trying to keep everything honest and on really firm observational and statistical grounds"; in an oppressive / corrupt system, the government may not like these kinds of people, and may not promote them to positions of influence from which they can direct funding for verification purposes as well as cry foul if they see systemic weaknesses in the process of both validation and implementation of regulation and policy).
Yes. This is what you said:
"If community values are indeed reflected in an effective democratic system where no one is disenfranchised and everyone has equal say and political dialogue is open without parties with disproportional external or internal manipulative or obstructionist force, then I would expect mental health professionals to be in constructive dialogue with society to manage the issues outlined above without any fear of career repercussions of criticizing current policies as potentially unethical."
That view of a democracy is Utopian. There is not any such democracy nor could there be. It's an ideal you've posited.Quoting boethius
This complaint is a universal objection, having no more to do with psychology than any other science, religion, political theory, or common mythology. Bad people use recognized authorities to persuade others to their view. There's no reason to target psychology in this attack over any other group of alleged experts or authorities.Quoting boethius
I'll concede the tautology. Oppressive governments will be oppressive. I just don't see how that translates into oppressive governments being more likely to use psychologists than they will plumbers to get what they want. Why are you targeting psychologists as the masterminds for the oppressive governments? If you think, for example, that today's America is manipulated by the government (and some surely do), that doesn't mean that this manipulation was orchestrated by a team of dark psychologists. What it means is that the people in power have manipulated people by the rhetoric and whatnot. They've not had their opposition institutionalized into psychiatric hospitals and declared crazy.Quoting boethius
The reason rehabilitative approaches were abandoned in the 1970s wasn't because dissident scientists challenged the status quo. It was because crime surged in the 1970s and it was felt we needed stricter punitive measures to being society under control. https://en.wikipedia.org/wiki/Crime_in_the_United_States; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762476/
You make it sound like the move toward retributive policies was an outgrowth of liberal ideas and a recognition of the damage done by psychologists. The move toward retributive policies was a turn to the right, with an emphasis on law and order, punishment, and personal responsibility. Today, due to issues of overcrowding and expense, we're moving back toward a less punitive model, which is considered a liberalizing of the criminal justice system. It may in fact be, but I'd submit it's motivated by pragmatics more than anything else.
I outline a "cause / effect" relationship. If the conditions I present exist, then I argue my expectations would follow. I do not say "we can achieve perfect democracy, and only in a perfect democracy will psychology and psychiatry be non-oppressive". In other words, I am presenting the features of democracy that I feel mitigate the problem. The more we approach such conditions, the more the problem diminishes.
Quoting Hanover
I am not targeting "only psychologists", I even mention police and soldiers who also maintain the power structure. In an oppressive society, some people are the oppressors, some the agents of oppression (how else does the system maintain itself?), and some the oppressed.
But it's best viewed as a spectrum, with some rolls very clearly the "oppressor" (dictator, top brass of secret police, and the like), some rolls are clearly agents of oppression (guy who rounds people up for torture), and some rolls are clearly the oppressed (slaves, poor farmer, factory workers); however, many rolls can be in various grey areas, perhaps contributing to oppression one day and undermining it a bit the next (if the activity is not particularly dangerous, the state cannot devote much energy to optimizing it's oppressive effect; i.e. an oppressive state will devote a lot more energy to controlling journalists and micro-managing what they say than to controlling how a plumber goes about his or her day).
My general framework here is that not all jobs are equal in an oppressive society, everyone just "trying to get by"; that, for instance, the torturer or executioner is just "doing a job". There is a moral dimension to what one does in society; now, passing moral judgement requires a lot more information than simply what nominal roll one is doing (and considering the state will select people for oppressive rolls that don't see their roll as oppressive but just a "job that needs doing" just like farming or anything) it makes moral evaluation even more difficult. However, though it's an important element to the discussion (since we must, at least, evaluate our own roll and decision), my main interest here is to argue that psychology/psychiatry is a particularly dangerous tool of oppression (like the police and soldiers are a particularly dangerous tool of oppression; why there was a movement against standing armies during the emergence of modern democracies).
I also mention, that most improvements to conditions in society is not by defeating the agents of oppression but by convincing enough of them to join the cause of justice and democracy of the day. The purpose of such analysis is that anyone wanting more justice and more democracy is more effective if they understand better the current structure of society what different rolls do in relation to existing oppressive features; how to actually go about changing things is another debate.
