My own best guess for an answer is that they know about behaviors - they have observed them. And have made observations that are essentially statistical in nature - no doubt it's not quite that simple - thus being able to make "educated" guesses by looking at the data. Not to be confused with knowledge. And not a criticism but a critique; that is, a fact, or so I think. — tim wood

I think I have mostly answered this already, but essentially a psychiatrist is a medical doctor with further specialist knowledge - so has all the knowledge of a GP and additionally has expert knowledge of mental illness and can conduct a differential diagnosis (what may be organic and what may be psychological in origin) and can conduct assessments, provide diagnosis, develop treatment plans, provide pharmacotherapy, and counselling. All of these are extremely specialized and intricate matters.

For psychiatry, the ability to make knowledge-based categorical statements a luxury they usually do not enjoy. — tim wood

I would say that is a limited lens - bi-polar disorder, schizoaffective disorder, schizophrenia, depression, etc, are fairly clear situations that can be described clearly and do respond to treatment, almost as well as diabetes can be managed by insulin.

I would agree that psychiatry is still in its infancy and that mental health treatment still has a long way to go in its development.

Personally I have provided testimony to several tribunals arguing that particular psychiatrists and hospitals have made mistakes and that the mental health system is deeply flawed and requires reform.

Ask a psychiatrist c. 1970 about a hebephrenic or a homosexual, and he will say they're sick. Except that in 2024 hebephrenia is not a thing and homosexuality not a sickness. And while that's a half-century ago, I don't think psychiatry has refined its understandings to qualify as knowledge. — tim wood

A few observations - in 1970 many psychiatrists were also reformers and challenged all kinds of notions of what qualified as 'sickness'. Psychiatry, like most disciplines, has had many reformers from within, contributing to many changes. In fact, the anti-psychiatry movement of the 1960's was led by psychiatrists. In 1970 there were psychiatrists who did not think homosexuality was an illness. Many psychiatrists I've known think that the DSM manual is inflexible and flawed.

To argue that because positions change and therefore psychiatry does not hold knowledge seems to be like the religious fundamentalists who say that science is bunk because science changes its paradigms over time.

Anyway, I'm going to leave this one here since there is no end to a debate like this and it's not really my role to defend psychiatry, which is an imperfect and evolving profession - and I am no expert. I simply know from decades of personal experince that psychiatrists can work scrupulously to provide extremely helpful life saving interventions for people. The profession is generally demonized and poorly understood. Which was my original observation.

You'd have to read the book or get a good summary. It's a long and deep study. But if you are going to say this.

My criticism being of those who represent the "witchcraft" as knowledge. — tim wood

Then you seem to be arguing that psychiatry is not knowledge. I guess there's not much to discuss then.

Yes, but always psychological reform, never social reform, because ... actually, the medical model still informs the social structure that is psychiatry - one goes to the doctor, not the politician/lawyer. — unenlightened

We weren't talking about reform but as you raised it I don't think this is right either. It doesn't describe what happens here. Reform to mental health system is generally led by people outside of medical services, by those with lived experience, by relatives, by lawyers, by community workers and by politicians. And when mental health unit workers meets a potential patient for the first time, the overarching view is ususally how can they keep people out of the system and away from the need for medication. Your question -

"how does your society fuck you up, and what are your coping strategies/self-medication?" — unenlightened

is to some extent the one which informs them.

At which point one can ask "how does your society fuck you up, and what are your coping strategies/self-medication?" — unenlightened

In my experience that is actually the starting point for most assessments. The conventional wisdom is that self harm and substance misuse are adaptive behaviours and the best resolutions are not found in medication, but in meaning. Hence the emphasis on the psychosocial.

psychiatrists by comparison are more in the way of witch doctors — tim wood

This is a pretty conventional view these days and was a thesis articulated rather well by a famous psychiatrist called E Fuller Tory in his 1980's best seller Witchdoctors and Psychiatrists: The Common Roots of Psycotherapy and it's Future. Like most good psychiatrists, Fuller Tory was critical of many aspects of psychiatry, just as many good philosophers are critical of aspects of philosophy.

