La la la. counts to 10 slowly.

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

But how is it possible to take these factors into account? What does this analysis consist of? Could an analysis of a patient's cognition, behavior and social welfare by any honest measure be called objectively scientific? Wouldn't you need to observe the patient in situ?

In my personal experience as a psychiatric patient for ADHD and depression, "taking external factors into account" consists of the psychiatrist diagnosing purely on the basis of self-reports that cannot be crosschecked and that are potentially wildly inaccurate, especially considering the political pressure there is on the patient to obtain a supposedly "objective" medical diagnosis for obtaining sick-notes.

Imagine if a dentist operated on teeth purely on the basis of questionnaires and self-reports...

At least in the UK, my experience with the NHS tells me that the cognition and behavior of mental-health patients is not evaluated by clinical psychologists - not even a stroop test - and that psychiatrists only provide superficial consultation services with respect to googleable psychopharmacology.

In case someone is interested but has missed the substance of my position, I will try and summarise/illuminate.
Back in the early seventies when I was studying philosophy and psychology, specialising in abnormal psychology, there was a deal of criticism of the practice of psychiatry from the libertarian Thomas Szasz, from existentialist Ronald Laing from psychonaut and novelist Ken Kesey, marxist David Cooper. (These were qualified psychiatrists, apart from Ken Kesey.)

At the time, psychiatry was busy divesting itself of the psychoanalytic tradition, which my psychology course dismissed as 'unscientific' (it was a major target of Popper, who was the leading philosopher of science at the time, and dismissed Freud and co as 'unfalsifiable'). But the criticisms of the psychiatrists mentioned above went much further.

The derogatory term for 'unscientific' here is 'quackery' and it is a very serious charge against any medical practice. So Bell's question from 1886 "Exactly what mental illnesses can be said to exist?"
is a vital one. I have already indicated that historically, a number of illnesses have been said to exist that are now regarded as rationalisations and promotions of social prejudice that have no substance. But the problem is, that there are no mental illnesses that can be diagnosed on any basis other than an assessment of behaviour. There is no bug, no gene, no chemical deficiency, no physical property at all that unequivocally marks out any psychological illness. And after 130 plus years, it's a major embarrassment or ought to be, that the scientific basis of psychiatry remains so weak as to be unworthy of the name - illnesses diagnosed on the basis of an individual's assessment of another individual, and treatments assessed in the same way.

However, while the biological neuro-physical materialist objective approach has not been successful, progress has been made in a direction much closer to the discredited psychoanalytic tradition. In very crude outline, the suggestion is that trauma and stress, and particularly childhood trauma activate psychological defensive responses, that are mediated by all those physical factors that have been discovered to be risk factors but not causes. That is to say, even more crudely, most if not all mental distress is a form of PTSD. For a more sensible exposition, see Gabor Mate, a mere medic, but still worth reading.

And so the environment, the society, and personal history returns to prominence, and this demands of the therapist above all a non-traumatising intervention - a humane and respectful relationship to the patient, even if at a moment of crisis, some vigor is required to remove the axe from the mad axeman.

incidentally, if anyone is interested, critical psychiatry is a thing, it's not just some rubbish I made up because I'm horrible.

Thanks.

At the 161st annual meeting of the American Psychiatric Association in 2008 the APA president Carolyn Rabinowitz told the audience in her opening-day address:

”We have come a long way in understanding psychiatric disorders, and our knowledge continues to expand. Our work saves and improves so many lives.”

But here is a conundrum. Given this great advance in care, we should expect that the number of disabled mentally ill in the United States, on a per capita basis, would have declined over the past 50 years. We should also expect that the number of disabled mentally ill, on a per capita basis, would have declined since the arrival in 1988 of Prozac and other second-generation psychiatric drugs. We should see a two-step drop in disability rates. Instead, as the psychopharmacology revolution has unfolded, the number of disabled mentally has skyrocketed. Moreover, this increase in the number of disabled mentally ill has accelerated further since the introduction these second-generation psychiatric drugs.

The disability numbers, in turn, lead to a much larger question. Why are so many Americans today, while they may not be disabled by mental illness, nevertheless plagued by chronic mental problems — by recurrent depression and crippling anxiety? If we have treatments that effectively address these disorders, why has mental illness become an ever-greater health problem in the United States?

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. — Hanover

This doesn't change the fact that psychology being a branch from philosophy, provides value through the structural reasoning that many researchers and professionals like myself use as a model to understand the foundation of the human mind.

