• andrewk
    2.1k
    I'm a big fan of CBT. It's not the solution to every problem, but it is the solution to many common problems. I also appreciate the commonality it has with Stoicism and Buddhism.
  • Noah Te Stroete
    2.1k
    I'm a big fan of CBT. It's not the solution to every problem, but it is the solution to many common problems. I also appreciate the commonality it has with Stoicism and Buddhism.andrewk

    The problem I have with therapy is that I know what the therapist wants to hear, but it is nearly impossible for me to control my thoughts from moment to moment. I know how I should think, but I CANNOT change my erratic thoughts throughout the day no matter the effort involved.

    I also have had a much greater than average share of trauma in my life, and CBT doesn’t seem suited to address my issues.
  • yupamiralda
    87


    I used to be, like, completely insane. Don't make excuses for yourself. Tyrannize your brain and only allow it to entertain what a psychiatrist would find kosher.

    If you have no idea how to achieve such discipline, take CBT seriously.

    One of the biggest problems with mental health is that, in general, nobody can force anybody to change. It's such a problem that most people think a psychiatric diagnosis is permanent. Lazy comparisons to diabetes abound.

    If you want to change yourself bad enough, if you don't allow yourself to fail, you'll succeed. Otherwise you won't respect yourself.
  • Noah Te Stroete
    2.1k
    Yeah, well, I’ve been told by my doctors that it’s a life-long illness with no cure. I’ve tried the willpower thing before and went off my meds. Then my doctor at the time threatened to have me committed. I didn’t think I was dangerous and thought I had things under control, but it turned out I was scaring a lot of people with my behavior. I know I can’t stop taking my meds until they find a cure. I am taking responsibility for my illness. I take my meds every night, and I never miss an appointment with my psychiatrist. I just found therapy to be like mental masturbation in the past. Or, it’s more like I’m jerking off the therapist when I know what s/he wants to hear.
  • Bitter Crank
    8.4k
    Are you bipolar?

    It seems to me that the best thing for bipolar people (and lots of others, as a matter of fact) is to do what you are doing: take your medication consistently, make your appointments, and monitor yourself so that you can access emergency intervention before your stability deteriorates too far.

    I've experienced depression, but nothing worth a journal write-up. Pedestrian, ho hum. My partner was bi-polar, and managed it for a good 40 years. He did have some hospitalizations along the way after going into pretty severe mania. He found support groups (not therapy groups) helpful -- he learned about manic depression/bipolar disease, made some good friends, and a couple of times got some very good leads on better psychiatrists. (He died of cancer a few years back.)

    So, good luck in your care. Mental illness is a tough challenge.
  • I like sushi
    1.8k
    I would say hubris is present in all realms of medical science. I think it’s a bit steep to say “incurable”, but I do understand the concerns given that diagnosis can be quite hit and miss (especially for minor problems).
  • Noah Te Stroete
    2.1k
    Are you bipolar?Bitter Crank

    Schizoaffective disorder, which is like a little bipolar, a little schizophrenia.
  • Anaxagoras
    349
    https://thephilosophyforum.com/discussion/comment/273156

    I started a thread here, so some of you can continue to bitch a moan under a proper subject. I say "bitch and moan" because apparently a couple of you perceive to act like you know more about the realm of mental health, and considering that I've spent almost ten years of my academic life in its study not to mention this is what my current profession entails.



    Sorry for your loss...
  • Chisholm
    14
    Ketamine May Relieve Depression By Repairing Damaged Brain Circuits

    https://www.npr.org/sections/health-shots/2019/04/11/712295937/ketamine-may-relieve-depression-by-repairing-damaged-brain-circuits


    “have found hints”

    “In mice”

    “appears to”

    “scientists have known relatively little about how ketamine and similar drugs affect brain circuits”

    “there are still many remaining questions”

    “appears to”

    “region of the brain we think is important”

    “seemed to be repairing”

    “finding suggested”

    “could be relieving”

    “research suggests”

    “somehow coaxes”

    “One possibility”

    “study suggests”

    “What we can imagine”

    “if that’s true”


    *************************

    In other words, these researchers don’t know jack sh*t about what this new drug does.

    :roll:
  • sime
    428
    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?
    andrewk

    If we accept that individuals are not self-causing agents, and therefore if we understand the concept of guilt pragmatically, in other words we define a person's guilt in terms of the social benefits of sentencing the individual, then we certainly need much more than mere analysis of the subject's brain, and in many instances the status of the subject's brain is irrelevant.