At the risk of becoming tedious, what exactly is "psychiatric intervention"; that is, that distinguishes itself as psychiatric? — tim wood

A psychiatric intervention is where a mental illness is suspected and then assessed and diagnosed and provided with treatment options under the clinal care and recommendations of a psychiatrist.

But I'm happy to move on. We obviously hold differing frames.

it seems to me the best treatment is holistic in approach, providing what is needed: drugs if needed; counseling/therapeutic/custodial support as needed, and likely a mix. — tim wood

Yes, most psychiatrists would completely agree with this.

There is a lot going on in the OP. Probably too much. — Leontiskos

That's for sure.

Mental illness is surely a problem, no? And how do we approach it? Psychologically, sociologically, medicinally...? You may not like the psychiatric approach to mental illness, but what alternative would you propose? — Leontiskos

Yes, I think this summaries the matter appropriately.

In some instances there may well be alternatives for the psychiatric approach. Many psychiatrists would be the first to say this. And this can mislead people, if they focus just on some alternatives and overlook the thorny end of metal ill health, which does appear to require medical and psychiatric intervention, not just an accepting buddy or a generic counsellor.

You might answer that a psychiatrist is a person who meeting certain licensure requirements and qualifications, is authorized to take responsibility for the care of mentally ill persons. — tim wood

Partly right. But also has the appropriate qualifications and capacity to undertake diagnosis (which is far from straight forward) and the expertise to determine the best treatment plan and medication, which includes ongoing case reviews. They may also supervise and take clinical responsibility for the ongoing treatment provided by an entire department and review all cases. These are things that a nurse or a GP can do to some extent, but they lack expertise and will make more errors or hold erroneous assumptions. They are generalists and have gaps. I've seen that plenty of times. How do we determine, say, Korsakoff syndrome as opposed to Alzheimer's, or determine whether the person has drug induced psychoses or has schizoaffective disorder, etc. It's nuanced work. How do we treat the woman who is trying to cut the baby out of her stomach because she believes her fetus is the anti-Christ? (I've had variations of this twice) I'd rather a psychiatrist lead the treatment provision than a nurse. But a nurse will no doubt be required too. And probably police.

That it is a matter of presuppositions and an unquestioning belief in those presuppositions. — tim wood

I have not heard anyone with unquestioning beliefs in any presuppositions. I am critical of psychiatry and have been viewed as denunciatory pain in the arse many times in my community. I'm not here to suggest psychiatry is a panacea. Not everyone needs it. And there are multiple types of psychiatry (modalities) some useful, some not. And I am no expert on the subject, except for what I have seen work at first hand over many years. Essentially I made the point that psychiatry is poorly understood and demonized. No doubt there are self-styled countercultural hippy types, prancing around in the ruins of the 1960s "all-you-need-is-love" culture, who view psychiatry as a tool used by "the man" and Big Pharma to suppress dissent. We all know why that is and to some extent this has been a fair criticism in instances, but shouldn't be the only frame.

But just thinking on this now - even if there were other occupations who can sometimes do a similar job to a psychiatrist (whatever that might look like) so what? There are people, other than philosophers who can do philosophy. This doesn't mean that philosophy as an academic profession is worthless, or does nothing. There are people other than mechanics who can service my car and maintain it. Does that make mechanics superfluous? I think expertise and credentialing remain important, and we generally opt for expertise where the stakes are higher, but this is the era of denigrating expertise, so there is that. I think it's fine to be skeptical of expertise, but I know where I draw the line. Others may draw the line differently.

If I understand your answer, it is that a psychiatrist, encountering behavior, using the DSM-V or something like, makes a diagnosis - provides a label - and then.... And then what? I'm asking because I do not know. — tim wood

So you left out that part of the answer in your summary -

treat and support the management of your issue. — Tom Storm

Your question probably should have been, 'what does treatment and support the management, look like?'

provides a label — tim wood

Seems a bit limited to say a diagnosis is reducing people's illness to just a label. Medicine works by identifying the correct diagnosis. Doing this saves lives. There's a big difference between bi-polar disorder and depression, or between schizophrenia and autism. Having expertise in mental illness and providing the right response, saves lives. Getting medication (the type as well as the dosage) right is critical. Linking people into psychosocial support is also critical. And when all this is done appropriately, it can lead to people's recovery and full participation in community. This is no small thing.

the analogy with religion is telling. — tim wood

And what does it tell you?

