Psychiatric Diagnoses a “Convenient Fiction,” Complex Systems Approach Needed

Psychologist Eiko Fried proposes studying mental disorders as systems, not syndromes.

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Eiko Fried, a professor in the Department of Clinical Psychology and Leiden University, has a new paper arguing for a paradigm shift in research practices in mental health. His approach to studying mental disorders as complex systems highlights how current understandings of psychiatric diagnostic categories may be convenient fictions.

“Research is often carried out as if DSM categories cut nature at her joints,” Fried writes. “Because diagnostic labels are convenient fiction – because diagnostic categories and thresholds to distinguish healthy from sick are manufactured rather than discovered – the question remains how useful, such designs can be.”

Historians of psychiatry have suggested that the diagnostic categories within the DSM are indeed manufactured, not “discovered.” But much of current psychiatric research design reflects twin approaches to mental disorders that oversimplify psychiatry’s history: diagnostic literalism and reductionism.

Diagnostic literalism assumes that ascriptions of psychiatric diagnosis are explanatory (“Why is Peter so sad? Because he has depression”). But as Fried points out, most diagnostic categories in the DSM have been shaped by historical forces and cultural attitudes, not empirical evidence. Reductionism proposes a hierarchy of factors for understanding the person, with one type – physiological forces – being primary. But reductionist models of the mind, too, have proved to be a dead-end for psychological researchers seeking meaningful change.

As Thomas Insel, former NIMH director, is quoted as concluding, “[after] 13 years at NIMH pushing on the neuroscience and genetics of mental disorders … I succeeded at getting lots of really cool papers published by cool scientists at fairly high costs – I think $20 billion – I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”

The reductionist approach in research, paired with the assumption of diagnostic literalism, has provided results of little utility – if not outright harm.

On the other hand, many robust phenomena can be explained by a systems or continuum approach to mental health disorders: for example, that inter-rater reliability for diagnosis is often only moderate; that many diagnoses feature marked symptom heterogeneity; and that considerable comorbidity between diagnostic categories. If today’s diagnoses are not best described as categories but are instead rough clinical approximations that refer to problems that lie on a dimension of severity, these robust phenomena – including especially the fuzzy boundaries between disorders – are easily explained.

The shift to a systems approach, and the rejection of both diagnostic literalism and reductionism, has important consequences for research that has for decades proceeded from the assumption that DSM categories cut nature “at its joints.” On this view, both biological mechanisms and psychological and environmental processes play complex roles in mediating disease trajectory.

“It is therefore questionable,” Fried writes, “how useful current research efforts can be that map biological (or other) markers onto specific DSM labels that are, for the most part, convenient fictions.”

Fried thus argues that a systems approach to studying mental disorders is necessary to reflect both the complexity and contingency of our current diagnostic categories in psychiatry. This involves widening our focus to biopsychosocial elements of mental health systems and moving beyond the current focus on symptoms.

If mental health phenomena are not simply physiological processes but emergent properties of complex, interrelated systems, they can no longer be decomposed into simple cause-effect relations. Thus, “understanding the macro-level behavior of mental disorders will require building more interdisciplinary bridges between biological, psychological, and social investigators.”

Fried goes on to argue for the necessity of mathematical models over the “ambiguous verbal accounts currently dominating the literature.” If the researcher’s task, in Fried’s view, involves translating verbal data into mathematical inputs, however, she must be careful not to simply naturalize or reproduce the inequitable and ineffective systems in which they operate.

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Fried, E. (2021). “Studying mental disorders as systems, not syndromes.” (PsyArXiv preprint) 10.31234/osf.io/k4mhv (Link)

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Editor’s Note: Eiko Fried, the author of the article covered here, removed the phrase “convenient fiction” from the preprint article three days ago. Dr. Fried’s comment is below:

Thanks for featuring the preprint. I removed the core term “convenient fiction” that you use in the header 3 days ago, because I found the term can be easily misunderstood. I updated the preprint before you featured the piece (so this is *no* criticism of your piece), but I wanted to make sure to let your readers know.