    And exactly the same logic applies when diagnosing the average depression.

    If psychiatry is a science which t accepts that individuals are not self-causing agents, then I cannot see how psychiatric evaluation as currently practiced is particularly relevant to establishing guilt.
  • andrewk
    2.1k
    If psychiatry is a science which t accepts that individuals are not self-causing agents, then I cannot see how psychiatric evaluation as currently practiced is particularly relevant to establishing guilt.sime
    I don't know a great deal about how it is used in the criminal justice system, but my impression is that the involvement of psychiatry is mostly related to determining the best method of dealing with the situation, rather than the assignment of guilt which is, in my opinion, purely a matter of opinion.

    I imagine that, if a claim is made that the accused was suffering mental disturbance at the time of the alleged crime, the value of psychiatry would be in assessing whether the frame of mind the person had at the time was likely to recur. If it was, and the crime was very grave, it may be necessary to restrain the person for longer than the range of criminal sentences allows. On the other hand, if it was a psychiatric event that was unlikely to recur, it may be considered appropriate to have a shorter period of incarceration, or none. These considerations could be made based on the principles of public protection and deterrence, rather than retribution, which is all that the notion of 'guilt' relates to.

    I also imagine this varies between cultures. In the US, which seems to have a retributive focus, 'guilt' may be seen as important. I don't think retribution plays much of a role in Scandinavian countries.
  • boethius
    318
    I started a thread here, so some of you can continue to bitch a moan under a proper subject. I say "bitch and moan" because apparently a couple of you perceive to act like you know more about the realm of mental health, and considering that I've spent almost ten years of my academic life in its study not to mention this is what my current profession entails.Anaxagoras

    If you review this thread, please consider the possibility that you are cherry picking (selection bias) engagement with only the most extreme anti-psychiatry position, which I am not even sure are as extreme as you think.

    As a "mental health professional" your usage of the words "bitch and moan" to minimize your opposition is incredibly typical of people in positions of authority who have no real argument justifying that authority.

    Your responses are on par for abrasiveness and some areas I would say exceed, for instance in the category of deflection, your opponents in this debate. In the vernacular, I would say you have been "triggered", far more than your counter-parties that openly admit to a history of mental illness whereas you claim to be, of one degree or another, an authority on mental illness.

    You also seem to have problems perceiving the reality here. No one has claimed to "know more about the realm of mental health, and considering that I've spent almost ten years of my academic life in its study not to mention this is what my current profession entails".

    Your interlocutors have pointed out philosophical problems in the construction of what "mental health" is, that it is as much a social construction as a scientific construction. The component that is a socio-political construction cannot by definition be professionalized, and naming experts of the socio-political component of mental health is for the purpose of imposing order ... an order that can be challenged on political grounds.

    Now, I will admit there is also a scientific component to mental health and that the various mental health professions do help people in this category.

    However, the socio-political component is incredibly dangerous to society, and not simply people misdiagnosed or "had bad service" that one can claim are bad apples the profession is always working to remove.

    Leo has provided a really good thought experiment that puts this issue in to perspective ... that you dismissed off hand in a thread entitled "Psychiatry’s Incurable Hubris".

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

    Your reply was:

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

    Leo's example is not a play on words, I don't see where you get that from. It's also not a hypothetical. The concentration camps actually happened, psychiatrists managed inmates with chemicals to increase compliance, and psychologists and psychiatrists made and applied criteria of what mental illnesses are "undesirable" and weakening German society.

    The German psychiatrists and psychologists had all sorts of "science based" theories on why some people needed to be put in concentration camps, developed the criteria for putting people in camps and, once in camps, criteria for distinguishing "good laborers" from the bad. They also experimented on and found chemicals to help people adapt to the conditions in the camp without challenging authority as much.

    Now, a lot of this is just bad science (some science specific to Naziism and some more or less global beliefs of the discipline at the time) and if you claim "well, we've learned since then", I'll accept that answer on the science component of mental health (in this debate).

    However, part of this practice stemmed from the values of Nazi society and was an entirely logical follow through of those values. "Getting rid of undesirables" is a logically consistent value system and many societies have shared this value, and "deficiencies in mental health" is a logical category of "undesirable". In this case, psychiatrists are charged with identifying, trying to "fix" and if that fails labeling "for extermination" mentally ill people. (They also had theories for why entire ethnicities were mentally ill and performed experiments to see if anything could be done to fix these people and concluded that no; however, to simplify the discussion I want to focus on the Germans identified as mentally ill).

