Mailbag: Anti-Psychiatry Fallacies and Falsehoods

mailbag letter

It is time for another entry in the mailbag series where I answer feedback email from readers and others. If you want to send me a question, comment or any other kind of feedback, please do so using the contact info on the about page.

Anti-science activism takes many forms. They can oppose specific scientific models such as climate change or evolution. They can oppose entire aspects of medicine, such as alternative medicine or cancer quackery. They can promote conspiracy theories on specific historical events such as 9/11 terrorist attacks or the Holocaust. They can oppose specific products developed by researchers such as vaccines or genetically modified crops. They can even be corrupted by specific ideologies such as natural birth quackery or race pseudoscience.

One form of anti-science activism that will be the focus of this mailbag installment is anti-psychiatry. It works virtually the same way that anti-vaccine pseudoscience does: it downplays or neglects the diseases or conditions (mental illness denial versus claiming vaccine-preventable diseases are not really dangerous), it attacks the treatments (rejects medication and therapy versus rejecting vaccines), rejects the mechanism (deny biological risk factors of mental illness versus denying herd immunity) and promote vile hatred of doctors.

Psychiatry is open to criticism

Jack starts off by explaining that he is a bit concerned with criticism of anti-psychiatry:

The disturbing thing about stigmatizing the so-called “anti-psychiatry” movement is that there may be a chilling effect, where rational and intelligent people are afraid to criticize psychiatry because they may be labelled as “anti-psychiatry”. This chilling effect would very dangerous for good science.

Psychiatry, like any other field must be open to criticism and free thinking, even if many of the criticisms end up not holding water. Psychiatry (and also psychology) are useful fields of study. However, they are not and should not be immune from criticism. *That* would be bad science.

Psychiatry as a medical discipline has criticized for many decades by a wide range of groups, both within science and medicine as well as from the outside. Indeed, the very practice of scientific research into the origins, mechanisms and treatment of mental illness is a form of criticism of what existed before. If one were to search for the term psychiatry in the PubMed database, one would find half a million scientific papers. Searching for antidepressant gives 150 000 hits and there are over 190 000 hits when searching for psychotherapy. Looking at the distribution for when these papers were published, we see a long-term trend were more and more papers are being published every year like in most other areas of science and medicine. All aspects of psychiatry are being critically discussed in the scientific and medical literature every day. Nothing of this is being suppressed or stigmatized.

In fact, there is currently a replication crisis going on in e. g. psychology where bad statistics and small sample sizes has meant that some findings cannot be reproduced by other researchers. The fact that this is being openly discussed (and actively mitigated with replication projects and improved statistical treatment) is the ultimate evidence that this discipline is open to criticism and correction. Can anyone seriously claim that anti-science activist groups show this level of openness to honest self-criticism?

In fact, many anti-psychiatry activists contribute to creating a chilling effect on mental illness and stigmatize people with mental illness. Those anti-psychiatry activists who are creationists blame the patient for causing his or her own condition by inviting satanic powers into their lives. Those anti-psychiatry activists who are stuck in new age ignorance also blame patients for having too much negative thoughts and that they can get well just by thinking positively. This, of course, is just as dumb as saying that you can get well from type-I diabetes just by thinking positively. Anti-psychiatry activists who are alternative medicine proponents scam people with mental illness into trying either ineffective or potentially dangerous products at the same time as discouraging them from taking science-based medicine. Because anti-psychiatry activists often spout so much nonsense, people can be discouraged from seeking help for mental health issues.

The anti-psychiatry movement is diverse, but has common features

Debunking Denialism has previously written about how diverse many anti-science movements are. People who oppose vaccines can be misinformed parents, alternative medicine proponent, religious fanatic, environmentalist extremist and opposing the government generally. Similar diversity can be found among anti-psychiatry activists. Some anti-psychiatry proponents are creationists, some are new age believers, some are selective skeptics, some are secular mysterians, some are shrieking conspiracy theorists and some scientologists are also against psychiatry.

Jack wants to use this diversity as an argument:

As you implied, there isn’t really a single “anti-psychiatry” movement. The opinions are far too diverse. I doubt the majority of critics of psychiatry believe in utter nonsense such as satanic contamination. It’s important to keep the discussion in the context of actual science.

