Philosophy of Psychiatry (2015)
plato.stanford.edu
plato.stanford.edu
How do you know which group is on the right course? It could be that the supposedly "rogue" jet that broke formation had realized the others had lost course, and thus reestablished the "correct" course.
Thus is the problem of psychiatry. It makes the subjective and critical judgement that the behavior exhibited by most people signifies health, and any deviance from the statistical mean is diseased; evolution be damned.
Such an assumption has led to a variety of compulsory "treatments": indefinite solitary confinement, electrocution, lobotomies[1], and gas chambers[2].
[1]http://www.pbs.org/newshour/rundown/the-forgotten-lobotomies...
A clear-cut case of Paternal Conflict Syndrome.
This analogy is flawed: it assumes there is some objectively "correct" course that exists.
We could say that psychiatry is flawed because it assumes that the mean corresponds to "health," but this does not seem to be the point of psychiatry. Psychiatry isn't attempting to bring individuals into some objective "healthyness," rather it seems to be attempting to reincorporate deviant individuals back into society, flawed and unhealthy as that society (and treated individual) may be.
The ethical implications of this are another question: a psychiatrist might argue that this is a good practice, as they are helping people remain within society, which will likely result in better outcomes along the broader society's axes of good and bad. Others, such as yourself, might argue that this is bad, for various reasons such as that the treatment results in suffering or that deviant individuals also have access to novel perspectives.
But at the same time if you've ever spent time with people with serious dehabilitating mental illness, it's clear there are a lot of people who are very seriously struggling and very much need help and aren't capable of seeking it out on their own. And if you've ever experienced any kind of mental illness or talked in depth to someone who has, it's clear it's a very real phenomena and not just someone daring to be different.
So while I agree with the general thrust of your post I think this:
>It makes the subjective and critical judgement that the behavior exhibited by most people signifies health, and any deviance from the statistical mean is diseased; evolution be damned.
Is unfair. It's a tough line to thread, which is why psychiatrists and philosophers spend lifetimes working on these issues and trying to figure out where the line is. It's absolutely not the case that "any deviance from the statistical mean is diseased"; this is not an unfair characterization of what was done at the inception of the field when people understood nothing, and it's certainly a good warning about how powerful and dangerous it is classify something or someone as 'insane' (read Foucault! Who is shockingly missing from this article!) but it's not a fair critique of modern day psychiatric medicine.
I would think that maybe they are performing a 'missing man formation' [1] and would not find it inexplicable. Not sure what the moral of that is. Perhaps that deviance from the mean may be purposeful and not maladaptive?
With regard to lumping disorders together, this is the camp that I fall in. I think we will look back at our present diagnoses the same way we look at a historical diagnosis of "fever;" it's correct but not as precise as it needs to be. The prevailing direction in research is to move toward clusters of symptoms rather than diagnostic labels. The relatively new NIMH RDoC will help with this:
https://www.nimh.nih.gov/news/science-news/2015/the-nimh-res...
One of the other things I'm seeing a lot in this thread has to do with the tension between autonomy and paternalism. This is a problem that keeps me and many of my colleagues up at night. At what point do you step in to limit a person's decisions? That's not something that most of us take lightly. I sure don't. At this point, in the US, the primary criterion for making decisions for someone is based on preventing injury to themselves or other people. This is a reasonable, but complex, dividing line. An unintended consequence is that it continues to over-emphasize and reinforce the connection between mental illness and violence.
In the medical field, no disease is ever voted into existence. There are lab tests, scans, x-rays, physical evidence of issues requiring medication. In psychiatry there are no tests to decide which medication to put someone on, and the profession largely admits to not knowing how the drugs they put patients on work.
Nevermind that most of these drugs cause horrible side effects in patients like massive weight gain, loss of sex drive, suicidal tendencies, psychotic episodes, etc...
Nevermind that most school shooters in the last 20 years were either coming off from or on some form of psychiatric medication.
Nevermind that over 100 000 toddlers are medicated, TODDLERS, with the same mind altering drugs in this country. How do you diagnose a toddler with depression?
Now your profession wants to go into prenatal and fetal psychiatry and start drugging the mother before the child is even born.
Nevermind you shamelessly do ECT, 450 volts through the brain which countless studies have proven is not a beneficial treatment once it is stopped and that patients do worse after (some who become complete human vegetables and require 24/7 care) as a form of "extreme treatment" when your pills don't work to numb the patient enough. (See http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi... )
Your profession is a sham. The threads are coming loose and you can't hide it anymore. Please quit and go find another job.
What's an example of a disease that people didn't denote as a disease?
> [...] while the people that do the voting largely are on the payroll of the big pharma companies that will then market the same "diseases" via massive marketing campaigns [...]
Like the previous commenter (and M.D.) said,
> Also, consider how changing the cutoff score for diabetes makes thousands of people diabetic with the stroke of a pen. The dilemma of an applied science is that I have to make a decision today, not in 10 years when we have more data.
Before there was "autistic psychopathy", now known as the ASD condition Asperger's syndrome, there existed people who exhibited all the symptoms. Before ADHD was a diagnosis there were people who had it. These conditions cause problems in people's lives -- health problems. Hence, medical professionals defined diagnoses accordingly and began treating them.