    So considering this actually happened and as a university student of the subject for 10 years you are certainly aware, claiming it is a "hypothetical" is deflection at best and disingenuous at worst.

    Now, the practice of psychiatry in the West today is not as extreme as in Nazism, but there are parallels.

    The danger today (in the West) is not exterminating people, but a displacement of ethical and political dialogue, society must engage in to resolve new political challenges, to psychiatric expertise. For instance, in the past if working conditions became intolerable, the reaction to these conditions was political action; this is how 40 hour work week, for instance, came into being. Today, there is another option available: working conditions are fine, it's individual people who have problems that are "maladapted". So, if the truth is that working conditions are not fine, then the situation is a direct analogue of the concentration camp example: society as a whole is the (granted not as bad) concentration camp and psychiatrists direct their efforts to the people who find conditions intolerable and improve their adaptability; and this can be tracked by science (even if we disregard self-reporting of moods, we can track "people getting back to work" and other objective behavioral metrics; and conclude that psychiatry is "helping people and society").

    However, the justification of mental health interventions rests on the justification of the government policies, both in the specific systems that deploy mental health but also in the general good governing sense. If government is oppressive, then the natural reaction is to be angry, anxious, depressed about it (if you are in an oppressed class, of course) and it is these feelings that motivate political change. To lower these feelings with chemicals is to participate not in the assistance of the individual, but in the sedation of society as a whole for adaptation to further oppression.

    An extreme example today is the Chinese "re-education camps" of Muslims. Professionally trained to a western standard, psychiatrists and psychologists help build the systems to identify who needs "re-education" and how to "re-educate" them to be adapted to Chinese state management of their land, economy and culture.

    Yet the mental health profession in the West has nothing to say about this, and any professional from China involved in the above system could easily move to the West, have degrees recognized and complete any remaining licensing condition, and practice professionally in the West. If they were an effective technician at enforcing state policies in China, there is no reason to question their effectiveness would change in the West. There has been little to no discussion (by the mental health professional community in the West) about the abuse of the science of mind to enforce compliance of an entire culture using large integrated AI systems, re-education camps, manipulating children to give information on their parents, and every other method available, all informed by the behavioral sciences. For instance, there has been no attempt to identify and blacklist participants in this oppressive system.

    It's not as extreme in the West, but is there really no analogous issues? And as Leo points out, would you be able to know just in virtue of having a psychiatrist degree?

    In the West, psychiatrists and psychologist are an integral part of the enforcement of compliance in school, the work force, public spaces, prisons and the home.

    Take school for example. Western schools are to a significant, but a lesser degree than China, also filled with propaganda. Lot's of things in textbooks are verifiably false, misleading or simply absent (for propaganda purposes and not simply time constraint purposes). On top of this, teachers can be prejudiced themselves. If a student evaluates the direction of society as "bad" and so makes the logical conclusion of needing to resist conditioning and "wakeup" his or her peers, what will be the result? An arms-wide welcoming of a critical thinker out to improve society, and a sit down with the student body to put on trial alleged state propaganda? ... Or, will that student be labeled a trouble maker and enter various pipelines to be "fixed", and after the failure of a few disciplinary measures, will find themselves quickly diagnosed with a mental health issue.

    Now, if the reality is there is not state propaganda in curriculum, no teacher prejudices in this student's case, and the general direction of society is morally justified, then indeed the student is living either "outside reality" or then the agitation, anxiety and disruptive behavior is due to brain chemical and wiring and the rational of "resisting conditioning" is simply a childish excuse to retroactively justify inappropriate behavior due to an unfortunate underlying physiological and mental condition the student does not have the skills to identify. If chemicals fix the emotions and disruption, it can be considered a win.

    However, if the evaluation of the student is correct, then the resistance is justified and diagnosis of a the reasonable response of the student becomes not medicine but an organ of state oppression, to fix the problem at the behavioral level: whether it means sedating political actions or as a form of mental harm to increase the cost of resistance beyond what the student is willing to accept, both mechanisms will have the desired behavioural outcome and contribute to the statistics showing the treatment is effective.

    Likewise, if legal working conditions are simply not acceptable, a psychiatrist employed by a company or even sought out by the worker to increase productivity by suppressing natural mental reactions to intolerable living and working conditions, is again a tool of state oppression. If working conditions are fine, then it's just helping the outliers have a normal and productive life. Again, a big difference as to the nature of what's happening.