The relevant section of the manuscript now reads:

“The superimposition of categorical diagnoses on the complex landscape of mental health problems explains the robust phenomena I listed above (Hyman, 2021). As Ash put it in 1949: “it is likely that the lack of congruity between the diagnostic label and the complexities of the biodynamics of mental structure is itself at the heart of diagnostic failure” (Ash, 1949). While many clinicians and researchers are aware of these complexities, clinical research is often carried out as if DSM categories cut nature at her joints. Scientific studies often take diagnoses for more than they are, which I refer to as diagnostic literalism. Case-control studies dominate the literature, where a healthy control group is compared to a group diagnosed with one specific mental disorder, regarding some variables of interest. Because mental health categories and thresholds are manufactured rather than discovered, the question remains whether such designs are optimally positioned to inform research on psychopathology (Cai et al., 2020; Hitchcock et al., 2021). Of note, this position should not be mistaken view the view that mental disorders do not exist, do not involve suffering, or should not be treated. My point is that our categorization of mental disorders remains somewhat arbitrary.”

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Jenny Logan
Jenny Logan is a visiting professor of law at the University of Oregon. Jenny has worked as a special education teacher in the Bronx, New York, and more recently in fair housing and environmental justice movements in Portland, Oregon. A psychiatric survivor, she is interested in the political economy of child sexual abuse and psychiatry's role in the erasure of various forms of oppression.

29 COMMENTS

  1. Thanks for featuring the preprint. I removed the core term “convenient fiction” that you use in the header 3 days ago, because I found the term can be easily misunderstood. I updated the preprint before you featured the piece (so this *no* criticism of your piece), but I wanted to make sure to let your readers know.

    The relevant section of the manuscript now reads:

    “The superimposition of categorical diagnoses on the complex landscape of mental health problems explains the robust phenomena I listed above (Hyman, 2021). As Ash put it in 1949: “it is likely that the lack of congruity between the diagnostic label and the complexities of the biodynamics of mental structure is itself at the heart of diagnostic failure” (Ash, 1949). While many clinicians and researchers are aware of these complexities, clinical research is often carried out as if DSM categories cut nature at her joints. Scientific studies often take diagnoses for more than they are, which I refer to as diagnostic literalism. Case-control studies dominate the literature, where a healthy control group is compared to a group diagnosed with one specific mental disorder, regarding some variables of interest. Because mental health categories and thresholds are manufactured rather than discovered, the question remains whether such designs are optimally positioned to inform research on psychopathology (Cai et al., 2020; Hitchcock et al., 2021). Of note, this position should not be mistaken view the view that mental disorders do not exist, do not involve suffering, or should not be treated. My point is that our categorization of mental disorders remains somewhat arbitrary.”

  2. The truth is, we are living in the dark ages when it comes to psychiatry and mental health and understanding the brain.

    Also, another interesting thing is, the brain is a mathematical system. Where I do think brain activity — and imbalances in brain ACTIVITY — can be seen similarly to what physicists call “standing waves.” You know how, in the brain, when one part of the brain gets extra active, it will selectively activate certain other parts of the brain while selectively dampening other parts. Similar to how, in a container of water, you will have several waves with peaks and troughs.

    When I was recovering from criminally induced PTSD via mountain climbing and other stuff like that, first of all I noticed that the same exercise indoors didn’t help, it had to be outdoors, and then I intuited, the biggest difference is the olfactory stimulation you get outdoors. Sure enough, olfactory sense networks with a bigger part of the brain than any other sense, meaning the capacity for olfactory sense to stimulate the brain or affect stimulation is bigger than anything else.

    The olfactory sense stimulates the brain — even while muscles produce chemicals in response to exercise, which get into your blood stream and go right to your brain. I will say, I think various parts of the brain will ignore those chemicals, if not being stimulated via olfactory sense the most (and the other senses too) at the same time. But, somehow, these chemicals plus the sensory stimulation causes the part of the brain that over reacts in response to ‘fight or flight’ adrenaline and causes PTSD — and which probably is implicated in schizophrenia which is something like a malfunction that is still tied to the brain’s “sensing of danger” — to re-evaluate, re-program, and change course. Permanently, though.

    As someone who took courses in math and physics, though, as I see myself slowly overcoming PTSD via mountain climbing, I visualized the process via thinking of physics and standing waves. The anxiety/fear/PTSD part was like a whole part of my brain had gotten way over stimulated or too liable to stimulate too intensely. Too active. And so strong, it stifled and totally clamped down on and completely shut down other parts of the brain more willing to re-evaluate “danger” and agree I was no longer in danger then (which I no longer was — but knowing that in an “intellectual” sense wasn’t the same as REALLY knowing that in ALL of my brain).

