I think it's interesting to look at how psychiatric disorders are invented. For example, is homosexuality a mental disorder? It's basically just a bunch of psychiatrists getting together, suggesting stuff and voting on it. It is not science.
A mental disorder means a stable cluster of symptoms in a population such that it is (1) statistically abnormal, (2) distressful to a degree (clinical significance), and (3) not ameliorated by a reasonable change in environment.
Statistical abnormality is one point that is debated among professionals today because some might say that if obesity becomes pandemic, it's still a disorder. Deafness is also an interesting discussion because there are deaf communities now, so a reasonable change in environment is possible.
One does not use science to determine if a cluster of symptoms warrants classification as a disorder. There is no inherency in the universe which demands that. Science can set arbitrary statistical brightlines, study the etiology of a stable cluster of symptoms, if it can be found, and then study a range of possible interventions to the distress.
Perhaps in the future, mental decline at age 90 will be considered a disorder, because everyone is mentally sharp even at age 100, the mental decline causes a lot of financial and social distress, and it's not ameliorated by a reasonable change in environment. In the past, it's comprehensible how homosexuality was (1) statistically abnormal, (2) distressful to a degree, and (3) not ameliorated by a reasonable change in environment.
People want a concept of mental disorder that is "objective". That's not possible. Disorder is absolutely context-bound.
> Deafness is also an interesting discussion because there are deaf communities now, so a reasonable change in environment is possible.
Not only that, but the "traditional" way of "treating" the Deaf was to force them to learn to vocalise, and to forbid them from learning sign language. The reasoning being that they should integrate with regular society as much as possible, and this was the best way to ensure that. Of course, in reality it is like forcing blind people to communicate exclusively via pictionary. Luckily this has been changing for a while now.
> A mental disorder means a stable cluster of symptoms in a population such that it is (1) statistically abnormal, (2) distressful to a degree (clinical significance), and (3) not ameliorated by a reasonable change in environment.
1) Every individual is statistically abnormal. That's how they're identifiable. It's debated amongst professionals because there are absolutely no consistent criteria for behavioural normality that wouldn't include wide swaths of undistressed people.
2) is incoherent in practice. Mental disease is diagnosed in people because they are not distressed by things that "should" distress people. Mental disease is also diagnosed if people are distressed by the reaction of others to their symptoms, not by the symptoms themselves.
3) "reasonable change" is a hint that 3) is completely arbitrary.
The context that the concept of non-physical mental disorder is bound in is a historical accident, non-physical mental disease doesn't translate between cultures (entirely culturally-bound and fashion-following), and most of our current concepts of mental disease have origins dependent on things like the order in which we happened to discover certain neurotransmitters and superstitions about epileptic seizures making people sane.
Mental illness is defined as when you don't get your work done, or you make it difficult for other people to get their work done. All of the handwaving around it, and the fabricated physical theories applied to a wide range of "disorders" that largely amount to disobedience and differing opinions and values, corrupt our society and undermine democracy. You take the drugs and you do what you're told, or you will be medicated for your own protection. It's also class/race-based - the range of behaviors a suburban white girl would be medicated for are largely different than the ones an inner city black boy would be medicated for, even though they would get the same diagnosis (since diagnoses are based on "distress.")
This is not new. Every third rebellious kid I knew in high school 25 years ago was diagnosed with Oppositional Defiant Disorder or Bipolar Disorder, and had month-long stints in mental hospitals that began when they stayed out all night that one time, or flunked a semester, or got caught drinking or smoking pot. ADD wasn't quite as trendy then, and the range of products being sold to parents for it was narrower.
Do you believe that mental disorders exist? If so, how would you go about identifying and treating them? If not, what empirically verifiable means do you know of to identify people who are a danger to themselves or society, and treat them?
While I think there's something to the idea that mental illness is largely determined by consensus and probably some of the diseases shouldn't be treated as such, it's hard to say something like extreme paranoia, hallucinations, or depression with suicidal ideation wouldn't be a problem if not for our cultural beliefs.
> People want a concept of mental disorder that is "objective". That's not possible.
With a bit of effort, I think it is.