Ooh, me sir, please sir, I have delusions of grandeur, sir. Why would anyone talk at all if it had no impact? I'm not certain, but I hope at least, that if I can hold to the best truth I can find and keep an open mind, then you and I and another can influence each other for the good. I call it 'therapy', or sometimes 'philosophy'.
Some people, such as the op, call such delusions of grandeur, 'incurable hubris'.
The pointy finger points and having pointed does not listen. I, you, they, suffer from delusions - there's no value in accounts of delusions, except as manifestations of pathology; they do not communicate. And so we expose in such topics our pathologies and each analyses with more or less sympathy the other. Here is a smart cookie, here is a clever dick, and here is just a Kookie.
Yes, this is my central contention, that psychiatry/psychology is a better tool of oppression than plumbing, that there will be more attention paid to who gets to be a psychiatry/psychologists (that their beliefs are compatible with state policy) than who gets to be a plumber. Plumbers are a group I would argue most oppressive states categorize as general population needing to be generally controlled.
For instance, using pharmacology to make bad working conditions more tolerable, I would argue is a mechanism of oppression in an oppressive state; part of the control system. From the perspective of psychiatrists implementing this policy, people feel better at work, they feel they've "done good". This is not to pass moral judgement, as they may not have any information (thanks to control of media) to criticize what they are doing; but from the outside analyzing such a situation we can very much doubt if they are really "doing good".
Or, perhaps more familiar, to make bad schooling ( and maybe home) conditions more tolerable. I refer to what used to be known informally as cabin fever, but is now called ADHD.
Again I feel examples go more clearly to the heart of the point. It used to be a mental illness to be a slave wanting to escape, and it used to be a mental illness to be homosexual. People wanted to have slaves, they saw their slaves as lesser beings, they wanted them to be good slaves, so wanting to escape was a defect to correct, a mental illness. People had an aversion towards homosexuals, they found them disgusting, saw them as an error of nature, so homosexuality was a defect to correct, a mental illness.
Then in a society where Science is venerated as giving access to Truth, once you carry out scientific research and studies that refer to these unwanted behaviors as mental illnesses, you legitimize this characterization of mental illness as having a scientific basis, as being grounded in truth, as being something to believe in. Then the psychiatrists who are the trained specialists in diagnosing and curing mental illness are the authority to believe in on the subject, so if they say that your behavior is a defect that needs to be corrected, you have to believe them, you must comply, and if you don't comply, if you defy this authority you are deemed to have an additional disorder, an additional mental illness, an additional defect that must be corrected.
The people who have power over others for whatever reason (they govern people, they belong to a majority, they are able to influence public opinion, ...) have the power to characterize specific behaviors as defects that need to be corrected, then children grow up in a society where they are taught that such or such behavior is a defect, and it becomes the truth.
If you're a homosexual and the society lets you be a homosexual in peace, doesn't discriminate against you, then you feel good. If however you're oppressed, pointed at, ridiculed, insulted, if you have to hide to be who you are, if you have to live in constant fear, then you suffer, and the trained specialists on mental illnesses can tell you "look, you can see that you suffer, that you suffer because you're a homosexual, you can see this is a defect that makes you suffer, but you will feel better if we can cure this illness you have in you", then all kinds of experiments may be carried out on these people to cure their 'illness'. Maybe these people then need to ingest pills every day for the rest of their lives because the causes of the illness are "not yet well understood", many factors are at play and more research is required. Then the specialists who work to 'cure' these people say they are helping them, they are helping them function 'better', even if they aren't happy at least their defect has been partially corrected and that's the most important.
In some societies today it's obvious that homosexuals aren't mentally ill, it's obvious that treating it as a mental illness was pseudoscience but now we know better, we won't make the same mistake! And yet back then it was as obvious that homosexuality was a mental illness.
Most people don't need to ingest pills to feel better and cure or hide their 'mental illness'. They simply need to be accepted, respected, listened to, supported. If mental health practice was focused first of all on that, I'm sure it would be much much more effective.
