Understanding 'Mental Health': What is the Dialogue Between Psychiatry and Philosophy?
I see this as a major area of debate. This is because mental health involves subjective experiences and objective aspects of behaviour. The traditions of psychology and psychiatry developed in conjunction with one another. Both draw upon ideas of cognitive science, especially as psychiatry involves psychochemistry as a means of stabilising the 'mind'.
In the past, there was the opposition of antipsychiatry, in which thinking of RD Laing and Thomas Szaz saw psychiatry as a limiting way of trying to 'normalize' human experience. Those who were deviant were often labelled as 'mentally ill'. However, the arguments against this perspective involved ideas about the 'reality' of 'mental health' for those experiencing mental health problems, as well as those affected by risks entailed.
Psychiatry draws upon ideas about what constitutes 'normal' behaviour and experiences. It also involves looking at the nature of causation and how the biological; psychological and social aspects of experience impact on life. Psychiatry may be seen as maintaining the 'status quo' or as progressive..it may also be seen as hinging on an understanding of the nature of "mind'.
In starting this thread I am interested in looking at the scope and limitations of psychiatry. To what extent is psychiatry able to look at subjective experiences of suffering and how does philosophy come into the picture of such understanding? Are the perspectives of psychiatry and philosophy compatible or divergent?
In the past, there was the opposition of antipsychiatry, in which thinking of RD Laing and Thomas Szaz saw psychiatry as a limiting way of trying to 'normalize' human experience. Those who were deviant were often labelled as 'mentally ill'. However, the arguments against this perspective involved ideas about the 'reality' of 'mental health' for those experiencing mental health problems, as well as those affected by risks entailed.
Psychiatry draws upon ideas about what constitutes 'normal' behaviour and experiences. It also involves looking at the nature of causation and how the biological; psychological and social aspects of experience impact on life. Psychiatry may be seen as maintaining the 'status quo' or as progressive..it may also be seen as hinging on an understanding of the nature of "mind'.
In starting this thread I am interested in looking at the scope and limitations of psychiatry. To what extent is psychiatry able to look at subjective experiences of suffering and how does philosophy come into the picture of such understanding? Are the perspectives of psychiatry and philosophy compatible or divergent?
Comments (51)
As a reflection of professional care, the difference between psychology and psychiatry concerns diagnosis and treatment. Psychiatry has developed as a medical approach and psychology has developed from views of individual behavior that come from many, often conflicting, models. The role of the "subjective" comes from different models of human development. The value and role of subjective reporting is also hotly contested. Both practices are keen upon useful approaches to real-time problems. In many clinics, both kinds are on teams evaluating people. The distinction between objective and subjective is too general in this case.
On the clinical psychology side, the development of the Boulder model has been prominent in the development of the practice. The goal was to introduce rigorous methods of research that could answer to the standards of "medical" research but remain as a separate discipline. I linked to it as a search page result to show that it is far from being a settled debate.
P.S. Both sides that I have encountered turn purple at the mention of Liang and Szaz.
I would guess that the experience of practicing psychiatry is different for doctors working in busy clinics, seeing one depressed, anxious patient after another, and doctors working in forensic psychiatry where their patients are in locked wards where some patients have barely contained murderous impulses. For that matter, the experience of being a depressed anxious patient isn't the same as being one with those with murderous rages.
It seems like we tend to talk about "mental health" as an absence. I haven't heard people say "she is really mentally healthy" -- just the reverse. Well, how crazy is she? Most people must be reasonably healthy mentally, else societies would be in far worse shape than they are. And even people who have episodic illness (like bipolar) may be described as "mentally healthy" a good share of the time. And then there are lots of highly functional, effective, people who have traits that are surely pathological.
Philosophy comes in handy here to explain some of the glaring contradictions humans exhibit, and for generalizing about how contradictory we are as a species, with our often uncoordinated and/or contradictory cognitive and emotional traits constantly screwing things up for ourselves.
Great question Jack, I have been wondering this for some time. I studied psychology at uni and taught it in high school for years, but have only recently begun to explore philosophy.
I was reading Oliver Keenan's "Why Aquinas Matters Now" this afternoon and started to think that cultivating 'virtues' like prudence, fortitude and temperance in a therapeutic / clinical setting was sensible. There seem countless fruitful applications, to be honest. Any that spring to mind as most obvious to you?
