Well the immediate alternative is a social model. Rather than that you have got the imaginary pathogen of depression leading to the wrong chemicals in your brain, we would start from the idea that you are manifesting symptoms of a dysfunctional social matrix, such that you are being blamed for something that you have no control over, perhaps, or some other toxic relationship. — unenlightened

I do think any method that is effective should be tried, and it might be that much unhappiness arises from dysfunctional social situations. But what of those that are well beyond that, like the schizophrenic, extreme cases of borderline, suicidal, seriously addicted. I don't feel any particular need to protect the psychiatric industry, but I'm not so willing to throw it out for all people if it has proven successes.

I am rather surprised that you challenge questioning the medical model. Also, I am not sure about your division between experience as being subjective and behaviour as objective.

As far as the medical model is concerned it is bound up with values, especially of what is 'normal' or acceptable. This involves ideas and what counts as delusions. For example, religious and spiritual ideas. The cultural context is important. Similarly, ideas of acceptable behaviour are socially constructed. The medical model and science are established by underpinning values, rather than being value free.

With difference between experience and behaviour, the fine line may be the interaction between experience and behaviour. Experience includes thoughts and feelings, whereas behaviour is about how a person acts in regard to thoughts and feelings. For example, a person may experience intrusive thoughts of suicide or harming others and what is critical is the perceived risk of a person acting out the intrusive thoughts.

How a person understands experience is important in itself. Interpretation of experience is not merely subjective because it involves others' understanding, which in turn affects subjective experience.

But what of those that are well beyond that, like the schizophrenic, extreme cases of borderline, suicidal, seriously addicted. I don't feel any particular need to protect the psychiatric industry, but I'm not so willing to throw it out for all people if it has proven successes. — Hanover

What is a proven success in this context? If one takes the view of the addict, a steady clean supply is success, but others might consider drug free life to be success, although the latter might then consider a steady supply to be success in the case of the schizophrenic or the suicidal.

From a social perspective, I think success would be more like finding a social niche where the 'illness' becomes an asset. A schizophrenic would be suited to a career in shamanism, communication with the dead, or some other blue sky thinking - fine art? For the paranoid, a job with security, perhaps; for the anxious, health and safety. (I speak of jobs and careers here, not to recommend that organisation of society, but simply because that happens to be the current socially recognised mark of success.)

Evidence about medication is important. It is a complex area because it involves quantitative and qualitative evidence and both subjective experience, as well as observations of others about a person's treatment. With any medication, there is an issue of placebo effects, but this would not explain the full impact of SSRIs as with any other medication. Part of the problem with forms of meditation is that effects do differ from individual to individual, which may say more about what is unique. Advances in neuroscience may help in tailoring medication.

If anything, it may be that medication is being prescribed or sought as a shortcut. I do take SSRI(Fluoextine) medication myself. I requested it when I was feeling very low in mood. If I stop taking it, sometimes I notice a difference and sometimes not. Mood is affected by so many variables, including overalk physical wellness and factors in life.

The shifts between different models of mind and behaviour is where philosophy and psychiatry is an important interface. I have read Jung and I often wonder what is going on my own psyche, as well as trying to understand others' experiences. How causation of thoughts and agency is significant.

Apart from the issue of how a person behaves in response to thoughts there is also the question how does thinking and feeling differ in itself? Feelings may be connected to the body more whereas thoughts with cognitive brain processes. However, the brain and thinking cannot be split off between body and 'mind'/brain as they are interconnected in a dynamic way. This is the case in differing models. In neuroscience, the chemistry of thought is intricate. Within psychodynamic theory, the conscious and subconscious are not completely separate too. But, the understanding of thinking and feeling does differ so much according to perspectives. I wonder to what extent psychiatry training includes philosophical reflection on this complex area.

Experience includes thoughts and feelings, whereas behaviour is about how a person acts in regard to thoughts and feelings. For example, a person may experience intrusive thoughts of suicide or harming others and what is critical is the perceived risk of a person acting out the intrusive thoughts. — Jack Cummins

The perceived risk is the subjective experience of another, of the person in question's behaviour. Are you claiming that the experience of the 'expert' is objective?

Hearing voices is fairly common, and not necessarily problematic for the individual or society.
https://www.hearing-voices.org/#content
So I suggest that intrusive voices speaking of violence are sometimes made intrusive and violent by being suppressed and ignored. My first advice to someone who hears voices would be to be very careful who they talk to about them, and then to listen and respond to their voices respectfully. One rationale for this is that they are part of the person who hears them that they haven't fully integrated; some people find their negative feelings unacceptable but undeniable and so project them into the ether as some 'other' within the psyche. And sometimes, it is just the way they think about things.

But such a tendency can also be an aid to creativity, such as the novelist whose characters are sometimes perceived by them to have their own views on where the novel should go. So again, the social aspect and the external assumption that there is a problem is a large part of the problem.

If you have a vivid imagination, it can be an aid to thinking and a boon to society. An architect's function in society is to visualise a building in such fine detail and completeness and realism, that they can give complete instructions on its construction in reality. She has to see the building that does not exist so clearly as to be able to draw detailed plans and elevations complete with measurements and materials specifications. We call them hallucinations when we cannot make sense of, or find a use for another's imaginings.

A schizophrenic would be suited to a career in shamanism, communication with the dead, or some other blue sky thinking - fine art? — unenlightened

Shamans impose themselves on others though, burning smoky sagebush and spitting magic liquid. I find them as annoying as you find psychologists.

But, sure, to the extent we can find jobs for the schizophrenic, let's do that. Many end up on the street, institutionalized, or heavy burdens on their family. To the extent there might be a cure or at least a way to mitigate the behavior to help them function in society, it ought be pursued.

I find them as annoying as you find psychologists. — Hanover

Keep taking the tablets! Annoyance is a serious and distressing condition, but it can be controlled with the appropriate medication. Have you read Brave New World?

I do take SSRI(Fluoextine) medication myself. — Jack Cummins

I tried SSRIs a long time ago, but the best positive effect they had for me was i felt a little calmer and smoothed out. There were multiple side effects, but the only one im willing to mention is it seemed to make me want to engage in other recreational drug behaviors more than when im not taking them.

Have you read Brave New World? — unenlightened

As far as you and my high school teacher are concerned, I did. You might be throwing the baby out with the bath water with your complete rejection of psychiatry. Maybe you've got a personal story there.

There are obvious "documented positive effects" for alcohol, heroin, and tabacco as well. — ProtagoranSocratist

Are you arguing that anti-depressants have no positive effects? Alcohol and heroin are demonstrably bad for one's mental health. Anti-depressants are not so even if associated benefits are a placebo, is there a problem with taking / proscribing them?

Tobacco is interesting - I've seen studies that suggest smoking is beneficial for the mental health of schizophrenics.

Talk of 'chemical imbalances' is perhaps outdated? I don't think knowledgeable proponents of medication use such language anymore?

the 10,000 foot takeaway there is that there are major risks/issues if psychology and the language of health/wellness come to define ethics and the philosophy of "living a good life" and "being a good person." — Count Timothy von Icarus

Is this not already happening? I see some conflation between "living a good life" and "being a good person" already in wellness circles?

Lo' and behold, programs when curricula loaded with texts that claimed that the illusory nature of the individual must be overcome also discovered that it the individual was illusory. And yet, this area later became ground zero for much of the replication crisis, and some of the claims it made for things like "priming" are, in retrospect, the sort of thing that should have rung alarm bells in the same way claims of psychokinesis do. — Count Timothy von Icarus

Very interesting. Jessie Signal's "The Quick Fix" looks at a lot of the issues you are outlining here. Certainly, the idea (as argued in a rather infamous study) that mere exposure to the concept of aging would 'prime' study participants into walking more slowly in a hallway reads closer to psychokinesis than science.

A criticism I'd like to point out here is that psychology, like economics, is not metaphysically neutral. Aside from empirical work, it provides an interpretive lens for how data is interpreted, which is based on ideals dominant in the field. — Count Timothy von Icarus

Greg Lukianoff and Riki Schlott describe a scenario in which male teens seeking counselling were instead provided lessons on 'toxic masculinity', which seems in danger of violating the 'first, do no harm' principle.

I share your skepticism of a philosophical 'gloss' being placed on concepts of wellness. But can you see a role for a robust philosophy helping to 'reign in' the excesses of psychiatry, or other social sciences? In Oliver Keenan's book on Aquinas, I recall him insisting on the value of discrete disciplines, and that if theology is going to offer anything to the other disciplines, it will do so through theology first? Can philosophy take on this role?

Nobody must question the medical model, because it is a scientific model. Scientists are objective and therefore mentally healthy. — unenlightened

This does seem to be a problem, despite psychiatry being in its infancy as a discipline when compared to medical science, or other sciences. Does recognizing the limitations of the medical model address this problem, or do you see the model itself as the problem?