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. — Hanover

I hope this was sarcasm and I hope there was a method to this madness. I take offense at someone who pokes fun at someone's mental health whether they are going through some form of mental abnormality or not.

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. — Hanover

Great self-reflection! but it doesn't change the fact that you may not have gotten down to the root cause as to why you were there in the first place, and why you were there is indicative that there exist something that required objective mitigation through therapeutic means.

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. — Bitter Crank

I like you

Your ability to put words together is interesting enough for me to say, you ought to write a book one day.

I hope this was sarcasm and I hope there was a method to this madness. I take offense at someone who pokes fun at someone's mental health whether they are going through some form of mental abnormality or not. — Anaxagoras

Hanover and I have been trading sarcastic broadsides for years.

we should expect that the number of disabled mentally ill in the United States would have declined over the past 50 years. — Chisholm

The statistics might be misleading.

50 years ago, give or take a few, the rate of "mental illness" per se was thought to be around 10%. Several factors could be raising the figure:

Maybe more people feel more comfortable about claiming to be mentally unwell? During the recession which began 12 years ago, people who were unable to find work (and were getting a bit old to change careers) tried salvaging the situation by going on disability related to mental illness. (It's hard to manufacture paralysis; it's much easier to manufacture mental illness.) Maybe there are more ways now than 50 years ago to be diagnosed as mentally ill? Maybe people believe that antidepressants actually work wonders, and were willing to give it a try?

And how do we know how many people actually are mentally ill? There's no registry of certified lunatics, as far as I know. Mental disorders are not reportable illnesses, like syphilis. Who is counting and how?

Why are so many Americans today, while they may not be disabled by mental illness, nevertheless plagued by chronic mental problems — by recurrent depression and crippling anxiety? — Chisholm

One possible reason is that so many Americans are living in a crazy society, and are going mad, in the colloquial sense of the word.

there are no mental illnesses that can be diagnosed on any basis other than an assessment of behaviour. There is no bug, no gene, no chemical deficiency, no physical property at all that unequivocally marks out any psychological illness. — unenlightened

True, and I don't think that genetics is anywhere close to parsing out all the genetic factors that control the behavior of the brain for learning 2 + 2 = 4, let alone somebody who thinks they are Jesus.

I knew a guy who claimed to be Jesus. (This was not in a psychiatric setting,) He was educated, charming, intelligent, funny, apparently grounded in reality, and so forth. There are three possibilities. A) he was pulling my leg. 2) Perhaps he was Jesus. Why not? 3) Perhaps he was a perfectly functional lunatic.

Why should there be some other method of diagnosing a mental illness other than observing behavior? If this guy thought he was Jesus, what more would you want to see in a blood test or MRI? A guy who thinks he is Jesus but is also witty, urbane, intelligent, educated, and an effective employee raises questions that behavior answers, it seems to me: He may be deluded, but he is otherwise behaving normally. So who cares if he thinks he is Jesus? It's more interesting than being a run of the mill bat shit white supremacist, don't you think?

If a patient is delivered to the emergency room of a hospital after being found on the street naked, screaming incoherently, displaying intense agitation, displaying inability to interact with the staff, what more than behavior observation do you need? Severe mania and psychosis produce this kind of behavior. The pt's blood can be checked for hallucinogens. No drugs? It's probably mania.

How long does the mania last? Does the pt. respond to major/minor tranquilizers or anti-seizure drugs? How long does the pt. stay awake in this condition? Doesn't respond to drugs? periodically and suddenly falls asleep wherever he happens to be? Better do a neurological work up.

Medicine -- including psychiatry -- has a very strong element of "practice". After seeing 500 pts. in mania, a pattern probably becomes pretty clear. How many moles does a dermatologist have to look at before than can say at a glance, "malignant" or "nothing to worry about". After a while they know the drill. Untextured red spot on skin? Probably cancer. Textured red spot on skin? Probably benign. Patient is counting the ceiling tiles in the waiting room. Probably OCD. Your friend has to check to make sure the stove is turned off, the refrigerator is closed, and the door is locked 5 times before than can leave. Definitely OCD. No need to see a psychiatrist.

But those are the easy kinds of cases.

There is no bug, no gene, no chemical deficiency, no physical property at all that unequivocally marks out any psychological illness — unenlightened

the biological neuro-physical materialist objective approach has not been successful — unenlightened

So your complaint is that mental illnesses are not reducible to simple underlying physical causes? That's what makes psychology and psychiatry "unscientific" in your assessment?

So your complaint is that mental illnesses are not reducible to simple underlying physical causes? That's what makes psychology and psychiatry "unscientific" in your assessment? — SophistiCat

Why do you think your one-liner is going to be more clear than my several lengthy posts with references.? What is it about unscientific that requires scare quotes? We say homeopathy is unscientific because there is no evidence that it works, and no evidence for the theory that underpins it.

Perhaps we can talk about 'the medical model' - behaviour understood as illness. Apart from the tradition, which applies also to 'the possession by devils model', what evidence is there that medicine is the right approach as the underlying theory of mental distress?

And why are you talking about 'my assessment' when I have just pointed out a long standing tradition within psychiatry and linked to an ongoing group of critical psychiatrists, along with another well respected expert in the field of addiction, proposing a rather different approach. Why are you even talking about 'my complaint'? I'm only the messenger, stop trying to shoot me.

I was responding directly to your own summary of your position. If you think that summary was inadequate, you could try again, instead of shooting the messenger.

Perhaps we can talk about 'the medical model' - behaviour understood as illness. — unenlightened

Perhaps. That would be an improvement over criticizing "the biological neuro-physical materialist objective approach" because it did not reduce all questions of medicine and psychology to simple, bite-sized physical explanations like bug, gene or chemical deficiency.

I hope this was sarcasm and I hope there was a method to this madness. I take offense at someone who pokes fun at someone's mental health whether they are going through some form of mental abnormality or not. — Anaxagoras

I think it was sarcasm. He might in fact be crazy as shit. I'm not a doctor, so can't be sure. It was all in fun though. Many of us have known each other here for a very long time and this was just gentle ribbing. As to calling me out when I am actually offensive, sometimes I care, sometimes not.

Great self-reflection! but it doesn't change the fact that you may not have gotten down to the root cause as to why you were there in the first place, and why you were there is indicative that there exist something that required objective mitigation through therapeutic means. — Anaxagoras

I knew exactly why I was there actually and I didn't want to talk about it. I wanted to talk about how introspective I was. Those Kleenex scared me.

This doesn't change the fact that psychology being a branch from philosophy, provides value through the structural reasoning that many researchers and professionals like myself use as a model to understand the foundation of the human mind. — Anaxagoras

I think being logical probably helps in all fields.

I have yet to hear from any psychiatrists as to what it is exactly that the profession of psychiatry has to offer, AND what it is, that is unique to psychiatry alone (as opposed to the various therapeutic technologies of psychologists, social workers, family therapists, community workers, etc. etc.), other than psychotropic medications and the pathological labels of the DSM. The profession of psychiatry is indeed suffering from a very deep identity crisis, belittled by other medical specialties for its lack of evidence-based rigor, and with the collapse of the biological mythology, no longer able to justify its dominance among the various mental helping professions. Psychiatry’s last identity crisis, back in the 1970’s, which was largely due to the challenge posed by other less expensive professionals to psychiatry’s dominance within the psychotherapy market, led to the biological reinvention of the psychiatric identity.

So my question for Anaxagoras is this:

What is a psychiatrist without his medications and diagnoses?

What is it exactly that he/she has to offer people in need and our society? What are psychiatrists offering us that we need so badly?

What is any doctor without their diagnoses?

What is the point of that question? You could play that game with any profession: what is a lumberjack without their cutting down of trees, what is Chris Froome without his bicycle, or Serena Williams without her racquet?

What psychiatrists offer to society is that they can eliminate or mitigate the suffering of many people who suffer chronic mental anguish, and in some cases cure them for good.

That psychiatry has been used for terrible things in the past is not in dispute. But so has teaching - just read Nicholas Nickleby, David Copperfield or Tom Brown's Schooldays. Yet we don't blame today's teachers for the sins committed by teachers past. So has nursing, with many nurses involved in forced adoptions from unmarried mothers. But we don't blame today's nurses for that.

What is the point of that question? You could play that game with any profession: what is a lumberjack without their cutting down of trees, what is Chris Froome without his bicycle, or Serena Williams without her racquet?

What psychiatrists offer to society is that they can eliminate or mitigate the suffering of many people who suffer chronic mental anguish, and in some cases cure them for good.

That psychiatry has been used for terrible things in the past is not in dispute. But so has teaching - just read Nicholas Nickleby, David Copperfield or Tom Brown's Schooldays. Yet we don't blame today's teachers for the sins committed by teachers past. So has nursing, with many nurses involved in forced adoptions from unmarried mothers. But we don't blame today's nurses for that. — andrewk

Great post!

Perhaps you could elaborate upon anatomical and/or physiological causes of behavioural atypicality (if not per DSM, then per ICD-10, Chapter V), and what psychiatrists do to eliminate these from consideration in arriving at a diagnosis?

What is the point of that question? — andrewk

its lack of evidence-based rigor, and with the collapse of the biological mythology, no longer able to justify its dominance among the various mental helping professions — Chisholm

I think this is the point. If the lumberjack's chainsaw turns out not to have a chain, and the trees turn out to be telegraph poles, then one is entitled to question what he is doing.

What psychiatrists offer to society is that they can eliminate or mitigate the suffering of many people who suffer chronic mental anguish, and in some cases cure them for good. — andrewk

One can say as much for priests. And personally, I am not against priests either.

What is the point of that question? You could play that game with any profession: what is a lumberjack without their cutting down of trees, what is Chris Froome without his bicycle, or Serena Williams without her racquet? — andrewk

What distinguishes the practice of psychiatry from the above, is that the the reason for the practice of psychiatry isn't politically neutral, either on the side of the patient who requests a diagnosis due to failing to conform to the social values of modern society, nor on the side of the psychiatrist who is diagnosing according to an illness ontology that is based on a narrow conception of an individual that serves capitalist interests in endorsing a particular system of moral judgement.

In the criminal justice system and the welfare state , psychiatrists and psychologists play the role of priests who in effect deliver a moral judgement of an individual in the guise of the presence or absence of a mental illness diagnosis, that is largely subjective with respect to unreliable and incomplete proto-scientific evidence. Of course the psychiatrist will claim to be only giving the best possible objective psychological diagnosis, but he is rarely paid for this reason, for his diagnosis is used by other institutions and juries to reward or punish a 'weakly performing' individual in relation to society's values.

the practice of psychiatry isn't politically neutral, either on the side of the patient who requests a diagnosis due to failing to conform to the social values of modern society — sime

It sounds like your concern about psychiatry relates to its practice in the criminal justice system, where the subject is not the doctor's client. That will always be problematic, just as it is with forensic pathologists and police surgeons.

But we can't avoid having that involvement, can we? What would be your preferred model for dealing with someone that is alleged to have committed a brutal crime and who pleads insanity or is suspected to be suffering from severe mental illness?

As a person that professionally works in the psychiatric field... — Anaxagoras

Your apparent reticence (no answer to this question) causes me to suspect that you're not actually familiar with the practise of Psychiatry.

So, @Chisholm's complaint is valid, to wit:

I have yet to hear from any psychiatrists as to what it is exactly that the profession of psychiatry has to offer, AND what it is, that is unique to psychiatry alone (as opposed to the various therapeutic technologies of psychologists, social workers, family therapists, community workers, etc. etc.), other than psychotropic medications and the pathological labels of the DSM. — Chisholm

Absent such information, the only conclusion I can come to is that psychiatric practise is inexplicable and/or indefensible.

First off I am participating in several other threads so whatever you said in quotes was pushed way down the line as I had 20 other responses. Two, I'm not a practicing psychiatrist. Although I have my doctorate, I'm not a medical doctor and although we use the DSM-V in much of our assessments we do not prescribe medication at least here in the state of California. Three, I work for a living so I'm in and out of this place. Four, to reiterate point two, I don't do private practice, as I'm a clinician and work in a hospital setting and deal with a different demographic.

If it weren’t for psychiatry, I wouldn’t be allowed to live in the community. Make whatever assumptions you will from this.

So, you don't "professionally work in the psychiatric field".
In fact, according to this post, you have a doctorate in Clinical Psychology, but work "professionally as a Social Worker", because you are not licensed to practise Clinical Psychology in your State.

No wonder you can't provide specific information on the practise of Psychiatry. That's fine, as long as we are all clear on the point that you cannot be considered an authority on Psychiatry.

If it weren’t for psychiatry, I wouldn’t be allowed to live in the community. Make whatever assumptions you will from this. — Noah Te Stroete

For all I know, maybe you shouldn't "be allowed to live in the community".
Britain's Care in the Community policy has not been an unmitigated success.

For all I know, maybe you shouldn't "be allowed to live in the community". — Galuchat

That’s a huge potential assumption. Where do you get off saying something like that?

Google Care in the Community.

I’m not going to research something unless or until you can give me a good reason to do so.