To be sure, there are no doubt good men and women who are psychiatrists - the original goal to alleviate the suffering of those warehoused in 19th century mental hospitals - but generally, to be any good, they have to not do psychiatry. That leaves referrals, therapy, and prescribing drugs for counselors/therapists who cannot themselves prescribe. — tim wood

I think you are getting closer with this answer. One of the psychiatrists I work with is 'doing psychiatry' to use your term and is overseeing the treatment of around 150 people who have psychotic illnesses. This involves the ongoing support of their patient - regular medication reviews, listening to feedback, tweaking and reducing mediation dosage, accepting people's decisions if they no longer want to take medication, supporting them with ongoing psychoeducation. Through this, most of the 150 have an enhanced quality of life.

But you'd be right if you said psychiatry isn't all they need. Psychiatry is always understood as being just a part of a person's recovery. They also need supportive friends, engagement with community, employment, meaning. And I would agree with those who say that community, connection with others and meaning often play a bigger role in people becoming well than just psychiatry.

No doubt there are shonky shrinks, just as there are dubious lawyers, doctors and plumbers. Are there some who abuse power? You bet. Are there some who are complacent and lazy? Yep. I am currently involved in lobbying to get some accountability from one local area mental health service, where the local psychiatrist and his team do too little too late.

Spoken like a true kool-aid drinker — tim wood

many people are incapable of considering the subject rationally — Tom Storm

Are you trying to make my point for me? :wink:

If I pay for the services of a psychiatrist, what, mainly, can I expect to get? — tim wood

Not the most useful question - rhetorical and disingenuous I assume, given the kool-aid smear? Wouldn't it depend upon your reason and the context for engaging a psychiatrist? If you are experiencing psychosis or delusions or bulimia, or suicidal ideation or acute paranoia or chronic addiction, or if you're trying to cope with a physical decline alongside a terminal illness, you might need one to help diagnose, treat and support the management of your issue.

Maybe you're more curious about psychiatrists in private practice who provide counselling or psychotherapy (analytic or otherwise) to wealthy neurotics? There's plenty of shit on the internet about that, good and bad.

I tend to find people are mostly friendly and helpful. Drivers less so. I have no real expectations of people and make no pronouncements about human nature. Culture and situations tend to shape behaviour. I am not often seen as rude but I have been known to give the odd person a rocket up the arse (as we say in Australia) but I don’t often need to.

Thanks but I would prefer a Mahler symphony.

I do think that most political opinions are cultural. I do not think my distaste for communism comes from being an American. I know from history that communist states are tyrannical, I think I understand conceptually why that is, and history shows that communism and food are bitter enemies. — Brendan Golledge

This itself seems to be a typical American answer. :wink: I referred to socialism not communism and perhaps like many Americans, you don't apprehend a difference? But more significantly, many American's seem to see dreaded socialism in good social policy like universal healthcare.

I find myself in agreement with some of your points. Some random reactions.

In conclusion, whether a person lives in a just society is mostly a matter of luck, and we ought to expect some degree of injustice more frequently than we would expect wise laws that are faithfully executed, and so the typical person simply has to endure whatever his state would do to him. — Brendan Golledge

Maybe a little more American than how I would frame it, but I see your point.

The political trichotomy was created to address the fact that the libertarian left practically doesn't exist. I think the trichotomy makes a lot of sense from an empirical standpoint. It explains why communists think that everyone else is Hitler, why fascists think that communists and capitalists are the same, and why libertarians think that fascists and communists are the same. It also explains why the political right is divided. — Brendan Golledge

I'm not sure people's political choices are much more than 'faith' based values inherited from culture and family. Post hoc rationalization provides the explanatory content. Whenever I talk to Americans there's an almost universal obsession with freedom and a fear of socialism. I don't think this necessarily comes out of any great reflection - it seems more of a cultural reflex. In Australia, in most cases buzz words like freedom and socialism don't provoke the same emotional reactions.

Tribalism seems to explain political differences pretty well too. Tribalism is instinctive and dispositional rather than intellectual.

The big quesion for me has always been why is it that the fiercest fights and hatreds are not between different parties, but within them. Having advised various political parties here and having met and known many insiders, it seems to me that politics is the art of never giving the game away. Telling the truth and having values are barriers to success. That said, I don't hate our political system. I'm pragmatic. I dislike the Murdoch influence and media propaganda's role in promoting panic and shaping voting patterns, but I am also suspicious of intellectuals and those who think they are above the hoi polloi.

I grew up in a Protestant tradition and the insistence upon a single path was heard by me in all of its cacophony. I do take the teaching that 'identity', on that level, is between me and my maker. It is not an explanatory principle for many other things. — Paine

But that's a key issue with religion. It's innate subjectivity and relativism. I also grew up in the Protestant tradition. Baptist. We were taught that all religions were a pathway to the divine. We were also taught that the Bible was an allegorical work and not intended to be taken literally. Religions, even within the one tradition, can't agree on anything.

The problem with this of course is what to do with the Jesus story. And given the tedium of the Bible as literature (for my taste), why not pick something more engaging as a source of allegory? The Great Gatsby, perhaps? It even ends in sacrifice, execution and redemption.

All by itself, space doesn't have directions like left and right. — frank

That seems intuitively true.

Left-right confusion is surprisingly common. I have known three otherwise smart adults who can't tell the difference and need constant prompting. According to Wiki 15% of people have LRC.

On what basis do you make this distinction? Is it a matter of experiencing the world through a human body? Or is there something objective about it? — frank

I think of myself as having two halves and I know the left is the side I don't write with. I think that's how I tell the difference. Is it objective? It's certainly an intersubjective agreement shared by culture - a tool we use to organise space. While there might be some who are confused as to which is which. Those who can tell will always agree as to which is which. Does that make it objective? Of course, further complicating this is that left or right change depending upon one's position or perspective - they are not like compass points.

:up: Interesting about the word 'unbearable'. A fine thing Kundera said, and I am paraphrasing - You build a utopia and pretty soon you're going to need to build a small concentration camp.

The purpose of the poetry is not to dazzle with an astonishing thought, but to make one moment of existence unforgettable and worthy of unbearable nostalgia. — javi2541997

I don't think I fully understand what this is supposed to mean. I do agree that nostalgia is often unbearable (cloying and tawdry) but what is unbearable nostalgia? Is this what happens when gown men in their 50's collect Star Wars action figures in some attempt to recapture the summer of 1977? :wink:

I'm not a poetry enthusiast, so while I admire the technical skill of some poetic works, poems generally do not move me. I find essays (another form of compressed writing) more affecting.

If a poem uses language in a way that makes it memorable and cathartic, how exactly does this become nostalgia (a sentimental longing for a time past)? I'm assuming that the point of K's writing here is that we look back on the experince of encountering that moment in print with a nostalgia? The way we might feel when we remember hearing soem significant music for the first time.

I have no theory, I only propose that psychoanalysis has done more wrong for the average person and it shouldn't be a first place resource except for those who need it. — Abdul

Psychiatry isn't psychoanalysis. Psychoanalysis is a very old fashioned approach, practiced by a handful of boutique, middle-class therapists.

For the most part psychiatry is built around the client's needs, around robust diagnostic criteria.

Your concern is perhaps more about the wellness and psychology industries that are not generally connected to psychiatry and are closer to Oprah Winfrey than Freud.

Like religion, which says we are all sinners who need god to be saved, psychology can sometimes fall into the trap of saying we are all bungled and need insight through treatment.

This is a very complex field, full of great and some terrible work. The psychiatrists I have worked with over the past 30 years (in public mental health) generally dislike psychology and are not especially tolerant of the self-help industry. They would rather people develop their own skills and resilience than make them dependent upon theories or ongoing counselling.

Psychiatry is of course poorly understood and one of the great bogeymen of popular culture and many people are incapable of considering the subject rationally ( also like religion) There have been some spectacular examples of poor practice and oppression from some sections of the mental health community, as there have been in many professions.