He also appreciated Laing’s insistence that psychosis could be understood as a meaningful experience, rather than simply as a disease process. — Joshs

There are certainly some people who have 'learned to live' with their voices. But generally, when I hear this idea, I am left assuming that proponents don't actually know a lot of people living with psychosis. Not that my experience of friends and family with psychosis is anything more than anecdote, but even if the communication I experienced with my brother was 'meaningful', it was certainly degraded and impoverished when he was psychotic.

I don't think this concept needs to be discarded - I certainly did see 'meaning' in some of my brother's obsessions and paranoid ramblings.

Freddie DeBoer often writes well on this subject. He fears that too often people amplifying 'learn to live with your voices' and other such messages are the most functional representatives of the disability, which can drown out those for whom their autism, for example, is not a 'superpower' but a crippling disability.

Freddie DeBoer often writes well on this subject. He fears that too often people amplifying 'learn to live with your voices' and other such messages are the most functional representatives of the disability, which can drown out those for whom their autism, for example, is not a 'superpower' but a crippling disability. — Jeremy Murray

Can you provide a link to something from DeBoer on this? I'd be interested in reading more.

Are you arguing that anti-depressants have no positive effects? — Jeremy Murray

no, read what you quoted again

Tobacco is interesting - I've seen studies that suggest smoking is beneficial for the mental health of schizophrenics. — Jeremy Murray

tobacco is like coffee, it's a mental stimulant: so it's not surprising it would have benefits for schizophrenics because the source of their problem seems to be alienation from a reality they want to engage with. There were also studies suggesting that nicotine/ciggs are good for people with dementia as well, but overtime these studies are always changing in how the information is phrased: it's still argued that nicotine itself helps dementia patients, but i think the researchers argues realized the issue with damaging the body to help the mind (like is done with cigarettes, at least when it's more than a little bit every week).

Another interesting thing you might want to look into is how native americans treated tobacco: it was more social, it wasn't packaged for addiction (they didn't have the technology to do that), and i read somewhere that the elders spent much of their time smoking (because what are else are they going to do)?

As far as heroin in concerned, the origins were in temporary pain relief, and the positive effects of heroin can be rather extreme...but I wonder at what point you can use things like opioids and anti-depressants without it turning into a form of self-destruction. I have a friend who has been on various psychiatric medications for years, and hasn't been able to get off of them. It seems these medications, from my point of view (and i don't lecture him on it, even though i've gently criticized some of his other drug use) have been assisting in physical degeneration for him, even though he's a very coherent person for me to talk to.

Freddie DeBoer often writes well on this subject. He fears that too often people amplifying 'learn to live with your voices' and other such messages are the most functional representatives of the disability, which can drown out those for whom their autism, for example, is not a 'superpower' but a crippling disability. — Jeremy Murray

A disability for whom? Where and how do we draw the line between disability defined in terms of the hardships it causes for those surrounding the allegedly disabled person ( as so often happens with ADHD) and their own sense of being disabled? And even with regard to the person’s self assessment, what percentage of it is made on the basis of non-conformity with the dominant culture and what part of it is truly a self-assessment? Would you agree there is a difference between someone born deaf or sightless and someone who develops such conditions as a result of injury or illness? Do you think the former consider themselves disabled in the same way as the latter?

Here’s an interesting take on what I’m talking about:

“ “Healthism” is the pervasive ideology according to which each of us is responsible for valuing and protecting our own health and prioritizing health over other values, while society has the right to enforce, surveil, and reward healthy living. Neurodiversity and other forms of cognitive difference are generally understood through the lens of health: they are taken as diagnosable pathological conditions that should be treated or mitigated via medical interventions. Putting these two ideas together, neurodivergent people are supposed to try to be “healthy,” through pharmaceuticals, behavioral therapy, and the like, and society has an investment in making them be “healthy.” But neurodivergence is not a morbidity in a typical sense, so it is unclear what “health” means in this context. In practice, our societal standards for health for neurodivergent people are defined in terms of what avoids disrupting neurotypical expectations and systems or making neurotypical people uncomfortable. “Health,” for neurodivergent people, is in effect respectability—it is not defined in terms of their own needs or flourishing but in relation to the norms and needs of others. This can be seen from a close reading of diagnostic definitions and official medical “treatment” methods and goals. Trying to “treat” neurodivergent people by making them respectable citizens who are palatable within neurotypical productivity culture is usually likely to backfire; typically bad for their own well-being, and a social loss.

https://youtu.be/5Wf0CuOiWOA?si=g6RrA06FAS9LzCBe

Can you provide a link to something from DeBoer on this? I'd be interested in reading more. — wonderer1

Hello wonderer,

From DeBoer's Substack. The first is on bipolar disorder, which DeBoer himself battles. He has talked elsewhere quite candidly about the devastating impact his disorder has had on his life and career. The second is more on the media coverage, the issue of 'learning to live' with the voices and such. Number three talks to the pain of those whose debilitating disorders are 'left out' of some conversations.

https://freddiedeboer.substack.com/p/perhaps-you-would-be-a-little-touchy

https://freddiedeboer.substack.com/p/the-new-york-times-remains-utterly

https://freddiedeboer.substack.com/p/who-neurodiversity-left-behind

DeBoer has tons of other great stuff free on his Substack - on Kanye and his bipolar disorder, for example. Given DeBoer's personal connection to mental illness, I think DeBoer on mental illness is maybe DeBoer at his best, although I believe he is more known for his writing on education.

I have a friend who has been on various psychiatric medications for years, and hasn't been able to get off of them. It seems these medications, from my point of view (and i don't lecture him on it, even though i've gently criticized some of his other drug use) have been assisting in physical degeneration for him, even though he's a very coherent person for me to talk to. — ProtagoranSocratist

There are definitely negative consequences for some psychiatric meds. Weight gain is obvious, but the worst outcomes I've heard described are from people on anti-psychotics who say they 'no longer feel like themselves'.

Johann Hari's "Stolen Connections" talks about the consequences of indefinitely taking meds that were designed as short or medium term, along with the dangers of 'medical-only' interventions. He positions mental illness as tripartite, with heredity, biology and social factors all critical components of mental illness. I agree with Hari here, and think his model points to realms that meds can, perhaps, assist with.

Obviously, plenty of things matter that are outside the realm of medication. It would be insane to argue that a pill can cure trauma, bereavement, alienation.

Does your friend wish to quit meds? Do you see the meds as the cause of his 'degeneration' or are they more a part of a causal whole?

A disability for whom? Where and how do we draw the line between disability defined in terms of the hardships it causes for those surrounding the allegedly disabled person ( as so often happens with ADHD) and their own sense of being disabled? And even with regard to the person’s self assessment, what percentage of it is made on the basis of non-conformity with the dominant culture and what part of it is truly a self-assessment? Would you agree there is a difference between someone born deaf or sightless and someone who develops such conditions as a result of injury or illness? Do you think the former consider themselves disabled in the same way as the latter? — Joshs

Key questions. I think psychosis is a fairly clear dividing line - when an individual is interacting with an environment different from physical reality, responding to stimuli not 'seen' or 'heard' physically, they can become a threat to themselves and others. And this is a 'visible' benchmark, in most cases, at least over time.

So psychosis sets aside issues of, say, non-conformity to me.

I do think there is a difference being born and becoming sightless, and that those groups would, and do, view their disabilities differently. My ex was an 'audio-describer' for the visually impaired, and also worked with some in the deaf community on film projects. She often talked about these identities as 'different' rather than impaired, as do some within those communities - people born deaf who refuse cochlear implants, for example.

But neurodivergence is not a morbidity in a typical sense, so it is unclear what “health” means in this context.

This is entirely fair, I just don't think it captures a full enough picture. Neurodiversity is simply too
broad a category. There is not enough commonality between severe schizophrenia and mild to moderate autism, for example.

I draw a hard line between psychotic and neurotic illnesses myself on these sorts of issues, and think neurodiversity a more valuable concept in the neurotic realm.

Trying to “treat” neurodivergent people by making them respectable citizens who are palatable within neurotypical productivity culture is usually likely to backfire; typically bad for their own well-being, and a social loss. — Joshs

I agree that this can be problematic, but that doesn't mean that some neurodivergent people don't want or need treatment.

I oppose insisting on it. The only 'forced' medication I feel comfortable with is psychotics who pose a danger to self or others.

And possibly addicts deemed threatening, although addiction is a different can of worms.

:up:

I would like to again underline a difference between psychiatry and psychology. A psychiatrist is a medical doctor. Think of her as a gathering place of different streams of research. That runs the gamut from neuroscience, genetics, pathology of diseases, drugs and their effects, etcetera. That doctor is also a gathering point for streams of psychological research. The psychodynamic is but one of many and they vary greatly upon what they build their models upon. Consider this search page of models of human development psychology. If you go down a few of the pages, you will start seeing reference to the big names of the twentieth century.

The social dynamics Vygotsky introduced has expanded into many other ways looking at environments where the individual emerges.

The research of therapies involves the range of such models but also performs researches of therapy as such. That is where the Boulder model comes in. Practice and theory are necessarily connected but also always apart.