    The mountain climbing, I just know, helped to calm down the anxiety part some, helped to stimulate the strengthen the other parts capable of keeping that anxiety part in check. Not just temporarily but, over time, permanently. But, actually, part of it is I distracted myself by becoming involved with intellectual stuff — which meant kind of “growing” a different part of my brain, which then got strong enough so as to shut down the over active “anxiety/fear” part.

    I ought to note, when studying math, I did a bit of set theory and then on my own started to think of how you could use that material to mathematically model the brain — which I later found out was a topic that had already been invented before I thought of it. “Neural networking,” it is called.

    I think they ought to get mathematicians, and good ones too, to start to think about the field of mental health, and see what they can imagine. Because I bet you could make some breakthroughs. Most psychiatrists, I note, are not mathematicians. And do not have mathematical literacy, which is something where it’s all hard wired into the brain. You either have it or you don’t. If you don’t have it, you will be incapable of being educated into it.

    So I imagine most psychiatrists would not like my suggestions at all. Especially the male ones who guard their academic “territory” very ferociously. I’ve been through this before. As a teenager I was involved in grassroots politics and wrote letters to the editor of local papers, including an op-ed piece in the Wall Street Journal at age 19. This was in Cambridge, MA. Well, I remember one Robert Winters who loved being an expert and talking in an authoritative way, like how some psychiatrists are. Well I was shy and didn’t talk, usually. But there was one time I’m standing with people in a conversation with Robert Winter about something, they are talking about something I know about. So I bravely muster up the courage to pipe in and say something. The moment I start talking, he instantly and very aggressively interrupts, cuts me off, and says something authoritative just to prevent me from joining in. It was clear he felt “threatened” by me, as a lot of people say.

    “They’re just threatened by you,” I have heard over and over again. Referring to my intellect, not my muscles, I note.

    Anyway, they should have mathematicians join the field of mental health, and see if they can use their math skills to somehow gain insights that might help. However, they will have to watch out for the attack dogs presently in the field. When I was at Harvard, I was told by administrators all about how each field is like it’s own fiefdom, where they ward off outsiders, and this results in intellectual segregation that is very bad. It is possible for people of another discipline to contribute insights to a discipline different from their’s. All sorts of amazing work could be done. It all isn’t done because of the territoriality of people in each discipline.

    Academia ends up being pretty stupid because of that. I would say the social studies, in particular, are especially dumbed down due to lack of contributions from people with anything even approaching rudimentary math skills. Actually, my mother had math skills and tried to go into sociology. Let’s just say, it was quite a disaster. Ostracism, backstabbing, etc.

    And I am not surprised. Every time I read an article that discusses sociology or anthropology or even theories regarding evolution, as someone with rigorous math skills, the stupidity and mathematical ineptness I can obviously see from the people presently in the field is very annoying. I get inspired to write facebook posts or blogs contributing my own insights, based on my mathematical mind, and I think they are good ones too. But no one, currently in the field, ever thought of them.

    Can you imagine trying to socialize with existing academics in a field like that? And, of course, I am a socially sensitive person who would know better than to explain to people that they are being stupid about something.

    Actually, one of my ideas I had re: evolution was, I noticed that the best way to deal with anxiety and depression is not merely to do outdoor exercise. Location and climate matters too. The white mountains of New Hampshire which are somewhat high altitude, and have lots of streams with cold water crashing over rocks makes the biggest positive impact of all.

    Why would we have evolved that way? Because routine climate change occurs. Absent those mental health issues, during wet periods, human beings might have chosen to move to much easier-to-navigate valleys that would, in time of drought, dry up causing everyone to die. But not if depression and anxiety – especially among women – forced everyone to live closer to mountainous areas. Which will be the places that stay wet in times of drought, unlike the valleys and plains.

    The moment people move — in wet periods — to the seemingly more welcome valley, some women, more prone to depression, will start saying “I just don’t feel right, I feel scared, I want to go back to the mountains, I felt better there.”

    Oh yes, here is the facebook post I wrote about it.

    https://www.facebook.com/damian.schloming/posts/10220089305435377

    Isn’t it a theory that ought to be considered potentially valid?

      • Our culture is caught up in science/scientism. With great relish, the Church was dethroned, only to be replaced by the White Lab Coat. I find it amazing how so many folks uncritically accept scientific truth claims. Perhaps the pandemic has pulled the pants down (somewhat) on the hegemony of science. But as the author will know, science/scientism still wields power in a court of law. Courts take the testimony of psychiatrists, not priests, shamans or gurus.