    If a justice and prison system is maintaining oppressive and racist policies and the conditions in prison are inhumane and closer to a concentration camp of forced labour than to anything resembling justice and rehabilitation, then it is justified to resist such conditions. Again, any mental health intervention to enforce compliance of prisoners with prison conditions is a tool of state oppression. If the justice system is great, rehabilitation as effective as it can be, then helping prisoners with mental health issues is part of a good rehabilitation system. Again, big difference.

    Now, in all these cases, genuine mental health problems will be mixed in with reasonable methods to resist oppression, so the practitioners will always have clear cases of a mental problem to point at and say: look, no one can deny this persons hallucinating or can't function at a basic level. But this is a red herring used to justify and enable state oppression as whole, which is far more dangerous and damaging to society as a whole than fixing the genuinely mentally ill along with the politically disruptive.

    Now, to be clear, this is not a personal attack on you. I don't know what system you are in, and, even in a bad system, being aware of these issues, an individual psychiatrist could try to do more help than harm by allying with the oppressed and either minimizing harm or helping them to "get through the cracks" and advance their cause without being caught by the mental health machine.

    However, based on your responses you seem to believe there is no issue, that psychiatry deals with "reality" and never dabbles in enforcing compliance of government policies.

    To be doubly clear, I am not asking for a justification of your system visavis the above issues, but response on the principles level. Are the Chinese mental health professional that are helping to track and predict using integrated surveillance and AI systems to minimize disruptive Muslim behaviour doing good work (are they potential terrorists with the mental culturally wide health conditions the Chinese government claims, or legitimate political actors seeking self-determination, as most other nations did at some point)? If they aren't doing good work, are they bad behavioral scientists, or just bad people? If they are bad people, would behavioral science tell them this, if, so, what papers and studies? If there's nothing in behavioral science that would point to an ethical problem, are they not then good behavioral scientist but simply with ethical and political beliefs you disagree with? Likewise, are the examples of the student, worker and prisoner simply impossible? If they are possible would you argue that psychiatrists are trained to identify and "leave alone" legitimate political grievances in the situations I described, in, for instance, the US?

    To preempt one potential response, I am aware that these issues have been written about and some professionals maybe aware of them; however, my rebuttal would be only a just society trains to understand and employs people who apply such considerations: an oppressive state will train for and select for effectiveness in achieving the policies.
  • leo
    705


    Really great post, thank you, you explained it better than I could.

    I would give it as compulsory reading to all psychiatrists and would-be psychiatrists, so they might ponder and be more self-aware about how much what they're doing actually heals people, and how much of it is nothing more than forcing people to adapt or shaping them to conform to oppressive social norms and policies. It's not easy to uncover a social norm as oppressive when one grows and is conditioned in a system where such a norm is taught as a normal part of reality, and to see people who refuse to bend to this norm or who suffer from conforming to it as legitimately oppressed rather than as mentally ill.
  • Anaxagoras
    349
    Now, the practice of psychiatry in the West today is not as extreme as in Nazism, but there are parallels.boethius

    This is all I need to know....
  • unenlightened
    4.1k
    This is all I need to know....Anaxagoras

    Really? Someone takes the trouble to write a long, detailed post teasing out some of the controversies and philosophical issues, and this is the best you can manage?
  • Hanover
    5k
    If a justice and prison system is maintaining oppressive and racist policies and the conditions in prison are inhumane and closer to a concentration camp of forced labour than to anything resembling justice and rehabilitation, then it is justified to resist such conditions.boethius

    You place a tremendous amount of responsibility on the mental health community for the enforcement of community values and propaganda on the citizens. That governments are often oppressive and horrific is undisputed, and their employment of any means possible for their ends is a historical fact, but blame rests more on the government leadership than their puppets. Mengele was a physician I suppose, but I can't blame medical science for the horrible experiments on human beings, often children, that the Nazis performed.

    As another historical fact (which is why I cited that quote of you above) the 1970s marked a departure from using psychiatric diagnosis and psychiatric treatment on inmates, leading to a far more punitive approach to corrections than previously. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762476/

    Many see this departure from the rehabilitative approach as the cause for current prison population surges. That is to say, while psychiatric approaches might be oppressive, so might be it be to ignore such approaches.
  • boethius
    318
    You place a tremendous amount of responsibility on the mental health community for the enforcement of community values and propaganda on the citizens.Hanover

    No and yes.

    No, I avoided using the term "community values", because an oppressive state generally doesn't reflect "community values. I'm sure you're aware that every oppressive and/or totalitarian state claims to be representing "community values".

    If community values are indeed reflected in an effective democratic system where no one is disenfranchised and everyone has equal say and political dialogue is open without parties with disproportional external or internal manipulative or obstructionist force, then I would expect mental health professionals to be in constructive dialogue with society to manage the issues outlined above without any fear of career repercussions of criticizing current policies as potentially unethical.

    Yes, if mental health professionals are engaged in creating and/or enforcing state propaganda, directly or through all sorts of subtle ways their profession in organized, I place a tremendous amount of moral responsibility on them for their participation.

    Mengele was a physician I suppose, but I can't blame medical science for the horrible experiments on human beings, often children, that the Nazis performed.Hanover

    This is exactly my point. There was no incompatibility between the Nazi value system and the science of mental or physical health. Being an expert in mental health therefore is not grounds to argue "we're helping more people than we're harming: trust me, I'm an expert"; Nazi scientists who participated could successfully argue they were top experts in their field. Nazi scientific expertise has no relation to the moral argument of what purpose it served in Nazi society. The point of this is to show that more evidence than "10 years of academic study in psychiatry" is required to argue the function of psychiatry in a given society is doing more good than harm.

    As another historical fact (which is why I cited that quote of you above) the 1970s marked a departure from using psychiatric diagnosis and psychiatric treatment on inmates, leading to a far more punitive approach to corrections than previously. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762476/Hanover

    This is deflection without any relation to the points I bring up.

    First, it's a false dichotomy, "punitive" measures, longer sentences, and worse conditions for inmates known to damage mental health, isn't the only alternative to relying on over diagnosis of the terrible psychiatric framework of the 70s. If you are accepting the premise that the US justice system is oppressive, then and now (something I'm not arguing here, but what principles would apply if it was; so substitute China or Saudi Arabia or then if no oppressive state exists, imagine one hypothetical), then government deciding to make it even more oppressive isn't a good argument for a previous "less bad" oppressive system.

    Second, the "departure from using psychiatric diagnosis and psychiatric treatment on inmates" was precisely because the profession entered the exact moral-political crisis that people in this thread are referring to. The state was happy when psychiatry as a whole would diagnose anyone making problems for the state as "mentally ill"; whether it be "all the blacks" are prone to more violence (especially in the sight of beautiful white women) and segregation is scientifically sound, that marijuana leads to mania and should be illegal, why homosexuality is a deviance and thus a crime and a disease, or to just paint any disruptive political behavior as mental illness whenever the need arises; it's a convenient synergy where the state doesn't even have to pretend there's an ethical argument for any given policy and psychiatrists and pharmacology producers make bank and can power-trip without state interfering with nuanced ethical questions: the opposition are all mentally ill! and questioning the profession is the worst mental illness of all (they are "experts in reality" after all, they should therefore know their profession is good in reality).

    The policy change from relying on diagnosis and psychiatric treatment of criminals was not because "we might be criticized for enforcing compliance, let's err on the side of safety" but because the discipline couldn't withstand scientific scrutiny. Experts couldn't come to the same diagnosis for the same people, and, famously, a healthy scientists pretending to be "a bit weird" was misdiagnosed and their explanation that it's an experiment to test accuracy of mental diagnosis was itself categorized as even worse mental illness (the scientist couldn't escape, no one knew where he was, and he had to pretend to accept the prescribed "reality" and pretend to get better in order to eventually get released and publish his findings).

    At the heart of the problem, there was no scientific basis for evaluating states of mind, but all diagnosis was based on the psychiatrist imagining the state of mind of the patient.

    So I don't see what you're suggesting, that it was some voluntary shift of a system that "worked" (to avoid uncomfortable but ultimately unfounded criticism?) to the sad only alternative of increasing punishment, decreasing all forms of rehabilitation (which, again, is a false equivalence with psychiatry and mental health to begin with), and increasing the prison population as a whole?

    ... Or, was increasing the prison population and increasing punishments a response from embattled institutions to turn the oppressive nobs up where they could on the black community, since the moral justification of the time honored tradition of segregation was falling apart?

    But whatever your answer, I don't see the link with the topic at hand.