Sure, it used to be considered a psychiatric illness to be homosexual, but it was hardly psychologists who first vilified homosexuals. They were pretty much just parroting the ideology of the times. Today's psychologists seem to be much farther left than right, being a force for greater human rights.Quoting leo
And what do you base your suggestion that the majority in the mental health field reject, disrespect, ignore, and refuse to support their patients? If you have arrived at a method to cure most people's mental illness, why don't you publish it so that it can be implemented if you're sure your method would be much much more effective?
Why is mental illness in quotes? Does it not really exist?
Thing is, what this demonstrates is that there is no essential difference between mental illness and social stigma. And when I say 'essential' I mean a difference that allows psychologists, psychiatrists, philosophers or anyone else to reliably tell them apart. And that means, that when anyone talks about 'mental illness', they literally do not know whereof they speak. And that's why it is in quotes and should be in quotes.
Now suppose the profession were to actually bite this bullet. Then we could stop talking about illness, and simply talk about distress as a manifestation of broken relationship. Perhaps we can ease the distress with drugs, perhaps we can work to make a better relationship. Perhaps the individual needs to change, or perhaps the environment needs to change. perhaps both. Not much would change, but the relationship between professional and client would change, and so everything would change.
Well, based on the context, the quotes are clearly meant to differentiate it from physical illnesses, and associated approaches to curing them. The picture of the Aurora guy is lurid and eye-grabbing, but based on what Leo's saying, it seems clear to me that he isn't suggesting the aurora guy was ok, mostly. He's suggesting that pills would help less than acceptance, respect, support and a listening ear. The best diagnosis they had for aurora guy was borderline personality disorder, something famously resistant to pills, or any attempt to treat it as some kind of contingent affliction which can be treated in isolation from the person as whole. It's a very serious 'mental illness' which takes a long time to treat, and the success of which treatment depends on very, very careful handling. Which, to be fair, the last psychiatrists he came into contact implicitly admitted, by wiping her hands of him after he repeatedly sought help, saying she thought trying to treat him would just make him mad.
[quote=Hanover, just before posting a pic of James Holmes as a trump card]And what do you base your suggestion that the majority in the mental health field reject, disrespect, ignore, and refuse to support their patients? [/quote]
Anyway, this is not an unusual approach to people who present with BPD, as any in-the-trenches psychiatrist will tell you. This is very clearly a bad example, not in service of you argument. So why did you choose it?
I think it's telling that your response to someone who is discussing how people with mental illness are shamed and stigmatized, making their problems worse - how the response is to post a highly inflammatory image meant to evoke the worst fears that people have about mental illness (fears shared by the mentally ill themselves.) Damn you're right, that's the aurora guy for christ's sake, look at his eyes, people really do have mental illness, they have them bad, so it is a good thing the mental health community was there to say 'we can't help' and help ingrain an idea of unable-to-be-helped' into his sense of who he was and what he was dealing with. Checkmate, new age Laingians.
It's this approach, and others like it, that leads to such stuff like: a pilot can be grounded if it comes out they have mental illness because fears of suicide-by-plane, so they hide their mental illness, so they can't work through it, so they get worse, which makes them more like to commit suicide by plane, which they're able to do, because they haven't revealed they have mental illness, so they're not grounded. (moral: even if you don't want to yield to some virtue-signalling idea that we should be concerned for the well-being of one person, because that's less important than the safety of society as a whole, you still make it unsafe for society as a whole. Arguing brass tacks here ultimately makes you defend Ideas at the expense of brass tacks.)
[edit: fired up, because this is a personal topic for me. I was lost for a long time in the system, out of the system, back in the system - untiI Ifound a therapist who actually seemed to care, or think me as something other than an in-the-wild example of a DSM species. The mental health industry in the US is terrible, from everything I've seen. There are exceptions, but they're exceptions. Most seasoned psychiatrists will admit this off-the-record. I don't know if anyone's to blame - but its a fact.
You completely misinterpreted my post, I suggest you re-read what I wrote, if you actually care about understanding my point of view.
I gave the example that many homosexuals suffered not because they were homosexuals, but because of how society treated them for being homosexual. And that the solution that ultimately helped them was not the latest drug or therapy or whatever, it was for society to accept them, respect them, listen to them, support them.