        • Of course, but I should make note of the fact that there are a few academics (“scientists”) who ARE researching the paranormal. One group known best to me is the Division of Perceptual Studies at the University of Virginian School of Medicine. So, it’s not that these subjects cannot be studied scientifically, it’s that most of science has not been permitted to study these subjects.

          I don’t think the answer is to let “the church” back into the scientific discussion. I think the answer is to expand the scientific discussion into fields that “science” has relegated to the purview of religion. For me, this transition has already been made, but for most people, definitely not!

          • RIght. I was painting some pretty broad strokes and you are correct to point out that the so-called “paradigm shift” might be underway. Having said that, I personally find that some – maybe not all – scientific studies of the paranormal are sort of rinky-dink and do not interest me. I myself am more interested in a holistic approach where we try to personally be scientific about our perceptions thru reason, humility, fact-checking (as much as possible) and a willingness to admit error. I think this last point is very important.

            I think Christian mysticism is just as valid – if not more – than any other type of mysticism and those who believe that it cannot happen within the Church are misguided, IMO.

            So for me, holism means considering as much as we can. Not just the flavor of the month.

          • It is true that that academic studies of paranormal phenomena are very reserved and – you could say – conservative in tone and verbiage. My point is that “science” CAN go there! They – as an institution – just don’t want to. There has been a lot of work done by non-academics in these areas which academics, of course, will tend to characterize as “unscientific.” This is because there are definite and real blocks in the human psyche to unearthing the truth about itself.

            I am happy to live in a time when a large quantity of that truth has been discovered. But frustrated by the human barriers that exist to studying the subject.

      • “Why not leave the brain work to neurologists and return psychology (and psychiatry, if you could ever drag them away from their love affair with drugs and other toxic interventions) to the actual study of their subject, the psyche?”

        ——

        Because mental health issues, all of them, ARE of the brain. What is the “psyche” anyway? It’s ill defined.

        Everything is neurological. I am a victim of brain injuries so I know. Also, sitting down and talking to a therapist? Honestly, the truth is, we are brainwashed into doing that — rather than a whole bunch of other things — because therapists need jobs and steady careers.

        I believe the soteria project involved people talking to schizophrenics and curing them of it — not sitting down in an office but WALKING WITH THEM. The walking with them part VERY important.

        Academia just has this psychology profession, which makes a lot of money. And it all works out so the (fake) notion is that you solve “psychological problems” by going to some psychologist, sitting down with them in their office, and paying them money.

        I have seen therapists in the past and, frankly, found it all to be really stupid. The social stimulation is good. But you can get that anywhere. The idea that you need to see a “professional” is — well, maybe it’s not 100 percent a scam, but to some degree it is. We used to have religion that involved teaching universal moral values, and I am not big on Christianity, but I have to say, the advantage of going to church is that enough people in the community get innoculated as to the right values of living in a social society, so it’s almost like you don’t need professional psychologists as much, if everyone went to church once a week — or something that was LIKE church. After all, I agree Christianity is obsolete, but something more modern should be put in its place to fill the gap it left. There is a NEED for that in human society.

        By the way, are you aware that Adolph Hitler did a ton of experiments in psychology? Well, not him personally. Nazi doctors. And some of what they figured out was imported to America, tricks to be used by the mafia.

        And then George W. Bush also goes and pays psychologists on some project regarding psychological torture and terrorism. Which everyone agrees was not a terror prevention program.

        Who knows what their interests were or what their agenda was. But the truth is, people usually have a pretty good understanding of their own self interests and are not stupid about it.

        For some reason, the conventional wisdom is that the government war on terror apparatus was “just being real stupid” with regard to their obsession with psychological torture and terrorism. The truth is that, as regards how to get confessions, no new research ever needed to be done. It’s common knowledge what works and what doesn’t work.

        I really feel, though, that psychological torture as a tool in the hand of would be terrorists, who wish to use it to incite OTHERS into committing terrorism, strikes me as much more of a research area where interesting things could be explored.

        • Everything is neurological? Who told you this?

          You are quite aware that people of ill intentions have been interested in psychology for a long time. Well, those guys are the same ones who are trying to convince us that it’s all in the brain. So, if you really think you have a neurological (brain) problem, then see a neurologist.