Most people are quite sane and therefore very capable and totally self-sufficient. But by increasing the distance between your intuition and your experience of the world, we destroy the tools you need to be self-sufficient.
Most people are healthy and therefore are not, as is commonly thought, a product of their past or of a mental condition that inhibits them from self-realization. The very idea of assuming oneself to be something that needs to be "fixed" or "corrected" is the disease of the modern world of abstractions — Abdul

Most psychiatrists I have worked with would agree with you that most people do not require their help or any treatment.

Brigitte Bardot is still living; she was making movies seven decades ago.

What is it? Not available in my country.

What would do if something awful happened and as far as you know, you are the only one to survive? — Athena

I don't know how I'd feel if it were for real, but it gives me enormous peace of mind to imagine all people gone and only me to potter about in an empty world.

Many are quite happy doing a bullshit job as long as it is engaging and provides community connection. In Graeber's seminal book on this, the key problems seem to be the waste, boredom and alienation. I would think there are bullshit jobs that are fun.

If one holds a critical view of human culture and society, it is pretty clear that the category of bullshit jobs can be enlarged beyond mere box ticking pointlessness to include CEO roles, marketing, conference organizing, consultants (in almost any area) management theorists, sociologists and a host of others. Obviously, this category of 'bullshit' is dependent upon what presuppositions one holds about purpose and value.

But there are carpenters, bakers, and chocolate makers who truly enjoy their labor. — L'éléphant

Indeed.

Thanks. All very interesting.

Please clarify. Not sure to what you are referring.

Interesting comments.

We are now more able than Plato was to acknowledge our finitude.

Far fewer people today believe in an afterlife. Whether or not one does, we are able to question such assumptions freely in the West. — Fooloso4

Indeed. Would you say this is an advance in human thinking or is this too value laden?

I got ya. Nicely put. Nevertheless I think I tend to sympathise with Rorty on this to some extent, but I totally see how for many his take would be anathema. Rorty is a divisive figure. My view is that what humans do is invent stories, some of these are more useful for certain functions than others, but at no point do we make contact with reality as such, we just manufacture defeasible, contingent and often poetic understandings of our situation. I can see the argument that Platonism (and its children) has been superseded (regardless of whatever wisdom there may be in Plato's broader writings). I think what Rorty is getting at is the (no doubt debatable) proposition that the quest for the transcendent is over and pointless and that poetry will do instead. Particularly if you are dying. All we really have is words and language games and we really don't know how (or if) words map on reality.

But this is too small a matter and too big a subject for me to venture much further.

You say "So?" Hey, you brought the whole thing up. — T Clark

I only said 'so?' because you didn't explain your comment. Now you have explained it. :wink:

Rorty's explication of poetry reminds me of an atheist trying to give an open-minded and sympathetic explanation of religion without really having any idea what it's about. — T Clark

That's a good line. But does this imply that Rorty has poetry wrong and therefore can't really be valuing it properly? Or are you saying that his way of understanding and valuing poetry is different to yours?

Not to be unkind to Mr. Rorty - or you - but his explication is very far from my thoughts about, or experience of, poetry. — T Clark

So? I don't share Rorty's views and, as I have said elsewhere, I have little interest in poetry. But I am interested in what others think, particularly influential philosophers.

I don't think we can learn anything worthy from Donald Trump and 2024 U.S. Elections threads. — javi2541997

I tend to find them more interesting threads - they explore, more or less in practice, the nature of politics, value, truth and social policy. I get less from threads on perception or reality.


Richard Rorty said that 'the purpose of philosophy is not to discover timeless truths, but rather to provide better ways of living and understanding.' This opens things up. Philsophy seems to be one of those subjects where the framing is wide or narrow depending upon one's biases.

Here is a short and famous piece he wrote on poetry and philosophy.

https://www.poetryfoundation.org/poetrymagazine/articles/68949/the-fire-of-life

Fair enough. Of those, the only ones I liked/enjoyed were Leon; Natural Born Killers; Pulp Fiction. :wink:

No, I never crossed paths with Sagan or Clairvision.

