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Author Topic: Epistemology & Psychiatry (Popper & Szasz)
Dan_Frank
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So, since the Trayvon Martin thread is still active with on-topic discussion, and Destineer and I have been on a tangent for like five pages now, I finally decided to move it to a new thread to spare everyone in that thread from having to scroll past our insanely long posts.

You're welcome! [Big Grin]

Anyhoo, Destineer, here you go:

quote:
Originally posted by Destineer:
Thanks for the interesting replies, Dan. Here's a book in response (I wish I could write papers as quickly as I write posts).

quote:
However, I think your dismissal of the second explanation is hasty. To addres your specific example: Does sexual molestation cause a brain disease? Some people who were molested as children forget/suppress the experience, right?
If 'disease' were synonymous with 'infection,' you would be quite correct. But heart disease is not normally an infection of the heart, for example.

A better analogy is probably with diseases that come about through stress on the body. In college I developed bursitis in my left hip, from over-stressing it through competitive fencing. There was no infection in my hip, nor would it be right to say that I developed a chronic condition. Yet what I had was a disorder, developed as a result of mistreatment of my body, and requiring treatment from a doctor and physical therapist.

The analogy with mental illness should be obvious. Like the joints, the brain can be "injured" by mistreatment or misuse. The illnesses that result from mistreatment or misuse are quite different in their source and effect from the type that occur through infection or genetic predilection. Which explains why the methods of the psychiatrist differ from those of the neurologist, at the present stage of medical science.

Neither I, nor Szasz, are saying that people's moods, like bursitis, can't be helped with therapy and superficial, symptom-managing medication.

Though I actually think your likening it to something like bursitis is fabulous, the more I think about it!

In the case of bursitis, the only long term treatment is essentially rest and physical therapy. The only thing that medications like anti-inflammatories can do is manage symptoms on a daily basis. The problem will still persist if you don't actually rest and retrain your joint. Right?

And depending on things like how well you've trained yourself to tolerate pain, medications may be more or less necessary on an individual basis. How would you feel about a doctor who told you that the correct treatment for bursitis was a daily cortisol injection for the rest of your life?

What about a doctor who told you that if you disagreed with those cortisol injections, and wanted instead to exercise your hip to strengthen it (or simply wanted to live with the pain), you would be imprisoned and forcibly injected with cortisol for your own good?

Some of Szasz's biggest objections by far with psychiatry is in their ability to imprison people against their will, and their monopoly on numerous drugs. I'm curious: Do you disagree with him on those points as well, or only on his broader philosophy re: mental illness?

On a deep level, bursitis and actual diseases like syphilis or pneumonia have really fundamental differences, because the entirety of an ailment like bursitis is manageable and correctable through behavior. If you know how to take it easy and how to exercise your joint, and you either have trained yourself to have excellent pain tolerance or you have an ample supply of anti-inflammatories/pain relievers, you can fix bursitis without any external help.

Right? If you know the right behaviors, regardless of any medication you ingest, you have a 100% chance of recovery.

To fix your syphilis yourself, you need the cure. Full stop. To fix your pneumonia yourself you need a pathologist to determine the type of pneumonia, and then, again, you need medication to fight the bacteria, virus, fungus, etc. that has caused it. Or you can let your body fight the illness and hope it wins.

You can't beat syphilis or pneumonia solely with your mind. But with bursitis, you essentially can, can't you? (My knowledge of bursitis specifically was limited, by the way, so I did a cursory google search. It seems similar to arthritis and other chronic aches, so I've gone from there. Let me know if I've misunderstood the condition)

A related problem that arises from consistently elevating mental problems to the sphere of "disease" is you get psychiatrists making really preposterous claims like "you can't overcome addiction by yourself," or even "addiction cannot be overcome," full stop (they say "cured" instead of "overcome" because they're couching their assertion in the language of disease, of course).

These are assertions of supposed scientific fact, and they are blatantly, obviously falsified: there are people who have done precisely what they assert is impossible, and only through various contortions ("they could always have a relapse, and the fact that they died without relapsing doesn't prove anything") can anyone claim otherwise.

I'm writing a lot but I very much want you to answer my question much further above, about whether or not you largely agree with me and Szasz re: involuntary treatment & monopoly on drugs. And of the two, involuntary treatment being the far more important.

I reiterate this because it really is paramount in the discussion to Szasz and I. If these things were taken off the table, the degree of importance the discussion would have would decrease dramatically.

For example, I think that many other areas are pretty rife with pseudoscience and scientism (like nutrition, neurology, and any other field that makes a habit of ascribing genetic determinism to behaviors) but those are all more trivial because they generally aren't being used to justify state-mandated coercion. That's important!

Now, getting back to the discussion: The bursitis analogy is definitely imperfect, but I think the places it breaks down shake out more on Szasz's side.

For example, repeated incidences of bursitis can probably result in an overall degraded joint. So my previous comment about 100% recovery was only correct in the sense that you can achieve 100% likelihood of X degree of recovery, not recovery of 100% joint efficiency.

I don't think there is nearly as compelling evidence that mental illness necessitates a permanently degraded mind. Minds are highly versatile and adaptable, and can overcome far more barriers than our bodies, on the whole.

Deutsch would put it this way: brains are universal computers. Are you familiar with his arguments to this effect? I'm not terribly good at computational theory, so I'll probably butcher the explanation. I'll admit that I accept it as basically true on a (lower?) practical common sense level than Deutsch does, because that's the way I tend to think.

As I understand it, he's essentially just saying that we're theoretically capable of creating any knowledge or idea. Anyone who is capable of abstract thoughts like language and epistemology is demonstrating universality, and so they potentially can create any idea. I don't know if you have strong arguments against this, mild quibbles, or general agreement, or what, but I'm sure you'll let me know. [Smile]

Anyway, if they can create any idea, they can also, in theory, change any idea (or behavior!), can't they? There's no fundamental law of physics preventing this, right?

Oh, I think this is going to segue nicely into the next snippet of what you said, so let's continue! Also, for clarity, I think I'm moving further away from Szasz in this line of thought and more into Deutsch's version of Popperian philosophy.

quote:
Originally posted by Destineer:
quote:
So either molestation causes an infection in our brain (and I think a substantial burden of proof would call on anyone claiming that) or our minds are sufficiently powerful to actively do things like suppress memories, all by themselves, without clear, explicit, active effort on our part.
I'm trying to parse out why you focus on "clear, explicit, active effort" here. I gather it's because, as you've mentioned previously, you think mentally ill people should be held responsible for the behavior we typically count as symptoms of their illness. So what I would call their "symptoms," as you would have it, must result from decisions on their part, albeit decisions that are unconscious, in the sense that they don't feel like they're making these decisions. The symptoms may feel involuntary, but are in fact voluntary.

I dispute this. I think that, at least in many cases, the symptoms of mental illness can be involuntary.

Think about the manic person's memory loss. The question of whether this is voluntary is really very much the same as the question of whether he should be held responsible for the resultant behavior. I tell the manic guy, "Remember to turn off the nuclear power plant tonight, or else it'll melt down." With manic confidence, he says, "Of course I will!" Of course he forgets, and hundreds die. Do we hold the manic guy morally responsible for those deaths?

Well, from his conscious perspective, it didn't feel like he made a decision to forget to turn off the plant. The best explanation for why he forgot has to do with the fact that he was manic, and the best explanation for *that* is probably that bipolar disorder runs in his family, and maybe there was some event that triggered this particular episode. The reasons why he did what he did were things he had no control over: the genetic predilection, and maybe the triggering event. So it seems ludicrous to hold him responsible.

Tourette's is an even better example for this purpose. Should we hold people with Tourette's responsible for the stuff they say? Do they *decide* to say those things? To them, it feels like a compulsion. Like a reflex, if you will. Analogy: someone makes a loud noise, startling me, and I drop the vase I was carrying. Did I decide to drop it? No. Dropping it was my behavior, it was something I did, but it was a reflex, not a decision.

So, I'm going to try and integrate my understanding of universality with some of what you've said here. Let's see how it goes!

First, a little parallel tangent based on the last bit you said, about dropping the vase.

People can train themselves to react differently to loud noises, right?

I know he's fictional, but I've been re-watching early seasons of Burn Notice lately, so I'll use Michael Westen as an example. I think there's a high likelihood that if he heard a loud noise, he would suppress his impulse to drop the vase, duck down, try to identify the source of the noise, and probably grab his gun with his free hand. While still holding the vase.

Again, he's a fictional character, but there are real people who can train themselves to react differently than normal like this, right?

So despite the fact that reacting by dropping the vase is a "reflex," that is, a natural, unconscious decision, it's still a decision you have some control over.

People have control over their reactions to stimuli. Even if I accept a genetic predisposition for mania (which I don't necessarily do, more on that later), you also spoke of a "triggering event." Isn't it possible to not react to the triggering event in a way that would bring on mania? Is there a consistent test for inducing mania in all manic people, or is it a subjective mental reaction on the part of the manic person?

This also relates to some stuff I hinted at before regarding drugs, actually. I mentioned that when treating bursitis you either need anti-inflammatories and pain meds, or you need a high pain tolerance.

Pain tolerance is a mental ability that can be increased by acts of the mind. Some people don't take advil for headaches, some people do, because of different pain thresholds. Some people like certain amounts of pain and use pain when having sex. Some people only like certain kinds of pain when that pain is on their tongue and called "hot." Etc.

I think this likens easily to medication in relation to mental illness. Medication provides stimuli, and often times people have relatively consistent reactions to specific stimuli. For example: alcohol and reduced inhibitions, or MDMA & euphoria.

But neither of these reactions are universal! People can react differently, and not just on a personal basis but on a situational basis. I used to act traditionally "drunk" when I got drunk. I don't anymore. I haven't been drunk in almost a decade, but the last few times I did I still experienced the altered perception (in terms of vision, physical coordination, etc.) but not the altered mental state. This isn't remotely unique to me!

There are some other semi-rare examples of people not experiencing much in the way of lowered inhibitions or other altered mental states, just the physical symptoms of alcohol.

Moreso, I've seen several studies showing people acting drunk after drinking non-alcoholic beer they thought was real. And instances of people making calculated decisions like getting drunk "to lower their inhibitions" so that they can then sleep with someone they are interested in or similar. At that point they're quite obviously and straightforwardly utilizing the altered perception as an excuse to engage in an activity they already wanted to do and could have done with or without alcohol, given enough willpower.

Do drugs convey thoughts to people? That sounds an awful lot like telepathy, to me. I don't think drugs have a lot of information in them. I don't think a drug can give someone a thought like "take off your pants." The person already has that idea somewhere, the drug simply activated it in some way. Drugs are altering perception, but it's still fundamentally the individuals ideas about that perception that are causing them to take off their pants.

And those ideas can be changed, like any other idea.


quote:
Originally posted by Destineer:
quote:
To the extent that people's mood and feelings can be manipulated by drugs, which is certainly a real phenomenon and just as certainly not a universal phenomenon, specific drugs can produce relatively consistent reactions in people. The fact that MDMA generally causes feelings of euphoria, coupled with the idea that euphoria is generally a "good" feeling, is not prima facie evidence that people are suffering from an MDMA deficiency. Right?
Of course not. But as Szasz's opponent in this debate has pointed out, drugs like antidepressants and lithium have vastly different effects on mentally ill people. A depressed patient who takes Prozac will likely notice a dramatic improvement in symptoms. A mentally healthy person who takes Prozac will likely notice nothing, except maybe the drug's side effects.
Oops, I think I got ahead of myself above, because I addressed some of this. I'll maybe reiterate myself a bit, but here goes:

So, even in people who take MDMA, reactions are not universal. That still doesn't mean people who react differently to MDMA are the only ones who don't have an MDMA deficiency.

It could, if I was a psychiatrist deciding what goes into the DSM, couldn't it?

I could say that the natural, normal state of people was a state of euphoria, and 90% (or whatever) of people have an MDMA deficiency, and the way to test it is to give everyone MDMA. The people who trip out and have horrible experiences already had sufficient MDMA in their brain, everyone who experienced euphoria should keep taking it.

Obviously this is absurd. And psychiatric guidelines for deviant behavior are largely based on our social norms, so they rarely seem this absurd to us (unless we look at previous assertions, like the Szasz's favorite, oft-mentioned examples of masturbation & homosexuality). But aside from being absurd to our morals, is there a fundamental principle differing from the MDMA-deficiency model and, say, the guideline for depression?


quote:
Originally posted by Destineer:
quote:
Characterizations of Popperian epistemology as Falsificationism are, to put it bluntly, gross misunderstandings.
Of course I'm aware that not every sort of knowledge falls under the rubric of 'science' for Popper. How else would he know that the falsifiability criterion is the right one to demarcate science from non-science, since that "hypothesis" isn't falsifiable. I guess I was assuming you thought memetics was a science. That's certainly Dawkins's position, and I thought it was Deutsch's as well.
Interesting, it seems like a theory of epistemological knowledge transmission to me. Does this get back to your reducing knowledge to the basic brains-firing-neurons biology? I think that's a form of science, but the important questions about knowledge still seem philosophical to me, not neurological.

I see memes as ideas that pass between people at a cultural level, for good or ill. Deutsch coined the term "static meme" for particularly pervasive memes that have developed lots of ways of confounding or deflecting criticism. For example: Western culture's concept of romance. (Oh, chasquido! Dan attacked romance now! No pitchforks, please.)

quote:
Originally posted by Destineer:
In any case, this gets to one of my major objections against Popper: he thinks that Science is a very different sort of inquiry, different in kind, from other ways we have of learning about the world (Science requires falsifiability, other ways of learning do not). I disagree. It's obvious to me that the scientific method is simply an organized way for many people to go about learning things the same way we individually learn things throughout our lives, by forming explanations for empirical evidence.

I don't think I got it in me to argue broad epistemology, brain universality, psychiatry, and induction in one sitting! But this does sound sort of inductivist. Is that fair to say, or would you object to that characterization?

All I'd say for now on that is that the simple act of gathering empirical evidence (what inductivists would call induction) requires pre-existing epistemology, conjectures, and explanatory power. So it's not just forming explanations for empirical evidence, it's making theories and creating ideas, gathering evidence, and using your existing ideas (or making new ideas) to explain the evidence.

Make sense? Oh, of course it makes sense, because of what you say next!

quote:
Originally posted by Destineer:
quote:
Now, meme theory, at least insofar as Deutsch uses it (full disclosure: Deutsch and other Popperians are my only exposure to meme theory, as I actually haven't read Selfish Gene yet. *ashamedface*), is about the implicit transmission of ideas. It's not really an empirically testable scientific theory. At least, not without doing some epistemology first. Why do I say that?

Because in order to understand any results you gathered scientifically, you first need a good grounding in epistemology and other nonscientific theories by which you can explain your results. When you present interpretions of data (that include things like moral and epistemological judgments) as if they were empirical fact, you're practicing what Popper called Scientism (link is another good, short essay by Elliot Temple).

Of course, it's absolutely true that epistemology is prior to science. You need to know how to learn things from experiments and theories before you can say what you've learned. I will even grant that psychologists (esp evo psych types) can be very bad about smuggling in hidden assumptions!
I agree with you 100% here. And: yay, acknowledgment of the problem with evolutionary psychology! Do you extend this criticism to genetic determinism re: behavior, too?

quote:
Originally posted by Destineer:
That said, every scientist makes epistemological assumptions (and I think that even in physics, they go far beyond anything Sir Karl, or Deutsch, would be comfortable with). The notion that the data supported Einstein's relativity over its competitors (which also predicted the same experimental outcomes!) was an interpretation of the data that went beyond the empirical facts. It just happened to be the correct interpretation of the data. I think the same goes for many explanations in psychology.

That's interesting! I don't have enough physics to really respond coherently. Except... I think the point is that the way to address epistemological assumptions is with criticism and discussion. And I think that's something Szasz does re: psychiatry pretty well.

quote:
Originally posted by Destineer:
Now, there is a flipside to this coin: when doing epistemology, or any form of a priori philosophy, one needs to be very careful about not smuggling in assumptions that are actually empirically testable matters best left to scientists. Philosophers have been very bad at this throughout much of history! I'm not sure what you mean by the "implicit" transmission of ideas, but can you see why an assumption about how ideas are transmitted looks like something for scientists to study? Say your epistemological theory rested on the assumption that ideas are transmitted through telepathy. I think science would have something to say about that!

Sure. But I think the science in this area has huge problems too. A lack of understanding universality leads to them attributing huge swathes of behavior to genetics. Ideas (memes!) can have, I think, a lot more explanatory power and control over behavior than genes usually can. But that's probably a super controversial claim? Not sure.

I do think that in order to understand anything or have good ideas, you need a certain baseline understanding of certain broad ideas that have extensive reach. Basic physics, for example, has a lot of reach. So yeah, a basic scientific understanding that telepathy isn't real is an example of a necessary before creating any epistemological idea.

In the same vein, though, thinking, say, that people are incapable of changing their minds about anything, would be an example of a very bad epistemological assertion that would completely bar you from making lots of good decisions in numerous areas of life. In this way, basic epistemology also has a lot of reach.

quote:
Originally posted by Destineer:
Similarly, I actually think the question about whether memetics is the correct theory of how ideas are transmitted is a question for science. (Although memetics isn't falsifiable; I reject the falsifiability criterion. Theories in cosmology are also not falsifiable, but they are good scientific theories.) And there has been scientific criticism of the meme idea. For example, from the great Wikipedia:

quote:
Luis Benitez-Bribiesca, a critic of memetics, calls it "a pseudoscientific dogma" and "a dangerous idea that poses a threat to the serious study of consciousness and cultural evolution" among other things. As factual criticism, he refers to the lack of a code script for memes, as the DNA is for genes, and to the fact that the meme mutation mechanism (i.e., an idea going from one brain to another) is too unstable (low replication accuracy and high mutation rate), which would render the evolutionary process chaotic.
If this guy is right, then the empirical evidence we have shows that ideas don't undergo natural selection in the same way that genes do. Of course it only makes sense that empirical evidence should matter to this question. Obviously it matters in the case of genes! And I think we can both imagine, without much effort, how beings might be very much like us mentally but still not transmit ideas via "memes" (they could use telepathy!).

Point being: I think the notion that memetics is part of epistemology, or something to be learned through a priori philosophy (pure reason alone) is pretty hard to accept.

I'm not sure that telepathy would prevent the transmission of memes as I understand them. Why would it? If memes are just ideas, then regardless of how you communicate, ideas are still passing back and forth, aren't they?

Fundamentally, I think there are a lot of problems with the idea of genetics predicating significant personality traits and behaviors. I can go into more detail in this, of course, though...

quote:
Originally posted by Destineer:
I should perhaps say: I'm not a huge fan of this Elliot Temple guy. His articles seem to come at things from a very superficial level, ignoring loads of potential criticisms and hidden assumptions. A common habit of scholars who spend more of their time preaching to the choir than engaging with qualified critics. And sometimes it's just sloganeering! Like that Scientism article; it doesn't contain any valid arguments from premises to their logical conclusions, not that I can discern.

Shucks! I found a great example of Elliot explaining some more flaws with the idea that ideas/behaviors are driven primarily by genes, but I don't want to subject you to something you aren't interested in.

I should probably say: Elliot and I have been good friends for a little over a decade, and it was Elliot that introduced me to Popperian epistemology in the first place. When communicating he tries for maximal clarity and simplicity, so charges against him of being superficial/simplistic etc. are common but I think unfounded.

It's true that his entries on fallibleliving are very short and don't address every possible criticism, they're more there to give you a grounding in terms and the basic ideas that inform their worldview. I don't really consider that sloganeering; I think he explained what Scientism is quite well, it's just that in his example he did not present a comprehensive case. I think that's okay, as it's just an illustration and not necessarily intended to persuade a hostile audience of his position on autism.

But he spends more time arguing with hostile audiences than almost anyone I know. He's gotten into extensive debates on places like Less Wrong.

In actual conversation he tends to take things step by step, in a piecemeal sort of fashion, because he finds that is the best way to avoid miscommunication and misunderstanding. I've seen him spend half a dozen emails just to completely convince someone that they were not actually agreeing with him (saying: "no, you don't agree with me" wasn't as effective as you might expect.)

Anyway, that was probably unnecessary, but I suppose I felt the need to defend him. [Smile]

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MattP
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Wow, there's a lot to read, but for now I just want to comment on this:
quote:
Some of Szasz's biggest objections by far with psychiatry is in their ability to imprison people against their will, and their monopoly on numerous drugs. I'm curious: Do you disagree with him on those points as well, or only on his broader philosophy re: mental illness?
Szasz's focus on involuntary treatment seems like a separate discussion which I'd like to take on separately from the more fundamental discussion about the nature of mental illness itself and I wish he'd not spend so much time tying them together. Whether mental illness is "real" is a much more important issue to get through first.

I have several family members and friends who have been diagnosed with a broad spectrum of mental illness that ranges from ADHD and mild depression to borderline personality, bipolar and psychosis. None of them have been treated involuntarily treated or detained with the exception of one who was running through an airport screaming because he was convinced that he was being chased by someone who wanted to kill him - the most severe of several episodes of paranoid delusion that he experienced.

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Strider
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Seems like an interesting conversation, I wish I had the time to get involved!

I'm pretty sympathetic to both an evolutionary epistemology and aspects of virtue epistemology, the former of which Popper explicitly endorsed and the latter of which he might have been agreeable to (I think, Destineer would know better than me).

That said, while I think the notion of falsification is an important one, and fits well with my pragmatist sensibilities, using it solely as a demarcation criteria is not sustainable.

I didn't realize memetics was still chugging along. Didn't the journal of memetics shut down? I always viewed memetics as a nice metaphor, but not as an actual science, or an actual thing. I'm not sure what kind of defense could really be given for that. Again, wish I had time to dig in to this argument, I could only scan really briefly.

side note - I just recently wrote a paper using the progress of science as a case study for/defense of (a version of) evolutionary epistemology.

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Dan_Frank
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quote:
Originally posted by MattP:
Wow, there's a lot to read, but for now I just want to comment on this:
quote:
Some of Szasz's biggest objections by far with psychiatry is in their ability to imprison people against their will, and their monopoly on numerous drugs. I'm curious: Do you disagree with him on those points as well, or only on his broader philosophy re: mental illness?
Szasz's focus on involuntary treatment seems like a separate discussion which I'd like to take on separately from the more fundamental discussion about the nature of mental illness itself and I wish he'd not spend so much time tying them together. Whether mental illness is "real" is a much more important issue to get through first.

I have several family members and friends who have been diagnosed with a broad spectrum of mental illness that ranges from ADHD and mild depression to borderline personality, bipolar and psychosis. None of them have been treated involuntarily treated or detained with the exception of one who was running through an airport screaming because he was convinced that he was being chased by someone who wanted to kill him - the most severe of several episodes of paranoid delusion that he experienced.

I think the reason Szasz focuses so much on involuntary treatment is because

1) he's a libertarian and it's far and away the most upsetting aspect of psychiatry to him, and

2) he thinks they are almost inextricably linked (certainly have been linked since the inception of psychiatry through today).

That is, that treating mental illness as a disease essentially amounts to dehumanization (he would call it infantilization) because you're denying the person responsibility for their behavior, which denies that they have the basic human ability to change their behavior.

If you deny that they can change their behavior, and their behavior has the potential to be destructive, then the logical conclusion is that their behavior will be destructive, so the best thing to do would be to lock them up for their own good/the good of society.

This is a stark contrast to normal rules for incarceration, which state that someone must actually engage in destructive behavior before being locked up. Looking up a site on making homemade bombs is not enough to get you incarcerated.

---

Now, all that being said, I do agree with you insofar as psychiatry is much better about this issue in the modern age than at any time in its history. I would credit the advance of liberalism and respect for individual autonomy, but regardless of cause, it's certainly improved!

Despite being schizophrenic/bipolar/whatever psychiatrists now think she is, my sister has only ever been involuntarily incarcerated for brief periods of time, and that was usually following her breaking of some minor law or another, so again, my personal experience largely matches up with yours.

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Destineer
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I'm afraid some aspects of this discussion are becoming a bit more muddled. Let me preface my next post with a couple of things.

First, I think you're making too much of the analogy I drew between repetitive stress illnesses and mental illness. My point was simply that by any reasonable criteria, if bursitis is an illness, so are a wide variety of mental disorders. Nothing I've said entails that the types of treatment that help with bursitis should be useful in treating mental illness, or vice versa. Nor do I think there's any reason to expect this to be the case, even given the ways the two are analogous. How far the analogy extends is itself a question for scientists to study. Do you disagree?

Let me apply this to one place where I think you've taken the analogy too far, to show you what I mean.

quote:

In the case of bursitis, the only long term treatment is essentially rest and physical therapy. The only thing that medications like anti-inflammatories can do is manage symptoms on a daily basis. The problem will still persist if you don't actually rest and retrain your joint. Right?

In the first place, what you observe about bursitis only holds true at our present level of medical technology and understanding. One day, I expect there will be pills we can take (or injections, or something) that will outright cure joint disorders with no need for PT.

But more importantly, why on Earth would anyone expect that depression should require a treatment analogous to that of bursitis, simply because the two disorders result from (two very different sorts of) stress? Maybe it's true, maybe not. Again, a question for science to study.

To finish my preface,

quote:
Originally posted by MattP:
Szasz's focus on involuntary treatment seems like a separate discussion which I'd like to take on separately from the more fundamental discussion about the nature of mental illness itself and I wish he'd not spend so much time tying them together. Whether mental illness is "real" is a much more important issue to get through first.

I agree with Matt here. Since you asked, I am in favor of involuntary treatment. As I mentioned in the Trayvon thread, a good friend of mine would have died without it. But to even discuss that issue, we first need to determine whether mental illnesses work in pretty much the way psychiatrists think they do, and whether patients are responsible for their symptoms. So I'll set aside your points about involuntary treatment, for the moment at least, if you don't mind. (As far as the drug monopoly issue goes, I'm generally in favor of drug legalization, so I'm open to the idea that "prescription drugs" should be available without a prescription, as well, if the buyer pays out of pocket.)

quote:
That is, that treating mental illness as a disease essentially amounts to dehumanization (he would call it infantilization) because you're denying the person responsibility for their behavior, which denies that they have the basic human ability to change their behavior.

If you deny that they can change their behavior, and their behavior has the potential to be destructive, then the logical conclusion is that their behavior will be destructive, so the best thing to do would be to lock them up for their own good/the good of society.

I absolutely agree with this, which is why I think the question of whether they can change their behavior should be addressed before the question of whether people should be treated without consent. Because the former question is a question for science to address, and its answer will basically tell us the answer to the latter question.

Now, on to some of the points you make.

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Dan_Frank
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quote:
Originally posted by Destineer:
I'm afraid some aspects of this discussion are becoming a bit more muddled. Let me preface my next post with a couple of things.

First, I think you're making too much of the analogy I drew between repetitive stress illnesses and mental illness. My point was simply that by any reasonable criteria, if bursitis is an illness, so are a wide variety of mental disorders. Nothing I've said entails that the types of treatment that help with bursitis should be useful in treating mental illness, or vice versa. Nor do I think there's any reason to expect this to be the case, even given the ways the two are analogous. How far the analogy extends is itself a question for scientists to study. Do you disagree?

Let me apply this to one place where I think you've taken the analogy too far, to show you what I mean.

quote:

In the case of bursitis, the only long term treatment is essentially rest and physical therapy. The only thing that medications like anti-inflammatories can do is manage symptoms on a daily basis. The problem will still persist if you don't actually rest and retrain your joint. Right?

In the first place, what you observe about bursitis only holds true at our present level of medical technology and understanding. One day, I expect there will be pills we can take (or injections, or something) that will outright cure joint disorders with no need for PT.

But more importantly, why on Earth would anyone expect that depression should require a treatment analogous to that of bursitis, simply because the two disorders result from (two very different sorts of) stress? Maybe it's true, maybe not. Again, a question for science to study.

Heh, I'll generally concede that I probably took the analogy too far. I have a tendency to draw analogies out pretty far. I do think I had some legitimate points bound up in my musings, but I won't deny there was also a bit of, eh, silly navel-gazing, for lack of a better phrase.

Frankly, though, I think that the assertion that someone who has been molested has been infected with a brain disease that is outside their ability to control is fundamentally pretty dehumanizing and insulting. Maybe I should have taken that approach, but it seems more adversarial than I'd like.

Anyway, I await your next post! Though I'll be busy the rest of the night, so not sure when I'll get to see it.

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Samprimary
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I'll just import what things I mentioned before, since I do readily suspect that this is more about what you think modern psychology is, versus Szasz's analysis of what it was ó literally over half a century ago.

quote:
Originally posted by Samprimary:
if you want to provide anything at all to give any semblance of an indication about the substance of your views, I would choose to hear on what substantive basis and from what sources you have come to use to demonstrate that modern psychiatry 'defines people with bad ideas as being out of their mind.' Where does this come from. What trend is it following. What is an example of a bad idea that leads modern psychiatry/psychology into defining someone as out of their mind. What do you understand a "out of their mind" diagnosis to be.

To answer an earlier question: I read szasz's critique because he was a prominent figure criticizing psychology and psychiatry during a time in which it direly needed those critiques. Of course, this is from so long ago that by the time I was even born, the institution no longer resembled what of its worst tendencies and hubris led to its worst abuses; further still, the institution and our understanding of neuropsychology make the institution yet again today not particularly resemble what it was in the 80's.
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dabbler
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I'm jumping into the conversation late. But I'd like to point out that there is involuntary treatment outside of psychiatry. If a patient is found to lack the capacity to make a medical decision that is life threatening, a physician can choose to act on their behalf to save their life. If a patient is found to lack the capacity in a non-acute situation, the physician should petition the judge to evaluate the patient for a medical guardianship.
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Destineer
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quote:
But neither of these reactions are universal! People can react differently, and not just on a personal basis but on a situational basis. I used to act traditionally "drunk" when I got drunk. I don't anymore. I haven't been drunk in almost a decade, but the last few times I did I still experienced the altered perception (in terms of vision, physical coordination, etc.) but not the altered mental state. This isn't remotely unique to me!

There are some other semi-rare examples of people not experiencing much in the way of lowered inhibitions or other altered mental states, just the physical symptoms of alcohol.

You don't think these things were under your conscious control, though, do you? Certainly that doesn't follow automatically from your description of the experience. And if these responses are involuntary, I don't see how that changes anything. All kinds of medicines have uncontrollable side effects and somewhat unreliable active effects.

quote:
Do drugs convey thoughts to people? That sounds an awful lot like telepathy, to me.
Not at all. In fact, people can convey thoughts to each other without telepathy. RICHARD MILHOUSE NIXON. There, I did it--forced you to think of Nixon! Or maybe you're one of the rare people who can read those words without thinking of Nixon. Nonetheless, if I put you in a Clockwork Orange-style theater and forced you to look at pictures of Nixon, while blasting the words "Richard Milhouse Nixon" loudly on the speakers, I'm certain I could get you to think of Nixon. What's more, no one could blame you for thinking of Nixon, because you would have no choice in the matter.

Our thoughts are not entirely under our control, even when we're mentally healthy. Sometimes they come from unconscious sources (neurological and hormonal activity we don't control), and drugs can absolutely influence those things. Absolutely.

quote:
The person already has that idea somewhere, the drug simply activated it in some way. Drugs are altering perception, but it's still fundamentally the individuals ideas about that perception that are causing them to take off their pants.
How do you know this? Have you done a study? Can you cite one? Or do you think it's something you know a priori (which seems highly unlikely to me)?

quote:
And those ideas can be changed, like any other idea.
Perhaps, but can they be changed by an act of will alone, the way our conscious actions can? That's what you need to prove, I think, to show that mental patients are generally responsible for their symptoms.

It seems obvious to me that even in a healthy brain, there are many important functions that aren't under our direct conscious control. Memory is one of them. We essentially never have the experience of being able to decide what to remember and what to forget.

There are indirect techniques we can use to set things up so that we'll remember something, but that's a very weak sense of control. In the same weak sense, we can consciously control our heartbeat. Just run in place for a minute, and you've made your heart beat faster. Take a nap and it goes slower. Yet the heart is not really under our conscious control. And importantly, we don't normally think that it's someone's fault how fast his heart is beating.

quote:
So, even in people who take MDMA, reactions are not universal. That still doesn't mean people who react differently to MDMA are the only ones who don't have an MDMA deficiency.
But in the case of depression, the effectiveness of the drug is strongly correlated with the symptoms of the disorder. That's not true with MDMA and "MDMA deficiency" in your example. People with and without the "deficiency" present the same "symptoms." So in the depression case, there's a further fact in need of explanation: why do only people who behave in a depressed manner notice improvement with SSRIs? The best explanation would appear to be: because the drugs ameliorate the underlying cause of the symptoms, namely a disorder of the brain.

quote:
And psychiatric guidelines for deviant behavior are largely based on our social norms, so they rarely seem this absurd to us (unless we look at previous assertions, like the Szasz's favorite, oft-mentioned examples of masturbation & homosexuality). But aside from being absurd to our morals, is there a fundamental principle differing from the MDMA-deficiency model and, say, the guideline for depression?
I'm open to the possibility (in fact, the likelihood) that our definition of "disease" depends on what we value. That's probably just as true for non-mental disorders. If we enjoyed joint pain, we wouldn't call arthritis a disease. I'm not sure why that should change anything, especially not about whether the symptoms of mental disorders are voluntary.

quote:
Interesting, it seems like a theory of epistemological knowledge transmission to me. Does this get back to your reducing knowledge to the basic brains-firing-neurons biology?
Not at all. It's just that we can perfectly well understand what it would be like to have knowledge, even if there were no memes transmitted. For example, a race of beings who couldn't communicate at all could still have knowledge. They just couldn't share it with one another. Hence, knowledge without memes. So the correct theory of knowledge (epistemology, that is) apparently can't depend on memetics, can it?

quote:
I see memes as ideas that pass between people at a cultural level, for good or ill. Deutsch coined the term "static meme" for particularly pervasive memes that have developed lots of ways of confounding or deflecting criticism. For example: Western culture's concept of romance.
I agree, and that seems like a topic for science (and the humanities) to study by empirical means. Certainly not a topic that can be understood a priori. But epistemology is something we know a priori.

quote:
I don't think I got it in me to argue broad epistemology, brain universality, psychiatry, and induction in one sitting! But this does sound sort of inductivist. Is that fair to say, or would you object to that characterization?
Not exactly. I'm talking about abductive reasoning, which is distinct from both induction and deduction. "Inference to the best explanation" is the credo. Anyway, I agree with the next few things you say.

quote:
Sure. But I think the science in this area has huge problems too. A lack of understanding universality leads to them attributing huge swathes of behavior to genetics. Ideas (memes!) can have, I think, a lot more explanatory power and control over behavior than genes usually can. But that's probably a super controversial claim? Not sure.
I'm happy to let this go, as long as you recognize it's an empirical question that lies in the domain of science. I don't necessarily agree with you about which way the empirical evidence points, but I don't want to argue that right now.

quote:

I do think that in order to understand anything or have good ideas, you need a certain baseline understanding of certain broad ideas that have extensive reach. Basic physics, for example, has a lot of reach. So yeah, a basic scientific understanding that telepathy isn't real is an example of a necessary before creating any epistemological idea.

Now I'm confused. I thought we agreed that epistemology was prior to science?

My point was that the assumptions that go into a correct epistemological theory can't be assumptions that lie in the domain of scientific research, or else epistemology would not be prior to science (which it obviously is).

quote:
I'm not sure that telepathy would prevent the transmission of memes as I understand them. Why would it? If memes are just ideas, then regardless of how you communicate, ideas are still passing back and forth, aren't they?
My thought was that you wouldn't have the equivalent of "mutations" that are needed for memes to undergo selection, since ideas would always be communicated perfectly. But maybe that's not a necessary component of memetics the way you understand it?
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Destineer
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quote:
Frankly, though, I think that the assertion that someone who has been molested has been infected with a brain disease that is outside their ability to control is fundamentally pretty dehumanizing and insulting.
Dan, sometimes the truth can be dehumanizing. Horrific, even. It's too bad, the way human life is, but we shouldn't shut our eyes to it.

And just like science can't tell us what's morally right, you can't answer a scientific question by complaining that it would be morally bad if someone's scientific theory turned out to be true. That kind of evidence doesn't even bear on the question.

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Destineer
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quote:

It's true that his entries on fallibleliving are very short and don't address every possible criticism, they're more there to give you a grounding in terms and the basic ideas that inform their worldview. I don't really consider that sloganeering; I think he explained what Scientism is quite well, it's just that in his example he did not present a comprehensive case. I think that's okay, as it's just an illustration and not necessarily intended to persuade a hostile audience of his position on autism.

That's fair, I understand the need to take rhetorical shortcuts when writing a piece for general consumption. Just keep in mind that I'm not a member of that audience, and stuff written for that audience will probably fall flat with me.
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MattP
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quote:
1) he's a libertarian and it's far and away the most upsetting aspect of psychiatry to him
I get that, but it makes this component of his argument into an appeal to consequences and the constant references to involuntary treatments gives everything he writes on the subject that fallacious flavor.

quote:
2) he thinks they are almost inextricably linked (certainly have been linked since the inception of psychiatry through today).
Well they are linked but that's really not relevant. As pointed out earlier sometimes there are negative implications of things that are true.

It's like a libertarian argument against the existence of murderers that is premised on the fact that if some people really are going to try to kill other people that those people might have to be injured, killed, or incarcerated in order to protect others, which is a rather distasteful infringement on their personal autonomy.

[ April 13, 2012, 11:56 AM: Message edited by: MattP ]

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GinetteB
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quote:
That is, that treating mental illness as a disease essentially amounts to dehumanization (he would call it infantilization) because you're denying the person responsibility for their behavior.
This is a key point in the discussion, and I think it's wrong.

Treating mental illness as a disease does not imply denying the persons responsibility for their behaviour.

In the first place, having a certain disorder mentioned in the law as a 'disease' (like PTSD for example) only means people that suffer from it get rights: the right to get proper treatment, the right to have leave of absence from their jobs, etc. That's the economic reason to call something a 'disease'.
In the second place, at least in my country, people are first considered not to be capable of being responsible for their own behavior when their behavior is a serious threat to themselves or others.

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Destineer
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I agree it's an important issue, but I don't think it's a key point in the disagreement between me and Dan. We're disagreeing about the scientific facts, not about values.
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GinetteB
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..lol...disagreeing about scientific FACTS?? I haven't seen a single one:=)
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Destineer
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I was just reminded of this when talking to a psychologist friend (cognitive psych researcher, not clinical). Mentioned to her that I'd been talking about Szasz recently, and was surprised to hear her respond, "Oh yeah, I kind of think that guy is right."

It turned out what she meant was that she agreed with his view that what we count as a mental disorder depends on what we value. Her view was that the same goes for physical ailments, kind of like what I was suggesting earlier.

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Dan_Frank
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Cool! I think that those are both true, with the caveat that I think most physical ailments are recognizable and treatable in the body, whereas many (most? all?) psychiatric ailments are at their core behavioral. The reason I think this is important is that there is a much clearer objective standard of what is a "healthy body" than there is for what is "healthy behavior."

I'm guessing the main place you disagree with me here is my premise: the many/most/all are behavioral bit. Do you also disagree with my conclusion in its own right, or only insofar as you think my premise is faulty?

In other news...

I've been working on a reply to the stuff you said above very slowly in between other things (despite what I said in another thread, when I stay home and don't work, I'm usually still working, just not on things that have foreseeable returns. [Frown] )

Plus arguing (mostly fruitlessly, but not completely!) about Rand's technical skill as a writer has sort of eaten up my "arguing on the internet" bandwidth.

But in the shower this morning I was thinking "Man, I really ought to finish up that post as much as it's going to be finished and then just post it!" So I will do so soon.

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pooka
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Who was that dude who used to post about epistemology all the time back in 2007 or so? Good times.

quote:
if I put you in a Clockwork Orange-style theater and forced you to look at pictures of Nixon, while blasting the words "Richard Milhouse Nixon" loudly on the speakers, I'm certain I could get you to think of Nixon
This is an awesome mental picture.
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Destineer
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quote:
Cool! I think that those are both true, with the caveat that I think most physical ailments are recognizable and treatable in the body, whereas many (most? all?) psychiatric ailments are at their core behavioral. The reason I think this is important is that there is a much clearer objective standard of what is a "healthy body" than there is for what is "healthy behavior."

I'm guessing the main place you disagree with me here is my premise: the many/most/all are behavioral bit. Do you also disagree with my conclusion in its own right, or only insofar as you think my premise is faulty?

I do disagree that it's all or mostly about behavior. If that were true, there would be no difference between someone who has Tourette's and someone who is faking Tourette's but doing it really well. But there is a difference: the person who is faking can consciously control the behavior and refrain from doing it at any time, just by deciding to.

But I can't deny (nor does it conflict with my views to affirm) that physical disorders are easier to identify than mental ones. This is only partly because, as you say, it's a bit harder to determine which mental states are valuable or harmful. It's also because it's hard to tell which mental states are under our conscious control (and to what degree, since most likely there can be degrees of control).

quote:

But in the shower this morning I was thinking "Man, I really ought to finish up that post as much as it's going to be finished and then just post it!" So I will do so soon.

Sweet!
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Dan_Frank
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quote:
Originally posted by Destineer:
quote:
Cool! I think that those are both true, with the caveat that I think most physical ailments are recognizable and treatable in the body, whereas many (most? all?) psychiatric ailments are at their core behavioral. The reason I think this is important is that there is a much clearer objective standard of what is a "healthy body" than there is for what is "healthy behavior."

I'm guessing the main place you disagree with me here is my premise: the many/most/all are behavioral bit. Do you also disagree with my conclusion in its own right, or only insofar as you think my premise is faulty?

I do disagree that it's all or mostly about behavior. If that were true, there would be no difference between someone who has Tourette's and someone who is faking Tourette's but doing it really well.
Diagnostically speaking, is there a difference?
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Samprimary
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You mean, could we separate with a great degree of bio/medical confidence, an actual tourettes sufferer from someone pretending to have it?

Because, yes. Not only would a person with tourettes look different under a brainscan than someone faking an episode, but you can test for faking and other munchausenings as readily as we can now segregate faked and psychosomatic MPD/DID in personal analysis.

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Destineer
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quote:
Diagnostically speaking, is there a difference?
Well, diagnostically speaking, there's also no difference between someone with chronic back pain and someone who's faking it. For a variety of illnesses, physical and mental, there is no way to diagnose except through patients' reports of their symptoms.

There are also, in principle, ways to uncover even perfect behavioral faking in psychiatry. For example, if someone claimed to be having a panic attack but their amygdala didn't show up as activated on an fMRI, that would be pretty strong evidence that the patient was faking the symptoms. Of course in practice this test is never done, because of the expense and the presumably low rate of faking.

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rivka
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quote:
Originally posted by Destineer:
quote:
Diagnostically speaking, is there a difference?
Well, diagnostically speaking, there's also no difference between someone with chronic back pain and someone who's faking it.
That depends on the source of the pain. For many, it's definitely untrue -- there's scarring, disc damage, and/or other things than show up with the right sorts of scans.
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Dan_Frank
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Ah, right, that makes sense. Thanks guys!
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Destineer
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quote:
That depends on the source of the pain. For many, it's definitely untrue -- there's scarring, disc damage, and/or other things than show up with the right sorts of scans.
Right, but all I need to make my point is the fact that there are some cases where the diagnosis can only be made on the basis of reported symptoms.
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rivka
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Fair enough.
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Dan_Frank
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Hereís what Iíve got. It was written in 3 or 4 different sittings, so, it may be a bit disjointed. Let me know if I missed something important to you.

quote:
Originally posted by Destineer:
quote:
But neither of these reactions are universal! People can react differently, and not just on a personal basis but on a situational basis. I used to act traditionally "drunk" when I got drunk. I don't anymore. I haven't been drunk in almost a decade, but the last few times I did I still experienced the altered perception (in terms of vision, physical coordination, etc.) but not the altered mental state. This isn't remotely unique to me!

There are some other semi-rare examples of people not experiencing much in the way of lowered inhibitions or other altered mental states, just the physical symptoms of alcohol.

You don't think these things were under your conscious control, though, do you? Certainly that doesn't follow automatically from your description of the experience. And if these responses are involuntary, I don't see how that changes anything. All kinds of medicines have uncontrollable side effects and somewhat unreliable active effects.
Oh, yeah, I definitely think that my changed behavior when drunk came about as a direct result of my changed ideas. Sorry I didn't make that clear. I still fully experienced the physical characteristics of drunkenness, I just tried not to let those changes alter my behavior.

I also failed sometimes! I'm not perfect, by any stretch. And Iím not saying that every aspect of being drunk happens in your head or anything like that.

As an aside on the matter of free will/decisions, many people get drunk with the clear intent of reducing their inhibitions so that they can do things that they explicitly recognize that they already want to do. And those that don't do so explicitly still generally know what the typical "symptoms" of drunkenness are. So even if we assume my assertions above are totally baseless, and reduced inhibition is a purely chemical reaction that is wholly uncontrollable, choosing to get drunk and reduce inhibitions is itself is still a decision being made with intent.

quote:
Originally posted by Destineer:
quote:
Do drugs convey thoughts to people? That sounds an awful lot like telepathy, to me.
Not at all. In fact, people can convey thoughts to each other without telepathy. RICHARD MILHOUSE NIXON. There, I did it--forced you to think of Nixon! Or maybe you're one of the rare people who can read those words without thinking of Nixon. Nonetheless, if I put you in a Clockwork Orange-style theater and forced you to look at pictures of Nixon, while blasting the words "Richard Milhouse Nixon" loudly on the speakers, I'm certain I could get you to think of Nixon. What's more, no one could blame you for thinking of Nixon, because you would have no choice in the matter.

Our thoughts are not entirely under our control, even when we're mentally healthy. Sometimes they come from unconscious sources (neurological and hormonal activity we don't control), and drugs can absolutely influence those things. Absolutely.

quote:
The person already has that idea somewhere, the drug simply activated it in some way. Drugs are altering perception, but it's still fundamentally the individuals ideas about that perception that are causing them to take off their pants.
How do you know this? Have you done a study? Can you cite one? Or do you think it's something you know a priori (which seems highly unlikely to me)?

I think we can discuss it a priori, unless you aren't interested in that. I'll assume you are!

The first thing I actually thought of is Bart Simpson's friend. Which is sort of a funny thing, but also illustrative: you expected to get one reaction and got another because of my ideas. And if I had no idea who Nixon was, no matter how often you said his name, I wouldn't think of him, right? My knowledge effects how I react to the stimuli you provide.

Obviously we react to stimuli... unless we train ourselves not to, of course. Plenty of people specifically train themselves to not react to specific types of stimuli, right? So not only does our implicit knowledge effect how we react, but we can take explicit action to effect it as well.

Now, to the matter of implicit knowledge/ideas effecting how we react to stimuli: one thing to bear in mind is that most people in our country share a TON of implicit knowledge: language like the meaning of given words, cultural attitudes like romance or individuality, basic physics like gravity and the idea that humans aren't made up of mashed potatoes, etc. So of course in many respects our reactions to stimuli are broadly similar to one another. It doesn't necessarily follow that those reactions are genetic or otherwise innate, any more than our knowledge of, say, gravity, could be called genetic or innate.

quote:
Originally posted by Destineer:
quote:
And those ideas can be changed, like any other idea.
Perhaps, but can they be changed by an act of will alone, the way our conscious actions can? That's what you need to prove, I think, to show that mental patients are generally responsible for their symptoms.

It seems obvious to me that even in a healthy brain, there are many important functions that aren't under our direct conscious control. Memory is one of them. We essentially never have the experience of being able to decide what to remember and what to forget.

There are indirect techniques we can use to set things up so that we'll remember something, but that's a very weak sense of control. In the same weak sense, we can consciously control our heartbeat. Just run in place for a minute, and you've made your heart beat faster. Take a nap and it goes slower. Yet the heart is not really under our conscious control. And importantly, we don't normally think that it's someone's fault how fast his heart is beating.

I think that conflating unconscious physical processes and ideas we have gained, even ideas gained implicitly, is a big mistake. It seems like that's what you're doing here, but I may be misunderstanding.

Maybe you're saying that these ideas are purely physiological, but that doesn't make sense to me. Let me try to explain:

A racing heartbeat is a purely physiological experience. An experience like a racing heartbeat is experienced the same even if you don't know what a heart is.

But if you hear a voice in your head that tells you to shoot your child, how can this idea arise purely physiologically? The concept of a gun is unequivocally an idea that you have. Your genes and brain chemistry don't know what guns are. Do they?

quote:
Originally posted by Destineer:
quote:
So, even in people who take MDMA, reactions are not universal. That still doesn't mean people who react differently to MDMA are the only ones who don't have an MDMA deficiency.
But in the case of depression, the effectiveness of the drug is strongly correlated with the symptoms of the disorder. That's not true with MDMA and "MDMA deficiency" in your example. People with and without the "deficiency" present the same "symptoms." So in the depression case, there's a further fact in need of explanation: why do only people who behave in a depressed manner notice improvement with SSRIs? The best explanation would appear to be: because the drugs ameliorate the underlying cause of the symptoms, namely a disorder of the brain.
Yeah, that's a good point. I'm not going to go too far back and re-read what I said because I'm trying to churn this out and post it, but... I'm not necessarily trying to deny the existence of brain chemicals that stimulate our senses like drugs. And extending from that, like drugs, I expect that people could have relatively similar reactions to these stimuli (brain chemicals), barring specific exceptions, and so would also have similar reactions to other, related stimuli (antidepressants).

Though I'm curious, to those that know more neuroscience: is it definitive that depressed brain chemicals precede the experience of depression?

quote:
Originally posted by Destineer:
quote:
And psychiatric guidelines for deviant behavior are largely based on our social norms, so they rarely seem this absurd to us (unless we look at previous assertions, like the Szasz's favorite, oft-mentioned examples of masturbation & homosexuality). But aside from being absurd to our morals, is there a fundamental principle differing from the MDMA-deficiency model and, say, the guideline for depression?
I'm open to the possibility (in fact, the likelihood) that our definition of "disease" depends on what we value. That's probably just as true for non-mental disorders. If we enjoyed joint pain, we wouldn't call arthritis a disease. I'm not sure why that should change anything, especially not about whether the symptoms of mental disorders are voluntary.
We talked about this already I think.

quote:
Originally posted by Destineer:
quote:
Interesting, it seems like a theory of epistemological knowledge transmission to me. Does this get back to your reducing knowledge to the basic brains-firing-neurons biology?
Not at all. It's just that we can perfectly well understand what it would be like to have knowledge, even if there were no memes transmitted. For example, a race of beings who couldn't communicate at all could still have knowledge. They just couldn't share it with one another. Hence, knowledge without memes. So the correct theory of knowledge (epistemology, that is) apparently can't depend on memetics, can it?
I'm not sure I understand. Sorry, man. Let me try, though: Are you saying, for example, there could be an individual in total isolation, who had knowledge and nobody else around him to communicate with, and thus no memes?

If so, sure, I agree. I don't think that transmitting memes is the only way knowledge is gained. Or even the only way implicit knowledge is gained.

quote:
Originally posted by Destineer:
quote:
I see memes as ideas that pass between people at a cultural level, for good or ill. Deutsch coined the term "static meme" for particularly pervasive memes that have developed lots of ways of confounding or deflecting criticism. For example: Western culture's concept of romance.
I agree, and that seems like a topic for science (and the humanities) to study by empirical means. Certainly not a topic that can be understood a priori. But epistemology is something we know a priori.
I don't understand why you think that static memes would be studied by empirical methods. Can you give me an example of an empirical test a scientist might try?

quote:
Originally posted by Destineer:
quote:
I don't think I got it in me to argue broad epistemology, brain universality, psychiatry, and induction in one sitting! But this does sound sort of inductivist. Is that fair to say, or would you object to that characterization?
Not exactly. I'm talking about abductive reasoning, which is distinct from both induction and deduction. "Inference to the best explanation" is the credo. Anyway, I agree with the next few things you say.
From what I've read of it, abductive reasoning makes even less sense than inductive reasoning, which at least intuitively sounds sensible despite not existing. Could you explain what abductive reasoning means to you in a bit more depth, maybe?

quote:
Originally posted by Destineer:
quote:
Sure. But I think the science in this area has huge problems too. A lack of understanding universality leads to them attributing huge swathes of behavior to genetics. Ideas (memes!) can have, I think, a lot more explanatory power and control over behavior than genes usually can. But that's probably a super controversial claim? Not sure.
I'm happy to let this go, as long as you recognize it's an empirical question that lies in the domain of science. I don't necessarily agree with you about which way the empirical evidence points, but I don't want to argue that right now.
As I may have hinted a couple sections above, I'm not sure that I agree. I think that in order for scientists to accurately study this they would first need enough epistemology to understand why some of their methodology in this area is bad. The problem that I have is that they interpret data badly, and smuggle in epistemological and moral assumptions in their explanations of data.

Maybe they could also answer this through brute force? A comprehensive understanding of exactly how every aspect of our genes work, with very little interpretation necessary? That sounds unlikely to me.

quote:
Originally posted by Destineer:
quote:

I do think that in order to understand anything or have good ideas, you need a certain baseline understanding of certain broad ideas that have extensive reach. Basic physics, for example, has a lot of reach. So yeah, a basic scientific understanding that telepathy isn't real is an example of a necessary before creating any epistemological idea.

Now I'm confused. I thought we agreed that epistemology was prior to science?

My point was that the assumptions that go into a correct epistemological theory can't be assumptions that lie in the domain of scientific research, or else epistemology would not be prior to science (which it obviously is).

I guess don't think the two are as definitively separate and confined as you do. You can accomplish a lot with a crappy framework, and modify and improve your framework piecemeal as you go. Often times, good ideas in one area can improve your ability to understand good explanations in another area.

quote:
Originally posted by Destineer:
quote:
I'm not sure that telepathy would prevent the transmission of memes as I understand them. Why would it? If memes are just ideas, then regardless of how you communicate, ideas are still passing back and forth, aren't they?
My thought was that you wouldn't have the equivalent of "mutations" that are needed for memes to undergo selection, since ideas would always be communicated perfectly. But maybe that's not a necessary component of memetics the way you understand it?
Interesting. I'll admit I'm not great at abstracts too far outside normal reality.

I think that a big part of the "natural selection" of memes has to do with their ability to evade criticism, both external and internal. I'm not sure how that would translate to a telepathic society. If they communicated like us but mind-to-mind, I don't think it would matter at all. If you assume "perfect" communication then static memes might die much much faster, effectively not existing at all, as soon as one person thought of a viable criticism. But again, this is so abstract and alien that I'm not really connecting to it. Sorry.

---

And Sam, here you go:
quote:
Originally posted by Samprimary:
if you want to provide anything at all to give any semblance of an indication about the substance of your views, I would choose to hear on what substantive basis and from what sources you have come to use to demonstrate that modern psychiatry 'defines people with bad ideas as being out of their mind.' Where does this come from. What trend is it following. What is an example of a bad idea that leads modern psychiatry/psychology into defining someone as out of their mind. What do you understand a "out of their mind" diagnosis to be.

"Out of their mind" is obviously a colloquial shorthand for mental illness. I hope you got that, if not, sorry.

So, some examples of people with bad ideas being diagnosed with mental illness by modern psychiatry:

People who feel like they can't go without X item and don't want to give it up. (Addiction)

People who experience very strong emotions like extreme sadness, happiness, anger, etc. and don't understand why they are having those emotions or feel in control of them. (Depression, bipolar)

People who think that people who don't exist are telling them true facts about the world (except religious people who do this). (Schizophrenia)

People who don't follow established social norms regarding social interaction and communication. (Autism)

There are a few. Now, am I saying that every instance of the above is like this? No. But I do think that often times behaviors that are characterized as uncontrollable mental illness are, well, not.

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Destineer
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Ah, good. I think we're getting down to brass tacks now. I think I will skip over some things that are redundant, or seem to be side issues. But I may return to some of these later.

quote:

Obviously we react to stimuli... unless we train ourselves not to, of course. Plenty of people specifically train themselves to not react to specific types of stimuli, right? So not only does our implicit knowledge effect how we react, but we can take explicit action to effect it as well.

Sure. I would say this is completely analogous to the sense in which we can indirectly control our heartbeat (by going for a long run a few times a weak, you can train your heart to beat slower, for instance). It's not real, immediate conscious control, like the control we normally have over our speech and actions.
quote:

Now, to the matter of implicit knowledge/ideas effecting how we react to stimuli: one thing to bear in mind is that most people in our country share a TON of implicit knowledge: language like the meaning of given words, cultural attitudes like romance or individuality, basic physics like gravity and the idea that humans aren't made up of mashed potatoes, etc. So of course in many respects our reactions to stimuli are broadly similar to one another. It doesn't necessarily follow that those reactions are genetic or otherwise innate, any more than our knowledge of, say, gravity, could be called genetic or innate.

I never claimed our reactions to stimuli were genetic or innate. Probably they are the result of nurture as well as nature, as you observe. My only claim is that often they are not under our conscious control (except indirectly, in the same weak sense that your heartbeat is under your control). When they're not under our conscious control, we aren't normally responsible for them.

quote:

But if you hear a voice in your head that tells you to shoot your child, how can this idea arise purely physiologically? The concept of a gun is unequivocally an idea that you have. Your genes and brain chemistry don't know what guns are. Do they?

Again, I'm making no claim about what is or isn't physiological. Only that in many cases it's not under my control what I think of, or what memories come into my head. What you think about is not always your decision.

Although there are cases where the cause of a thought or conscious experience is very obviously physiological. For example, brain surgery patients have reported recalling particular memories in response to electrical stimulation of the temporal lobe. Obviously their response to this stimulation is an idea whose immediate cause is physiological (and, of course, not under their control).

quote:
Though I'm curious, to those that know more neuroscience: is it definitive that depressed brain chemicals precede the experience of depression?
Can't say I know much neuroscience, but wouldn't the effectiveness of antidepressants in treating depression count as pretty good evidence that imbalanced brain chemicals are the cause of depression, and not vice versa? If the chemical and neurological changes are a side effect of the depression rather than the cause, one would not expect drugs which alter the brain's chemistry to be effective in reducing the symptoms.

quote:
I'm not sure I understand. Sorry, man. Let me try, though: Are you saying, for example, there could be an individual in total isolation, who had knowledge and nobody else around him to communicate with, and thus no memes?

If so, sure, I agree. I don't think that transmitting memes is the only way knowledge is gained. Or even the only way implicit knowledge is gained.

Actually, you understood my point very well! Now, since you grant that there can perfectly well be knowledge without memes, I don't see how you can claim that memetics is part of epistemology. Epistemology is the project of defining the word 'knowledge.' Since one can have knowledge with no memes, memes will not enter into the correct definition. Your only claim seems to be that knowledge can be gained by transmitting memes. OK. Knowledge can also be gained by receiving email. Does that mean that email will turn out to be a crucial element of the correct theory of knowledge? I should think not.

quote:
I don't understand why you think that static memes would be studied by empirical methods. Can you give me an example of an empirical test a scientist might try?
Sure. A sociologist or historian could, for example, test whether there are any static memes. Do cultures include ideas that get reinforced by the sort of defense mechanisms you mention? Or are cultures changing their ideas all the time, with no stable ones? (The obvious answers are yes to the first question and no to the second, but you have to admit that the only way we know this is through our empirical observation of actual real-world cultures.)
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Samprimary
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quote:
So, some examples of people with bad ideas being diagnosed with mental illness by modern psychiatry:

People who feel like they can't go without X item and don't want to give it up. (Addiction)

People who experience very strong emotions like extreme sadness, happiness, anger, etc. and don't understand why they are having those emotions or feel in control of them. (Depression, bipolar)

People who think that people who don't exist are telling them true facts about the world (except religious people who do this). (Schizophrenia)

People who don't follow established social norms regarding social interaction and communication. (Autism)

There are a few. Now, am I saying that every instance of the above is like this?

More importantly than that, do you think what you have typed up in any way represents modern psychology's diagnostic criteria for the represented illnesses?
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MrSquicky
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Samp has already said a lot of the things I'd have, but I'll add a couple of clarifications of misconceptions:

quote:
People have control over their reactions to stimuli. Even if I accept a genetic predisposition for mania (which I don't necessarily do, more on that later), you also spoke of a "triggering event." Isn't it possible to not react to the triggering event in a way that would bring on mania? Is there a consistent test for inducing mania in all manic people, or is it a subjective mental reaction on the part of the manic person?
There's a whole school of psychology/treatment dedicated to this. It's commonly called Cognitive Behavior Therapy (CBT). So you don't have to wonder, you can go check the many, many studies of the efficacy of CBT in treating various ailments. It works pretty well for certain types of depression. For mania, it has a small beneficial effect when coupled with drugs but doesn't seem to work on its own.

Also, I don't think it works the way you want it to. A lot of CBT's effectiveness relies on strategies of cognitively challenging "natural" patterns of thought and behavior and also using non-conscious behaviorist techniques to alter people's reactions to stimuli. It's not really a case of people choosing to do one thing or another.

From Dest:
quote:
Can't say I know much neuroscience, but wouldn't the effectiveness of antidepressants in treating depression count as pretty good evidence that imbalanced brain chemicals are the cause of depression, and not vice versa? If the chemical and neurological changes are a side effect of the depression rather than the cause, one would not expect drugs which alter the brain's chemistry to be effective in reducing the symptoms.
A lot of people like to think that, which doesn't really make sense to me. First off, as I noted above, for a lot of types of depression, non-pharmacological treatments work really well in treating it. Second, drugs to treat depression alter how the brain works and they do it in a variety of different ways. There's not this 1 to 1 correspondence to lack in brain function to a drug that restores that function. It's more complicated than that. Just as an example, for most forms of moderate depression, regular aerobic exercise is as or more effective than most anti-depressants. Third, there is a well established strong relationship between preceding stressful life events and the onset of depression.

Brain chemistry may be a causative factor in developing depression (it certainly is for many of the severe forms), but it is not clear that this is definitely true and it is clear that it is not the sole cause.

Myself, I think most moderate forms of depression are better understood as symptoms of underlying behavior patterns resulting in a lack of physical and mental stimulation*, but I can't prove that...yet.

* likely exacerbated by predispositions related to brain chemistry.

---

quote:
So, some examples of people with bad ideas being diagnosed with mental illness by modern psychiatry:

People who feel like they can't go without X item and don't want to give it up. (Addiction)

People who experience very strong emotions like extreme sadness, happiness, anger, etc. and don't understand why they are having those emotions or feel in control of them. (Depression, bipolar)

People who think that people who don't exist are telling them true facts about the world (except religious people who do this). (Schizophrenia)

People who don't follow established social norms regarding social interaction and communication. (Autism)

There are a few. Now, am I saying that every instance of the above is like this?

This is a bizarre list. It's like you wanted to really drive home that you really don't know anything about modern psychology.

Forgetting about the vast oversimplifications, several of your descriptions are specifically contra-indicative of the condition you are associating them with. For example, the more or less accepted definition of addiction that is driving the upcoming DSM definition includes prominently a consistent failure to give up the addiction despite a strong desire to do so.

Even more telling, depression is definitionally not being really sad. If someone is really sad, they are not depressed. One of the major diagnostic criteria is a lack of affect.

---

I'm pretty critical of psychiatry as well (driven by money, relies almost exclusively on drugs, lower efficacy/higher side effects compared to other forms of treatment), but most of the criticisms raised here don't really make much sense. As Samp pointed out, they may have made sense 50 or so years ago when they were first made, but things have changed significantly between now and then. Criticisms like "you can't know that schizophrenia, manic-depression, etc." are caused by brain abnormalities and aren't just conscious choices" aren't really feasible in light of the fact that yes, we really do know that now. Public policy and the fundamental way we classify mental issues have experienced massive changes. I've mentioned here multiple times the change from the DSM II to III that was precipitated by the homosexual rights crowd challenging the classification of being gay as a mental illness and I'll say again that if you don't know about it and are interested in how psychology classifies mental issues, it's really important to understand.

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Samprimary
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quote:
This is a bizarre list. It's like you wanted to really drive home that you really don't know anything about modern psychology.
Right. I mean, I don't want to be mean about it, dan, but those conceptualizations of diagnosis are flat-out saying you don't have an informed disagreement with modern psychology. Your confrontation of "modern psychology" is one that makes sense when you understand it is valid critique ... albeit of an institution that honestly does not exist.
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Destineer
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Squick,

quote:
I'm pretty critical of psychiatry as well (driven by money, relies almost exclusively on drugs, lower efficacy/higher side effects compared to other forms of treatment),
Are you just referring to the way depression and ADHD are treated? It does seem like drugs are over-used with these two diagnoses. But my impression is that with other disorders, the way psychiatrists normally treat them is by far the best way we know of.
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MrSquicky
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quote:
Originally posted by Destineer:
Squick,

quote:
I'm pretty critical of psychiatry as well (driven by money, relies almost exclusively on drugs, lower efficacy/higher side effects compared to other forms of treatment),
Are you just referring to the way depression and ADHD are treated? It does seem like drugs are over-used with these two diagnoses. But my impression is that with other disorders, the way psychiatrists normally treat them is by far the best way we know of.
There's quite a bit more than depression and ADHD that I think fit into this, but there are also plenty of cases where psycho-pharmacology is clearly the best core treatment that we currently know of.
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Destineer
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What would be some other examples?
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MrSquicky
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Anxiety disorders, eating disorders, and phobias are ones that I'm aware of.
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Destineer
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Yeah, anxiety disorders (including phobias) are an interesting case. Sometimes there's a simple issue of convenience involved. For example, if you don't fly very often in the first place, it's probably not worth going through exposure to deal with a flying phobia when Valium will work in a pinch, even though exposure would probably do a more thorough job of treating the phobia.

I'm pretty torn about this over-prescription issue. On the one hand, I agree with you that there's good empirical evidence that non-pharmaceutical methods are typically more effective at treating actual mood disorders. On the other hand, I can actually see the argument for using SSRIs as general-purpose mental performance enhancers. Probably not a good idea at present, given how poorly we understand the effects of life-long use. But it would not surprise me if someday, if we were to develop the ability to predict individual reactions to drugs (as some people think is likely with genetic medicine), it became common for mentally healthy people to use SSRIs on the "better than well" rationale.

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Dan_Frank
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quote:
Originally posted by Samprimary:
quote:
This is a bizarre list. It's like you wanted to really drive home that you really don't know anything about modern psychology.
Right. I mean, I don't want to be mean about it, dan, but those conceptualizations of diagnosis are flat-out saying you don't have an informed disagreement with modern psychology. Your confrontation of "modern psychology" is one that makes sense when you understand it is valid critique ... albeit of an institution that honestly does not exist.
That's awesome!

Not being sarcastic at all, in case it's unclear. I appreciate you and Squicky and Destineer's comments to this effect. I'll happily admit to not paying a lot of close attention to psychiatry in quite a while... at least not since the last time I really paid attention to my sister's issues with going in and out of institutions and on and off of drugs, which was probably a decade ago.

So, if I'm totally wrong and psychiatry is vastly improved, that's great!

Out of curiosity, the next time someone passes along a story of what appears, to me, to be a case of psychiatrists dehumanizing and drugging people based on their preferences... if I passed it along to you would you be willing to explain why I'm misunderstanding it?

Because lately I think I tend to approach stories like that from an exasperated, very superficial, level... sort of "Oh, those psychiatrists!" followed by a frustrated eye roll and moving on. I don't devote a lot of bandwidth to the issue, most days.

Sort of the same way some people here treat stories of Republican idiocy, I think. And, in the same way, it could lead me to being snookered (like the semi-recent hullaballoo Lyr raised over Republican "abuse" of the emergency clause in the Michisconsin legislature, for example).

So, yeah. Next time I see something like that, I'm coming here. [Big Grin]

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Destineer
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Good deal! [Smile]

There was another side to our original disagreement, though, besides simply the status of psychiatry as medical science. It had to do with the extent to which people with various impairments--not just mentally ill people, but children and some disabled people--should be considered responsible for what they do, and how careful we should be about respecting their liberties and desires. Another place this sort of thing ties in with psychiatry and epistemology is with research about cognitive biases, which I recall you speaking ill of before. I'm curious where you're at on this other issue.

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Dan_Frank
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Oh no, Destineer, don't worry, I'm nowhere near done with this issue in general! I will post more responses to you and probably Squicky too, when I have time. I was just acknowledging that my criticisms of psychiatry don't come from an up-to-date, highly informed position.

Insofar as I'm voicing good criticism of a nonexistent institution, that's only gonna make me happy. So I appreciate it when people let me know that. The bigger discussions arise in places where (you think) I voice illegitimate criticisms. I think there are still some of those pending response, so, as I said, I'll post again when I have more time.

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MrSquicky
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Dan,
I'm not sure you got my point. I do believe that there is a lot to criticize psychiatry about.

However, a lot of the specific criticisms that you were making are either outdated, disproven, or so lacking in a basic understanding of the topic as to be nonsensical.

Thomas Szasz was an important voice in calling for reform - a half century ago. We've moved on from that, both in terms of enacting reforms and changing how we classify mental issues (again, I highly recommend checking out the change from DSM II to III, you can search on Hatrack for a couple of discussions on it), and in terms of advances in medical technology allowing us to get a better idea of what's going on in the brain.

With your description of mental illnesses, it seems clear that you are not working from an understanding of how these things are actually diagnosed. As I said, they are all absurdly simplistic and at least a couple contain things that are specifically contra-indicative of the condition you attribute them to. That is, if the person has those symptoms, it rules out the condition.

But again, that doesn't mean that psychiatry doesn't have a lot wrong with it. It's just a lot more complex than you are making it out to be and also it seems that whatever sources you are using for information are extremely superficial and inaccurate.

I think, if you are interested in becoming more knowledgeable about this, that looking into the easily available information on the switch from the DSM II to III, Cognitive Behavioral Therapy, and the current understanding of mental disorders as codified in the DSM IV would serve you well.

If you read through this stuff and want to talk about it, I'd be amenable to that, although my Hatrack time is pretty limited.

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Destineer
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Interesting panel discussion about the foundations of psychiatry on Charlie Rose. The central topic is the contemporary insight that psychiatric disorders are biological diseases, and the fruits that this idea has borne.
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Destineer
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One guy mentioned that a large fraction of severely autistic patients have a major reduction in symptoms when they run a high fever. Makes the idea that this is "just a different, equally healthy way of thinking" seem pretty ridiculous.
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Itsame
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Does that mean I'll be less weird if I just figure out a way to adjust my internal body temperature to 104? Of course, I'll be pretty gross, smelly, and possibly dead, so that creates a whole other set of issues.

Edit: So I glanced at the original article (http://www.sciencedirect.com/science/article/pii/S0165017308001379) then at articles that cited it. Unless there are follow ups that haven't cited it, it doesn't look like there's much further research being done on this. Too bad. It has been cited 25 times, but much of the stuff is barely related.

Maybe it's that research of this kind takes a long time. I don't know much about biomedical stuff. Anyone care to enlighten me?

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GinetteB
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What I miss in discussions about mental illness, is a definition of what 'mentally healthy' would be. For example this could be taken into account:

In 1996, the World Health Organization recognized violence as a global health problem and issued a recommendation. But until today, no recommendation for prevention and treatment of violence, focussed on the victimizer can be found. All the recommendations are focussed on better help for the victims and on the means the victimizer uses (weapons, unsafe environment). The only one that is mentioned in the prevention section of the annual WHO report on violence, that could be read as being focussed on the victimizer, is to support better strategies for the upbringing of children.

The fundamental problem of this disease lies in not recognizing possible victimizers as a serious danger before they can do harm to others, and not giving them education, mental health care, treatment. As it is now, the victimizer isn't helped and the damage they cause is not only done to the victim, but also their loved ones. It is helping, curing and healing the symptoms, but not the cause of this global disease.

To treat the problem at the root, we need a new set of definitions for mental health and mental illness, and to develop new methods to cure victimizers. It is in the first place the victimizer not being mentally healthy. As it is now, most of them are either imprisoned or walk free. Globally speaking, only few of them get mental health treatment. Relatively few methods have been developed to cure victimizers, as most of those receiving mental health care have been victims. As a result, developing methods and treatments in mental health care, have been focussed on curing the victims illness. But that's no reason to think it is not possible to find effective treatment for victimizers

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Kwea
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Biomedical stuff takes a long time to test, and that only complicates the issues.
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