    As for psychiatry, the whole crisis in the 70s emerged precisely because American society was resisting oppression and psychiatry was correctly identified as an integral part of justifying and enforcing those oppressive policies (segregation, homosexuality, female opportunity-gap and "female hysteria", etc.), so dissident scientists set out to test these claims using the scientific method rather than just "some expert said so". In some cases, best practices, under scientific scrutiny, turned out to be literally torture to maintain a disincentive for bad behaviour. In other-words, the entire "science of mind" was under the mass psychosis of believing they could imagine correctly what other people thought and perceived and could predict correctly how their interventions corrected the thoughts and perceptions, and a further mass-psychosis of believing that actual science, starting with basic scientific principles, could and did support this belief. There may have been a period that followed the crisis of more caution, more discussion of the difficult ethical and political questions, but I would say that period has ended since a while now: there's too much money to be had in making society believe it's normal to be mentally ill, which is more or less the point we're at. There's an even larger portion of money to be had making society believe false things are true. Everyone involved has been selected for efficiency in attaining these goals, and benign parts of the profession are selected based on not asking uncomfortable questions. The danger to society, as I mentioned, is mentally healthy people believing that poor performance in adverse conditions are a "you problem" and not a "how society is organized problem" and that luckily you can be fixes! or at least feel less bad about being broken; the other danger is a large portion of people believing total nonsense is fact.
  • Anaxagoras
    349


    The rest of your post is duly noted.
  • boethius
    318
    Now, the practice of psychiatry in the West today is not as extreme as in Nazism, but there are parallels.
    — boethius

    This is all I need to know....
    Anaxagoras

    Since you're continuing to participate, I'll assume you're serious about your proposed moral standard of "not as extreme as the Nazi's".

    Please educate me, is this a mainstream view in psychiatry that the moral standard to clear is Nazism? Are there papers, from which you derive the content of your expertise, that explain how this ethical standard follows from sound scientific principles in understanding reality and how it is to be applied in psychiatry practice?
  • Noah Te Stroete
    2.1k
    Is it the job of psychiatrists to change society into a more just one? Or is it their job to help individuals who are struggling to feel better?

    Furthermore, there are good psychiatrists and bad psychiatrists. When I was at the UW psych ward, I was told by the head psychiatrist that he couldn’t change the world, but he could help me feel better. In my opinion, he was a good psychiatrist.

    Dr. Israelstam of Madison, Wisconsin, told me after I told him that I was suicidal that he hoped he’d never see me again after he suggested that I might want to try heroin. He ended up going to prison on child pornography charges. He was a bad psychiatrist.
  • andrewk
    2.1k
    Boethius gets the Godwin Prize for being the first in the discussion to play the Nazi card. Yet another confirmation of Godwin's Law.

    Perhaps it should be a rule that any thread gets automatically closed after one hundred posts, to head off the inevitable Nazi comparisons.
  • boethius
    318
    Is it the job of psychiatrists to change society into a more just one?Noah Te Stroete

    At least as much as anyone else.

    Or is it there job to help individuals who are struggling to feel better?Noah Te Stroete

    This is one of the central issues. To what extent is "feeling bad" a mental health issue, and to what extent it is a good reaction to bad circumstances (that can be changed through political action). In what circumstances is government intervention in how people "feel" about society, morally justifiable, to what extent it a tool of oppression.

    Furthermore, there are good psychiatrists and bad psychiatrists. When I was at the UW psych ward, I was told by the head psychiatrist that he couldn’t change the world, but he could help me feel better. In my opinion, he was a good psychiatrist.

    Dr. Israelstam of Madison, Wisconsin, told me after I told him that I was suicidal that he hoped he’d never see me again after he suggested that I might want to try heroin. He ended up going to prison on child pornography charges. He was a bad psychiatrist.
    Noah Te Stroete

    In my responses, I pointed out that even in a oppressive system, a given psychiatrist could be helping more than harming. The general issues here are not reducible to "bad psychiatrists and good ones", and so the only ethical issue is "bad apples" that are progressively being removed with best practices discovered over time.

    I also point out that I believe mental health does exist and a valid science can exist addressing it, and the practice of psychiatry today, under most if not all systems in the world, can point to successes.

    But pointing to some successes, this does not establish that more good than harm is taking place, neither in a given system nor if we consider psychiatrists as a global community.

    My intention here is not to prove this is the case, and to what degree, but to discuss the relevant principles.