I can't help but thinking that a 'philosophical' approach to counselling might feel more substantial or accessible to a certain subset of people who might need / want counselling but who are suspicious of the affirmative, empathetic approaches most associated with counselling?
Quoting BC
Well put. This certainly characterizes my experience with a psychiatrist over a year's worth of counselling at CAMH here in Toronto. Appointments with him were less frequent than those with my psychologist, but my psychologist was the one who benefitted me, likely due to the time constraints on him but less so upon her.
Quoting BC
Good point. There is conflation with poor mental health and mental illness as well. For the concept of 'mental health' to be effective, it seems it would have to shine light on both ends of the spectrum. It's almost as if good mental health is considered the default, which is clearly not the case.
Quoting BC
It feels to me as if that 'handiness' isn't being deployed as much on the subjects of mental health and mental illness? Or am I missing something?
I see references to 'philosophical counselling' in therapeutic fields, but I am not sure if this is psychology with a philosophical gloss or a substantial philosophical project?
Does anyone know more about 'philosophical counselling'?
People are still against psychiatry: even though the whole mental health system has achieved more praise and acceptance. Now adays, the main opposition is based on the lack of effectiveness in taking the drugs. People in general are less concerned about normalization than they are about keeping their head on their shoulders. However, there will always be those who don't conform to socual norms and work performance expectations.
Psychiatry itself can't really do anything with subjective experience without patient input: "these pills are not helpful, give me different ones", and philosophy is largely unable to comment on the specific drugs, but we can talk in generalizations about them:
-is taking medication an effective way to survive? If yes, then when?
-can psychiatry exist without prescription drugs?
-Can psychiatrists eventually just make recommendations about fully legal drugs or herbal supplements?
-is psychiatry immoral, destructive, or flawed?
I'd have to say that psychiatry is very limited: it's basically just something people use in desperation, and i can't comment on how to properly administer it. You have to get a referral to see a psychiatrist, because MH proffesionals know that talk based therapy is more effective than medicating for a wide range of issues.
Psychology does draw upon the meaning aspects of understanding experience as well as neuroscience. Of course, there are different schools of thought within psychology. Some emphasise the physical basis of the brain.
Psychiatry is often focused on the way of correcting what is regarded as 'abnormal' through chemical treatments. However, the field of psychiatry often draws upon a bio psychosocial approach, understanding the way in which developmental and social circumstances affect or impinge on psychological wellbeing.
I hadn't come across the Boulder model, so thank you for pointing to that. It does seem that Szasz and Laing have lost their influence in the critique of psychiatric practice. There is a focus on critical psychiatry though. Psychiatry is bound up with values about norms or what is considered 'normal'. There are also political aspects of the practice of psychiatry too.
What does that tell us about the universe and its properties, like humans? And what does it mean for humans' defiance of the universe?
Thank you for your detailed reply to the outpost. Often chemical treatments of what is regarded as 'abnormal' are the focus within psychiatry. I am also thinking that differences may occur geographically. I am most familiar with the profession of psychiatry in England. The psychiatrists are trained in medicine initially and often do training in therapy in later training. There was an emphasis on the psychodynamic model developed by Freud and others. More recently, that has shifted towards a cognitive behavioral approach.
The cognitive behaviourist approach does involve a philosophical look at underlying beliefs and the way that they affect emotional life. There is some emphasise on positive aspects of mental wellbeing as opposed to just looking at correcting what is perceived to be 'abnormal'.
The idea of philosophical counselling does sound worthwhile. There was a tradition of pastoral counselling but this was often in conjunction with a religious or spiritual approach to human life. However, idea of philosophical counselling could be much wider into the examination of human values, which would be compatible with the person-centred emphasis on values and human meaning.
Psychiatry may still be seen in a negative light insofar as it involves treatment to 'normalise' people. Often, the medications given have problematic side-effects. Nevertheless, many people do seek medication, especially antidepressants and sleeping tablets. It is often a combination of medication and talking therapies which may help. There is a move towards online therapies and my own feeling is that the online approaches may help some people. Nevertheless, the experience of being listened to by a human being may part of the essential experience of therapy.
that's usually what the professionals recommend, there are those who believe that the medications may have more of a placebo effect than a "correction of chemical imbalance". There doesn't seem to be any evidence that SSRIs correct neurotransmitter imbalance.