          The psyche has been defined and has been studied scientifically. Even a few psychiatrists and psychologists have been involved in this!

          Science has the option of using different models for the same phenomena, then by experimentation determining which model predicts behavior the best.

          In the model I believe is the most accurate, the psyche is an immortal spiritual (non-physical) being. Though the human situation is a bit more complex than that, my point is: Why is psychology studying neurology? If someone wants to study the brain, they should study neurology. If someone wants to study the psyche, they should study psychology.

          It makes sense to me.

          • Um, wow. I think, in some ways, depression and ptsd are neurological — but just in such a super complicated way, science won’t figure out directly how they should be treated. Humans evolved with instincts that help them instinctively “know” or be able to “figure out” how they should be treated.

            Just as, I think religion evolved, organized religion evolved, because it has always been some form of societal construct that results in positive mental health rather than negative mental health.

            That is a scientific way one can think of it. Dry and scientific. And no fun.

            But I believe in the spiritual too and feel there is no sharp dividing line between the “dry scientific” and “spiritual.” I do suspect some intuition and foresight maybe could be seen as quantum mechanics in the brain.

            Meaning, it’s “scientific.” Even so, I would still not dismiss the spiritual.

            I DO think a big problem with modern day society is that science does not respect or even positively DIS-respects the spiritual.

            Which is strange and awful — and also anti-scientific too. It fully makes sense to argue that the spiritual amounts to collective wisdom we evolved over eons, because it gave us a competitive advantage.

            Just like how maybe WE as babies are not born knowing how to walk, yet deer are born knowing to walk, because they evolved that ability HARD WIRED in the brain, we evolved the tendency towards spirituality HARD WIRED IN THE BRAIN.

            Scientists and academics need to RESPECT THE SPIRITUAL much more. Respect it AND respect it AS something that is scientific. Respect it in a scientific way.

            Rather than, we have a form of ghettoization today where those who would embrace the spiritual try to define themselves overly in contrast to science, and in such ways so that they don’t really have the best language for describing the various spiritual or psychic phenomenon they both believe in and experience and know others who experience.

            I have been both very scientifically trained and also with lots of spiritual ability and someone who hung out around psychics, lots of psychics, and maybe was “trained” in that too, in some kind of informal way. But all in such a way so that I can speak both languages. As well as see the scientific consistency in much of my intuition.

            Much of which I have actually written down, over the course of many years, and ended up stored in my computer files. It’s very interesting, actually.

            Anyway, what’s the difference between “psyche” and neurology? Maybe “psyche” is neurological in such an extraordinarily complicated way that we will never be able to have advanced mathematics complex enough or sophisticated enough to be able to study it using tools of neurology. But the psyche evolved along with innate wisdom about the psyche, enabling us to rely on that innate wisdom, when scientific tools would fail, and we call that reliance on innate wisdom “psychology.”

            But here’s the thing. Psychology can be distorted and corrupted, in a societal way where the whole society ends up somewhat unhealthy. And when that takes place, the only way it can be fixed is by people who believe in themselves strongly and believe in their intuition very strongly, and who resist the lemming-like mindset of the herd. And who resist it strongly enough so the herd eventually rights itself. Here is an interesting fact about human society. All of society can start going in the wrong direction, in a lemming like manner, where the majority all “agree” with one thing that is wrong. All “agree” — but not really too fervently.

            It only takes a VERY few group of people in society, who are REALLY grounded and who REALLY believe in themselves. To speak up, speak the truth, hold their ground, and not back down. And get the majority to wake up, think about things, and change their minds.

            Feminist legal scholar, Catharine MacKinnon, wrote a book called The Butterfly Effect recently. The title of her book recognizes that same point.

          • OK! Well, I’m really glad you are thinking about this stuff.

            Just want to point out again, though, that “spiritual” is about something, and that thing is Spirit. And several people who have looked at this subject have concluded that Spirit (and spiritual beings) are immortal (they exist outside of time).

            And some people thought to ask spiritual beings (each other -as we are all spiritual beings) what they could remember. And different researchers found different ways to validate these memories. So, even though they are “only memories” this gives us a history of life and the universe from a spiritual point of view.

            Spirit and its ability to “remember” provides a continuum for living things that helps explain many aspects of life, including mental and emotional difficulties. The stories we get from spiritual memory challenge our teachings about evolution, the brain being “hard wired,” where religion comes from, and where humans come from. In my view it is long past time for those teachings to be challenged. They were inadequate and now we know why.