I disagree with your definition of a disorder.
A disorder is anything that negatively impacts an individual when compared to the mean. With a bit of effort, you can statistically measure that based on fecundity.
"A disorder is anything that negatively impacts an individual when compared to the mean."
Not every deviation from the mean has only negative impacts (e.g. A person with OCD probably makes a better air traffic controller.) and the definition of what is "negative" can actually change over time.
Last but not least we should look at why they are negatively impacted. The impact often comes from society and maybe society should be more tolerant instead of medicating everyone who is deviating from the mean.
Your point - that mental illnesses aren't always seen as entirely negative by the people who have them is a good point. And this point is excellent:
>The impact often comes from society and maybe society should be more tolerant
However
> A person with OCD probably makes a better air traffic controller.
Obsessive Compulsive Disorder is often a severely debilitating[1] illness. It's marked by intrusive thoughts, and rituals to cope with those intrusive thoughts.
I can't see how those could help someone be a better air-traffic controller.
The most important part from that link is probably this, which talks about the difference between the normal anxieties that everyone has, and what happens in OCD.
> Although many people experience minor obsessions (e.g. worrying about leaving the gas on, or if the door is locked) and compulsions (e.g. rituals, like avoiding the cracks in the pavement), these don’t significantly interfere with their daily lives, or are short-lived.
> If you experience OCD, your obsessions and compulsions will cause you considerable fear and distress. They will also take up a significant amount of time, and disrupt your ability to carry on with your day-to-day to life, including doing daily chores, going to work, or maintaining relationships with friends and family.
OCD is probably not going to help someone be a better air traffic controller.
OCD is a much misunderstood illness, and there's some stigma around it, so I hope you don't mind me dumping some information here.
[1] WHO list OCD in their top 20 debilitating illnesses.
> Of the 10 leading causes of YLD in the world among individuals of all ages, four are psychiatric conditions, with unipolar depression being the leading cause (2). Among individuals between the ages of 15 and 44, panic disorder, drug use disorders, and obsessive–compulsive disorder (OCD) were included in the top 20 disorders.
Do you believe that psychiatry provides us valid knowledge that allows us to identify, study, and treat individuals who have mental influences that cause them to be a danger to themselves or society? If not, by what means to propose that we do so?
> Do you believe that psychiatry provides us valid knowledge that allows us to
No, it really doesn't.
If someone comes into a clinic and ask psychiatrist for a help, he is gonna be diagnosed with some kind of a disorder 100% the time.
But if you think about it, it's not psychiatrist who determines if the person is healthy, it's the person himself. If you meet with a psychiatrist, you have a disorder. Period.
> treat individuals who have mental influences that cause them to be a danger to themselves or society?
It reminds me of an old Soviet practice to treat people who were under influence from Western countries. Quite obviously, it was considered a mental disorder which was dangerous to themselves and for the (Communist) society. So those were usually locked up in a psychiatric clinic and never heard from ever since.
The methods to determine if a person is "ill" never changed. "I think that person has disorder, so let's come up with a disorder that fits more or less." As mentioned in the article above, the response should be: where is your blood test?
> If not, by what means to propose that we do so?
Quite easy really. Whether a person is a danger to society or not, should be determined by a court jury based on his previous actions.
> If you meet with a psychiatrist, you have a disorder. Period.
Whether or not that's true, it's irrelevant to the statement about providing valid knowledge. If a person goes to a family doctor, they have a health issue. If a person goes to a lawyer, they have a legal issue. To an accountant, they have a fiscal issue. Merely 'going to [professional]' does not mean that they have invalid knowledge.
> Whether a person is a danger to society or not, should be determined by a court jury based on his previous actions.
Not only is this is a huge waste of time and money (court officials, jury, legal teams...), but it's even more subjective that the system you want it to replace. And it's already well-known that courts deal with mentally ill people far worse than mental health services do.
>> Quite easy really. Whether a person is a danger to society or not, should be determined by a court jury based on his previous actions.
