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:

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.... 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,... The profession is generally demonized and poorly understood. Which was my original observation. — Tom Storm

Not so easy! The discussion - I don't consider it a debate; what would we be debating? - is about knowledge. Your representation that psychiatrists have knowledge. Mine that to be sure they have some but with respect to their subject matter, not much knowledge. Again not itself a criticism. And I think that the disrepute psychiatry has had - I'm not sure of its status today - is not so much because of the practices of some bad apples, but because of the general claims and practices of psychiatry itself, still among them, though perhaps muted, claims to knowledge that isn't.

The failure of any claim to knowledge is not just an "Oops" moment. Rather instead it is an indictment of the work that led to the claim and the system that supports the work. If nothing else, the evidence that psychiatry still needs work would be its still claiming knowledge it does not have, to the degree it still does so. My guess is that most professionals in their personal practices have taken the historical lesson and try not to make such claims.

The failure of any claim to knowledge is not just an "Oops" moment. Rather instead it is an indictment of the work that led to the claim and the system that supports the work. If nothing else, the evidence that psychiatry still needs work would be its still claiming knowledge it does not have, to the degree it still does so. My guess is that most professionals in their personal practices have taken the historical lesson and try not to make such claims. — tim wood

The same observations you’re making concerning psychiatry could be made with respect to philosophy. The only difference is that most philosophers don’t claim to be doing science. Underlying your analysis is what I detect to be an assumption concerning the nature of scientific objectivity and the difference between empirical
objectivity and the aims and methods of philosophical discourse. I reject this dichotomy. Science is just a conventionalized form of philosophy, and the reason that psychiatry seems inadequate in comparison with the ‘harder’ sciences isnt that it fails to solidly ground itself in objective facts like a domain like physics does, but that it has one foot in philosophy and one in science. This gives it a vantage on its subject matter that is more nuanced and richer than the abstractive generalizations that define the hard sciences. It is what the hard sciences ignore (namely, the interpenetration between subjectivity and objectivity) that makes them seem more successful and certain in their descriptions than psychiatry. But their grasp of the world is no truer in an ultimate sense than psychiatry’s.

The same observations you’re making concerning psychiatry could be made with respect to philosophy. — Joshs

Some no doubt, but in terms of my argument, nonsense and non sequitur. Knowledge is a something. To claim to have it is a claim to have something. If it turns out you don't have and never did have it, then whence the claim? There's a piece of difficult forensic accounting to be done, the usual results of which not-so-honorable.

Where the rubber meets the road, psychiatry and psychiatrists have claimed knowledge that turned out not to be, and often enough to be, as Mr. Storm points out, as a profession demonized. Trust, once lost, is hard to regain. My impression is that many psychiatrists have retreated from false claims to providing services that will foster trust: prescribing, managing certain kinds of care, and so forth.

My own bias would have the title "psychiatrist" done away with, replaced perhaps with a degree in mental health practices or something like. The word itself means doctor of the psyche - psyche itself, defined too many different ways to itself retain any unqualified sense.

My impression is that many psychiatrists have retreated from false claims to providing services that will foster trust: prescribing, managing certain kinds of care, and so forth — tim wood

Oooh, false claims. That sounds like a terrible thing. Imagine not accepting true claims like the idea that mental illness is the result of a chemical imbalance in the brain. Anyone trying to peddle ‘true’ claims with respect to psychological issues is someone I would run away from as fast as possible. I don’t want the claims of my therapist to be true, I want them to be useful, and that is as much a function of the mesh between client and therapist as it is the theoretical orientation of the therapist. Also , the ‘true’ claims of one era of psychiatry will inevitably be seen as false, or more likely simply forgotten by a succeeding era. Does any one remember when what we now call depression was understood very differently as melancholy? How long before the rage of bipolar and Adhd diagnosis gives way to something else? Is this the result of runaway pseudoscience , or does all science operate on the basis of historically changing social constructions?

or does all science operate on the basis of historically changing social constructions? — Joshs