Your reply is important in pointing to the way in which the philosophy of mind is inherent to psychiatry. It may be asked to what extent can the 'cure' be found in the body? It is complex because the brain and nervous system are the centre of experience but influenced by so many factors, especially issues of beliefs and construction of meaning.
Are they beyond the reach of the body (by-products)?
Agreed. I propose that some measure of that is because of the focus upon diagnosis organized around saying what is wrong with a particular patient. There is also the politics of care or the lack of it.
Psychology is a part of that dynamic too but provides a better background to address your concerns. The different approaches to treatment grow out of models of human development. The range of differences between Freud and Vygotsky, for instance, are attempts to say where the "normal" comes from. The shift in treatment you observed in your comment to BC ultimately hinges upon models of development.
One work that vividly captures that dimension is Jung's On the Nature of the Psyche. When read by itself rather than as a component of a greater theory, it shows a caregiver suddenly coming face to face with individuals and asking: "What the hell is going on here?"
Talk therapy in conjunction with medication is best practice for neurotic disorders, I believe?
But I'm not sure how quantifiable the benefits of, say, anti-depressants are. There is no causation established, but despite not knowing why, exactly, anti-depressants help, there are clearly documented positive effects. One of the best arguments for an anti-depressant is that it can provide a 'window' of improved functionality. Timed correctly, ideally supported with counselling, a depressed individual can take actions during this window to improve their mental health that would otherwise be unavailable.
But when it comes to psychotic disorders? Medication is hugely important. We have a controversy here in Canada regarded a schizophrenic man, high risk to self and others, paranoid delusions, who was not forced to take his meds (as he had been, previously) and who later killed a number of festival goers with his vehicle while in a psychotic state.
I know that as a population, mentally ill people are at a higher risk of being victims than perpetrators, but that generalization does miss high-risk populations.
Personally, mandated medication saved my schizophrenic brother's life. Obviously, this is a morally complex subject. And the side-effects that Jack references are pretty severe with anti-psychotics, which is another disincentive for high-risk individuals.
Is it morally justifiable to compel psychotics to take their medication? To what degree is a psychotic individual responsible for their actions?
There are obvious "documented positive effects" for alcohol, heroin, and tabacco as well.
James Davidson Hunter's "The Death of Character: Moral Education in an Age Without Good or Evil" has been less influential, but deals with the wider effect of the "therapeutic" ethos, along with Dewey, Maslow, and Rogers profound effect on education.
Hunter does a pretty good job showing just how far psychology has penetrated into cultural institutions at least. For instance, he pairs texts prepared for Girl Scouts in the first half of the 20th century versus the 1980s, and a range of texts from the late 1700s to early 1900s versus those after 1970, showing how radically they have changed. The framing of ethical life is his focus, and this shifts radically towards the procedural ("values clarification"), while psychological terms like "self-esteem" and "self-actualization" take on a central role, while a explicit moral framing of "character" largely vanishes (although, pace Hunter, I would argue this older framing had already badly atrophied since 1500, and was essentially incoherent by 1900, and this is why it was banishedafter all, what does "don't cheat because it isn't [I]morally[/I] good" even mean?). An interesting finding he documents is that different worldviews (broken into: expressivist/emotivists, utilitarian, civic humanist, conventionalist, and theistic) are the strongest predictors of ethical decisionmaking (or at least, given how this research is done, simulated decisionmaking); moreso than race, class, sex, etc.
Certainly, psychology played a very large role in philosophy and culture more broadly. A criticism I'd like to point out here is that psychology, like economics, is not metaphysically neutral. Aside from empirical work, it provides an interpretive lens for how data is interpreted, which is based on ideals dominant in the field. This sort of philosophical backdrop, which one might describe better as a "world-view," "social imaginary," or even a "religion" (as in, the widest possible interpretive lensGod normally makes no appearance) obviously tracks with what is dominant in the culture, but even more so it tracks with what is dominant in the academy, which can drift quite far from the mainstream culture, or even between disciplines. But because the academy has had a huge influence on education (the key organ is socialization and indoctrination in Western society) there is a sort of feedback loop here, where the values of the academy make it into the wider culture. Our lexicon is chalk full of therapeutic terms today.
Hence, you can get prior philosophical (or almost aesthetic) commitments driving the ship in some ways. This is perhaps most obvious in the situationist critique against personality, character, etc. in social psychology and sociology, which centered on a philosophy that wanted dissolve the subject/individual (one might suspect, for largely philosophical reasons). Lo' and behold, programs when curricula loaded with texts that claimed that the illusory nature of the individual must be overcome also discovered that it the individual was illusory. And yet, this area later became ground zero for much of the replication crisis, and some of the claims it made for things like "priming" are, in retrospect, the sort of thing that should have rung alarm bells in the same way claims of psychokinesis do. But it was in line with fashionable and politically relevant dogmas, so it didn't.
What's also interesting here is how far different, related fields can diverge, social psychology and economics (which tends to absolutize the atomized rational actor) being prime examples. Social psychology might say the whole of economics is built on the fundamental attribution error.
I guess a difficulty here is that the tendency in philosophy to want to "defer to the sciences" can miss the ways in which the sciences are themselves often built on particular philosophies. And the more dominant and philosophy is in a science, the more transparent it becomes.
Quoting Jack Cummins
This is misleading. All experiences are subjective and all behaviour is objective.This applies to the experiences and behaviour of clinicians and patients alike.
The medical model belongs in the first instance to the clinician, internalised into her subjectivity as a way of seeing a patient. 'Patient' is thus an identity and social role projected onto the other, which he may accept or resist. This will inform his behaviour, and thus in turn the clinician's diagnosis. Hence resistance to the authority of the clinician is commonly regarded as a symptom of mental illness, sometimes called 'lack of insight'.
Nobody must question the medical model, because it is a scientific model. Scientists are objective and therefore mentally healthy.
Quoting unenlightened
There are those that have benefitted under the medical model, which would mean that the medical model should not rejected entirely. But accepting your position that the medical model ought be subject to question and not accepted uncritically, what alternative do you propose for those suffering psychologically.
The question is, how exactly have they benefitted under the medical model.
The medical model probably helps those who already believe it.
It can also help in a "reverse psychology" kind of way, in that it helps people realize that the only thing worse than their suffering are the medical methods that are supposed to alleviate that suffering.
Well the immediate alternative is a social model. Rather than that you have got the imaginary pathogen of depression leading to the wrong chemicals in your brain, we would start from the idea that you are manifesting symptoms of a dysfunctional social matrix, such that you are being blamed for something that you have no control over, perhaps, or some other toxic relationship.
The late David Smail has developed this sort of model and written some nice books, and there are some other folks with related approaches that I might remember tomorrow.
Yes. I was waving toward that in my comments above concerning the world of the "patient."
I see some hope from the developmental conception side where there is a big world outside of the industry of the practitioner.
As far as assigning blame goes, there is a parallel dynamic in the practice of law in shifting sands of what it stands upon.
Edit to add: The two sides have some unsightly hook ups on a regular basis.
Quoting Paine
Not if you include psychotherapeutic models like the person-centered approach founded by Carl Rogers , or cognitive therapies influenced by constructivism and social constructionism.
Szaz stood outside of the community of practitioners and called a pox upon all their houses. Liang was more of an 'ordinary language' protest to the accretion of diagnostic hierarchy. They annoyed practitioners for entirely different reasons.
Rogers was a well ensconced practitioner in the discipline of "organizational psychology", hardly a voice from the wilderness. Let me leave off from describing Liang other than to question his generalities.
Quoting Paine
Are you referring to R.D. Laing?
Yes. Dyslexic spelling.
Rogers agreed with Laings rejection of the traditional medical model that treated patients as cases rather than persons. He also appreciated Laings insistence that psychosis could be understood as a meaningful experience, rather than simply as a disease process.
In A Way of Being (1980), Rogers recalls how the antipsychiatry movement (Laing, Cooper, Szasz) echoed, in its own way, his own belief in the primacy of the subjective experience and the destructiveness of authoritarian institutions.
There are many other practitioners who agree and the importance of theories of development is that such views held by many are meaningless theoretically.
The acknowledgement of a defect is not a theory in itself. It is new theory that leads to new treatments. Rogers wants his seat at the diagnosis table.