A couple of problems with this solution come to mind. You say that the knowledge that psychiatry produces is invalid because it is non-scientific. The process by which the justice system produces knowledge is decidedly non-scientific and inherently subjective. Why do you hold the knowledge produced by the non-scientific process of justice above the non-scientifically produced knowledge of psychiatry?
Additionally, by the time the justice system gets involved, a crime against society has already occurred. Surely we can do better than waiting for tragedy before intervening?
Homosexuality was once considered a psychiatric disorder. That alone tells you that it is a reflection of social norms, not objective truth, and therefore, inherently unscientific.
This is different from medicine (which also had an interesting past as it evolved) in that there's broad, objective consensus as to what's harmful and what's not, and its work is detailed and reproducible and there's few questions how the mechanisms of action work - infectious particles harm the body and cause disease, and there's no debate on that matter.
Whether or not psychiatry can help those who are a danger to themselves or others (answer: of course it can.. one way or another) is orthogonal to whether it's scientific or not.
The idea of evidence-based medicine and using the scientific method in medicine came up in the 1960s. It took longer still for it to become widely used and there are still massive problems in that area today, take a look at drug testing as an example. You can't reasonably claim psychiatry to be significantly more or less scientific than medicine.
You're idea that there is an objective consensus on what's harmful and what's not is simply ridiculously wrong. Just look at discussions about making insecticides or pesticides illegal that come up quite regularly.
You're idea that there is an objective consensus on what's harmful and what's not is simply ridiculously wrong.
I didn't say for all things, but I did say broad. And most importantly, the results of the studies have nothing to do with what people think is harmful or wrong, only what actually can be measured and reproduced.
People argue over climate science too (and for the same reason as your counterexample). There's still broad consensus at the end of the day.
Meanwhile, the psych "science" is inherently anchored to whatever the social norms of the day are. Medical science and biology can define a healthy body with much more certainty and detail than psychiatry can define a healthy set of thoughts.
We know very little about how the brain and the mind actually work. Nevertheless we need to somehow people who have problems with these things. It makes sense to try things that might not be fully supported by science as has been done successfully in medicine. Of course mistakes happen when you do that but it doesn't make sense to abandon psychiatry as worthless because of that.
Nobody suggested abandoning it, merely that as a "science", it's woefully deficient. I have no doubts that we'll begin figuring it out soon enough.
In the meantime, I suggest treating all psychology with a few more grains of salt than usual, keeping in mind that the science is often based on opinion rather than fact.
..especially when a nontrivial amount of peer reviewed papers can't be reproduced.
Yeah, I agree that psychiatry's value rests less on its categorization as science or not but rather its ability to reliably reproduce valid and accurate knowledge of use to society and individuals.
I have began to push back against the position that the scientific method is the exclusive measure of valid and valuable knowledge, and I detected a bit of that in your assertion.
Personally I believe that psychiatry can be both a science and not a science, depending on how one practices it. And that some highly valid and valuable knowledge remains outside the reach of science, and always will. And other highly valid and valuable knowledge can only be produced by the scientific method and will remain outside the reach of subjective methods.
> Personally I believe that psychiatry can be both a science and not a science
Like alchemy, astrology or theology? Or medical sciences in middle ages?
Like all those "sciences", psychiatry lacks a solid base, a set of verifiable facts which entire science is based upon. Why those disorders happen? Which substance causes them? Anybody can answer that?
Medicine as practiced now has both scientific and non-scientific parts. Original research, as in bioinformatics, drug discovery, etc. constitutes the scientific part as it uses systematic experimentation, logic, statistics, etc. to deduce universal laws that can be independently verified.
However, the application of this knowledge to actual individuals in an doctor's office or hospital is an inherently subjective and non-scientific process, involving subjective inputs such as 'Rate your pain on a scale of 1-10.', 'How are you feeling after we upped your dose?', 'Is this treatment plan allowing you to get back on the job?' etc. The value a doctor provides is taking the vast corpus of medical knowledge (both scientific and not) and applying it to a single individual. This is not science, but is critical for the medical treatment process.
So what's the argument, that we should just wait a few centuries to help anyone who is mentally ill because we don't know enough about the underlying mechanisms?