As to why mental illness was in quotes, if you had cared to read my post seriously you would have seen the examples where being a slave wanting to escape and being homosexual were mental illnesses. Do these mental illnesses really exist to you, are they due to a defect in the brain of these individuals, or were they a fiction in the minds of the people who wanted their slaves to behave and who didn't like homosexuals?
Then if you believe that these were mistakes of the past but there is nothing of the sort in the mental health practice of today, here is an interesting article I have come across which gives good insights as to why people who are anti-authoritarians are much more likely to be diagnosed with some mental illness. Not because there is something wrong in their brain, but because of how society and psychiatrists treat them. https://www.madinamerica.com/2012/02/why-anti-authoritarians-are-diagnosed-as-mentally-ill/
You seem to be either arguing against a strawman, or then that the fact there are other means of oppression as well somehow dilutes the ethical implications of any particular means of oppression.
As for the srawman, I don't see @leo or anyone else trying to single out psychologists as necessarily more oppressive than other means of oppression.
As for some sort of "nothing to see here, plenty of oppressive rolls exist or can exist", if this is your argument, please elaborate. What's it's basis?
I don't think anyone here disagrees that there are other means of oppression available.
Nor is anyone saying, as far as I can tell, that psychologists / psychiatrists form as a group the intention to oppress society.
As I mentioned, the (oppressive) state will try to select for psychologists / psychiatrists who see no problem with state mental health policies, either because they genuinely believe the state is not-oppressive or because they see it as a job that needs to be done (mentally ill do exist; participating in an oppressive system is necessary to help the genuinely mentally ill) or because they simply support an oppressive state and its policies and enforcing compliance they view as simply a good thing (that it's needed to have a "strong country" for instance). And, in terms of moral evaluation, because they are selected for these qualities, moral evaluation becomes more problematic (just as if secret police are selected for brutal and sociopathic qualities, moral evaluation is complicated; "just following orders" becomes a viable defense, that a given agent of oppression is too a victims of oppression is very viable, depends on the particulars).
However, if you are not arguing the above points, we seem to be in agreement that as a position of authority, both in a particular form of deciding how the state deals with particular problematic individuals (either dissidents or "maladapted" to productive life in a oppressive state), as well as a social form in participating in appeals to moral and expert authority of psychiatry to justify oppressive state policies (to for instance label enemies of the state as mentally ill: delusional, maladapted, inherently violent, unproductive due to some mental or moral defect, or or what have you), that they are indeed agents of oppression.
So we agree here, but you seem to want to then imply that because there are other means of oppression, that it is not interesting to discuss any particular roll in an oppressive state.
If this is your point, then we disagree. For people wanting to make their society, as well as contribute to analysis that can help others in other societies, less oppressive, understanding how systems of oppression work, what rolls do what to either maintain the status quo or regress further into despotism, is a prerequisite for effective action.
If it is simply uninteresting to you to carry out such analysis as you don't see a problem where you live, I trust you can agree that it is not therefore uninteresting or useful to all?
If you don't quite see what roll psychiatrists / psychologists can play in oppression, though agree in the abstract that they may play a roll, that is one of the main subject of debate here, and I can offer more examples if your skepticism is on the mechanisms that maybe employed through the practice psychology / psychiatry to enforce compliance to government policy.
If you view all the arguments presented as implicitly against the US system, then it's best to qualify your arguments as "perhaps elsewhere, but not in the US of A". If we are in agreement in principle, then it is a constructive extension of the debate to consider the example of the US: in what ways democracy maybe ineffective and to what extent that could impact the practice of psychology / psychiatry as well as it's public perception.
However, if it is only to circle back to an argument that no one could be responsible anyways, or that contributions of psychiatry and psychology to oppressive mechanisms would be insignificant anyways, then we should first discuss these principles.
Perhaps there simply never was a meaningful basis to claim homosexuality was a mental illness, but that it was actually only so categorized due to reliance upon the morality of the time. Is the same true of schizophrenia though? Do you believe we consider a man who believes he is Jesus, who talks to a person who is not there but who he thinks is, and who meticulously stores all his fingernail clippings so that he can have them tested for the drugs he is certain the CIA is injecting into him when he sleeps simply someone we have socially stigmatized but who in a more enlightened time will be considered healthy?
My point here is simply to concede the fallibility of the profession in having in the past medicalized what really were simply moral judgments, but to also recognize that some people really are terribly mentally ill regardless of how liberal or conservative we might be in our political beliefs.