    To offer a simplification that can synthesize my points so far and where I am going with them, mental health professionals become the agents of state oppression in an oppressive state, simply because an oppressive state will set things up to achieve it's oppressive policies. So, mental health becomes in the same category as the police and military. Of course, policemen and soldiers of an oppressive state can too point to instances where they are "helping people", but ultimately they are enforcing oppressive control that does more harm than good. The roll of psychology and psychiatrists is less obvious in the maintenance of control but, I would argue today is actually more effective. Keep in mind that an oppressive state uses an excess of propaganda and educates people from a young age with that propaganda, and so if and when an individual starts to "feel something is wrong" they have not been provided the opportunity to study the history of philosophy and so cannot immediately articulate "why they feel things are wrong". In an oppressive state, mental health practitioners main function in the state system is to intervene in this process of become socially conscious and convince the would-be-political-active person that they have a mental health issue, that they are not adapted to society and they will feel better if they are fixed and able to adapt. Adaptability of presupposes it is a worthwhile objective to adapt to society as it is. The claim psychiatry is helping people more than harming them, is thus reducible to the claim that society is justly organized, and so people that "don't feel good" have a mental health issue and they should be convinced, and in some cases forced, to adapt to government mandated expectations of behaviour. If society is not justly organized but oppressive, then people who "don't feel good" are having, most of the time, a healthy reaction to intolerable social conditions. Now, what is "a just organization of society" is of course the central question, one discussed on this forum tirelessly, but if my argument follows, the point is that psychiatry cannot refer to a scientific standard to justify it's roll in society.

    Now, if all this is established, I of course don't expect many psychiatrists in an oppressive system to care or do anything; they are selected for training and elevated to positions of authority precisely because they either agree with the social engineering program of the state or don't view it as their business to care or comment on. The purpose of my argument is first to simply to establish the truth of what basis psychiatry can be be said to doing more good than bad, and, a second less important point, that understanding the roll of psychiatry and psychology in state oppression is essential to resisting it, just as understanding the roll of police and the military are prerequisites to resisting oppressive power. Now, in such a struggle against oppression, the agents of oppression are both an obstacle and a potential ally; most large political changes occur when the agents of the state abandon state propaganda and side with the resistance.

    Of course, in an effective democratic society where everyone has equal say and neither the political process nor social organization in general cannot be argued to be lowering the say or marginalizing any would-be-oppressed group, there is no need for "resistance" but simply participating in the political process if one has concerns about government mental health policies.
  • boethius
    318
    Boethius gets the Godwin Prize for being the first in the discussion to play the Nazi card. Yet another confirmation of Godwin's Law.andrewk

    Great attempt at deflection, but in this conversation your point isn't even factually correct. I cited Leo's mention of Nazism and explained why it had good points that merited a response. The entire purpose of my post was to recast what I viewed as salient philosophical points into less extreme circumstances.

    How could I be first, if I'm citing someone else and trying to explain the philosophical merits of their comment?

    Perhaps it should be a rule that any thread gets automatically closed after one hundred posts, to head off the inevitable Nazi comparisons.andrewk

    No one here is calling anyone else a Nazi, so you're not even using Godwin's law correctly to begin with. Furthermore, any academic course of medical ethics will bring up the Nazi's, but you seem to think it's irrelevant, is my understanding of your comment correct? Should we just ignore this period in history or at least cut off any attempt to learn from the evils and mistakes committed at 100 posts?
  • Noah Te Stroete
    2.1k
    Do you live in the United States? Is this an oppressive society? It certainly is if you are a young black man living in poverty, for example. That said, society evolves naturally. Most people would RATHER adapt than bang their heads against the wall of the slowly evolving organism that is society. If one makes too much of a stink, one finds oneself in prison, dead, or possibly even tortured. That is the stark reality of human civilization since the very beginning, and I very much doubt that will change any time soon.

    So, yes, I decided that it is best not to rock the boat too much because I was a target of the authorities at one time. I decided that I cannot change the world. Most psychiatrists are no different, and the good ones want to help people out of compassion. I decided I want to feel better as the world is. I suggest you give up your idealism and just let society evolve as it is wont to do.
  • Anaxagoras
    349
    Furthermore, there are good psychiatrists and bad psychiatristsNoah Te Stroete

    This...