The colors of visible light form a continuous spectrum. "Red" vs. "blue" is a meaningless criterion devoid of all content which invites arbitrary judgement.
That's not a good comparison. Red and blue have very objective definitions given that we have three types of light receptors in our eyes, and a given kind of light can be measured to activate the "blue" or "red" kind without any subjective input.
It is sometimes speculated that Homer wrote about "wine-red seas" because the ancient Greeks considered blue and red "the same" color. Or, to take a more modern example, the Japanese consider blue and green the same color (there are words that can distinguish, of course, but we have words that can distinguish various shades of the same color too). Clearly the division into different colors involves some degree of subjectivity and yet it doesn't make sense to claim that, therefore, words for colors are meaningless.
Exactly, which is why I support the National Institutes of Mental Health's (NIMH) efforts to move away from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is just a dictionary of subjective labels for collections of mental health symptoms, to the Research Domain Criteria (RDoC), which is a matrix of measures that place patients along a variety of psychological spectrums to understand their mental illness [1]:
While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
In contrast with the vastly superior RDoC Matrix [2]:
The RDoC research framework can be considered as a matrix whose rows correspond to specified dimensions of function; these are explicitly termed “Constructs,” i.e., a concept summarizing data about a specified functional dimension of behavior (and implementing genes and circuits) that is subject to continual refinement with advances in science. Constructs represent the fundamental unit of analysis in this system, and it is anticipated that most studies would focus on one construct (or perhaps compare two constructs on relevant measures). Related constructs are grouped into major Domains of functioning, reflecting contemporary thinking about major aspects of motivation, cognition, and social behavior; the five domains are Negative Valence Systems (i.e., systems for aversive motivation), Positive Valence Systems, Cognitive Systems, Systems for Social Processes, and Arousal/Regulatory Systems. The columns of the matrix represent different classes of variables (or units of analysis) used to study the domains/constructs. Seven such classes have been specified; these are genes, molecules, cells, neural circuits, physiology (e.g. cortisol, heart rate, startle reflex), behaviors, and self-reports. Circuits represent the core aspect of these classes of variables – both because they are central to the various biological and behavioral levels of analysis, and because they are used to constrain the number of constructs that are defined. Investigators can select any level of analysis to be the independent variable for classification (or multiple levels in some cases, e.g., behavioral functioning stratified by a genetic polymorphism), and dependent variables can be selected from multiple columns. In addition, since constructs are typically studied in the context of particular scientific paradigms, a column for “paradigms” has been added; obviously, however, paradigms do not represent units of analysis.
To be fair, it's mostly an attempt to classify and not "invent." A large part of this is trying to understand things that genuinely bother people, e.g. visual and auditory hallucinations, anxiety, suicidal thoughts. Why wouldn't you want some naming convention so that clinicians can have a conversation about it? But of course there are abuses as well, like your example of homosexuality, though it don't think that's the same as something like schizophrenia, which is a horrible experience regardless of what society calls it.
The former is no longer a mental illness in of itself since it formed the basis of a popular movie. (Said representation was piss poor, but the point stands.)
I don't know, I found "Secretary" to be quite all right. Isn't that the big movie with the lawyer named Grey that everybody was talking about last year? :-)
I find it interesting that if you have odd/unusual sexual preferences, then you are often considered mentally ill, but if you have some odd/unusual preferences for other things (like operating systems, for example), then that is in most cases not considered a mental problem.
What's so special about sex? I guess psychiatry basically took over and continued the old Christian religious prejudices.
Even outside of psychiatry, sex is widely held to occupy a special place in the psyche. This is why forcing somebody to have sex with you is a very serious crime, but forcing somebody to use Windows is not.
Sexual preferences that psychiatry considers mental disorders, like BDSM, fetishism and transvestism, or previously homosexuality and masturbation, usually have nothing to do with forcing anybody. Seems like much of psychiatry basically boils down to "we don't like this, so we consider it a mental disorder". As for the sexual stuff, I guess it comes from the old Christian idea that sex that is not for procreation is wrong, which is probably a result of agriculture. In an agricultural society, you want the maximum amount of children, I guess.