This seems like a typical categorization problem we always have with most things we do, where there is one group of things we call X, another not X, and the last maybe X. So, there are certain behaviors that are healthy, some clearly not healthy, and the last, maybe healthy, maybe not. I can't buy into the argument, though, that Charles Manson was essentially fine and that I can't reliably tell him apart from the average man next door.
Quoting csalisbury
I disagree that that's why it was in quotes. The way one differentiates between mental and physical illness is simply to use the word "mental" or "physical." The reason mental illness was put in quotes was to question whether there really was such a thing.Quoting csalisbury
The posting of the image was to respond to the poster's suggestion that there really wasn't any such thing as mental illness. The image chosen was just because it was dramatic, not because it was of a homicidal maniac. I could just as much made my point posting someone clearly breaking from reality in a non-violent way. My point is just that there really is a thing called mental illness, and while I'll concede there are the hard cases where we're not sure if the behavior is to be designated an illness, there are many cases that are abundantly clear.
Quoting csalisbury
I have sympathy for your personal experiences, but this comment seems to admit to the two things I was arguing for (1) that there is such a thing as mental illness, and (2) psychologists can and do help. Your complaint seems to be that you were burdened with some really bad therapists, but if you're acknowledging there is such a thing as good therapy, then the failure is in systematizing it so that it can be predictably available to everyone.
I fully understand your post. It generalizes to the profession from a few examples. It just doesn't logically follow that because you have examples of past errors that the entire enterprise is failed. Or, more concretely, the fact that slaves were once diagnosed as mentally deranged because they sought emancipation does not mean that Charles Manson is sane. I agree entirely that anyone in a position of influence, from doctors to Indian chiefs, should exercise prudence when reaching their decisions because what they decide matters.
Regarding the article you posted, the author begins with this paragraph:
"In my career as a psychologist, I have talked with hundreds of people previously diagnosed by other professionals with oppositional defiant disorder, attention deficit hyperactive disorder, anxiety disorder and other psychiatric illnesses, and I am struck by (1) how many of those diagnosed are essentially anti-authoritarians, and (2) how those professionals who have diagnosed them are not."
This is non-scientific anecdotal opining. If you want to know what makes the profession unscientific, it's stuff like this. If they actually can show that the diagnoses of these disorders correlates simply with volitional objections to authority, then that might be cause to reconsider the current treatment and categorization of these behaviors as disorders.
I personally do question the ADD diagnoses that are often placed upon children, and I agree that it should be studied more and maybe reconsidered. I've often thought it better stood for Adult Discipline Disorder, where the problem really rested on poor parenting and not mentally troubled kids.
What kind of social environments produce autism and catatonia?
Also, if there are anatomical and/or physiological causes of atypical behaviour, and there is not a widely accepted general definition of the noun phrase "mental illness", would it be more appropriate to refer to neuro-behavioural typicality and atypicality?
If the practice of clinical psychology was politically "neutral", psychologists would able to prescribe financial gifts, holiday cruises and supermodel escorts as remedies for treating depressed patients, as opposed to prescribing them "numbing" medications and talk therapies ....but this runs up against society's need to prioritize it's finite resources. So there cannot be a politically neutral practice of psychology.
The notions of mental illness, diagnosis and treatment, are better understood holistically from a utilitarian perspective. It is never the lone individual who is diagnosed and treated for a mental illness, but the individual as part of a wider cross-section of society whose broader interests are often in conflict with the individual. The particular interests of the psychology profession are but one component of this greater good.
Then don't make the argument. It's certainly not one that I make. One can fairly reliably tell the difference between a homosexual and a heterosexual. Diagnosis is not the the problem. You like going for the scary extremes don't you. I'm not that familiar with Manson, but if I remember, the case was actually very much to do with the social environment - the creation of an oppositional social sub-group, amplified by drugs. Rather a good example of how limited an understanding one gets from looking at individual behaviour in isolation. It's not that one cannot spot a murderous paranoid schizophrenic, or that one ought ideologically to pretend not to notice. And no one would be so silly as to try and suggest that. So remove the stuffing from your straw man and put it on the compost heap.