Indeed, not all anti-psychiatry activists are creationists who believe in satanic contamination. However, there are common features to most or virtually all of these different aspects of anti-psychiatry: there is a general mistrust or denial of mental illness diagnostics or mental illness as a phenomena, there is a general rejection of the mechanisms behind the origins of mental illness, there is a general opposition to science-based treatments such as medication or therapy and there is a general intense dislike for psychiatrists. These common features is why we can group these different anti-psychiatry activists under the label of “anti-psychiatry movement”, while acknowledging that it is a divers movement.

Science gets many things right and updates and improves the stuff it gets wrong

Jack continues:

As scientists, we must realize that science gets things wrong all the time. For example, the 2011 paper in the prestigious Lancet journal made claims about the positive effect of CBT and graded exercise on sufferers of ME/CFS. Most of the findings were later debunked, but not until health organizations began implementing the results of the incorrect findings. ME/CFS is still often considered to be a psychosomatic disorder, even though there is scant evidence to support this.

Ah, the classical “science has been wrong before!1” gambit. It is certainly true that science sometimes makes mistakes. But this has to be weighed against all the other times when science does get things right or makes highly empirically accurate models of reality. It is not enough to merely point out a few mistakes and then use this in an effort to undermine science. You have to push away confirmation bias, take it all into account and are not really allowed to cherry-pick selected examples.

Indeed, scientists were among the first to criticize the PACE study and follow-up papers. This is not a weakness of science, but one of it strengths.

Medical diagnoses rest on facts, not merely trivial conceptualizations

More generally, psychosomatic disorders, CBT and in fact all conditions and diseases in medicine (not psychiatry) rest on conceptualizations, just on different levels of abstraction. E.g. cancer is not one disease. Even a single “type” of cancer is different in each individual. At what number does a blood pressure reading result in a “disease”? We needed to create a sensible framework to answer these questions.

Conceptualizations are certainly used in science and medicine as a pedagogical tool to explain whatever needs to be explained in specific situations. However, this does not mean that diseases are a matter of convention or that there are no scientific criteria for them. It is certainly true that cancer is not a single disease, but a category of disease. Every cancer patient is unique. However, the reason for why you can group people with cancer into different categories is because of the large similarity between, let’s say, different cases of leukemia. While blood pressure is a continuous measure, we need to find a region where you have dangerously low or dangerously high blood pressure. How is this done? The answer is by doing medical research. How much of a risk factor are different blood pressures for cardiovascular diseases? Those are scientific questions that can be answered by research. Thus, when Jack suggests that we “need to create a sensible framework”, he is forgetting that those frameworks already exists and are quite robust.

Note: In this last sentence, I misread what Jack wrote. He wrote “needed” when I incorrectly read it as “need”, creating a clear misunderstanding on my part. I have now retracted that sentence by striking it out. See this comment for additional details (note added 20170124 01:51 UTC+1).

We do not know all the details of how the brain works, but we know enough to refute anti-psychiatry

The challenge with psychiatry is that since we are as of yet so incredibly ignorant about how the brain functions, the constructs of mental disorders are much further away from reality i.e. there is unlikely to be a one-to-one mapping between disorders listed in the infamous DSM and what science will discover about diseases of the brain in 100 years time.

It is absolutely true that we do not know all the details of how the brain works on different levels. However, we know enough to fill libraries with research papers, medical documents and textbooks. We know that the brain is an organ of the body. We know that our minds are a function of that brain. We know that precise injury or other problems cause precise cognitive deficiencies. We know that the brain, like any organ, can get diseases and conditions. There is no magical barrier that makes the brain completely invulnerable. While it is certainly true that another 100 years of scientific research will create massive improvements, none of it is likely to overturn core facts. This is because these facts are based on a massive amount of independently converging evidence and any future model must make the same predictions as an older one in area where they both apply. This is known as the correspondence principle. It is the same reason for why we landed on the moon using nothing but Newtonian mechanics, even though general relativity can explain a lot more.

Furthermore, this issue is not restricted to psychiatry. Developments in medicine during the next 100 years will likely lead to massive improvements in our understanding in everything from cancer to autoimmune diseases. This does not for a moment justify the stance that cancer is a fungus or that autoimmune disease are caused by having too many negative thoughts. Similarly, 100 years of research will probably not find that the brain is invulnerable to disease or that the mind is actually purely a function of the kidneys.

An anti-psychiatry contradiction

Because anti-psychiatry is a form of pseudoscience it contains a number of curious contradictions where proponents simultaneously tout two different lines of argument that are fundamentally incompatible. Both of them cannot be true at the same time. Previously, we have seen how Jack was quite concerned by the use of structured diagnostic manuals when we do not know everything there is no know about the brain. Now we can read that he is concerned of the exact opposite:

That is not to say a diagnosis of say, a “psychosomatic” illness is not useful, we just need to be careful not to irresponsibly go around diagnosing people at a drop of a pen. From studying medical journals and talking to people working in mental health as well as patients, I am utterly appalled and disturbed by how often diagnoses are made based on poor evidence and plain wishful thinking on the psychiatrist’s/psychologists part.

Jack seems to take the opposite position here: now the problem is not so much that psychiatrists consistently use and follow structured diagnostic manuals, but that they randomly go around diagnosing people based on wishful thinking. An equally curious and lethal contradiction.

The risk of false positives or wrong diagnoses exists and it is a real problem. This is one of the reasons for why structured diagnostic manuals exist. It offers a consistent language and criteria that relevant mental health professionals that use as an aid for accurately diagnosing people with mental illness. This is the very opposite of randomness, arbitrariness or wishful thinking.

For any diagnostic algorithm, the issue of false positives must also be weighed against the risk of false negatives. Right now, most people with mental illness who would benefit from getting help are never diagnosed and never receive the medication and therapy that they need. Government cutbacks in healthcare generally and mental health specifically is a major problem and a major threat.

Just imagine what could be accomplished if anti-psychiatry activists would stop recycling myths and misinformation and instead helped mental health advocates fight for mental health funding, treatment availability and access for those who need it.

Good science does need protection from e. g. anti-science forces

Jack finishes his concerns with a statement that seems to suggest that he is not fully aware of the threats posed by pseudoscientific and anti-science forces:

Bad science doesn’t deserve protection, and good science doesn’t need it. So, it worries me that many members in the field of psychiatry is so defensive at times. It is only when people criticism fearlessly that there is a chance of correcting problems in the scientific method.

Bad science certainly does not need protection, but good science needs to be constantly defended. This is because there are cranks and quacks out there that spread pseudoscientific nonsense and misinformation in an attempt to undermine solid science. Powerful politicians can also attack science in a wide range of ways, from claiming that climate change is a hoax or block import of life-saving HIV medication (a move that killed at least 340 000 people). Good science is constantly under attack. They can also cut science funding from very important projects that help save lives and develop crucial technology. Mental health professionals can certainly be defensive when someone regurgitates anti-psychiatry misinformation that has been recycled and refuted thousands of times before. This is not a cause for worry, but a badge of honor that they take the time needed to combat pseudoscience.

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Emil Karlsson

Debunker of pseudoscience.

2 thoughts on “Mailbag: Anti-Psychiatry Fallacies and Falsehoods

  • January 23, 2017 at 21:01
    Permalink

    Hi, Jack here!

    I appreciate greatly the detailed response. Perhaps my very own experience with psychiatrists deeply colors my views on psychiatry and psychology.

    When I was 15 I was diagnosed with depression and for well over a decade was on SSRIs. It was unclear to me whether I was really depressed (I didn’t think I was). However I was in quite some emotional distress due to some issues about my sexual identity and relationships (and was scared to talk about it, even to doctors). As a teenager it wasn’t as easy to talk about these things. Anyway, I was told I had clinical depression from a 10 minute quiz and a brief chat with a psychiatrist, so I was put on SSRIs. So maybe in a total of 30 minutes I was diagnosed with severe depression.

    Looking back, a few things disturb me:

    1. I was diagnosed in an incredibly short amount of time and put on SSRIs.
    2. The SSRI I was on is no longer an indication for adolescents with clinical depression due to new evidence suggesting ineffectiveness for depression in adolescents, and also suicidal ideation for anyone under 25.
    3. The dose I was initially given is now deemed unsafe even for adults due to the risk of causing heart problems. I don’t think anyone knows what other negative effects it has on children and adolescents.
    4. I was handed off to my primary care physician the kept on the SSRI for so many years. Many years later another doctor expressed doubts on whether I even had depression. That set me on a path to get off SSRIs. Now being off them (taper down took many weeks) after so long, I don’t feel any different…
    5. Looking back, my coming ON the anti-depressants coincided with a time of making new friends and support groups, so whether it’s the friends that helped me feel better or the anti-depressants, who’s to say?
    6. I felt that my psychiatrist didn’t have any empathy at all. Never smiled. Every session, she just cared about how I ‘felt’ from a scale of 1-10 (or 1-5), and whether I had any suicidal thoughts. If I said I felt bad then we’d go into all sorts of sensitive stuff I didn’t want to talk about. Sometimes I lied that I felt better just so I didn’t have to try to explain….I hated the sessions.

    I also had the opportunity to closely acquaint myself with a girl with *many* diagnosed mental illnesses. She was on about 5-6 different psychiatric medicines simultaneously. I don’t doubt that mental function was not what would be statistically considered nominal, and that medications would could have helped. But to me she was a human being and friend, not a statistical outlier. Talking to her for many hours, it *seemed* the psychiatrist was just throwing things up against and wall and seeing what would stick. She was later hospitalised in the intensive care unit for unexpected reactions between the medicine after blood came seeping out of her mouth. There may legal action against the psychiatrist, but the chance of it even making it to court is very, very slim.

    I hope that my experience, and hers are the exception. But to be honest, given my experiences, I have a hard time believing that the field of psychiatry is in an ideal position as compared to the other branches of medicine. You might be eager to invalidate my experiences, perhaps saying I am a statistical outlier. I have to accept the possibility that it is true – as an engineer and being passionate about statistics, I have accept to that. But at the same time I have a right to feel and think the way I do without being labelled a “denialist” or whatever other label is given to people who express too much mistrust in science. I think that’s morally irresponsible. But that isn’t even the case, since I have no mistrust in science. Instead, I have developed mistrust in the institution of science.

    In any case, I feel I need to respond with a few points to your rebuttals:

    1. I believe my “diversity argument” is valid. General and/or widespread mistrust (either short-lived or prolonged) in all sorts institutions exist for many reasons. Science is just one institution (which includes psychiatry), and it’s not immune. Financial institutions is another. But being mistrustful is not at all the same as being anti-science or being “denialist”. I don’t see how that connection exists. For example, the 2008 financial meltdown caused a lot of mistrust in the financial institutions. For people who had their retirement savings wiped out overnight, could you blame them? It doesn’t mean these people stopped believing in the body of Finance Theory or Economic Theory or whatever, it more likely just meant they had no confidence in the influential leaders participating in the financial system at the time.

    2. You quoted me – “Thus, when Jack suggests that we “need to create a sensible framework””……. No that’s not right. You misquoted me. I really meant “we needED [sic] to create a sensible framework”. Past tense. There should be no point of disagreement here!

    3. I think we’re at odds on the meaning of “anti-psychiatry”. The term is far too broad to be meaningful for me. But let’s just assume anti-psychiatry only encompasses people like Scientologists and other critics coming from a non-scientific viewpoint. Then I would agree with you that “anti-psychiatry is a form of pseudoscience”, otherwise I think it’s just way too self-indulgent to get further into pedanticism (even as an engineer…).

    4. You said “Medical diagnoses rest on facts, not merely trivial conceptualizations”.
    You may already be aware, but it is in mainstream agreement that psychiatric diagnoses are NOT medical diagnoses. There is almost no controversy in that regard. Also, conceptualizations are not trivial, they are necessary in every scientific field.

    So … I assume you meant “Psychiatric diagnoses rests on facts”. But that still doesn’t get us anywhere. Sure, it is a fact that people with Internet Gaming Disorder – yes, this is a disorder that was seriously considered for addition to the official DSM-5 and for which extra research has been requested – share certain (rather broad) attributes in common. But what is the significance of that? You may as well start with the premise that a person is mentally ill, then create diagnostic criteria for it.

    You have misunderstood what I wrote and are getting things upside down… I’m NOT saying that the DSM or diagnostic algorithm is arbitrary or random. Even pseudoscience like Chinese Medicine or Homeopathy have standardized manuals. I’m saying that I believe the framework for deciding what will become a mental disorder is too weak. It’s made even weaker by the fact that mental illnesses of the DSM are voted in and out (e.g. Aspergers syndrome has been removed from the 5th version of the manual) by committee.

    Again some personal background: I’m a software engineer with a BSc degree. We accept that our field is in a crisis (well, ever since the late 60s and 70s). We often joke about how our field isn’t really an “engineering” field. Mechanical engineers joke about us. Even I personally don’t think most contemporary software engineering is actually “engineering”. It’s just my opinion.

    5. “Just imagine what could be accomplished if anti-psychiatry activists would stop recycling myths and misinformation and instead helped mental health advocates fight for mental health funding, treatment availability and access for those who need it.”

    I think thats naive/wishful thinking. While overtly shocking pseudoscience including Chinese Medicine or Homeopathy can definitely cause damage, we can’t forget that insidious pseudoscience and misinformation comes within the walls of scientific institutions. It’s easy to see the obviously bad stuff, it’s harder to see the rot hiding amongst the apples until it’s too late.

    6. You say – “While it is certainly true that another 100 years of scientific research will create massive improvements, none of it is likely to overturn core facts. This is because these facts are based on a massive amount of independently converging evidence and any future model must make the same predictions as an older one in area where they both apply.”

    Well, that’s your opinion. I personally believe that scientific research in centuries to come will mostly overturn the so-called “core facts”. I have read a lot of the DSM-5 and to me it is intellectually disturbing. You should read at least 200 pages of it. It’s very interesting (but expensive) so get it from the library or something.

    Also, I cautiously disagree with you that there is reliable “independently converging evidence”. We don’t know that! Personally I believe other fields such as Computational Biology and Artificial Intelligence (fields both of which I have some experience in from university) are likely to provide divergent evidence, not convergent.

    You make a good point about Newtonian vs Einsteinium vs Quantum Mechanics. Mathematicians and physicists are trying so hard to find a Unified Theory. But they accept physicists being happy is not a requirement of the universe. The 3 models, while all incredibly useful, do not have independently converging evidence! General relativity doesn’t only explain more than Newtonian physics, it explains differently. That’s very important to understand.

    TO CONCLUDE:

    I’m NOT saying anywhere that psychiatry or psychology is useless or bad or (insert other value judgement). I merely voiced my opinions and concerns about the quality of science in the field, and the worrying level of complacency in research and practice.

    I think this website has good intentions, but I feel it’s got a much too righteous and smug tone and that can make your cause counter-productive by alienating otherwise potential allies. At times Debunking Denialism sounds almost like a religious crusade. The world around us hugely complex (maybe infinitely so). Our thinking needs to be far more nuanced, and I think Debunking Denialism should work on that. You don’t want to sound like many of those you are trying to debunk!

    Again, thanks for your detailed response and I’m privileged to have an opportunity to respond!

    Best Regards,

    Jack

    For more opinions …

    Please see: https://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/

    Also see: http://reason.com/blog/2012/08/10/dsm-editor-says-mental-disorders-most-ce

    Reply
  • January 24, 2017 at 01:49
    Permalink

    Thank you for your response. Here are some of my thoughts:

    Can individual experiences color one’s view of an entire field?

    I think you are on to something when you suggest that perhaps it is possible that one’s own experience can affect one’s view of a medical field. If someone was treated exceptionally good by, let’s say, a cardiologist, that person might come away with a really good opinion of the field and the doctors working there. Perhaps the person might even dismiss valid concerns about cardiology and cardiologist departments. In the same way, it is possible to get a really bad experience with some health professionals and come away hating the system. In Sweden, for instance, there is a lot of criticisms of bad dentists who engage in malpractice or claim that there are more holes than the scans really show.

    But we have to ask ourselves the next critical question: without invalidating anyone’s real and harmful experiences, how much can we generalize? I am 100% certain that there are psychiatrists who are incompetent at diagnosing mental illness and some psychotherapists who really have no idea how to relate to clients whatsoever and whose therapeutic alliance is worse than a failed soccer team. But how do we put this into relation to the mental health professionals who are careful and considerate? What about the fantastic psychotherapists who help people to get out of their most darkest places? What about all those people who suffer from mental illness but are not able to get access to treatment?

    There will always be false positives. That is the nature of any diagnosis. But how do we put that into context of true positives and false negatives? I think that shitty experiences with psychiatrists (or any other medical specialty) can make it a little bit harder to think in these terms.

    What about rating scales?

    It is probably a challenge to give psychotherapy to teenagers and young adults. It sounds like your therapeutic alliance was shit and that the psychotherapist was bad at her job. That sucks. I hasted to add, however, that rating scales and inventories are tools that give doctors a way to look at e. g. depression symptom severity over time without getting too much subjectivity get in the way. They are not perfect, but pure subjectivity is worse.

    How do we know that antidepressants are effective?

    From analyzing a single individual case, it is of course not easy to tell if antidepressants were a key factor in an improvement. As you point out, there are many other factors that are at play. That is why we need to do scientific studies. That allows us to tell the signal from the noise. Large-scale meta-analyses on the efficacy of antidepressants that also take into account publication bias show that their therapeutic effects are between small and moderate and comparable to psychotherapy. Anti-psychiatry proponents do not like these studies and invent a wide variety of ways to attack them, even when those studies themselves are carried out by other anti-psychiatry researchers and has the same results as psychiatry researchers.

    As for suicidal thoughts and behavior as an alleged side-effect, it is actually a bit more complicated than that. Here is what I wrote in a previous post:

    While it is true that the FDA requires that all antidepressant medications carry black box warnings that notes that it is possible that, in some cases in certain subgroups, patients may have an increase in suicidal thoughts and behaviors when taking antidepressants. However, the increase that media reported was just from 2 to 4% and this may have been due to increase in reports (Hall, 2009). Also, after the prescription rate fell by 18-20%, suicides increased by 18% (Hall, 2009). The Olfson et al. (2006) study that appeared to show an increase in suicidal thoughts and behaviors was problematic, since it made the incorrect assumption that the two groups had the same risk for suicide, whereas it was likely that the group treated with antidepressants had more severely depressed patients and thus a higher risk for suicide. Furthermore, Bridge et. al. (2005) showed that suicidal behavior and thoughts in antidepressant tests were similar to psychotherapy trails and Simon et. al. (2006) showed that suicide rates before starting antidepressant treatment were higher and that this declined progressively after starting medication.

    The label “denialist”

    Many people do not like getting the label “denialist”. But denialism is a consistent and well-understood set of rhetoric techniques used by proponents of pseudoscience. Sometimes we must call a spade a spade. If denialists are allowed to say very vile things about doctors or climate scientist, then I think “denialist” is a timid description by comparison. If someone uses typical denialist rhetoric and typical pseudoscientific arguments that have been debunked literally thousands of times before, you start seeing a clear pattern.

    The diversity argument

    The core of my rebuttal was that different kinds of anti-psychiatry stances come from different places, but that they share a common core of features and that we can therefore put them under the same larger umbrella of anti-psychiatry movement. You did not clearly engage this rebuttal. It is also not a good idea to compare science to finance, since there is a much larger ability of science to test their ideas than economy.

    Misquoting issue

    Indeed, I misunderstood your last part there completely. I will strike that out and fix that mistake. Thank you for showing me that I was wrong.

    The term “anti-psychiatry”

    When I and other scientific skeptics use the term “anti-psychiatry” we genuinely mean it to refer to groups of people who are against psychiatry. Let us compare to vaccines, for instance. People who are anti-vaccine are really against vaccines. When someone like vaccine researcher and pediatrician Paul Offit says that maybe U. S. troops should not get a smallpox vaccine since they are extremely unlikely to face a disease that has been eradicated decades ago, he is not being anti-vaccine. When health activists want to lobby the government to develop ways to grow flu vaccines in mammalian cells instead of eggs to reduce the tiny risk of allergic reactions to eggs when getting a flu vaccine, they are not anti-vaccine.

    Anti-psychiatry, like anti-vaccine, is a term reserved for pseudoscience activists who are clearly against these things. Just as it is virtually impossible to be against, let’s say cardiology, without making up nonsense and promoting pseudoscience, so to is there really no “other kind” of anti-psychiatry than this. Genuine efforts to improve vaccines is not anti-vaccine and genuine efforts to improve psychiatry is not anti-psychiatry. Repeating the same old canards that has been solidly refuted before, however, just might be.

    Psychiatric diagnoses are medical diagnoses

    Psychiatric illnesses are illnesses of the way the brain functions. There is no special non-material entity that these afflict. It is only in the U. S. there is a special diagnostic manual for mental illnesses. In Europe, people use ICD-10 from WHO, which does not make a radical difference between conditions of the kidney and conditions of the brain/mind. It is the same diagnostic manual.

    Psychiatric diagnoses are based on facts

    You claim that “the framework for deciding what will become a mental disorder is too weak”, but you have shown virtually no grasp of what this framework is or how it functions. There is no difference between how conditions of the brain and conditions of other organs are handled. They are explored with scientific research, evaluated by expert committees and voted on for inclusion in diagnostic manuals. Guess what? All the specific things that go into any medical diagnostic test are voted for, either directly or indirectly via established consensus in the literature. Science works via consensus. How low do your T cell count have to be before they can diagnose someone with AIDS? That was voted for. Does not mean that AIDS does not exist or that there is no scientific basis for its diagnostic process. You have been taken in my bad arguments.

    Asperger’s syndrome was not “removed”, it was merged into autism spectrum disorder because of the growing scientific realization that autism is not one thing, but a spectrum condition. The fact that science updates itself as new evidence becomes available is a good thing. Stop trying to make it look like it is something shady or bad. By the way, this is another classic anti-psychiatry argument that has been refuted many times before, even on this website.

    What anti-psychiatry activists could do

    My point was that many anti-psychiatry activists want to make it appear as if they genuinely care about people with mental health problems. However, they attack the existence and treatment of mental illness all the time and thus their words carry little weight. Instead of this, they should help improve access and funding for mental health. Then they might be taken more seriously.

    Correspondence principle

    No, it is decidedly not my opinion. It is a demonstrable scientific fact. I can guarantee you that there will be no future research that will find that psychiatric conditions are really disease of the toe or the kidney.

    General relativity makes the exact same predictions as Newtonian mechanics in areas where they both are applicable. This is why we could land on the moon using nothing but Newtonian physics. This is not an opinion. It is a fact (calculations can be seem here). The reason why we will not one day find out that mental illness are all just diseases of the kidney is because there is independently converging evidence that it is connected to the brain. Your name-dropping of “computational biology” or “artificial intelligence” does nothing to change this.

    Smugness? How dare you!

    Listen, I have absolutely no problem sounding smug.

    This is because pseudoscience is literally killing people by the thousands every year. Over 330 000 people died prematurely when AIDS denialist Thabo Mbeki blocked HIV medication because of conspiracy theories he had read on the Internet. Astrologers scam people for millions of dollars every year. Parents force thousands of autistic children to take bleach enemas that corrode their intestines. People spend 34 billion dollars every year out of pocket for alternative medicine. Alkaline diet proponents scam people with terminal cancer for almost 80 000 USD.

    If your main concern after understanding those facts is that I might sound smug at times, then I think you have some pretty screwed up priorities. When over a quarter of a million people died due to AIDS denialism in just a few years, calls for “let’s be more nuanced” is frankly anti-reality.

    Bottom line

    Look, the DSM is a diagnostic manual for mental health practitioners that is intentionally atheoretical. You are trying to treat it as if it was a textbook or review paper. It isn’t. The information you are looking for is intentionally left out. It is a manual for practitioners to make sure that we are all talking about the same thing. It is not geared towards explaining psychiatry or scientific evidence to anti-psychiatry activists or “psychiatry survivors”.

    I have read it and I have also read scientific research on mental illness for many years. I suggest that you read at least some of the literature on the subject. I will even give you an entry into the literature with this recent 20 page review paper:

    Christian Otte, Stefan M. Gold, Brenda W. Penninx, Carmine M. Pariante, Amit Etkin, Maurizio Fava, David C. Mohr & Alan F. Schatzberg. (2016). Major depressive disorder. Nature Reviews Disease Primers, 2, 16065. doi:10.1038/nrdp.2016.65

    It will tell you about what we know about the causes, epidemiology, prevention, treatment and management of depression. Go read that paper and tell me we are as ignorant about the brain and mental illness as you claim we are. It is not a perfect paper and some of the sections are too brief and simplifies a few things, but it should get you started.

    You probably cannot access this paper from the journal website, so you will have to use a service like Sci-Hub. Mandatory disclaimer: none of this should be taken as encouragement to circumvent paywalls or otherwise violate copyright law. Information is only provided for educational purposes.

    As a final note, I would encourage you to read more scientific papers than clearly politically biased blog posts. Think about what sources are credible and which might not be.

    Reply

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