Regarding big pharma, that's more of a political issue. Where big corporations can put money before people, they often do. It's noncontroversial to say that the pharmaceutical industry has financial interests in getting people to take their drugs, as well as to jack up prices on drugs people need, and other unethical practices. But if you're trying to say that the DSM is developed by people who make up diseases for which they have drugs to give people, you're already assuming they have a mechanistic understanding of what to give people to treat the symptoms of diseases that you're claiming aren't diseases. While there are psychiatrists who probably push the limit and prescribe vyvanse to anyone who says "I can't pay attention in class, I have ADHD", there are likely physicians who prescribe blood pressure medications more liberally. Those can have side effects too, e.g. kidney damage.
>to an uninformed public who thinks what you do is science.
How are the relevant fields of psychology, neurology/cognitive science, etc., not science? Maybe you could also elaborate to explain what science is.
>In the medical field, no disease is ever voted into existence. There are lab tests, scans, x-rays, physical evidence of issues requiring medication. In psychiatry there are no tests to decide which medication to put someone on, and the profession largely admits to not knowing how the drugs they put patients on work.
Besides carrying on the same argumentative direction which the previous commenter already preempted you now assert that a difference between 'real' medical science and psychiatry is "physical evidence of issues". When a schizophrenic, say, pulls out their own teeth, or stabs themselves, or so on because they report hallucinations telling them to do so, what would be your criterion of "physical evidence of issues"? What about proper treatment? Would you at least consider forcing them to take benadryl to nap for a while?
The phrase "physical evidence" leads me to suspect you have some metaphysical motivation here akin to pseudo-philosophical internet forum-based atheism. Like you think that somehow psychotic ideation isn't "physical". If I'm headed in the right direction here feel free to unpack your philosophy of mind related issues with the questionably "physical" basis of psychology and such.
>Nevermind that most of these drugs cause horrible side effects in patients like massive weight gain, loss of sex drive, suicidal tendencies, psychotic episodes, etc...
All medicines have side effects. What conclusion should that yield specific to psychiatry?
>Nevermind that most school shooters in the last 20 years were either coming off from or on some form of psychiatric medication.
Do you have a source that compares perpetrators of mass shootings who received some form of psychiatric medication with those who hadn't? Regardless, have you considered that maybe the shootings and the psychiatric illness they were prescribed medication for had the same cause, a disease? For someone denying the legitimacy of an entire medical field asserting that psych meds cause school shootings doesn't seem indicative of keen empirical insight.
>Nevermind that over 100 000 toddlers are medicated, TODDLERS, with the same mind altering drugs in this country. How do you diagnose a toddler with depression?
Ignoring the "mind altering" description, by asking about how to diagnose children are you implying that children can't get depression? Or that we couldn't be sure whether one has it or not? Throughout your comment you seem to mix up ontological concerns (what exists) with epistemological concerns (what knowledge is).
>Nevermind you shamelessly do ECT, 450 volts through the brain which countless studies have proven is not a beneficial treatment once it is stopped and that patients do worse after (some who become complete human vegetables and require 24/7 care) as a form of "extreme treatment" when your pills don't work to numb the patient enough. (See http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi.... )
You're providing as a source a petition against ECT. Again, doesn't seem to reflect scientific approach to psychiatry. ECT is a last resort. If you've ever encountered patients who have undergone ECT, it works for many of them. Those for whom it doesn't, pretty much nothing will and they will return to their prior level of functioning. It does cause some short term memory loss. Patients often have to relearn names and so on. Either way, you're lumping that one specific controversial psychiatric treatment along with all others to try asserting a general characterization of psychiatry.
Ignoring all the blatantly dramatic insults and tone throughout (little injections like "mind altering drugs") or the direct advice to quit psychiatry, your comment is a cut and dry example of the kinds of pseudoscientific and folk-psychology common to "stem-lord" type arguments against psychology, and it's closer to Scientology than science.
By the way, if you haven't met anyone with a condition like schizophrenia (I'm not saying you haven't), you should.
I think the pile of circumstantial evidence for this being the case is pretty large at this point. There is no single treatment that works for a majority of people with major depressive disorder. The types of schizophrenia are sufficiently different that using the same term for them is practically misleading and seems to be driven more by tradition than by any consistent system (cf. diabetes). There's at least one lab test that is believed to identify a type of depression; it seemingly fell out of favor because nobody figured out how to choose a treatment based on it and a negative result doesn't exclude an MDD diagnosis [1].
[1] https://en.wikipedia.org/wiki/Dexamethasone_suppression_test
I also hope and believe that humanity transcends biology / hardware / strange-loopiness-in-software. We see less and less of a transcending viewpoint in "the [rational] West", and that belief still present comes less now from traditional sources and more from the influence of Eastern religion / philosophy. From a Screwtape Letters viewpoint the ultimate prosecuting lawyer is comfortable with the West in its current materialistic stupor ... but I grew up in circumstances where transcending factors were much more plausible and understood.