Quoting Galuchat
Indeed, I don't know how it goes generally, but my limited experience is that when an organic, neurological condition can be identified, one does not talk much about mental illness, but neuro-atypicality or disability, or some such, and one does not so much focus on treatment as on careful education and adapting the social environment. To be clear, I am saying that one should look at mental distress as relational, I am not saying it is all the environment, but that it is always in relation to an environment. Thus homosexuals still suffer distress because they still live in a society that condemns them. They are shamed, and that is traumatic, maybe depressing, etc.
Again, PTSD is a condition defined as a neurological/physical change produced by the environment. It doesn't quite fit the Hanoverian serial killer paradigm, but is much more common. Childhood abuse, and the stress of combat -environmental factors - are typical causes, an neurological conditions are the result. Treatment may involve palliative drugs, talking (mind-changing?) cures, and special environments of quiet and safety.
That's great. Thanks for the elaboration.
Can you be more specific when you say what are my thoughts? Thoughts in what way? In general?
Nice set up. This is known as “psychological fixedness”. This is relatable to “functional fixedness” but here we’re referring to the application of ideas beyond their immediate means. Simply put if X works for a,b,c,d and e we tend to assume it will work just as well beyond these - a kind of ubiquitous “cure” that can easily blind us from seeing the methodology as being either at fault or misapplied. This is a common occurrence in brain sciences in general.
Note: There has been a push to refer to “mental illnesses” as “brain disorders/malfunctions” instead. The physicalist implication of this - if we stretch it somewhat - could be such that conditions are treated physically with bias toward pharmaceutical medications over more nuanced and less empirical scientific research in the field of psychology.
By whom?
Quoting ICD-10, Chapter V, Classification of Mental and Behavioural Disorders, Clinical descriptions and diagnostic guidelines, p.11.
There is inductive evidence in terms of physiological correlates, and criterial evidence in terms of observed behaviour, which establish the relations between body, mind, and behaviour. Mind and behaviour have causal relations, whereas; mind and body (i.e., nervous systems) have correlative relations.
That being the case, and given appropriate medical indications, it seems reasonable to expect that psychotherapy would be more effective than psychosurgery, brain stimulation, and medication, however; there is apparently not sufficient data available to make that determination.
Here are some more recent examples of the confused debate about how to label these things and the reach of biological reductionism:
https://eiko-fried.com/all-mental-disorders-are-brain-disorders-not/
https://www.madinamerica.com/2019/03/mental-health-concerns-not-brain-disorders-say-researchers/
A lot of this likely stems from the advances in neuroscience as well as people pushing for a more reductionist approach as a means to fight the “snap out of it!” reactions by people who don’t understand the extent that some people are suffering. The argument being that showing a physical underlying condition is akin to someone telling another to “snap out of it” if they have a heart attack.
Thanks for the links.
Well, there are definitely things that happen to people that are not good and are not primarily physical. I don't think anyone was denying that. But calling it 'mental illness' is to suggest that it is a certain kind of thing - like a physical illness, only mental. So the idea is that this is misleading, and contributes to methods of treatment which are not felicitous.
Quoting Hanover
Yes, I think there is such a thing as good therapy, though I probably overstated the degree to which it's contributed to my relative stabilization. It's a big part of it, but only one factor in a sort of recovery ecosystem.
When this works, I think it usually works in spite of the existing paradigm. 'Systematizing it so that it can be predictably available to everyone' - I don't know. It makes me think of studies that show religion and a sense of community are good for people. But there would be no way to systematize it so that it could be predictably available without, in so doing, creating something totally different than what you were trying to make available.
I agree.
Terminology is key to:
1) Accurately describing a problem.
2) Determining how a problem is understood within a social group.
3) Affecting the self-esteem of social group members who are labelled as having a problem.
4) The selection of a problem-solving method (e.g., a Bio-Psycho-Social approach).
The underlying problem relevant to this thread is: the mental conditions which produce maladaptive (unproductive) behaviour. There are degrees of (mild to severe) maladaptive behaviour.
Maladaptive behaviour is perceived to be a problem, because it:
1) Prevents individuals from conforming to social norms (social group rules concerning appropriate and permitted behaviour), resulting in social exclusion and/or marginalisation (stigmatisation).
2) Impedes social cohesion (a measure of the extent of agreement between social group members).
3) May be a risk to personal and/or public safety.