  3. I know that I repeat myself but I dont understand this obsession with finding the right model.

    It looks like to me that this is a need from the provider which is manufacturated by his perception of status, rather than the embracing of reality. In other words, a delusion.

    Yes thats it. All this fuss about the right ‘model’, which unavoidably implies that there are ‘right’ people dangerously veers on the side of the egotic delusion.
    It looks like some people are trying to flesh out their power and flex those muscles.

    This is a scary pitfall for me.

    One does not need to go from the ‘right’ model (that is to say the ‘right’ muscles), but simply to go from the person.

    Systemic approaches are doomed to failure. They will tend to support systems and powers rather than people.

    We just need to focus on people. Why is it so complicated?

    There seems to be this blindness lurking around, as if a lot of people cant relinquish the holy model.
    There must be several reasons for that, but I quite dont like this need from providers to polishing their delusional power.

    • That’s an interesting perspective. No doubt social power plays a role in the whole setup. I’ve also noticed how incredibly skewed the doctor-patient relationship can be. Anyone who has been to a psychiatrist might get the feeling that they are talking to an answering machine and not a real person. It’s all about the patient “confessing” their inner workings while the doctor wears a phony mask of objectivity.

      For the most part, I don’t believe in objectivity.

      Having said that, I do embrace what we might call “working theories.” I think we need to limit reality to some extent. Actually, I don’t think we can escape it. So best to be honest and admit where we are coming from, be open to being wrong, to making mistakes, and to developing a more comprehensive theory or model.

      The psychiatric model is a farce, philosophically speaking. It’s just so bad that I don’t know where to begin critiquing it. I tried doing so at grad school but met with a backward-thinking prof. who just cut me down.

    • The right model is when people bow out of having all the crazies
      point out the crazy in them.
      The only insurance of not getting a label is to either become a shrink or
      never EVER talk to one. No answering questions. It is incriminating.
      They are literally the thought police.

      • I think the situation is a bit more complicated than what you say.

        Like anything in life, there are good psychiatrists, mediocre and incompetent ones. Some of the better ones, I would argue, question the paradigm in which they practice but also realize they need to toe the line if they are to do what they do as a “medical” doctor.

        It can become intensely political. Some psychiatrists may try to penalize or de-license other psychiatrists because they have different approaches and ideas. The sad thing is the average vulnerable patient doesn’t realize all this is going on and buy into a monolithic ideology about psychiatry that simply does not exist in actual practice.

        I find a similar dynamic within Catholicism. And that’s not surprising. Both are human organizations. Psychiatry and Catholicism both have this human element which they tend to play down in favor of a “front” of unity.

        • Sam speaks from personal experience, I believe. More personal experience than I have.

          I belong to a “human group” too. But that group taught me about the existence of something that very few other groups ever talk about. In ordinary lingo it is commonly referred to at a psychopath.

          My group has methods for detecting and handling such people. We would prefer to be totally open in our membership policies, but this one is pure poison, so we act to keep them out. Not many other groups even try to do this, or they wait until it is too late and the damage is already done.

          Of course there are good people in psychiatry and psychology. Some of them realize their mistake and leave (Kelly Brogan) and some stay in and try to exert a humanizing influence (Peter Breggin). But all of them have a hard time, per reports submitted to websites like this one, because the group is dominated by a criminal element.

          As much as some would like to leave “politics” behind, it is a part of life; inescapable. So best to know the real situation and confront it. Yes, it is “complicated.” But it is also simple: In the absence of psychopathy people of good will do OK. In it’s presence they become sick or upset, until they come to realize what is really happening. Our challenge is to recognize what is really happening, and decide what to do about it. Staying totally away from psychiatry IS a valid choice at this time.

          • The Swiss depth psychologist Carl Jung worked at a Nazi-occupied clinic, if I remember right. Jung says he believed he could do more good making that compromise than by not working at all. Perhaps some of the more humble, sincere, and intelligent psychiatrists rationalize their situation that way. Perhaps some are correct in doing so.

  4. Look at those dirty words just above: ‘mental disorders should be treated’.

    You dont ‘treat’ people. You listen, welcome, try to understand, accompany, etc human beings.

    Psychiatry will always be a problem as long as it will rest on people purporting to ‘treat’ other people.
    This is just not how you ‘treat’ human beings.

    It reminds me of this sentence from james davies: “So much in psychiatry has to do with who has the power”.

    We are right in it.

  5. When I first discovered this article referencing a preprint, I wondered. For to apply a legal context that purports an erasure of oppression, when the conceptual is hatching forward in a robust manner of informed scales surely will tip the evolving body of knowledge held by us. And I am not so sure if complexity thinking will bring a resolution to the challenge all of us are facing. If anything, the superficial manner by which decisions have been realized can be fleshed out with a quantitative analytics (see Bar-Yam) or a qualitative orientation (See the short lived E:CO Journal). Depending on the mood of the day, across the live forms where one is, the reading of the situation is quite arbitrary. The certainty of attempted efforts to monetize the situation at hand poses incredible risks (quantitative and qualitative) to the extent one can find healing increasingly on one’s terms. Finally, if the DSM is a product of the professionals, then does the product not cut the organization that is creating an expansion/revision somewhat of a monster in and of itself? And to what extent does the sovereign nature of LIFE, particularly that of a potential client stir up the political economy of reconciliation of any abuse across the players involved with a particular situation?

  6. OK. Yet another thoughtful person realizing that we aren’t there yet, that the problem is more complex than neurons misfiring, and that our “model of mental illness” is deplorable.

    But this thoughtful person hasn’t bothered to look around a bit and be curious enough to wonder, “is anyone else working on this problem?” And if so, “what models do they use?”

    Because the answer is YES! And I’ll give you a hint of what model is more workable: One that actually attributes psychological phenomena to the psyche (loosely, the Spirit)! And one that respects each person as a spiritual being regardless of their level of difficulty or confusion in handling their current environment (which is often very challenging).

    Psychiatry, and psychology to a lesser degree, dropped studying the psyche for irrational if not stupid reasons which included things like greed and lust for power. Reformers should recognize that, too! It’s not that everyone has had such a difficult time finding their way; it is that so many were purposely avoiding it!

    Good data about the psyche began to be available in the 1950s (and probably earlier). It was offered to academic people who totally rejected it. And that has been their attitude, to their eternal shame, up to and still including the present. If you’re going to discuss this problem at the level of theory, why don’t you? Include, at least, concepts of psyche in the discussion! They DO have something to do with psychology, you know!

    • I tend to tailor the way I talk about this material to my audience or, while on the web, perceived audience. I try to connect with people, to bridge the gap, realizing that their experience and ‘theory’ probably differs from mine. Such is the nature of the beast. Language itself is a wonderful medium. Just talking about this is good. Silence does nothing. Well, it could do something if someone intercedes for another person and vice versa thru contemplative prayer. But in terms of building a working public knowledge base, we also have to talk.

      I once knew someone who seemed to possess extremely high psi or gifted intuition, yet was reluctant to talk about it. This made me wonder if they were afraid others might “pick up” what they were really up to. There might be a dark side to psi, just as we see in the movies.

      True, some may not talk because they think others just won’t understand what they are about, what they do (as Jesus in the NT says, “Do not cast your pearls before swine…”). But others might be quiet because they are using their gifts to do bad things and are afraid of getting caught.

  7. I agree with a lot of what Eiko says – as he knows – but I feel compelled to make my usual point. What on earth is a ‘mental disorder’? It’s as much of a ‘convenient fiction’ as any of the specific diagnoses. Sure, we need a systemic understanding, but that applies to all human experience. We will get nowhere if we are not able to drop, or at least question, or at very very very very least, avoiding assuming, that there is such a thing as a ‘mental disorder.’

    • It is true that we could get by very well without this concept of “mental disorder.”
      But things will happen to people and they will reach for words to describe it.

      I recently witnessed a woman read a request from her supervisor to “pick up the pace.” Her reaction was to burst into tears. What are you going to call that? Does this mean she has a “mental disorder?” I would never tell her that. But I would also hope that she could do something to feel less intimidated by her supervisor. So I think the way doctors and others use these concepts is more important than the concepts themselves. I would never tell this woman to go to a doctor or therapist to “get treated.” Yet I imagine others are sent away for reactions much less dramatic than this one.

  8. Thanks Jenny.

    Dr I am depressed.

    “You have Depression. It’s in the DSM.
    Here are some “Anti-depressants”. If you come back, I am sure we can
    get the correct diagnosis as to the cause of your depression.
    It could be any one or more of the hundreds of mental illnesses.”

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