I do think any method that is effective should be tried, and it might be that much unhappiness arises from dysfunctional social situations. But what of those that are well beyond that, like the schizophrenic, extreme cases of borderline, suicidal, seriously addicted. I don't feel any particular need to protect the psychiatric industry, but I'm not so willing to throw it out for all people if it has proven successes.
I am rather surprised that you challenge questioning the medical model. Also, I am not sure about your division between experience as being subjective and behaviour as objective.
As far as the medical model is concerned it is bound up with values, especially of what is 'normal' or acceptable. This involves ideas and what counts as delusions. For example, religious and spiritual ideas. The cultural context is important. Similarly, ideas of acceptable behaviour are socially constructed. The medical model and science are established by underpinning values, rather than being value free.
With difference between experience and behaviour, the fine line may be the interaction between experience and behaviour. Experience includes thoughts and feelings, whereas behaviour is about how a person acts in regard to thoughts and feelings. For example, a person may experience intrusive thoughts of suicide or harming others and what is critical is the perceived risk of a person acting out the intrusive thoughts.
How a person understands experience is important in itself. Interpretation of experience is not merely subjective because it involves others' understanding, which in turn affects subjective experience.
What is a proven success in this context? If one takes the view of the addict, a steady clean supply is success, but others might consider drug free life to be success, although the latter might then consider a steady supply to be success in the case of the schizophrenic or the suicidal.
From a social perspective, I think success would be more like finding a social niche where the 'illness' becomes an asset. A schizophrenic would be suited to a career in shamanism, communication with the dead, or some other blue sky thinking - fine art? For the paranoid, a job with security, perhaps; for the anxious, health and safety. (I speak of jobs and careers here, not to recommend that organisation of society, but simply because that happens to be the current socially recognised mark of success.)
Evidence about medication is important. It is a complex area because it involves quantitative and qualitative evidence and both subjective experience, as well as observations of others about a person's treatment. With any medication, there is an issue of placebo effects, but this would not explain the full impact of SSRIs as with any other medication. Part of the problem with forms of meditation is that effects do differ from individual to individual, which may say more about what is unique. Advances in neuroscience may help in tailoring medication.
If anything, it may be that medication is being prescribed or sought as a shortcut. I do take SSRI(Fluoextine) medication myself. I requested it when I was feeling very low in mood. If I stop taking it, sometimes I notice a difference and sometimes not. Mood is affected by so many variables, including overalk physical wellness and factors in life.
The shifts between different models of mind and behaviour is where philosophy and psychiatry is an important interface. I have read Jung and I often wonder what is going on my own psyche, as well as trying to understand others' experiences. How causation of thoughts and agency is significant.
Apart from the issue of how a person behaves in response to thoughts there is also the question how does thinking and feeling differ in itself? Feelings may be connected to the body more whereas thoughts with cognitive brain processes. However, the brain and thinking cannot be split off between body and 'mind'/brain as they are interconnected in a dynamic way. This is the case in differing models. In neuroscience, the chemistry of thought is intricate. Within psychodynamic theory, the conscious and subconscious are not completely separate too. But, the understanding of thinking and feeling does differ so much according to perspectives. I wonder to what extent psychiatry training includes philosophical reflection on this complex area.
The perceived risk is the subjective experience of another, of the person in question's behaviour. Are you claiming that the experience of the 'expert' is objective?
Hearing voices is fairly common, and not necessarily problematic for the individual or society.
https://www.hearing-voices.org/#content
So I suggest that intrusive voices speaking of violence are sometimes made intrusive and violent by being suppressed and ignored. My first advice to someone who hears voices would be to be very careful who they talk to about them, and then to listen and respond to their voices respectfully. One rationale for this is that they are part of the person who hears them that they haven't fully integrated; some people find their negative feelings unacceptable but undeniable and so project them into the ether as some 'other' within the psyche. And sometimes, it is just the way they think about things.
But such a tendency can also be an aid to creativity, such as the novelist whose characters are sometimes perceived by them to have their own views on where the novel should go. So again, the social aspect and the external assumption that there is a problem is a large part of the problem.
Shamans impose themselves on others though, burning smoky sagebush and spitting magic liquid. I find them as annoying as you find psychologists.
But, sure, to the extent we can find jobs for the schizophrenic, let's do that. Many end up on the street, institutionalized, or heavy burdens on their family. To the extent there might be a cure or at least a way to mitigate the behavior to help them function in society, it ought be pursued.
Keep taking the tablets! Annoyance is a serious and distressing condition, but it can be controlled with the appropriate medication. Have you read Brave New World?
I tried SSRIs a long time ago, but the best positive effect they had for me was i felt a little calmer and smoothed out. There were multiple side effects, but the only one im willing to mention is it seemed to make me want to engage in other recreational drug behaviors more than when im not taking them.
As far as you and my high school teacher are concerned, I did. You might be throwing the baby out with the bath water with your complete rejection of psychiatry. Maybe you've got a personal story there.
Are you arguing that anti-depressants have no positive effects? Alcohol and heroin are demonstrably bad for one's mental health. Anti-depressants are not so even if associated benefits are a placebo, is there a problem with taking / proscribing them?
Tobacco is interesting - I've seen studies that suggest smoking is beneficial for the mental health of schizophrenics.
Talk of 'chemical imbalances' is perhaps outdated? I don't think knowledgeable proponents of medication use such language anymore?
Quoting Count Timothy von Icarus
Is this not already happening? I see some conflation between "living a good life" and "being a good person" already in wellness circles?
Quoting Count Timothy von Icarus
Very interesting. Jessie Signal's "The Quick Fix" looks at a lot of the issues you are outlining here. Certainly, the idea (as argued in a rather infamous study) that mere exposure to the concept of aging would 'prime' study participants into walking more slowly in a hallway reads closer to psychokinesis than science.
Quoting Count Timothy von Icarus
Greg Lukianoff and Riki Schlott describe a scenario in which male teens seeking counselling were instead provided lessons on 'toxic masculinity', which seems in danger of violating the 'first, do no harm' principle.
I share your skepticism of a philosophical 'gloss' being placed on concepts of wellness. But can you see a role for a robust philosophy helping to 'reign in' the excesses of psychiatry, or other social sciences? In Oliver Keenan's book on Aquinas, I recall him insisting on the value of discrete disciplines, and that if theology is going to offer anything to the other disciplines, it will do so through theology first? Can philosophy take on this role?
Quoting unenlightened
This does seem to be a problem, despite psychiatry being in its infancy as a discipline when compared to medical science, or other sciences. Does recognizing the limitations of the medical model address this problem, or do you see the model itself as the problem?
Quoting Joshs
There are certainly some people who have 'learned to live' with their voices. But generally, when I hear this idea, I am left assuming that proponents don't actually know a lot of people living with psychosis. Not that my experience of friends and family with psychosis is anything more than anecdote, but even if the communication I experienced with my brother was 'meaningful', it was certainly degraded and impoverished when he was psychotic.
I don't think this concept needs to be discarded - I certainly did see 'meaning' in some of my brother's obsessions and paranoid ramblings.
Freddie DeBoer often writes well on this subject. He fears that too often people amplifying 'learn to live with your voices' and other such messages are the most functional representatives of the disability, which can drown out those for whom their autism, for example, is not a 'superpower' but a crippling disability.
Can you provide a link to something from DeBoer on this? I'd be interested in reading more.
no, read what you quoted again
Quoting Jeremy Murray
tobacco is like coffee, it's a mental stimulant: so it's not surprising it would have benefits for schizophrenics because the source of their problem seems to be alienation from a reality they want to engage with. There were also studies suggesting that nicotine/ciggs are good for people with dementia as well, but overtime these studies are always changing in how the information is phrased: it's still argued that nicotine itself helps dementia patients, but i think the researchers argues realized the issue with damaging the body to help the mind (like is done with cigarettes, at least when it's more than a little bit every week).
Another interesting thing you might want to look into is how native americans treated tobacco: it was more social, it wasn't packaged for addiction (they didn't have the technology to do that), and i read somewhere that the elders spent much of their time smoking (because what are else are they going to do)?
As far as heroin in concerned, the origins were in temporary pain relief, and the positive effects of heroin can be rather extreme...but I wonder at what point you can use things like opioids and anti-depressants without it turning into a form of self-destruction. I have a friend who has been on various psychiatric medications for years, and hasn't been able to get off of them. It seems these medications, from my point of view (and i don't lecture him on it, even though i've gently criticized some of his other drug use) have been assisting in physical degeneration for him, even though he's a very coherent person for me to talk to.
Quoting Jeremy Murray
A disability for whom? Where and how do we draw the line between disability defined in terms of the hardships it causes for those surrounding the allegedly disabled person ( as so often happens with ADHD) and their own sense of being disabled? And even with regard to the persons self assessment, what percentage of it is made on the basis of non-conformity with the dominant culture and what part of it is truly a self-assessment? Would you agree there is a difference between someone born deaf or sightless and someone who develops such conditions as a result of injury or illness? Do you think the former consider themselves disabled in the same way as the latter?
Heres an interesting take on what Im talking about:
https://youtu.be/5Wf0CuOiWOA?si=g6RrA06FAS9LzCBe
Hello wonderer,
From DeBoer's Substack. The first is on bipolar disorder, which DeBoer himself battles. He has talked elsewhere quite candidly about the devastating impact his disorder has had on his life and career. The second is more on the media coverage, the issue of 'learning to live' with the voices and such. Number three talks to the pain of those whose debilitating disorders are 'left out' of some conversations.
https://freddiedeboer.substack.com/p/perhaps-you-would-be-a-little-touchy
https://freddiedeboer.substack.com/p/the-new-york-times-remains-utterly
https://freddiedeboer.substack.com/p/who-neurodiversity-left-behind
DeBoer has tons of other great stuff free on his Substack - on Kanye and his bipolar disorder, for example. Given DeBoer's personal connection to mental illness, I think DeBoer on mental illness is maybe DeBoer at his best, although I believe he is more known for his writing on education.
There are definitely negative consequences for some psychiatric meds. Weight gain is obvious, but the worst outcomes I've heard described are from people on anti-psychotics who say they 'no longer feel like themselves'.
Johann Hari's "Stolen Connections" talks about the consequences of indefinitely taking meds that were designed as short or medium term, along with the dangers of 'medical-only' interventions. He positions mental illness as tripartite, with heredity, biology and social factors all critical components of mental illness. I agree with Hari here, and think his model points to realms that meds can, perhaps, assist with.
Obviously, plenty of things matter that are outside the realm of medication. It would be insane to argue that a pill can cure trauma, bereavement, alienation.
Does your friend wish to quit meds? Do you see the meds as the cause of his 'degeneration' or are they more a part of a causal whole?
Quoting Joshs
Key questions. I think psychosis is a fairly clear dividing line - when an individual is interacting with an environment different from physical reality, responding to stimuli not 'seen' or 'heard' physically, they can become a threat to themselves and others. And this is a 'visible' benchmark, in most cases, at least over time.
So psychosis sets aside issues of, say, non-conformity to me.
I do think there is a difference being born and becoming sightless, and that those groups would, and do, view their disabilities differently. My ex was an 'audio-describer' for the visually impaired, and also worked with some in the deaf community on film projects. She often talked about these identities as 'different' rather than impaired, as do some within those communities - people born deaf who refuse cochlear implants, for example.
This is entirely fair, I just don't think it captures a full enough picture. Neurodiversity is simply too
broad a category. There is not enough commonality between severe schizophrenia and mild to moderate autism, for example.
I draw a hard line between psychotic and neurotic illnesses myself on these sorts of issues, and think neurodiversity a more valuable concept in the neurotic realm.
Quoting Joshs
I agree that this can be problematic, but that doesn't mean that some neurodivergent people don't want or need treatment.
I oppose insisting on it. The only 'forced' medication I feel comfortable with is psychotics who pose a danger to self or others.
And possibly addicts deemed threatening, although addiction is a different can of worms.
:up:
I would like to again underline a difference between psychiatry and psychology. A psychiatrist is a medical doctor. Think of her as a gathering place of different streams of research. That runs the gamut from neuroscience, genetics, pathology of diseases, drugs and their effects, etcetera. That doctor is also a gathering point for streams of psychological research. The psychodynamic is but one of many and they vary greatly upon what they build their models upon. Consider this search page of models of human development psychology. If you go down a few of the pages, you will start seeing reference to the big names of the twentieth century.
The social dynamics Vygotsky introduced has expanded into many other ways looking at environments where the individual emerges.
The research of therapies involves the range of such models but also performs researches of therapy as such. That is where the Boulder model comes in. Practice and theory are necessarily connected but also always apart.
I think, at least for now, the medical model is inescapable. But perhaps we can at least keep an awareness of some of the questionable features. First off, I would like to raise a question with you about "medical science" This is something necessarily very different from "medical practice", simply because the science deals with generalities and statistics, whereas practice consists of individual relationships. The practice must serve an ethic of medicine laid out by the hippocratic oath, and the science can only put that into temporary and strictly limited abeyance with the informed and competent consent of patients, without which one has something akin to the nazi experimentation of a Mengele. In the case of mental patients, this becomes highly problematic, obviously. One should bear in mind that 'good science' can be evil, when conducted on living beings.
Quoting Jeremy Murray
I cannot comment on your brother from this distance, but when someone is in the middle of an episode - schizophrenic, psychotic, or whatever - they are a long way away from the mundane world. In fact it is the incomprehension of others around that constitutes the manifestation we used to call 'madness'. One can see a person who is in distress, and yet one cannot reach them or comfort them. And that is distressing to others. I don't want to diminish the pain of these things for the individual and their family, and eventually, very often, something has to be done.
One of the things that often happens in these situations is that the individual in question is so agitated that they hardly sleep for days or weeks, and as a result, the people around them cannot sleep properly either. And so many of the crisis interventions basically address this problem by various tranquillising and soporific drugs. Sometimes one cannot persuade the person to take the drugs, and involuntary treatment occurs. It should though be troubling to all concerned at least; a mark of failure and desperation, rather as when the lifeboat is overfull and near to sinking one must fend off others from boarding and drowning all.
Hello unenlightened, I agree with you here. I think it entirely worthwhile to keep the limitations of science generally and brain science specifically in clear view. I find the skeptical stance empowering. It is far too easy to differ to external expertise as a person with depression, which can worsen the embodiment of 'learned helplessness'.
I face this problem myself but if I refer to anecdote, I only do so as they are illustrative of a larger population facing the same problems. Being depressed does give me a 'unique' perspective but it by no means makes me an expert. Social media is certainly empowering people to self-identify as experts, based simply on their 'lived-experience' which further complicates the role of 'experts'.
But I do think there are 'experts', as long as we acknowledge that this is a highly speculative discipline, a good portion of which is social science. In the medical context, these 'experts' are confronting issues that are, in addition to biology and heredity, socially and culturally embedded, factors literally beyond their control to address.
But if we overstate the insights 'experts' such as these can offer, we do run real risks, as you outline. And I do think we overstate these insights.
Quoting unenlightened
Good point, irregular sleep and other habits are further fuel on the fire of psychosis.
Involuntary treatment is deeply concerning, but I believe it has an obvious role to play in highly specific situations.
In many cases, a forced treatment of anti-psychotics will alleviate the psychotic state. The argument here is that this window provides the opportunity for 'informed consent', and there are plenty of people with schizophrenia who identify this as a positive event for them. This was the case with my brother, but his experiences also involved my family in the schizophrenic community in my hometown. My father ran a support group for family members. My brother had friends with schizophrenia. A lot of people want to try anything to get better. Psychosis can be terrifying.
My brother was violent with my father twice, the first time, we called the police hoping for an involuntary committal and he was able to convince the doctor that he was rational - not uncommon for certain schizophrenics, to be able to produce short windows of rationality during psychosis. He was violent again, committed and then, better, a couple of weeks later.
But he battled side-effects from these drugs the rest of his life. People reporting that they are 'not themselves' when medicated is an enormous concern. Again, just using anecdote to illustrate common issues.
Certainly, you can at least argue that people who have never been medicated are incapable of informed consent?
Also, I think it is impossible to deny that certain mentally ill individuals pose a threat to themselves, and most importantly, to others, and we therefore have a responsibility to involuntarily commit and treat them. The fentanyl crisis and the pandemic have dramatically worsened problems of homelessness, addiction and mental illness in marginalized (and mainstream). I fear a traditional 'due process' approach that made sense prior to the explosion of these problems, and the skyrocketing strain on existing systems, no longer does. There needs to be stronger mechanisms for identifying high-risk individuals and mitigating that risk.
That said, I'd be happy to hear critiques or disagreements!