The mental conditions which produce maladaptive behaviour may be described in terms of:
1) Illness: corporeal and/or mental condition which entails discomfort and dysfunction ("and" being the operative word).
a) Mental Illness: mental condition which entails mental discomfort and mental dysfunction. This is consistent with the ICD-10.V definition of disorder, and implies treatment.
b) Mental illness becomes a matter of public health, involving the regulation of therapeutic practise in certain jurisdictions. Therapy type (e.g., psychosurgery, brain stimulation, medication, psychotherapy) depends on mental illness type.
c) Mental illness may be curable or incurable.
d) Symptomatic treatment may be effective or ineffective.
2) Conformity: behaviour in accordance with social norms.
a) Non-Conformity: behaviour not in accordance with social norms.
b) Non-conformity becomes a matter of social control.
c) Social norms are enforced formally and/or informally.
d) In addition to corporeal and/or mental disability-disorder, other causes of non-conformity include: creativity, eccentricity, dissidence, and criminality.
So, I agree with ICD-10.V that mental disorder should not be defined in terms of "social deviance or conflict alone, without personal dysfunction."
3) Typicality: an independent variable within 1.96 standard deviations from the mean of a normal distribution.
a) Mental Atypicality: mental condition greater than 1.96 standard deviations from the mean of a normal distribution.
b) Mental atypicality becomes a matter of diversity within a social group.
c) Mental atypicality is a conventional measure which should have cross-cultural validity, like intelligence.
So, if a condition entails dysfunction, but not distress or discomfort to the person who has it, it should probably not be defined in terms of illness or disorder, but rather in terms of atypicality or diversity within a population.
You said:
Quoting unenlightened
I said:
Quoting Hanover
You then said:
Quoting unenlightened
Quoting unenlightened
Mine wasn't a straw man, it was a reductio ad absurdum. That is to say, if one holds that there is no essential difference between mental illness and social stigma, one implicitly holds that Charles Manson (or, another example, Jeffrey Dahmer who raped and ate his victims) is not mentally ill but just someone we have chosen to stigmatize. That there might be hard cases where it's hard to distinguish if the person is mentally ill or whether we just find the person's behavior violative of certain societal norms doesn't mean there aren't obvious cases of mental illness.
Well Szaz would be your true absurdist. We do stigmatise murderers do we not? And sometimes we call them mad, and sometimes we don't. And what is the difference, and how do you tell in these supposedly easy to tell cases? Do you measure their madness on the scale of your own repugnance?
I do not say these people are fine. Did you think I might? I say their relationship with others is in a bad way; do you disagree? The odd thing is that this view is not even controversial, merely old-fashioned. It is the basis of talk based therapy, that a personal relationship can be therapeutic, in a way that it is not when there is an organic illness. It is the first premise of the psychoanalytic tradition that the source of mental distress is the exigencies of civilised society. Bears do not become anal-retentive because they get to shit in the woods.
Opposition to the illness model predates the writings of Drs. Szasz and Laing, and was promoted by various individuals and professions, including psychiatry itself. The history of how this opposition was muted within psychiatry and of how the vast majority of psychiatrists came to align themselves with the Pharma--APA orthodoxy has not yet been fully written, but WILL probably emerge in the coming years, as increasing numbers of retiring psychiatrists speak out against the hoax and the recruitment methods used to promote it.
[....]
Psychiatry is not something good that needs minor adjustments. Rather, it is something fundamentally flawed and rotten. Based on spurious premises, and devoid of even a semblance of critical self-scrutiny, it is utterly and totally irremediable. It has locked itself into the falsehood that every-problem-is-an-illness-and-for-every-illness-there’s-a-drug from which it cannot extricate itself. It is nothing more than legalized drug-pushing, endlessly attempting to mask its guilt by proclaiming its innocence, vilifying its critics, and calling for more “treatment.” It has built into itself the seeds of its own destruction, and will eventually fade away as its credibility dwindles, and more and more potential recruits recognize the sordid reality and seek careers in genuine, ethically-driven medicine.
Read here:
https://www.madinamerica.com/2019/04/in-defense-of-anti-psychiatry/
I mean, everything else, from 'lack of insight' into one's condition to above and beyond would fall into place.
Now, obviously, one can surmise that this task is inherently dangerous and prone to authoritarian superstition; but, the can be only be kicked down the road as long as it has been.
On the other hand, the medical concept of depression is merely a description of the neuro-anatomical correlates of individuals who tend to be judged by society as being depressed in the natural sense. Consequently, a medical diagnosis of medical depression is neither necessary nor sufficient for establishing a diagnosis of natural depression.
The natural concept of depression should be compared to the legal concept of guilt. In both cases, judgements are sought for political reasons, and hence both concepts are inherently political. In being political, the outcome of such judgements often refer more to the state and needs of society than to the state and needs of the individual.
There is a great deal of politics and special interests wrapped up in the approval of drugs, and the lack thereof. Many remedies are rebuffed and suppressed, and diagnostic procedures are constantly warped and twisted by socio-political agendas.
I was diagnosed with ADHD in kindergarten. I was so distracted they couldn't get me to complete the diagnostic test. That was when I started learning to take pills. I took Ritalin, and Strattera, and eventually Adderall, which I took for years through high school and into college. The approval of amphetamine use in children was a huge boon for drug companies, but it doomed children like me to a life of unforeseen problems. Now that we've be had by this great experiment, it has surfaced that childhood stimulant use likely hypersensitizes us to dopaminergics for the rest of our lives. The rather common-sensical idea that "you shouldn't give kids speed" was completely oblated in the minds of my parents by the dictum of educated psychiatry.
Now I have Raynaud's — another side effect of the help doctors gave me — and will probably be dependent on some sort of motivationally modulatory drugs for the rest of my life.
So no, I don't judge people who want to pursue solutions outside of the system. I think that this can be far worse than trusting your life to psychiatrists, and that some people waste themselves on stupid delusions of medicament as they destroy their brains and bodies with drugs, but the comparison with organized medicine is far less distinct that you would think.
I certainly don't shy from telling people to make use of the diagnostic power of blood assays and professional help, but psychiatry plays a pretentious game admonishing those who seek to help themselves without a doctor's permission. It's far from right for everyone, but it isn't evil, and wishing for the pharmacological domination of those who wish for autonomy isn't going to do any good.
I'm sorry to hear this. It is a money making paradigm based on poor philosophy and questionable science. My mother ended up 'in their care' and her medications caused untold problems. She had PTSD, but was diagnosed all over the place. Related to this is a generalized hatred of emotions, which pharma and psychiatrists systematize. There are also very strange assumptions of normality.
On the one hand it is less empirical, but on the other it is often more empirical since sociological studies can show correlation and cause related to external factors -poverty, sexual abuse, alcoholic parents, pretty much any trauma, sexuality, and more. IOW the brain based physicalism approach actually goes against much extremely well documented research. Pathologizing individual reactions to different kinds of traumatic and long term stress is a good business model, leads to terrible social policies - since the pharma/psychiatric model basically shuts off feedback about society both a the individual and the general levels - and create dependencies since it generally does not resolve resolvable patterns.
It's a bit like if doctors prescribed pain killers for most symptom patterns. To do that is to shut off information and feedback our bodies are giving us.
With psychotropics it oddly acts as if we were effectively solipsists, not part of any external relations and causal patterns.
Which is delusional.
A new book by the Harvard Medical historian Anne Harrington, “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness,” argues that the “tunnel vision” of modern psychiatry, with its fixation on wiring and fixed diagnoses, cannot adequately address what has yet to be understood about the human psyche.
https://www.nytimes.com/2019/07/27/opinion/sunday/its-not-just-a-chemical-imbalance.html?action=click&module=Opinion&pgtype=Homepage
You see, life tries everything, what endures, endures, all the rest is given up on. I know it is terribly cold and unemotional, but it is what it is. Parallel to this, and also human, the fear of difference.
The point is that the brain is extremely complex, and just now we scientists and psychiatrists are getting to unravel the first layers. There are, indeed, defects, that can be corrected.
But it´s not the psychologists way, today everyone is defected, in need of correction. Psychology is the just modern day fortune teller or witchcraft.
We have a long way to go in truly understanding the brain.
Did you know that if Einsteins' brain was analysed by modern models it would be immediately sent to an hospice?
Also we must consider the hypotheses that the brain is not equipped to understand itself, as "security measure" :) .