21 ms·

Philosophy of Psychiatry (2015)

46 points by lainon 9y ago

sortudo9273834 9y ago
Still reading the article, and this likely is addressed therein, but I think the problem or "difficulty" with the "strong" medical model of psychiatry, which seeks to know the underlying biological pathology involved in mental disorders (as opposed to the "minimal" model, which treats mental disorders as heuristic labels of bundles of symptoms that tend to follow similar evolutions in most cases) ... is that there will be many conditions, traits, behaviors that society sees as pathological that won't be distinguishable on the "hardware" / brain structure & abnormalities level, but will be purely seen on the software level alone. It likely will take a long time for us to see, or will be never, that we'll manage to observe brains running at this level ... and too many pathologies will be completely unknowable to a strong medical modelist. 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.
0xcde4c3db 9y ago
> They worry that we are lumping together different groups of people based on behavioral evidence alone, when in fact their observable similarities mask important underlying differences, including differences between normal people who are troubled but basically healthy, and their pathological counterparts. 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 https://en.wikipedia.org/wiki/Dexamethasone_suppression_test
imperio59 9y ago
Psychiatry is a failed science. False promises of cures that usually do more harm with debilitating "side effects" to their drugs and barbaric shock treatments. Best to seek the help of a real medical professional, nutritionist, fitness trainer, etc. All these have a better chance to help you than the dice roll of a psychiatric "diagnosis".
- DanBC 9y ago
  You rail against psychiatry, yet list "nutritionist"?
  - imperio59 9y ago
    People have such terrible diets in the US. Deficiency in certain vitamins and other essential nutrients is scientifically proven by medical science to lead to mental health-type symptoms. Some people need help to learn what foods to eat properly because their parents never taught them how or they just have bad eating habits.
    - DanBC 9y ago
      > scientifically proven by medical science to lead to mental health-type symptoms. Which vitamin or mineral deficiency leads to psychosis? (With a link to this scientific proof please)
      - tertius 9y ago
        The easiest candidates for an answer is obviously Scurvy (Vitamin C) and Rickets (Vitamin D). Both can cause mental symptoms (retardation for example). But both are rare.
    - kbart 9y ago
      "Some people need help to learn what foods to eat properly because their parents never taught them how or they just have bad eating habits." You don't need a nutritionist to tell you to stop eating junk/processed food. All other diet advice are pure b.s. as there's no scientific answer to what "a proper diet" is. What is "healthy" and what is not changes on a similar rate as weather broadcast i.e. see a recent turn on fat.
adamqureshi 9y ago
Mental diseases are not really understood the way, say, liver diseases are understood, as a pathology of the body and its tissues and cells. Researchers understand the underlying structure of very few mental ailments. What psychiatrists call a disease is usually just a label for a group of symptoms. As the eminent psychiatrist Allen Frances writes in his book, “Saving Normal,” a word like schizophrenia is a useful construct, not a disease: “It is a description of a particular set of psychiatric problems, not an explanation of their cause.” - David brooks.
wu-ikkyu 9y ago
Imagine you see a squadron of fighter jets flying in above in the sky. Then, one of the jets inexplicably breaks formation and flies off by itself. 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-on-world-war-ii-vets/ http://www.pbs.org/newshour/rundown/the-forgotten-lobotomies... [2]https://www.ncbi.nlm.nih.gov/pubmed/23511221 https://www.ncbi.nlm.nih.gov/pubmed/23511221
- dwringer 9y ago
  > Imagine you see a squadron of fighter jets flying in above in the sky. Then, one of the jets inexplicably breaks formation and flies off by itself. A clear-cut case of Paternal Conflict Syndrome.
- Nav_Panel 9y ago
  > It could be that the supposedly "rogue" jet that broke formation had realized the others had lost course, and thus reestablished the "correct" course. 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.
- 9y ago
kingkawn 9y ago
Like trying to rebuild a tool while using it.
- iamcurious 9y ago
  Metaprogramming ftw!
auserperson 9y ago
I find really weird that it doesn't talk about Focault and Deleuze.
phren0logy 9y ago
I'm a psychiatrist. Much of the valid criticism in this thread could be applied equally to all branches of medicine. For example, the number of good randomized controlled trials for surgical interventions is probably smaller than you think. 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. 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-research-domain-criteria.shtml 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.
- imperio59 9y ago
  Your profession is still largely a fraud. It votes into existence new "diseases" 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 to an uninformed public who thinks what you do is science. (https://en.wikipedia.org/wiki/DSM-5#Criticism https://en.wikipedia.org/wiki/DSM-5#Criticism) 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-Citizen-Petition.pdf 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.

46 points by lainon 9y ago

Still reading the article, and this likely is addressed therein, but I think the problem or "difficulty" with the "strong" medical model of psychiatry, which seeks to know the underlying biological pathology involved in mental disorders (as opposed to the "minimal" model, which treats mental disorders as heuristic labels of bundles of symptoms that tend to follow similar evolutions in most cases) ... is that there will be many conditions, traits, behaviors that society sees as pathological that won't be distinguishable on the "hardware" / brain structure & abnormalities level, but will be purely seen on the software level alone. It likely will take a long time for us to see, or will be never, that we'll manage to observe brains running at this level ... and too many pathologies will be completely unknowable to a strong medical modelist. 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.

0xcde4c3db 9y ago

> They worry that we are lumping together different groups of people based on behavioral evidence alone, when in fact their observable similarities mask important underlying differences, including differences between normal people who are troubled but basically healthy, and their pathological counterparts. 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 https://en.wikipedia.org/wiki/Dexamethasone_suppression_test

imperio59 9y ago

Psychiatry is a failed science. False promises of cures that usually do more harm with debilitating "side effects" to their drugs and barbaric shock treatments. Best to seek the help of a real medical professional, nutritionist, fitness trainer, etc. All these have a better chance to help you than the dice roll of a psychiatric "diagnosis".

DanBC 9y ago
You rail against psychiatry, yet list "nutritionist"?
- imperio59 9y ago
  People have such terrible diets in the US. Deficiency in certain vitamins and other essential nutrients is scientifically proven by medical science to lead to mental health-type symptoms. Some people need help to learn what foods to eat properly because their parents never taught them how or they just have bad eating habits.
  - DanBC 9y ago
    > scientifically proven by medical science to lead to mental health-type symptoms. Which vitamin or mineral deficiency leads to psychosis? (With a link to this scientific proof please)
    - tertius 9y ago
      The easiest candidates for an answer is obviously Scurvy (Vitamin C) and Rickets (Vitamin D). Both can cause mental symptoms (retardation for example). But both are rare.
  - kbart 9y ago
    "Some people need help to learn what foods to eat properly because their parents never taught them how or they just have bad eating habits." You don't need a nutritionist to tell you to stop eating junk/processed food. All other diet advice are pure b.s. as there's no scientific answer to what "a proper diet" is. What is "healthy" and what is not changes on a similar rate as weather broadcast i.e. see a recent turn on fat.

adamqureshi 9y ago

Mental diseases are not really understood the way, say, liver diseases are understood, as a pathology of the body and its tissues and cells. Researchers understand the underlying structure of very few mental ailments. What psychiatrists call a disease is usually just a label for a group of symptoms. As the eminent psychiatrist Allen Frances writes in his book, “Saving Normal,” a word like schizophrenia is a useful construct, not a disease: “It is a description of a particular set of psychiatric problems, not an explanation of their cause.” - David brooks.

wu-ikkyu 9y ago

Imagine you see a squadron of fighter jets flying in above in the sky. Then, one of the jets inexplicably breaks formation and flies off by itself. 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-on-world-war-ii-vets/ http://www.pbs.org/newshour/rundown/the-forgotten-lobotomies... [2]https://www.ncbi.nlm.nih.gov/pubmed/23511221 https://www.ncbi.nlm.nih.gov/pubmed/23511221

dwringer 9y ago
> Imagine you see a squadron of fighter jets flying in above in the sky. Then, one of the jets inexplicably breaks formation and flies off by itself. A clear-cut case of Paternal Conflict Syndrome.
Nav_Panel 9y ago
> It could be that the supposedly "rogue" jet that broke formation had realized the others had lost course, and thus reestablished the "correct" course. 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.
9y ago

kingkawn 9y ago

Like trying to rebuild a tool while using it.

iamcurious 9y ago
Metaprogramming ftw!

auserperson 9y ago

I find really weird that it doesn't talk about Focault and Deleuze.

phren0logy 9y ago

I'm a psychiatrist. Much of the valid criticism in this thread could be applied equally to all branches of medicine. For example, the number of good randomized controlled trials for surgical interventions is probably smaller than you think. 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. 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-research-domain-criteria.shtml 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.

imperio59 9y ago
Your profession is still largely a fraud. It votes into existence new "diseases" 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 to an uninformed public who thinks what you do is science. (https://en.wikipedia.org/wiki/DSM-5#Criticism https://en.wikipedia.org/wiki/DSM-5#Criticism) 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-Citizen-Petition.pdf 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.