I find it fascinating that so many people are holding on to these obsolete beliefs (I mean, there are probably already too many people on this planet from an environmental point of view), although these beliefs do seem to gradually crumble as we speak.
Definition of mental illness is relying on whether a condition conflicts with society. Therefore, as a function of 19th century western society, it was a mental illness; thankfully, now it is not.
Without a context of environment a definition of mental illness can not possibly exist. For example, paranoid schizoprenia wouldn't be a mental illness in an environment where all paranoid fantasies turned out to be true.
Yes, paranoid schizophrenia would still be a mental illness in which the fantasies turned out true, if they turned out true by complete fluke.
That is to say, if some crazy nonsense for which you have absolutely no evidence turns out true by amazing coincidence, it was still crazy to have believed it.
The definition of mental disorder is a permanently context-bound construct. There is no inherency in nature or physics which requires a classification of disorder. However, the construct is both useful and abusable.
In the broadest sense, Psychiatric disorders are internal mental conditions that prevent a person from being a happy productive member of society. If you live in a society that demonizes homosexuality, then it kind of makes sense to call it a psychiatric disorder. In this case however the solution wasn't to cure the homosexuals, but to cure society.
You don't vote on science. You vote to gauge degree of consensus.
Science would be a bunch of experts getting together, suggesting stuff, and systematically invalidating each incorrect suggestion with rigorously controlled experimentation until the remaining suggestions can be presumed to be correct at a certain degree of precision.
Well it's only a matter of time before being a 'homophobe' is considered a mental disorder and will make the person liable to be sent to a mental 'hospital' until he recants his viewpoint.
This was a favourite strategy of Stalin, by the way. If somebody didn't like communism enough then surely he must be a loon.
1. This actually happened to homosexuals in the west during the twentieth century. The worst social ostracization faced by individuals who disapprove of homosexuality today really is not even noteworthy by comparison. Compare Brandon Eich to Alan Turing, for example.
More-over, pathologizing homosexuality continues to happen in many parts of the world and even, de facto, in some parts of the US (e.g., "gay camps", which often have some component of psuedo-psychology on top of their religiosity).
2. Popular presidential candidates and members of the party that controls congress openly and proudly express anti-homosexual views. The idea that society is on the verge of pathologizing people who disagree with homosexuality is absolutely absurd.
It worked for conservative society for horrible aeons. Pressure the queer into social services - reap "justice" and stability as reward for this. Its the first form of power pillars in check and balance. Religion wields the power of enforcing encoded "peoplepropertys" , believers wield the power of withdrawing "believe" from this pillar if that order is not enforced, the psychopaths- push against the restraints this setup puts them under.
All those calls to purify sexual morality when corruption and injustice become obvious- maybe there is some sand and ugly truth to this behavior?
Maybe that sad truth is not fixed by simply saying we looked at a optical illusion - and now we know them, and it will never ever deceive us. \n
Maybe accepting constant mental deficits and diversity of the species is part of growing up, and working around those that creating suffering with tech is the only way to fix it for now.
To be functional in an inherently dysfunctional system that is the nature of hierarchical society. It is made for certain personalities to thrive at the cost of others who may or may not be economically as important, but then why should personality and behavior be judged by the economic and social ability of an individual, but that's what psychology is really for... for enforcing, disciplining and punishing people that don't conform to the economic or social norms, who are therefore not functional in conventional settings. Who are hunter gatherers by their nature and not corporate drones, for instance.
> but that's what psychology is really for... for enforcing, disciplining and punishing people that don't conform to the economic or social norms...
This is quite fallacious. You are essentially describing fundamental peer/societal pressures, not psychology, in some sophomoric attempt at wit. There are individuals who truly suffer from deep psychosis and other troubling issues. Let's not be so callous with our broad brush strokes.
> There are individuals who truly suffer from deep psychosis and other troubling issues. Let's not be so callous with our broad brush strokes.
As Foucault pointed out (and even Sapolsky) these people used to have a job, we called them Oracles or Shaman or Prophets.