The stretch from psychology to all science misses a rather important difference that is peculiar to the 'human' sciences. When one studies electrons, or planets, or plate tectonics, one can reasonably assume that right or wrong, one's hypothesis about phenomena will not materially affect the behaviour one is studying. But human behaviour is radically transformed by human understanding, so that as soon as a psychological theory has some measure of success, it alters human nature and the phenomena one is studying change. This explains why psychology appears more like the fashion industry than a science.

or does all science operate on the basis of historically changing social constructions? — Joshs

The stretch from psychology to all science misses a rather important difference that is peculiar to the 'human' sciences. When one studies electrons, or planets, or plate tectonics, one can reasonably assume that right or wrong, one's hypothesis about phenomena will not materially affect the behaviour one is studying. But human behaviour is radically transformed by human understanding, so that as soon as a psychological theory has some measure of success, it alters human nature and the phenomena one is studying change. This explains why psychology appears more like the fashion industry than a science — unenlightened

I like what Rorty has to say about this:

To deny the existence of facts and truths about protons long before the term “photon” appeared in language leads to para­dox. This is because it seems reasonable to infer as follows:
( l ) There were photons five million years ago.
(2) It was the case then that there were photons.
(3) It is true that it was the case then that there were photons.
(4) It was true then that there were photons.
It seems reasonable, but of course philosophers have, paradoxically, denied it. Heidegger notoriously said that “before Newton, Newton’s laws were nei­ther true nor false


We should think of normativity, of the possibility of correctness and incorrectness, in terms of human beings’ answerability to one other. We can say everything we need to say about ob­jectivity, about the possibility that any given judgment we make, no matter how unanimously, could be wrong, without ever talking about “answerabil­ity to the world” or “world-directedness.” This account of objectivity works just as well for mathematics as for physics. It is as applicable to liter­ary criticism as to chemistry. The centrality of perception and of natural science to his treatment of the topic of answerability becomes explicit when John McDowell says:

“Even if we take it that answerability to how things are includes more than an­swerability to the empirical world, it nevertheless seems right to say this: since our cognitive predicament is that we confront the world by way of sensible in­tuition (to put it in Kantian terms), our reflection on the very idea of thought’s directedness at how things are must begin with answerability to the empirical
world.”

When discussing literature or politics, however, it is a bit strained to say that we are in a cognitive predicament. It is even more obviously strained to say that this predicament is caused by the need to confront the world by way of sensible intuition. McDowell’s choice of Kantian terms is a choice of visual metaphors, metaphors that Kant used to lament our lack of the faculty of intellectual in­tuition that Aristotle had described, overoptimistically, in DeAnima. It is also a choice of natural science as the paradigm of rational inquiry, a Kantian choice that Hegel explicitly repudiates. When one switches from Kant to Hegel, the philosopher whom Sellars described as “the great foe of imme­diacy,” these metaphors lose much of their appeal. So it is not surprising that it is among anglophone philosophers, who read far more Kant than they do Hegel, that these metaphors should remain most prevalent.

From a Sellarsian, Davidsonian, Brandomian, or Hegelian viewpoint, there is no clear need for what McDowell describes as ‘a minimal empiricism’: the idea that experience must constitute a tribunal, mediating the way our thinking is answerable to how things are, as it must be if we are to make sense of it as thinking at all. We are constantly interacting with things as well as with persons, and one of the ways in which we interact with both is through their effects on our sensory organs and other parts of our bodies. But we don’t need the notion of experi­ence as a mediating tribunal. We can be content with an account of the world as exerting control on our inquiries in a merely causal way, rather than as exerting what McDowell calls “rational control”.

But we don’t need the notion of experi­ence as a mediating tribunal. We can be content with an account of the world as exerting control on our inquiries in a merely causal way, rather than as exerting what McDowell calls “rational control”. — Rorty?

I'm not sure if I understand this, but if I do, then it goes something like this:— the cliff doesn't mind if you have a theory of gravity or a theory of under-cliff trolls that will suck you down and eat your soul, as long as the effect is that you don't fall off the cliff. But when it comes to Psyche, and more so when it comes to Sophia, then either rational, or irrational control is what it is all about and the causal effect cannot be predicted at all either way, other than by a rational or irrational calculation that is itself in the purview of those same goddesses.

