
Philosophy of Psychiatry (2015) - lainon
https://plato.stanford.edu/entries/psychiatry/
======
wu-ikkyu
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...](http://www.pbs.org/newshour/rundown/the-forgotten-lobotomies-
on-world-war-ii-vets/)

[2][https://www.ncbi.nlm.nih.gov/pubmed/23511221](https://www.ncbi.nlm.nih.gov/pubmed/23511221)

~~~
wfo
It also led to the classification of homosexuality as a mental disorder. And,
e.g. the chemical castration of Alan Turing.

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.

------
phren0logy
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-
res...](https://www.nimh.nih.gov/news/science-news/2015/the-nimh-research-
domain-criteria.shtml)

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
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-Citi...](http://emord.com/blawg/wp-
content/uploads/2016/08/1-ECT-Citizen-Petition.pdf) )

Your profession is a sham. The threads are coming loose and you can't hide it
anymore. Please quit and go find another job.

~~~
btrask
Your post contains some good arguments, but it's couched in a tone that makes
HN unwelcoming to professionals in all fields, not just psychiatry. When you
try to put so much pressure on individuals (especially ones voluntarily
spending their time here), they're less likely to see the error of their ways,
and more likely to just disengage.

------
0xcde4c3db
> 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)

------
sortudo9273834
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.

------
adamqureshi
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.

------
kingkawn
Like trying to rebuild a tool while using it.

~~~
iamcurious
Metaprogramming ftw!