    I rather like to back away with the discussion on Nazism trope
  • boethius
    318
    Do you live in the United States? Is this an oppressive society? It certainly is if you are a young black man living in poverty, for example.Noah Te Stroete

    This is another issue, certainly warranting debate. However, in this discussion I'm only interested in establishing that an oppressive state will naturally use mental health sciences as a tool to further oppression. And evaluating whether a state is oppressive or not is outside the domain of psychiatry.

    That we should expect to find psychiatrists, on the whole, agents of and beneficiaries of state oppression, rather than other jobs like agriculture and factory work where we would expect to find the oppressed (assuming an oppressive state, of course). Now to what extent is each psychiatrists personally morally responsible and to what extent "just plodding along and following orders" is again another debate.

    So, yes, I decided that it is best not to rock the boat too much because I was a target of the authorities at one time. I decided that I cannot change the world. Most psychiatrists are no different, and the good ones want to help people out of compassion. I decided I want to feel better as the world is. I suggest you give up your idealism and just let society evolve as it is wont to do.Noah Te Stroete

    To answer your first question, I don't live in the US; I moved to a country (from a country other than the US) where I have even less fear of "rocking the boat" and becoming "a target of the authorities" then from whence I came.

    I decided that I cannot change the world.Noah Te Stroete

    Not even a little?

    But even if your statement is true for you and for me, I am largely an adherent to stoic formulation of ethics where the intention and "giving a good ol' try" is what matters.

    Most psychiatrists are no different, and the good ones want to help people out of compassion.Noah Te Stroete

    Because most people are like you? Or because psychiatrists are selected based on having a similar outlook? Though, at no point did I morally condemn any psychiatrist; for me it's largely irrelevant part of the debate. Just like condemning individual police or soldiers for their roll in state oppression. However, there are exceptions to this general rule, but simply being in the category is not such an exception in my view; more particulars would be needed about what someone knows, what actions were participated in, opportunity to do otherwise, degree of coercion etc. I have pointed out twice now that an individual psychiatrist can still be doing more good than harm even in a system that does more harm than good.

    I decided I want to feel better as the world is. I suggest you give up your idealism and just let society evolve as it is wont to do.Noah Te Stroete

    Society's evolution is not independent of my actions, so what you say is simply not logically coherent: it is not an exterior system I can choose to leave alone. If I choose to maintain the status quo, I would be contributing to that evolution not letting it "evolve as it is wont to do".
  • Noah Te Stroete
    2.1k
    Society's evolution is not independent of my actions, so what you say is simply not logically coherent:boethius

    It seems like you think you can have an impact on societal affairs. If so, that sounds an awful lot like delusions of grandeur. In reality, you have very little to no effect on society. State oppression? Welcome to the world as it’s been since the formation of communities. No one will ever change that. Now, if you live in Saudi Arabia, then it does very well need drastic changes. Just don’t stick your neck out too far lest your head get cut off.
  • Anaxagoras
    349
    However, in this discussion I'm only interested in establishing that an oppressive state will naturally use mental health sciences as a tool to further oppression.boethius

    You can say that about any powerful first world society.

    But even if your statement is true for you and for me, I am largely an adherent to stoic formulation of ethics where the intention and "giving a good ol' try" is what matters.boethius

    Which is what I've done during my residency yet according to you, psychiatrists/psychologists are agents of oppression.

    even in a system that does more harm than good.boethius

    pray tell what system do you refer?
  • boethius
    318
    It seems like you think you can have an impact on societal affairs. If so, that sounds an awful lot like delusions of grandeur.Noah Te Stroete

    Really? That's what you understood from my comments.

    I say "But even if your statement is true for you and for me [that we cannot change the world at all], I am largely an adherent to stoic formulation of ethics where the intention and "giving a good ol' try" is what matters." And you deduce I have delusions of grandeur?

    State oppression? Welcome to the world as it’s been since the formation of communities. No one will ever change that.Noah Te Stroete

    Democracy doesn't exist? The transatlantic slave trade is still humming along? Segregation never ended? Or are none of these things changes to the oppressive nature of all human communities?

    Now, if you live in Saudi Arabia, then it does very well need drastic changes. Just don’t stick your neck out too far lest your head get cut off.Noah Te Stroete

    So trying to make the world a better place would be reasonable in Saudi Arabia in your view, as long as you don't get caught? But elsewhere your recommendation is to just feel as good as you can about the world and let it evolve as it wont to do? Or are you also recommending that to people in Saudi Arabia, just pointing out they got a bad lot?
  • Noah Te Stroete
    2.1k
    I’m talking about individuals. You’re talking about generalities.
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