Instead Psychologists and Psychiatry either wishes to fix them when in many cases they can't be "fixed", by giving them drugs to mess with their already fragile minds or through other means and therapies. Where the humane thing would be to simply give them autonomy and some sort of social way of acquiring food and resources. Many of their problems are caused by the inability of society to accommodate things which are not machines, for instance anxiety problems and depression caused by interaction with the economy itself.
We have a a whole set of treatments to make them conform. Rather than accepting them for who they are, and giving them some sort of role to play. Because as I said they are not good corporate drones that follow the logic of production and consumption in the modern economy. If they wish to have any sort of autonomy they must do it through the economy, which has made making a living as a quack more and more difficult through this sort of societal logic.
Sure there are minor and major ailments, but don't go around telling me treatment for those ailments is not inspired by making people into tools that are then asked to perform on command.
If anything your attempt is sophomoric and completely tone deaf to the larger picture of how these systems fit into our society and what they actually say about it, rather than just trying to "help", it's trying to make them into tools that can be economically exploited so that they are integrated into the system in a very specific, ordered, logical way.
Just like religion was trying to "help" those that could not properly be possessed by imaginary things and mental illness. This attempts to do the opposite for those that fit into the mentally-ill religious category. Oh how things change.
Even hunter gatherer societies had social structure and norms. And in those societies people far outside the norm were probably treated much worse than they are in today's society.
Nothing as it is today. If you could hunt or gather you had a place. And you were related to everyone in your tribe by blood. So it is a similar relationship to the one that you have with your family or extended family.
So yes to an extent you are right, but at the same time the social cohesion was much greater. In modern society if you are out you are out, you have no recourse at all. Hunter gatherer societies probably not as much. But I am sure if you did certain things in some of those groups that were out of the social norm they would kill you.
But lots of things that you would get in trouble for today would not raise a brow in their societies. There are lots of trivial things that you can get in trouble for in mass societies that are of no concern to someone living in a tribal setting today for instance.
I suspect (I don't have evidence I will admit, I'd be interested in any real evidence that exists!) that you have far too rosy a view of hunter / gather lifestyle.
Mostly, it was more important for people to follow the rules, or people die. You (for example) couldn't keep quiet when you had to (while hunting, or hiding)? Food would escape, people would die. You felt some days you couldn't face going outside to hunt or gather? There wasn't a safety net for people to keep bringing you food until you felt up to it again.
Hunter-gatherer societies were much more egalitarian than today's, this much is agreed upon by the anthropological community. It's just a result of small group size and homogeneity, along with a lack of specialization. What you're talking about is real, that if you couldn't fit into the norms of the group you would be shunned. Typically you wouldn't have trouble fitting into those rules, because they would have been all you were ever exposed to. You would have no reason to ever doubt them. Some people would be better than others at various tasks, for example, keeping quiet on a hunt, but then they would just do something else. Maybe you're worse than useless on a hunt, but instead you have a good eye and can spot and identify a mushroom better than anyone else.
There wasn't a safety net for people to keep bringing you food until you felt up to it again.
These small societies were built on reciprocity. In the short term you would be supported by general human goodness. If you simply couldn't contribute to collecting food, there were other things you could do as well. If you were too fond of animals to kill them, you might be coralled into some kind of medicinal role. If you were afraid to leave the settlement, you might find yourself weaving ropes, or maybe building weapons, fixing roofs.
Not directly to your point, but I feel it's relevant: there's a hypothesis that ADHD is a remnant feature (not a bug!) from hunter-gatherer times. So actually the hyperfocus of ADHD would actually make quiet hunting easier (if that's what the hunter is hyperfocused on).
If you talk about illness, it's not about importance, it's about detriment. It's a matter of perspective and an agent can only consider one perspective. Altruism can impose unsolvable constraints on that perspective.
You can't say in the same paragraph that a system is dysfunctional and that the personalities thrive, who enforce the system. One functioning part of the system is enforcing the convention. A dysfunctional system is an oxymoron. Enforcing altruism is a different matter. Altruism is inhibited by differing conventions, that preclude cooperation.
http://www.theatlantic.com/health/archive/2013/05/the-real-p...