You don't seem willing to entertain a social analysis, and at the same time seem reluctant to actually say what you mean. — unenlightened

Well, maybe it's a definition problem. Mental illness as reaction may possibly be treated by changing whatever the cause of the reaction is. But I think of mental illness as a condition, and as such in itself, not addressable through any social analysis. Not to dismiss it entirely; social analysis as consideration of the community, writ in whatever way is relevant, may influence for example treatment options. But if a fellow's brain chemistry is messed up, I do not see how a visit to the town zoning commission might help him.

My take on psychiatry, in sum, is that while most doctors are akin to mechanics in the sense of dealing with the more-or-less, and mostly more, known, psychiatrists by comparison are more in the way of witch doctors. That is, in having theories and models to deal with the mainly unknown. As noted above, this may be the best that can be done at the moment. And while most other doctoring has a hands-on component that distinguishes it in its specialty, psychiatry apparently does not - which is reasonable for witch doctory.

As to what psychiatrists do, that appears to be a many rather than a one, and no one of which itself characteristic. Which leads to a kind of joke: while most medical specialties can be identified through specific actions of the specialist, to identify a psychiatrist calls for a DSM style listing of possible behaviors that, enough of them presenting, might lead to a diagnosis of psychiatrist.

I get it that as a group psychiatrists have to take themselves seriously - how could they function otherwise - and that as a group they take on difficult even intractable problems and do the best possible. But imho they sometimes forget and mistake their theories for knowledge. And there is a dark side as well: dealing with mental illness can be extremely stressful; easier to deal with theories and models and labels to avoid the nightmare of dealing with the thing itself.

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

They are the priestly caste, and the priestly caste is always taken seriously both by others and by themselves, in part because their function within society is seen to be so important. And of course it cannot be denied that it is important.

:up: Well said.

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.

My take on psychiatry, in sum, is that while most doctors are akin to mechanics in the sense of dealing with the more-or-less, and mostly more, known, psychiatrists by comparison are more in the way of witch doctors. — tim wood

We agree thus far at least, so I might be able to convince you to consider that the medical model may be somewhat at fault. Witch doctors have a rather similar model, in which 'evil spirits' play the role of 'chemicals in the brain'. One of the difficulties of the medical model is the way pathologies change over time. Anorexia and self-harm, for instance are modern epidemics, and in the complete absence of any physical explanation for such novelties, social change should surely be considered as a possible explanation? At which point one can ask "how does your society fuck you up, and what are your coping strategies/self-medication?" to psychiatrists and their clients even handedly,

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.

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: — Tom Storm

Do you remember enough about what you read to offer a brief precis of his defense of his use of "witchdoctor"? My use to contrast in-a-word those operating mainly with knowledge with those obliged to rely to some significant degree on less than knowledge. My criticism being of those who represent the "witchcraft" as knowledge. And maybe that's the answer to what psychiatrists do - I wonder if you'll agree - they use information bases and their training to determine and apply best standards for treatment of mental illness. Thus as corollary no characteristic "hands on" action to identify/distinguish psychiatry. Yes? No?

We agree thus far at least, so I might be able to convince you to consider that the medical model may be somewhat at fault.... One of the difficulties of the medical model — unenlightened

My understanding of the medical model is inherited from those who don't like it. And it amounts to this: if you go to the doctor you are by definition and understanding a patient and thereby something must be wrong, and it is the doctor's business to find something wrong - that he or she can treat.

As to any social change theory of mental illness, I suppose it can offer a cause as a reason for a behavioral change, but connecting that to behavioral change as a result of illness not-so-easy. That is, that which makes it an illness would to me seem to inhere in the patient - the persistence of the symptom, the "cause" being removed, being evidence that the illness is in the patient. Shell-shock. or PTSD, and multiple-personality disorder (now dissociative identity disorder) being just two examples.

Thus like a tool in a tool-box. Ultimately useful only when and as appropriate, otherwise not; and when not, a dead weight that may not be worth the having.

the best resolutions are not found in medication, but in meaning. Hence the emphasis on the psychosocial. — Tom Storm

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.

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.

Then you seem to be arguing that psychiatry is not knowledge. — Tom Storm

Back to the question then, in different form: what exactly does psychiatry know, and what does it know about it? 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.

Ask an orthopedist how he knows the leg is broken and he will reply something like this, "Lookee here at this x-ray! It's broken!" And that in such tones and terms and with such evidence as command assent. 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.

Maybe more simply, medical knowledge is categorical; the leg is broken or the leg is not broken. For psychiatry, the ability to make knowledge-based categorical statements a luxury they usually do not enjoy.

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.

It is better that seeking psychiatric help! Anything that comes before medication should be recommended.

In today's world many people do not have the social outlets they need to confront personal issues. Forms of basic therapy are more or less a means of mental maintenance than treatments of disorders.

All that said simply not using social media so much would help SO many people out - especially teenagers!

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. — Tom Storm

:up: