Psychiatry seems to exclude an important aspect, the external reality like socio-economic factors and other things you guys mentioned, which have causal import to mental health and focuses, unduly, on the inner world/self of a person. — TheMadFool

No it doesn't. This is not how assessments work. We take into account all external as well as internal factors that could contribute to a persons dysfunction. I'm seeing a lot of you guys make assumptions here without any real support. When I evaluate my clients I take into account all factors.

No it doesn't. This is not how assessments work. We take into account all external as well as internal factors that could contribute to a persons dysfunction. — Anaxagoras

If you were a psychiatrist trained in a system where you are taught that concentration camps are normal, and that mentally healthy people are well-adapted to concentration camps, if your career and social status depended on you accepting that concentration camps are normal, would you look at the concentration camp itself as an external factor that could contribute to a person's dysfunction, or would you see the concentration camp as an essential part of reality that the person ought to adapt to? Would you then look for other causes behind the person's dysfunction, such as hypothesized brain defects, and then attempt to treat them by making the person ingest some drugs? If these drugs made the person's behavior appear less dysfunctional in the concentration camp, would you then consider these drugs to be an effective medication to treat the mentally ill?

Leo, that is an unfair question, of the type that no one can answer convincingly who has not lived through it. We know that it is very hard to resist social conformity though, and one can well look at the history of psychiatry, which has by turn pathologised race, as mentioned above, gender (see hysteria), and sexual orientation - seeing homosexuality as a mental illness. So without making it personal, one can see that the profession as a whole has a piss poor record in regard to such issues.

These were more rhetorical questions rather than a personal attack, I only phrased them that way to provoke thought. Probably many german people back then didn't see anything wrong with concentration camps. What might we see as the concentration camps of today's society, infrastructures and ways of doing things that lead many people to suffer but that we see as normal?

Humans tend not to be consciously aware of many of their beliefs. Scientists and professions that rely on science work within a system of beliefs they often are not consciously aware of. They believe they take all factors into account, because they omit to take into account the factors that depend on the truth of their beliefs. They think they are looking at all the factors that could be responsible for why one individual suffers, without looking at what they take for granted or what they see as normal.

In an earlier post you mentioned the reality of being stuck in traffic. That's one example where many people might have come to see it as a normal part of life that one has to adapt to. Like sitting in an office looking at a screen for 9 hours a day doing some repetitive task, while being occasionally pressured by some other individuals who get to decide whether you can keep doing this every day, so that you can get at the end of the month some pieces of paper or some numbers in an account that give you the right to sleep in a place you can temporarily call your own. Taking part in all this is the normal thing to do these days, and not adapting well to it is being mentally sick.

Possibly one of the dumbest things the scientific community did was to allow businesses like Pharma to use science as a marketing tool, hide their data and then sell billions of dollars of drugs whose efficacy was exaggerated and risks were downplayed. Great job shooting yourself in the foot. The fact that most keep their mouth shut about this is a travesty.

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020138

I can understand if research is not replicable due to honest mistakes — science is hard — but to allow it to be exploited for profit at the expense of sick people trying to get better is a deep betrayal.

Here is another article which explains exactly why a large portion of the "scientific" literature is BS.

https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12147

I believe psychiatry as it now functions is a menace and should disappear.... There is a need for medical doctors with special additional training regarding mental and behavioral problems, psychoactive drugs, medical diseases presenting with psychological and behavioral symptoms, et cetera to work with other professionals and non-professionals but should never be anything but equal members of a team.

No it doesn't. This is not how assessments work. We take into account all external as well as internal factors that could contribute to a persons dysfunction. I'm seeing a lot of you guys make assumptions here without any real support. When I evaluate my clients I take into account all factors. — Anaxagoras

You're a professional psychiatrist so I can't completely reject your claims but it is quite odd to blame and treat a person who's depressed with medication because people treat him/her badly. You see the problem is not with him. It's the people who mistreat him. The pills don't treat that significant part of the problem do they?

If you were a psychiatrist trained in a system where you are taught that concentration camps are normal, and that mentally healthy people are well-adapted to concentration camps, if your career and social status depended on you accepting that concentration camps are normal, would you look at the concentration camp itself as an external factor that could contribute to a person's dysfunction, or would you see the concentration camp as an essential part of reality that the person ought to adapt to? — leo

You're using a play on words and hypotheticals here because this would be utterly ridiculous. If you expect a serious answer can you use a less ridiculous hypothetical example?

but it is quite odd to blame and treat a person who's depressed with medication because people treat him/her badly — TheMadFool

Again, the kneejerk reaction is not to assess someone and medicate them immediately, but more importantly why would you assume someone who has psychiatric distressed is "blamed" by the psychiatrist? This is ridiculous and it is harmful. We would do a disservice to clients by blaming them for their psychiatric distress.

The thing is, if someone has issues with coping with stress and/or are having a psychotic breakdown some clinicians may use a combination of psychiatric medication as well as behavioral modification techniques to aid the individual. Some clinicians use medication primarily, some don't. All psychiatrists aren't one size fits all.

You see the problem is not with him. It's the people who mistreat him. The pills don't treat that significant part of the problem do they? — TheMadFool

Are you referring to someone specifically or is this a general opinion? Someone who is for example expressing the idea that demons are trying to kill them and are going to use physical means to absolve their situation, can indeed become dangerous. Sometimes therapy alone may not help and unfortunately chemical intervention is necessary to regain a mental balance on the situation.

You definitely sound like someone who had a bad experience,.

I bring up psychology's pseudoscience and racist past in order to encourage you and others to have a little less hubris, a little more humility, and a more careful use of language. — unenlightened

That is beneath your usual level, and rather disappointing. Such a statement is an insulting grab for the moral high ground and bears no relevance to anything that had been written earlier.

If you've had a bad experience with psychiatry, or someone close to you has, then bring it out so it can be discussed openly, fairly and constructively. Making unsupported slurs, disguised as wisdom and impartiality by the use of poetic language (poetry being something for which, as all regulars here know, you have a gift) is unfair and unhelpful.

One of the things psychology has been quite good at is identifying social risk factors for mental illness. Unfortunately, it has never been seen as its business to mitigate them. — unenlightened

Just like ambulance officers don't see it as their business to stop people driving so fast. Should ambulance officers all quit attending road accidents and take up jobs as highway patrol police until we reach that utopian ideal when nobody drives dangerously any more?

it is quite odd to blame and treat a person who's depressed with medication because people treat him/her badly — TheMadFool

This just shows that you don't understand what depression is. Many people with depression are not that way as a result of being treated badly at all. Many people in unfortunate circumstances are not depressed.

And nobody with an ounce of understanding of psychology blames people who are depressed.

There is a need for medical doctors with special additional training regarding mental and behavioral problems, psychoactive drugs, medical diseases presenting with psychological and behavioral symptoms — Chisholm

It sounds like you are not aware that that is exactly what psychiatrists are.

Just like ambulance officers don't see it as their business to stop people driving so fast. — andrewk

And the medical profession doesn't campaign against smoking, over eating, poor sanitation, or poor air quality? I seem to remember a story of doctors stopping a cholera epidemic by removing the handle of a pump.

Such a statement is an insulting grab for the moral high ground and bears no relevance to anything that had been written earlier. — andrewk

A large part of my argument is precisely to deprive the profession of its automatic presumption of the moral high ground by showing as a matter of historical fact that they are not entitled to that presumption. And one of the disqualifying factors is just such personal attacks as you have mounted. You cannot dispute the facts, so you impugn my motives. And present fatuous suggestions that the emergency services should be speed cops. Yeah- I'm saying that, aren't I? C'mon man play the ball not the man!

Possibly one of the dumbest things the scientific community did was to allow businesses like Pharma to use science as a marketing tool, hide their data and then sell billions of dollars of drugs whose efficacy was exaggerated and risks were downplayed. — Chisholm

As I brought up earlier in a casual way, psychology is heavily implicated and has great impact and influence on the advertising industry, and it is no mistake.

To put it very simply, a contented person does not spend money. The way advertising works, therefore, is to make people discontented, to make them anxious about their body hair, or how clean their work surfaces are, or whether Johnny Foreigner is coming to steal their children, or all their friends are secretly laughing at them because they have last year's suit. Psychologists are very good at this, because when you treat people as objects in the name of objectivity, then you learn how to manipulate them like objects.

Psychologists set out to create the anxiety; psychiatrists try to cure the anxiety. This is no foolish mistake, but central to the functioning of capitalism and economic growth. This is why the profession does not protest and this is why mental health is deteriorating despite all the professionals working to improve it.

This conversation really isn't one that fits within the purview of philosophy as far as I can tell. Because psychology is a scientific discipline, the value of psychiatric treatment is an empirical question, meaning we can look at the data to determine if the various treatments are effective. That is, if we can show statistically that Xanax offers relief from anxiety, then it simply does, regardless of whether that causes you to ponder "what really is normal" and the moral implications of normalizing normal and other naval gazing activity. It's also seems irrelevant whether there are some bad actors in the pharmaceutical industry or whether the medicalization of conduct you'd rather see characterized as accepted idiosyncrasy is offensive. If the bottom line is that psychiatry is offering assistance to those seeking assistance, then psychiatry has the right to some degree of pride in doing what it's doing.

As I brought up earlier in a casual way, psychology is heavily implicated and has great impact and influence on the advertising industry, and it is no mistake. — unenlightened

1) This is correct.

The Joe Camel and Joe Chemo campaigns provide good examples of the Elaboration Likelihood Model of Persuasion proposed by Petty & Cacioppo (Social Psychologists) in 1986. (Petty, Richard E.; Cacioppo, John Terrence. 1986. "The Elaboration Likelihood Model of Persuasion". Advances in Experimental Social Psychology. 19: 123–181.)

2) However, it is also irrelevant (i.e., off-topic).

The OP is concerned with Psychiatry, not Psychology. Psychiatry is a regulated profession in most western jurisdictions, which requires a medical qualification. And the title "Psychiatrist" is legally protected.

Whereas, Psychology is an extensive field, and its clinical practitioners generally do not have a medical qualification, hence; they cannot legally prescribe medications.

It is my understanding that with regard to practise, Clinical Psychology is the only branch of Psychology associated with Psychiatry (although other branches may contribute to Psychiatric research).

That said, the OP raises a very good point concerning treatment scope and method which is conducive to philosophical discussion (i.e., that the treatment of neuro-behavioural atypicality should be a multi-discipline enterprise).

As Harrington ably documents, a series of fiascoes highlighted the profession’s continued inability to answer Clark Bell’s question. [*] Among them was the 1973 vote by the American Psychiatric Association declaring that homosexuality was no longer a mental illness. The obvious question—how scientific is a discipline that settles so momentous a problem at the ballot box?

[*]Exactly what mental illnesses can be said to exist?

...even as the DSM (now in its fifth edition) remains the backbone of clinical psychiatry—and becomes the everyday glossary of our psychic suffering—knowledge about the biology of the disorders it lists has proved so elusive that the head of the National Institute of Mental Health, in 2013, announced that it would be “re-orienting its research away from DSM categories.”

However, it is also irrelevant (i.e., off-topic). — Galuchat

Medicine is supposed to be science based, so one would not, I hope, claim that biochemistry is irrelevant. But as it is exactly the scientific base as opposed to the socio-political base that is in question, the science of psychology should certainly inform the practice of psychiatry. It seems very odd to suggest otherwise, and also historically untrue.

the value of psychiatric treatment is an empirical question, meaning we can look at the data to determine if the various treatments are effective. — Hanover

This is likewise nonsensical. One can devise an effective treatment for homosexuality, and be as empirical as an empire about it, but the successful treatment of something that is not an illness is bad medicine at best, and a serious violation of human rights if imposed against an individual's will as in the case of Alan Turing.

If the bottom line is that psychiatry is offering assistance to those seeking assistance, then psychiatry has the right to some degree of pride in doing what it's doing. — Hanover

But that isn't all psychiatry does. Alone of the branches of medicine, it frequently and systematically imposes treatment on those not seeking assistance against their expressed will.

Treatment that is for illnesses listed in the DSM that get voted on and off from time to time in a manner closer identified with social attitudes than any kind of science, and that even researchers have decided to more or less ignore.

You have quoted me out of context, and misrepresented my further comments; cheap tricks. So we are done here.

M'kay.

Medicine is supposed to be science based — unenlightened

Medicine is a practice, and in so saying I'm not knocking it. Ditto for psychiatry. Ditto for dentistry. On their way to practice, students study science (like, major in molecular biology), then take more classes, and rotate through clinics. Along the way a good deal of solid science is encountered and (we hope) absorbed. But let us face a fact: The various sciences behind medicine, and all their content, is way too voluminous for the brightest doctor to carry around in his or her head.

Students mostly learn how to be doctors and dentists (and psychiatrists) by practicing on patients. Once they get good at it, they keep 'practicing'. They go with what works, what makes patients happier, or at least not dead.

@Hanover, lawyers used to prepare for the bar just by reading and practicing. Abe Lincoln became a lawyer that way. Worked for him. The Mayo brothers weren't master scientists, they were very good organizers.

So, a psychiatrist is presented with two different patients, The first is clearly out of his mind -- screaming incoherently, flailing about, totally nuts. The other patient is unhappy, is doing poorly in life, but is functional. What to do?

In the first case, administer Thorazine, put him in a padded cell, and wait for the drugs to work. Then out of the cell into a locked ward, then into an unlocked ward, and eventually, home with an Rx for lithium. The psychiatrist doesn't need to know (and doesn't, in fact know) how Thorazine and lithium work, just that they do what they do. Patient gets better.

The unhappy patient doing poorly in life, but who is behaving more or less 'appropriately' presents a lot more difficulty in a way, because there is no particular drug or intervention that will dramatically change his behavior. From his practical experience, the psychiatrist knows that soothing words help, some drug or placebo will help; encouragement, helping the patient develop some insight, and so on may all be helpful--or not.

Where psychiatrists really earn their status is in dealing with major mental illness, where life and death issues are at hand. Their waiting room full of merely unhappy, dissatisfied, pissed off, worried sick patients will mostly get better on their own, as they always have, but he gets paid to help them, so...

This is likewise nonsensical. One can devise an effective treatment for homosexuality, and be as empirical as an empire about it, but the successful treatment of something that is not an illness is bad medicine at best, and a serious violation of human rights if imposed against an individual's will as in the case of Alan Turing. — unenlightened

But what I said was:

If the bottom line is that psychiatry is offering assistance to those seeking assistance, then psychiatry has the right to some degree of pride in doing what it's doing. — Hanover

This would require that those being assisted are those who want to be assisted. I've not suggested that any branch of medicine impose itself on unwilling patients, and I don't know that anyone was suggesting that the fundamental rules requiring informed consent be changed.

But that isn't all psychiatry does. Alone of the branches of medicine, it frequently and systematically imposes treatment on those not seeking assistance against their expressed will. — unenlightened

There are fairly strict laws regulating the imposition of unwanted treatment, requiring judicial intervention. http://brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/INVOLUNTARY%20TREATMENT.pdf

The state often has an interest in seeing that certain people are treated and not left to their own devices, especially when they pose a risk to themselves or others. Even in those instances, there are strict standards and limitations imposed on the treatment.

You're attempting to define the medical profession by the rare instances of extreme examples where a responsible society can't just stand idly by under some over-reaching theory of self autonomy and allow people to self destruct or destroy others.

What you're referencing has less to do with medical ethics and the proper role of medical professionals in treating patients than it does the proper role of police powers vested in the state and the state's right to promote the public welfare. Such is the purview of law enforcement and the judicial system more than doctors, but to the extent you have an over-zealous doctor trying to impose treatment on an unwilling patient, his power will be checked by the law and judges.

The unfortunate reality is that there are more people in need of treatment sleeping in the street than there are people not in need of treatment forced into hospital beds.

Where psychiatrists really earn their status is in dealing with major mental illness, where life and death issues are at hand. Their waiting room full of merely unhappy, dissatisfied, pissed off, worried sick patients will mostly get better on their own, as they always have, but he gets paid to help them, so... — Bitter Crank

Most people are psychologically healthy enough that they can function with or without any form of therapy. Since there's minimally wrong with them, they invest at most a few hours a month going to their therapist, and sort of like getting a massage from time, it feels good, but you're no better or worse off long term from it. Your back is going to hurt sometimes and it's going to stop hurting sometimes regardless of what you do, but a massage might help you through the worst of times.

I've been to a therapist before and it did offer some insight. Whether it was a life changer, not really, but I wasn't in need of a life changer. I also didn't leave embittered, with the feeling the process was bullshit and a money grab. It had its value and I'm not ready to jettison the whole profession as a scam, or worse yet, a destructive, controlling cancer on our society.

There are fairly strict laws regulating the imposition of unwanted treatment, requiring judicial intervention. — Hanover

Up until the late 60s and early 70s, it was possible for a family or a state agency to commit a problematic person to a psychiatric hospital without much concern about civil rights. As bad as that was, it was just as bad that most state hospitals were not really doing much to effectively treat patients. They were, for all practical purposes, merely custodial.

I've been to a therapist before and it did offer some insight. — Hanover

I've seen psychiatrists and three different therapists. The best one was finishing her therapy doctorate at St. Thomas University. We met weekly for a year; her approach was non-directive psychotherapy. That year actually produced significant progress. 6 or 8 week workbook based counseling programs aren't much. If you could solve a psychological problem with a workbook, you didn't have much of a problem to begin with.

It had its value and I'm not ready to jettison the whole profession as a scam, or worse yet, a destructive, controlling cancer on our society. — Hanover

Isn't it strange. I entirely agree with you. I offer some criticism, I make some connections between psychology and psychiatry, but I have actually been confronted with an axe wielding schizophrenic, and I have no doubt whatsoever that something needed to be done quick smart. I say, along with the article from the op, that it is largely hubris for anyone to claim to know causes or cures, but I have a huge respect for folks who take on that problem and do their best. And getting rid of some of the hubris would I suggest result in more humane, more responsive, more personal, and probably better treatment. This would be especially so if one could discuss openly the limitations of a scientific approach to such things and the heavy influence of social conditions on both the patient and the therapist and their theories and practices.

I've seen psychiatrists and three different therapists. — Bitter Crank

And you're still crazy as shit, so I guess I'll have to concede the point that psychiatrists and psychologists are useless. Well played sir.

I went to a therapist who just sat there and made me talk. I didn't like the awkward silence, so I kept talking. I'm not sure it accomplished anything, but I didn't want to object that it was bullshit because I have this tendency to do that and impose whatever the hell I want on things. I thought it'd be ironic for me to do to her what I do to others, so I fought the urge.

I eventually quit going, saying I had other shit to do.

What I noticed about myself is that I tended toward such introspection that I failed to actually emote. I recognized that as I rambled on and on self-diagnosing, when I noticed the lonely box of Kleenex on the table, realizing that it must be there for a reason, that some people actually cry on that couch where I was sitting. I thought to myself that was an astute observation I just made about myself as I sat there, further self-diagnosing and self-treating. Sort of like I'm doing now.

Nice chat.

And the medical profession doesn't campaign against smoking, over eating, poor sanitation, or poor air quality? — unenlightened

And psychiatrists campaign against conditions that contribute to psychiatric disorders. For instance they have been foremost in the campaign in Australia against the inhumane treatment of refugees in detention, many of whom are now suffering psychological disorders. So what's your complaint?

C'mon man play the ball not the man! — unenlightened

Such a plea would have a greater ring of sincerity if you hadn't said:

in order to encourage you and others to have a little less hubris, a little more humility, and a more careful use of language. — unenlightened

I don't know why you launched this bitter, unprovoked attack, but it would be a good idea to reflect on why you have done it, rather than doubling down.

So what's your complaint? — andrewk

My complaints are many, and they are mainly generalisations admitting of honourable exceptions. My complaint against you is that you are making personal remarks with no justification. And an additional complaint is that when confronted with the nonsensicality of your insinuation that it is not part of a medical profession's remit to criticise and campaign for social improvements, you resort to suggesting that instead that I have denied that any psychiatrist has ever done such a thing. So I question in turn your own sincerity.

in order to encourage you and others to have a little less hubris, a little more humility, and a more careful use of language.
— unenlightened
I don't know why you launched this bitter, unprovoked attack, but it would be a good idea to reflect on why you have done it, rather than doubling down. — andrewk

I really would like to know where you see the bitterness in that quote. As to unprovoked, I think I can point you to the several provocations, not particularly directed at me, but It's off topic really, as are your remarks about me.

Nice chat. — Hanover

That will be $150.

Now you're dodging:

My complaints are many — unenlightened

... but you won't identify one of them,

I think I can point you to the several provocations — unenlightened

... and yet you don't.

It's off topic really — unenlightened

If you are now saying your attack on an individual and a profession was off topic then it's hard to see why you pursued it so vehemently. But if your grudge is spent then let's drop it.

I've seen psychiatrists and three different therapists. — Bitter Crank

And you're still crazy as shit — Hanover

Well, that wasn't all in the same week! It took 25 years to stumble on the last one who was really quite good.

You are supposed to do most of the talking. Only you, after all, know just how fucked up your family life was, the horrible things that happened in the cradle, and so on. The therapist is there as a guide, a mirror, and an echo chamber, in whom you see and hear yourself, and come to understand just how horribly wrong it all went.

Then, after you have finally collapsed in a paroxysm of weeping, wailing, rending your polyester double knit shirt and sprinkling the ash tray's cigarette butts on your head, have really used that box of Kleenex, you're reading for Phase II, where the silent therapist who listened to you for 3 years comes to life and instructs you in detail in how to get your shit reorganized, and to move on to finally become a whole, integrated, and somewhat satisfactory person. That may take another 5 years.