The motto of The Radical Therapist", a leftist, anti-psychiatry mental health zine from the early 70s, was "Therapy means change, not adjustment." That seems like truth for people who are unhappy; frustrated by their life circumstances; in chronic debt; in abusing relationships; stuck in bad jobs; and so on and so forth. The kind of change a lot of people need is possible and doesn't require professional help. It's just damned hard to bring about. So, a lot of us remain unhappy, frustrated, unfulfilled, and so on.

Psychiatry has little to offer people who are merely very unhappy, other than tranquilizers and antidepressants.

The people who really need psychiatry are those with major mental illnesses -- bi-polar; schizophrenics; psychotic disorders, OCD, CD / MI, and the like. Changing one's life circumstances might improve life for someone experiencing episodes of psychosis. Or not. It won't cure them.

My own experience with psychiatry -- antidepressant and sedative therapy on the one hand, and extended talk therapy on the other -- is that they help one cope with the life one is living but not liking. In the end what helped me was major change, not adjustment. I can't claim that I engineered the kinds of change that helped. Life changed and I started feeling much better.

I've seen major mental illness up close--in partners and relatives. It can be pretty ugly. They needed all the psychiatric help they could get. And it helped. Bi-polar, MI/CD, and the like are not really 'curable' but they benefit from the benefit which the medical model of psychiatry can give.

There certainly are abuses by the pharmo-medical industry. I suspect that far too many children are being 'identified' with Attention Deficit Disorder (ADD) and being prescribed stimulants (which in children have a 'paradoxical' effect). This idea was being studied in the late 1960s, early 1970s in Boston in largely black elementary schools. (I was working at a hospital at the time where the research was being done, though I wasn't involved in it.) Drugging overly active black boys seemed like a good idea to both the schools and the doctors.

For these disruptive boys what was needed was change -- better homes, better communities, better schools, better opportunities, better environments -- not therapy.

I make a very sharp distinction between psychiatry and therapy. The business of one to cure patients - and to date (subject to correction) they cannot. The other about facilitating for clients what you call change, or (re)habilitation. From the psychiatrist I expect first he or she will act in accordance with the principle of primum non nocere , then act to safeguard/improve quality of life including confinement if needed and the option of drugs. I believe that the basic training of psychiatrists as MDs would tend to disqualify most of them - nearly all - as therapists, at least without a lot of additional training/retraining.

And therapy for those who may be able to benefit from it, being about trying to understand circumstances thereby to develop strengths to deal with them, usually not always through talking about them. And a good therapist can accomplish in a mercifully few hours what otherwise might take years to get through. Having made this distinction, I'll suppose we're both in the same choir and on the same page. That will save me the strain of writing what already a matter of assent maybe does not need to be writ.

It takes about 12 years to become a psychiatrist. A good therapist will probably need a masters or a doctorate -- that's another 3 to 5 years, minimum. The motivation required to be a psychiatrist (or a heart surgeon, whatever) is different than the motivation to be a psychotherapist (not thinking of Freud, here).

There are people without MDs, MAs, or PhDs--even without BAs, who--because they are healthy, intelligent, reasonably insightful, good listeners, and kind can help people they know through rough patches of life. For a lot of people that kind of "helping volunteer" is all they will need.

This is a very old study -- it's maybe 60 years old now, and I can't vouch for its quality. When I was in graduate school in 1970 we discussed a study in Wisconsin where psychiatrists, counselors, and laymen (people without any training in therapy) were each assigned several patients with fairly serious mental health problems. Each "therapist" provided the kind of therapy they thought would be beneficial. What was remarkable in the finding was that patients who were treated by laymen did as well as patients assigned a trained therapist.

What this shows is that either a) one kind of therapy is as likely or unlikely to work as a different therapy, OR that some kinds of mental illness (like schizophrenia) are resistant to psychotherapy. This strikes me as consistent with reality. A kind, insightful, skilled psychiatrist can use medication to suppress outbreaks of psychosis. All the kind insightful talk in the world probably won't help. On the other hand, a schizophrenic or bi-polar person is likely to enjoy the social contact of talking with a kind, friendly, thoughtful person, whether that cures them or not.