Fin de siècle aside, I'm not especially keen on 1999's flicks. I don't have a favourite year, but my favourite decade is the 1970's. Most of those films I didn't see until the 1990's, when every film I saw from the 70's shat on the things being made then (and now). Or something like that.

https://www.imdb.com/list/ls000019899/

In Melbourne? I had a short foray in the area (intellectual area) and Melbourne was a hot bed at the time (circa 2010-2015). I still quite like the Thesophical Society Bookstore — AmadeusD

Yep, Melbourne. They used to be in a really coool 1920's building which was sadly demolished a couple of years ago. Now they're around the corner in Flinders Lane. In the 1980's I used to almost live in that bookshop.

However, I think I have found a semi-objective basis for morality. — Brendan Golledge

Lots of people attempt this move. As you probably know, Sam Harris wrote a book on secular morality based around the principle of wellbeing (The Moral Landscape 2010) . As you've already suggested, if you can get people to agree upon a presupposition (or some foundational values) you can build a moral system from there. But the challenge is getting people to share those presuppositions. I'll leave this kind of task to the system builders. :wink:

Consciously thinking about what things we ought to consider good and bad is the point of this discussion. Because of the arbitrariness of value-assertion, using an external guide as a rule (such as a religious tradition) can be very helpful. — Brendan Golledge

Are you particularly concerned by what we use as an external guide? Isn't this itself arbitrary too? We can pick secular humanism, a political ideology or fundamentalist Islam. How do we know which oughts and ought nots within a system are useful or 'correct'. Seems we have to step outside of the external guide to make an assessment.

Where we obtain our oughts from is itself a curious thing - it appears to be contingent and may have nothing to do with right or wrong (in a more transcendent sense), just perceptions of right or wrong. Isn't it the case that oughts and ought nots are located in the contingent system of values we gain through culture and experience? Some of these might coalesce into a system of sorts. Isn't morality essentially an intersubjective agreement, with many outliers and willing transgressors?

I am sorry for your bad experiences. — boundless

The people were 'bad' but I regret nothing.

even if the bad practicioners, teachers etc were the majority, this doesn't a priori negate the validity of a particular tradition. — boundless

Of course - and if I argued that I'd be making a fallacy. I make no claim about higher consciousness as an idea, I was referring to who the subject seems to attract and the innate difficulty (perhaps impossibility) of persuing it a useful way. But I'll leave this to others who are more interested.

(and here I mean the unsophisticated kind which is IMO the true naive realism, not more 'refined' ones that are actually not naive realism), then one accepts automatically some kind of notion of 'two truths'. Naive realism errs in interpreting pragmatic 'truths' as ontological ones. — boundless

I think phenomenology may do away with the need to pars the world into realism or indirect realism or idealism models, but I am not sufficiently versed in the thinking to articulate an argument.

Naive realism errs in interpreting pragmatic 'truths' as ontological ones. — boundless

That's fair. I'm skeptical that we can access ontological truths, or that we should we be overly concerned to identify them. I'm content with tentative models of the world, which is all science can provide. But even an idealist becomes a naive realist when he leaves the house to go to work. That's paraphrasing Simon Blackburn. Which comes back to my take on all this. None of it much matters since the world we inhabit can't be denied in practice and for the most part it makes no difference to how we live if we believe that all is an illusion.

You do not need to leave your room. Remain sitting at your table and listen. Do not even listen, simply wait, be quiet, still and solitary. The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet.
— Franz Kafka
— T Clark

I'd never heard that quote before. Maybe I should read Franz Kafka. — Brendan Golledge

There's a kind of companion quote which I prefer and it comes from Pascal - “All of humanity's problems stem from man's inability to sit quietly in a room alone.”

Re Kafka - I suspect that if you don't discover him in your 20's, he may be less affecting. I like The Metamorphosis and The Trial best.

:up: Glad Viz is remembered.

Thanks for the considered reply and interesting comments. I was connected the New Age movement and the Theosophical Society through the 1980's and into the 1990's, so I am moderately familiar with the thinking. Most of the folk I knew in those days were as anxious, status seeking, consumer obsessed and money oriented as any contemporary yuppie. But I guess the serious thinkers are always in the minority. I have never arrived at a reason to take this kind of metaphysics seriously. True or not, it makes no practical difference to how I conduct my life. I suspect a lot of this comes down to person's disposition. Some of us are unhappy in particular ways that seem to be ameliorated by philosophy and thoughts of higher consciousness. And perhaps some of us ruminate less and are more distractible. :wink: