Researchers Call on Psychiatry to Abandon Biomedical Framework

Scholars reveal concerns about biomedical psychiatry, calling for a more scientific, unique, and effective approach to mental health care.

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A newly published study in the Journal of Theoretical and Philosophical Psychology by researchers Sara Campolonghi and Luisa Orrù from the University of Padua in Italy illuminated serious concerns about the biomedical framework psychiatry uses to treat mental disorders.

They argue that psychiatry, a discipline attempting to understand the mind using a medical approach often reserved for the body, finds itself in a perplexing position. This confusion, they say, has led to more problems than solutions, creating “more illness than effective treatment and relief.”

They point out that the conflation of medical illness and mental health has resulted in significant ethical issues and an urgent need for a more scientific and practical way to help those who suffer from mental disorders.

The authors stress that it’s time to recognize the limitations of psychiatry, stating that there are “implications of abandoning psychiatry’s biological framework in mental health care and the possibility for psychiatry to find its own specific, unique, and legitimate space of knowledge and practice.”

In modern, Western cultures, ‘mental illness; is often attributed to abnormalities in brain functioning. Whether they are described as genetic malformations, chemical imbalances, or epigenetic disturbances, the cause of depression, addiction, schizophrenia, and other mental diseases are seemingly always assumed to reside at the biological level. However, we do not diagnose mental illness via tools such as blood work or fMRI imaging, where doctors would be able to see the malformations and apply a diagnosis, leading to a set of possible treatments and cures.

Causal genes have yet to be found for mental disorders such as schizophrenia. For over a decade or more, we have known that the “chemical imbalance” theory is false (even if we still hear it in drug advertisements). fMRI imaging still can’t identify the differentiations between normal brains and those with ADHD. And the field of epigenetics, wherein a person’s genes are “turned on” or “switched off” due to environmental and experiential factors, suggests that the nature-nurture distinction cannot hold– a person’s biology is adapting to the environment.

Yet, psychiatry, especially in the United States, adheres strictly to this medical model. This model “is concerned with the human body and its parts,” “aims to ‘correct disease and restore normal functioning’ and conceptualizes disease as a biological dysfunction within the body,” the authors explain. “Since it developed primarily to cure acute infectious disease, this model is based on a monocausal theory of disease.” Monocausal means that if we look hard enough, we will find a singular, biological cause for a person’s distress.

Campolonghi and Orrù critique this approach to mental suffering by raising new and old questions about psychiatry’s stubborn adherence to this model. In their latest research, they ask questions about the implications of this model on how we understand people’s suffering, including at the cultural level, and then describe how psychiatry could abandon this model and instead “find its own specific, unique, and legitimate space of knowledge and practice.”

The Medical Model and Psychiatry

The duo starts by dissecting the medical models’ theoretical and philosophical underpinnings, first by explaining how “etiology,” or the study of causes (in this case usually monocausal and biological), became primary to medicine.

“Etiology and the related notion of causation have been central in Western medicine and pathology since the 19th century. The diagnosis explains the symptoms by indicating the cause, that is, a specific, necessary, and sufficient biological mechanism,” they write. “In bodily medicine, etiology, or the study of causes (aitìa, in ancient Greek), represents the gold standard for disease classification… which is necessary for medical diagnosis and treatment.”

Medicine groups the symptoms (clues) and works backward to find the monocausal, etiological mechanism causing the malady. For example, stiffness, fever, stuffiness, coughing, and a sore throat are usually identifiers of a viral infection. Yet, if a person also adds the symptom of loss of taste, doctors will know it is more likely COVID-19 because that biological mechanism causes that symptom in addition to the others.

This system led to the birth of modern medicine, virology, pathological anatomy, and other forms of medical science. It is within this structure that psychiatry has tried to fit itself.

“Psychiatric research and practices apply physical disease models and medical classifications to the realms of thoughts, feelings, and behaviors based on reification and on a superficial medical analogy where mind and mental disorders are assessed and treated the same way as bodily tissues/organs and physical symptoms. This happens in the absence of any reflection or discussion regarding the epistemological suitability of the biomedical criteria and concepts in its context of knowledge, nor the possibility of applying them scientifically in its praxis.”

This approach leads psychiatry to “emulate the medical approach by borrowing medical concepts such as symptom, disease, diagnosis, or syndrome, and using the health/disease axis as reference.” But does this system work for the actual ‘thing’ psychiatry is studying?

The “Mind” and the Brain

Psychiatry’s focus on the human psyche and its pathologies can be traced back to Aristotle’s view of the physical and the psyche as a united entity representing the human essence. This concept shifted with Descartes, who separated the psyche from the body, conceptualizing the body as a biological machine and psychological functions as the “mind.” This led to the mind-body dualism that underpins modern Western medicine and psychiatry.

French physician Pinel introduced the idea that psychological problems might have physiological roots, pushing psychiatry to adopt a medical perspective on the psyche. This required psychiatry to follow a reductionist biomedical model, treating the mind like the body. It focused on diagnosis and removed meaning and context, aiming for objectivity and disregarding subjectivity. However, this move away from subjectivity led psychiatry to sever its connection to its foundations, losing its theoretical and methodological groundwork.

The consequence of this shift was that psychiatry had to anchor itself in believing that mental disorders were rooted in the brain and primarily caused by underlying brain dysfunctions. The mental and physical realms were seen to have a causal relationship. To maintain its status within the medical community, psychiatry embraced the Cartesian idea that the physical world could cause issues in the non-physical realm or the mind.

Psychiatric Diagnoses and Classification

While there is an apparent connection between the brain and mental processes and pathologies, “the consistent and systematic search for biological and neurological causes of distress and problematic behaviors conducted over more than a century did not provide any evidence or support for the existence of ‘mental disorders’ as natural kinds, and the lack of progress in this line of research is striking… despite the significant technological advances [during those years].”

So, psychiatry still moves forward based on the assumption that those biological causes will be found in due time. As for now, psychiatric diagnoses (outside of identifiable neurological disorders) are identified not using technology but by gathering and applying subjective experiences (“apparent phenomena, surface characteristics”) and then grouping those to form clusters of symptoms that are then categorized via an “illusory correlation [process],” that becomes a “diagnosis.”

Yet, the criteria for these groupings “are grounded in culturally specific and locally defined judgments about normal or abnormal behaviors and feelings… and psychiatric ‘diagnostic’ decisions are mostly based on self-reports and interpretation of behaviors rather than justified by objective, empirical signs, or laboratory test.”

Even though the physiological causal links have yet to be identified, psychiatry has doubled down on this biomedical approach.

“The first and second editions of the [DSM] were at first still informed by psychological theories (i.e., psychoanalysis) and etiology… the third edition of the manual (DSM-III) saw the removal of the distinction between psychological and biological disorders, in order to proceed in a supposedly atheoretical fashion. This return… was once more undertaken to make psychiatry more credible and closer to medicine.”

Interestingly, when analyzed, this turn has led psychiatry to become less empirical and grounded in hard science. As Johnstone and Boyle describe, “A person can be told that they hear voices because they have schizophrenia, and that they have schizophrenia because they hear voices. As such… a person “has” a mental disorder simply because someone says they ‘have’ it.” There is no measurable, standardized test to prove this diagnosis.

Furthermore, there is disagreement over whether or not hearing voices is always a pathology. Must a person who hears voices, such as a religious person who believes they are hearing the voice of God, have the disease of schizophrenia?

Treatment

As psychiatry continued to double down on its stance as a physiological medical practice, its approach to treating mental suffering was limited in scope. Culturally, the psychiatrist has been depicted as someone who performs talk therapy, such as in Dr. Melfi from The Sopranos. While Dr. Melfi prescribes medications to her patient, she also has hour-long talk therapy sessions now usually reserved for psychologists and therapists.

According to Campolonghi and Orrù, psychiatry’s shift away from talk therapy and towards psychopharmacology started in the 1950s and has ended with the practice becoming increasingly focused on psychopharmaceutical “cures” for mental suffering. The problem is that “the drug-centered approach of psychiatry and how medications are created fully reflects its theoretical and methodological flaws and fueled the overwhelming process of medicalization of human experience and problems of living.”

There has yet to be a psychotropic medication that was created by identifying an underlying physiological cause and then reverse engineering the drug to “fix” that cause of suffering.

Instead, “their invention originated from casual observations of their effects on mood or behavior in the absence of any etiological disease theory…  As such, they do not target nor ‘cure’ any specific underlying dysfunctional mechanisms involved in producing the supposed symptoms of what we call ‘mental disorders’.”

Notably, the authors are not suggesting that psychotropic medications be stopped altogether but that we better understand their long-term impacts:

“While psychotropic drugs can be useful in alleviating suffering and preventing harm in certain acute situations and conditions, in the long term, they interfere with the healthy function and reactions of neurotransmitters as they create the chemical unbalance they are supposed to resolve, leading to serious damaging effects and to cognitive and physical disability… psychotropic drugs create abnormal brain states rather than ‘cure’ them.”
Science vs. Common Sense

It’s essential to recognize that additional time, biomedical research, or technological advancement will not lead to discovering cures for mental disorders or identifying the right psychotropic drugs or therapies that will finally be effective. This lack of progress stems from psychiatry’s reliance on common sense rather than scientific principles. Its knowledge system pertains to an illegitimate level of ontology and epistemology, dealing with constructs that have never been precisely defined.

The authors argue that although psychiatry appears to fit into the medical model, its practice lacks a grounded, empirical understanding of mental suffering that would justify this alignment. Psychiatry does not rest on the foundations of physical sciences but adheres to a neo-positive-empiricist tradition. It claims to deal with observable medical phenomena independent of the observer’s interpretative process. However, its subjects of study, such as the mind, personality, behavior, and anxiety, considered dysfunctional or symptoms, are, in reality, purely hypothetical or subjective constructs.

Furthermore, unlike the language of physical sciences that focuses on concepts like atoms, gravity, and temperature and exists outside of cultural contexts, psychiatry and social/human sciences study constructs like society, norms, experiences, and emotions. These are built inductively through discussion and interpretation rather than replication and calculation. Since psychiatry doesn’t rest on physical sciences, it deals with constructs rather than concepts and employs common language similar to that of the community, like being “depressed” or having “anxiety.” Yet, it makes claims using specific language and medical terms, such as diagnosis and syndrome, akin to physical sciences and medicine. Consequently, these constructs become reified or treated as real and concrete.

Conclusion
“Psychiatry does not define its constructs, does not refer them to any psychological theory, and treats them as empirical objects existing a priori and factual truths as medicine does. Indeed, the biopharmacological approach applied to ‘mental health’ does not work and creates more illness and sufferance than solutions.”

Not only does the medical model of “mental health” not have empirical, theoretical grounding, but it also has not been successful in limiting mental health suffering. It has worked to remove the social and cultural dynamics of human life from our understanding of the etiology of mental ‘illness.’

External stressors, such as un/underemployment, systemic discrimination, and workplace stress, become secondary to an imagined, theoretical biological mechanism for mental suffering that has never been found.

The authors take on the idea that the old paradigm needs alternatives.

“To be able to assume scientific legitimacy and better understand the complexity of human phenomena and health, psychiatry must find a new space of knowledge and paradigm of care where to clarify and respect its theoretical foundations within which to define clear norms, aims, and objects of investigation. This is the only way for a discipline to create knowledge, operate scientifically and ethically, and find effective solutions. However, while working toward alternative approaches to psychiatry, the search for potential biological and microlevel factors and processes should not be abandoned.”

According to Campolonghi and Orrù, it must move from being reductionistic to expansive, becoming inclusive of biological, psychological, and sociological factors in describing, researching, and alleviating suffering.

However, the authors also note some interesting problems that any alternative must tackle. For example, immediately abandoning the current system would lay open the possibility that protective policies could be removed. Instead of a more empathetic structure being put in place, a more punitive one could arise. This also means that the current system that is offering some support to those suffering could lead to the deprivation of that support. Much of that concerns how diagnoses can, to a certain degree, increase the acceptability of suffering while blocking more moralized and judgmental ‘faults’-based approaches.

Whatever is to come cannot completely abandon the past nor the language and lexicon that are now part of the cultural milieu. However, it must also help the culture develop an inclusive “vocabulary that can represent and express a different reality, phenomena, and experiences.”

The authors agree with Boyle and Johnstone that, while a change will take significant work, “the need for a paradigm shift away from disease models and diagnosis is clear and urgent.”

 

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Campolonghi, S., & Orrù, L. (2023). Psychiatry as a medical discipline: Epistemological and theoretical issues. Journal of Theoretical and Philosophical Psychology. (Link)

54 COMMENTS

  1. A wonderful article and study. What I’d offer is that until we acknowledge the root cause of mental health conditions – which is clearly trauma in my view – we’re not going to have much luck escaping psychiatry’s marriage to the biomedical model. It’s more than clear by now how psychiatry got off-course and why it continues to stay there.

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    • The problem with the trauma concept is that it is just as much a medical biological approach to suffering than that that is criticised above. Many, many positions especially by psychiatric survivors who were harmed in trauma therapy have made clear on Mad in Amercia that the turn to trauma theory makes psychiatry not and inch less harmful.

      It makes it worse. Now people who do not have chronic and severe mental and emotional struggles but simply need some time and good support to find a way to deal with harmful experiences do not find anyone who is willing to be such a support but are left with no choice but to consult a psychiatrist/psychotherapist where they directly receive a psychiatric diagnosis on the grounds that they have experienced a harmful event.

      This is great news only to those who are engaging in violence and oppression of human beings. I see them literally rejoice about the fact that the personhood of their victims are now immediately pathologized after their violent acts.

      What is correct is that violence and oppression AND the exclusion of people with such experiences from human circles of care in families, among friends, and in the community leads to chronic struggles for people. And this is exactly the process that the trauma approach is complicit in.

      But there are even more problems. Trauma therapy is also complicit in the denial that there are political causes to the violence and oppression in our societies. Furthermore that the politics of victimising, devaluing, and pushing out the victims of violence and oppression of communities are foundational to Western society. The approach of trauma therapy actually increases this tendency in society by giving it further “scientific” credence.

      Trauma therapy has been applied and researched for decades and the results aren’t any better than those of the older paradigms of treatment.

      Trauma therapy doesn’t work. It doesn’t help people get better and for many it is the cause of developing chronic and severe struggles around their mental and emotional well-being.

      Find an overview of 45 years of research into the approach of treating psychological trauma with psychotherapy in: Bessel van der Kolk, The Body Keeps the Scores, 2015.

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  2. This article sums up the problem well. The thing is when psychoanalysis was first abandoned as a theoretical framework technically the disease categories inherited from it should have been thrown out alongside it. After all if psychoanalysis is false maybe these categories have no validity. You’re certainly not going to find a biomarker for a disease that is the psychological equivalent of phlogiston. Instead the biomedical psychiatrists should have come up with their own diagnoses based on their knowledge of the brain and genetics which they claim causes mental illness. Of course they couldn’t do that because they have no such knowledge. The result is incoherence. Conceptually empty disease categories that result in lottery diagnoses. If you have 3 out of 5, or 6 out of 10 – BINGO! You’ve got the disease! There is no explanation – not even an attempt at explanation – why these particular symptoms tend to appear together as a cluster, rather than other possible permutations of symptoms.

    Imagine you had 3 out 5 symptoms:

    -pain in the arms
    -angina
    -shortness of breath
    -nausea
    -sweats

    BINGO! You’ve had a heart attack! Have you actually had a heart attack? Who knows, the science is still incomplete. Have you been harmed by drugs given to you for your ‘heart attack’? Suck it up! Your constant wheezing is abnormal and the opinions of abnormal people do not count! It’s inconceivable that people with physical diseases would be treated like this.

    Of course psychoanalysis has its flaws but it least it offers explanations, whereas biomedical psychiatry has been morally and intellectually bankrupt for over 50 years. The fact that people with an ‘atheoretical’ understanding of mental illness (=no understanding) should count as ‘experts’ on mental health and be given unaccountable power over others is outrageous.

    In terms of treatment, predictably, this means a return to the days before psychoanalysis when mental illness was attributed to moral degeneracy or demonic possession, and treated with things like submersion in ice baths, being hung from the feet and violently shaken, or put in sensory isolation rooms. In other words, inflicting shock trauma until the person collapses, their symptoms ‘disappear’ and they are ‘better’, meaning they’ve stopped inconveniencing others. At the time psychoanalysts denounced this as ‘a system of tortures’ and fought for the recognition of the humanity of the mentally ill, whose symptoms can be humanly understood rather than suppressed. Nowadays the violence and coercion are chemical, and if that doesn’t work, let’s shock people’s brains. If my fridge is broken and I’m an atheoretical individual, I can give it a good kicking or I can unplug it and plug it in again and hope for the best, after all sometimes it starts working again. Unfortunately that’s not science.

    In fact, if you think about it biomedical psychiatry is not that different from the old theory of demonic possession, because no-one ever asks about the cause of the ‘chemical imbalance’. It seems to just come out of nowhere, with no traceable antecedents in nature (a totally unscientific view), rather like a miracle, only a negative one. Let’s call it a demonicle. Demonicles are striking down more and more people these days (no-one knows why), imbalancing their brains, causing epidemics of disease, depression and anxiety. It’s unbelievable that pharma companies and their psychiatric enforcers have managed to manipulate public opinion to the point where people actually believe this nonsense that doesn’t survive 5 minutes of critical thinking.

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    • I love the phlogiston comparison, Freud called it force I think, dressing it in scientific lingo. Or impulse, he was really good at using one word to suggest another, subconsciously, by concealed association with other words. Like his free association method, I guess that’s why he was good at it. That he could see often enough.
      “People hate or fear what they do not understand. Only the curious mind amazes at such sight!”, “early” treatments were so inquisitorial. And I guess morally, as in the Inquisition, maybe the idea was for people to “give up” their symptoms, like their heresies, like in gender alignment therapy. Which sounds inspired by electromagnetics, earth and compasses, but I guess I’m confused, they don’t call it alignment either.
      That kind of demonicle sounds like the reverse picture of medieval exorcism, the devil instead of going out the mouth by revealing “its?!” name, it goes into my brain by taking a pill.
      And they still talk about repression, countertransference, transference, dynamics, ego, superego, underego, resistance!. I follow Paul Eckman: no Freudian concept has validity except for the slip of the tongue.

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  3. Excellent and comprehensive description of an acute problem. I see the underlying issue here (as alluded to in the first part of the article) as a total misunderstanding by psychiatry of what “mind” actually is! There is a brief mention of the “non-physical realm” which is at the basis of the conundrum. We must first address what “mind” and consciousness actually *is* before the premise of a biological basis for so-called “mental illness” can be eradicated forever! And while I completely agree with the researchers’ attitude to psychotropic drugs, it cannot be stressed enough that it is surely wrong to put a person with an existential dilemma on a drug that may cause dependency and brain damage and ruin their life.

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      • Exactly! And therein lies the deeper problem…it will take an enormous shift in “awareness” to change our thinking. I think that Bernardo Kastrup is the leading edge in the needed shift, but how many are listening?

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      • I would like to see this false idea be overturned. The “mind” is not the brain, nor is it a physical/material “substance”! So how can something that is non physical be described as “ill”? As the researchers point out, the illness idea came from the idea of the body having a (biological) breakdown in one form or another. So, to equate anything to do with “mentality” as illness, is clearly wrong. A reaction to stressful situations? Yes, and much more!

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    • Yeah, apparently some famous philosopher told me that from what I narrated to him way back when, decades ago, sounded like mental health pros took people with existential issues properly, maybe, addressed by philosophy and turned them into something worse.

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    • I think of the mind as simply a shorthand word for the processes of thinking, feeling and experiencing. The question “where is the mind located?” is like asking “where is running located?”. Both refer to activites. The former regarding the activity of thinking and the latter the activity of rapidly moving your legs to accelerate. There is no “mind” without brain just as there is no “running” without legs because those are the conduits through which those activities occur.

      Even funnier is when psychiatrists attempt to critique Szasz and others by invoking a strawman: that they are supposedly talking about mind-brain dualism (which does not even exist in, atleast, Szasz’s work).

      A funny interaction I saw with Dr. Thomas Szasz on YouTube once. I can’t recall the exact video or time in it, but it went along the lines of:

      Audience member: But Dr. Szasz, there is no mind without a brain.

      Dr. Szasz: And? There is no mind without a liver either.

      I laughed at that one quite a bit. xD

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      • I think on computational/complexity terms in that field they categorize the mind as an emergent property. Like societies, not just humans, “emerge” when you have a group of them.

        With behaviours that are not predictable from the “known” behaviour of the individual parts.

        It comes from the research of Ilya Prigogine in the 60s or 70s I think.

        Unfortunately there is some feedback on mind by the then new emergent property, i.e. society. Mind emerges from the brain, that gives emergence to society, or group, and then the group feedsback on the mind, and possibly back to the brain (but no one has proved that the mind alters the brain except in rare people under rare ciscumstances like “extreme or altered” states without drugs).

        But trivially, heavy rocks changes my brain probably in a good way!.

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  4. Sorry, but psychiatry does NOT rely on “common sense.” Common sense dictates that people who have been emotionally distraught need to talk to someone. Anyone who has witnessed a car accident or experienced an upsetting incident has an immediate urge to tell their story to another human being, who helps best by listening. There is nothing common sensical about the idea that “mental disorders are caused by faulty brains.” That is a very non-intuitive idea that has been sold and sold HARD to the public through massive PR campaigns and through TV and movies and other media methods.

    Common sense says that psychiatry is BS. It is only the pretense of “science” coming from the mouths of pseudo-“doctors” claiming “special knowledge” that allows people to actually invalidate their common sense and believe this unscientific and intuitively offensive nonsense!

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  5. There is, AFIK, no data on general population about psychiatric symptoms. Also there is no data that tells a practitioner how those symptoms are more or less present in normal population under different circumstances, without getting into biological cokcamamie.
    Like knowing that although normal blood pressure is such, people with certain weight at a certain age, lower or higher, have lower or higher normal blood pressure, in the statistical sense (may or may not increase bad outcomes in those circumstances).
    How living at sea level affects that, and how living halfway the Himalayas affects a given blood pressure reading.
    As an example of how that works in “true” medicine: Excercise cause potassium levels in blood to decrease. it’s normal, yet a drop in blood potassium levels after exercise is a criteria used to diagnose some difficult to diagnose potassium blood levels genetic diseases. And those genetically are difficult to diagnose BECAUSE there are so many mutations on several genes that HYPOTHETICALLY cause those diseases.
    Many with unknown reasons for why they cause the disease. Just correlations. But the diseases are real, just caused by many genes, some with unknown function.
    The paralysis or excessive contraction is meassureable and very obvious, and is hard to fake. Even a simple reflex test with a small soft hammer does, not can, does prove that, the paralysis. Unlike infamous hysteria. Which actually Freud proved was not a neurological disease, because it didn’t follow anatomical rules.
    I see that kind of thingy in sudden arrhytmic cardiac deaths, same thing. False positives, false negatives, hypothesis, etc., but all under the guidance of basic medical, not clinical, sciences. As Freud disproved the neurological basis of hysteria, another irony.
    Except, there is good strong validated science that tells you how potassium levels work, how the hearth rhytm is started and mantained, and how that can go awry. One can even educatedly speculate how potassium levels and hearth arrhytmia influence each other IN A GIVEN PATIENT. There are electrocardiograms that show that, for decades!.
    Psychiatry has none of that, NONE.
    And the human mind is still a black box. The brain’s working might be elucidated enough. But the mind lies on a different, higher, descriptive level. Like going from protons and electrons to atoms, from atoms to molecules, from molecules to cells, etc.
    Except the descriptive level for the human mind is a black box, below and above it there could be science, but at that level no more than correlations.
    No amount of input and and output correlations is going to PROVE how the box works. Mathematics has PROVEN that for blackboxes in general, in it’s most simple abstract form. Without needing the gooie stuff below, or the complex stuff above.
    I do not think a blackbox is an oversimplification of a mind. On the contrary, my mind exists outside my brain, my mind exists in someone else’s brain, as a representation of what they think, do, feel and what I am going to do in a given situation.
    Following the mind in the brain hypothesis, which I am not questioning. Even if I have a better view of the innards of my mind, I can see that as behaviour everyone else has a better shot at it, they stand a better chance at objectivity. But it’s still mine you know 🙂
    And Paul Eckman thinks that what people say about their mind when it comes to lying is irrelevant to whether they are lying or not. So he kind of admits that the mind in psychology is not necessary for experiments. It’s a void hypothesis/experimental input.
    The human mind is the product of evolution in social apes like us, or at least me, I’m an ape and I am not ashamed. So my mind is not even in mee brain, is in everyone elses as an image, a representation of what those others think of me, and why I do what I do.
    In that sense is ethereal and made up. My different minds as such won’t agree between multiple observers as to how it works. At least when it comes to voting, family, romance, etc.
    How is any experimenter gonna sample that large universe of other apes now brains just to figure out how much my mind liked my breakfast? By asking their minds? And will go on and on and on, and for me by then, by the answer I will have no more breakfast, hopefully way, way into the future.
    Even dissecting the box requires science before doing that. Anatomy shows that, it took a lot of tinkering before becoming what it is now, for a while (centuries), so much so that classical anatomy as a fruitfull field of research, last time I checked is gone, it’s a done deal. Nowadays is the basis of physicial exam, surgery, radiology, physiopathology, etc.
    Before the science of anatomy told anatomists how to do their job properly, it required a lot of “trial and errors”, a lot of pretending to be scientific. But it took less than psychiatry to become a done deal, no MUCH more research needed.
    In the brain they do “microanatomy”, a sophisticated version of histology, that is going now the way of the dodo, unless you like, need or want to be a pathologist. And even them, are going molecular. In many areas histology is becoming a done deal, and that AFIR, as a BASIC medical, not clinical, discipline STARTED after anatomy…
    Centuries of psychiatists have given me as a medical and scientific disclipine less than the Swiss: Less than a cuckoo clock. Which last time I checked is now a relic…
    That kind of “trial and error” was before the 20th century of science, not anymore.
    Modern scientific trial and error IS based on beyond doubt true facts, aka Theories, not hypotheses to be corroborated or discarded by future generations.
    The trial and error is in the experiment, not on the methodology, and certainly not on the “theory” (uugh!).
    Unless of course the methodology is relatively new, but checkboxes date from at least, at least, the 13th century, in the double entry book. At least!. Well, actually egyptians and babylonians had them in stone or clay, but… I heard they found a millenial or millional cave with scratchings that looks like being used as checkboxes, but…
    And if there is no valid scientific knowledge to treat a patient given they have no theoretical basis whatsoever beyond the millenial checkboxes, as correlations, hence the double entry book reference, if at all existing, and given we live in an evidence based medicine status quo, therefore psychiatry violates the lex artis of medicine in general.
    They have a niche medical practice, unscientific, without real scientific evidence and harmfull, just by being unscientific, it’s called quackery for a reason and the FDA was created to fight that.
    And! based on millenial/millional technology used by psychiatrists without even knowing how checkboxes work. They at least confuse intra class with interclass correlations!. They do, the definitions and metrics are different, they actually are. They mean different things. they work in different ways. In short: They represent different people, as groupings. Honestly.
    But they are not alone in that, pretending to confuse them improves the researchers chance to get a significant P. The P used in statistical significance. Hence the confusion 🙂
    Sociologists stand a better knowledge chance when they use checkboxes…
    “And I won’t so easily be fooled ANYMORE by the analogy, the paralell psychiatrists want to draw between what I narrated and what they do!.
    I’m taking the red pill since they put me outside the matrix in such callous violent illegal and harmfull way!. Why didn’t they just leave me alone with my blue pill inside the matrix hum?
    I fear, not really, they are trying to get me back in the matrix with their blue pills. I’m not Neo you quacks!. I am a Szaszian!.”
    The fool is on them, not on me anymore…
    Hahaha, that sounded better in my mind, sorry 🙂

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  6. I love to tell you this:
    ———-My diseased mind is in your brains you quacks! Like an spongiform hyperhypothesizing atheorical mad quack disease! (shamQD for acronym). And with such symptoms, it causes illegal recalcitrant behaviour among others too, sometimes…
    You stand a better chance of studying my mental diseases by applying a self reflecting microscope into your brains. Since I do know not even fMRI is accurate enough to that effect. And your blackboxy minds are not just black, they are dark! muahahahah… cape going to mee face… bunny sign in my forehead…
    Just for the record: That “theory” of mind is over 30yrs old. It appeared in a annual review…

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  7. In this article, Kevin Gallagher makes a very important point:
    If the mental health system AS IS is just all of a sudden completely debunked and destroyed THERE WILL BE CATASTROPHIC DANAGE!
    How many of you readers out there are in or have been in psych medication WITHDRAWAL?
    What is they abandoned the biomedical model and it resulted in massive groups of people being denied access to psych meds they have been taking for decades???
    What about all the people in the labor force who find out their psych meds are unsafe and ineffectual and suddenly stop taking them????
    How many of them will be able to continue to work? How many sick days will they be able to take before being fired???? Statics show acute withdrawal can last several months to 3 years!

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  8. My niece suffers from borderline personality disorder. She was misdiagnosed for 25 years and only in the past two they discovered it. So, after reading this article, what am I supposed to tell her? What good is it for her to see her psychotherapists if the latter adheres to these medical models of psychiatry? She will end up with another 25 years of psychotherapy and it will not make a particle of difference. There has to be a way out of this.

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    • Forget about “borderline personality disorder” or any other of their anti-scientific labels. What does she really need? What behavior or issues does SHE think are creating problems for her? What does SHE want to be different? What does SHE think would be a good approach?

      Usually, people who get branded with the “Borderline” label are those who have difficulty trusting others in relationships. See if you can talk to her about trust. Most are also people who have had traumatic experiences early in their lives. What kind of historical trauma is she still dealing with?

      She needs support and understanding, not more labels. Psychotherapy CAN be helpful but only if you find the right person who can create a safe place for her to explore her life and what she wants to do with it. Another person bullying her around and telling her “what’s wrong with you” and what she needs to do will not be helpful. I don’t know what the best way to go about it is, but it starts with NOT accepting the labeling process and find some other people, professionals or not, who agree with you and are willing to help.

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      • There’s nothing wrong with having “trust issues”, especially if you’ve been seriously mistreated. And there’s more than a few therapists who get angry if you don’t trust them, which not only tells you what kind of person they really are, but how entitled they truly feel.

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        • It has always infuriated me when therapists expect their clients to automatically trust them! Don’t they get that this is Step One of any decent helping process? I used to work with foster kids, and I’d often say to them, “I suspect you don’t trust me. That’s pretty smart. I wouldn’t trust me, either – you have no idea who I am or what my agenda is! And I don’t automatically trust you, either. I’m hoping as we get to know each other, we could develop some trust.” Or words to that effect. Oddly enough, I managed to earn the trust of many of them. I wonder why?

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    • The only way out is for her to make the decision to walk away. Cut her losses. I did this after 3 decades 4 diagnoses (including borderline), 25 drugs, ECT, TMS…when what I had was trauma, which was not only never addressed but was exponentially compounded by psych wards stays and abusive “providers”.

      25 years for a diagnosis? If anything these people said was true, it wouldn’t take them 25 years to make a diagnosis. They are liars, abusers and charlatans, and they are never held accountable.

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    • Hi George, assuming your niece “has BPD”, to have missed it for 23 years (If I’ve done the math correctly, here), and to suddenly discover “it”, is either a veiled admission of incompetence or desperation-if not shameless convenience. FWIW, this diagnosis was likely given to appease her caregivers, and ‘not’ to advance your nieces health. Either way, a promising turn for improved therapeutic care isn’t any more likely as result. Worse, still, the BPD, historically speaking, tends to considerably worsen both care and outcomes. FWIW: I Completely agree with Steve McCrea’s wise comment, and wish your niece precisely that kind of help moving forward!

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    • I agree with Kevin’s comment. I’m very suspicious of the fact that it took 23 years to make a diagnosis of borderline personality. My first thought upon hearing this is that your niece is potentially in danger of serious iatrogenic harm (if in fact she hasn’t already been the victim of it).

      In my case, the borderline diagnosis was given immediately after I tried to file a complaint against a psychiatrist because I learned that he hadn’t kept any records of 6 years of treatment. After I tried to file the complaint, I was given ECT, then the borderline diagnosis, then they started prescribing antipsychotics on top of the 3 classes of drugs they’d already been prescribing for 6 years (and keeping no records of).

      The borderline diagnosis is sometimes used preemptively if providers suspect that a patient may start “making noise” about incompetent or unethical treatment. It makes the person be seen as unreliable, and that is especially dangerous, because they become even more voiceless than a patient with “just” depression or anxiety diagnoses.

      There’s a huge amount of stigma against people with the borderline diagnosis (especially within the mental health system), which, considering the fact that the diagnosis has no scientific validity, makes it all the more alarming.

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      • Rather Ironic Kate, that you should have to shoulder a BP diagnosis as a result of “borderline professional competence” (intellectually and hermeneutically ethically honorable professionalism). The amount of trauma and subsequent oppression by professionals leveraging hermeneutical and epistemological marginalization, especially in mental health care settings, is, IMHO, one of the more hidden (repressed!) destructive epidemics in our modern societies.

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    • I am not saying your sister is not suffering. She must be. Perhaps even terribly. But your sister was not diagnosed or misdiagnosed with anything. “Borderline Personality Disorder” goes into the same bin as “Poor at Maths Disorder”. A meaningless, circular label. “Finding” “Borderline Personality Disorder” is like finding “My Computer Does Not Work Often Disorder”.

      The problems to identify are the actual distressing behaviours themselves, the reasons behind them and dealing with those. Just like with anything else in life. There’s normal English language for that.

      Those labels are harmful: medically, legally and also in how one views themselves and how other view them. They are not needed at all.

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    • Well, I am not advising, I am a retired physician and I can narrate how I did things way back when.

      First, it’s important the sufferer knows the truth, in a form that is appropiate, understandable, timely, etc. And not given in a way that is prejudicial or harmfull. But, I am no lawyer, at least in my country, as far as I know there is no legal precept that would allow me, as a provider, specifically to conceal, hide or obfuscate the truth from a patient.

      There are moral arguments and discussion about lying or concealing from a patient, but a more fundamental question always omitted in the texts I’ve read is the legal part. If there is no legal way to do it, or if, as almost always, the patient is entitled to redress or hearing by the judiciary I can’t see how lying gets down from the legal higher protection to a moral one, particularly when it involves consent, but not exclusively.

      I think I’ve read some judges have allowed that fudging or hiding the truth in some other countries. Speaking of providers, not relatives. But I doubt as the law in my country stands now that would prevail at my country’s Supreme Court, for several reasons. Presumably in appearance the most important is informed consent, even in persons with “cognitive” disabilities, since all persons with disabilities fall under the umbrella of recent precedent. No distinctions as far as I understand, I am no lawyer.

      And in fact, in my country, administrative law obligates every public servant, official etc. to be honest, in the first articles of the relevant law. As far as I know. Honesty involves not omitting relevant, etc, information. Is more stringent than lying because it involves more antisocial “expressions” as: you do not do that if you work for any part of this government…

      Then, the sufferer has a right, even a legal one, not just moral, in some places of constitutional level to ask, receive and understand the new information that affects her health, wellbeing, legal rights, etc. It is essential for informed consent and access to the judiciary, to verify a given decision by a provider, to say the least. Especially when it is potentially life changing.

      And peculiarly when that access to the judiciary involves or could involve the provider. That leaves the provider in a bad situation to be the judge of what, when, etc. to tell the patient. And since beforehand the provider could not know certain things, particularly about the future, well, that’s what informed consent is for, among other things.

      When the treatment situation of a patient/sufferer changes, way back then, we had to inform the patient or the relatives about the change, and how could that be addressed, and whether the patient was ok with the proposed changes, or if the patient was unable, what the patient expressed, would have prefered to their relatives. Hence the need in cases of having an advanced directive, or a living will. One does never know…

      Now, who is obligated to provide the new information TO THE PATIENT? The provider, simple as that, as far as I know. The provider, to my mind, would be in dark waters if him or her speaks first with the relatives, since how can the provider know that the patient authorized the provider to give ALL information to them?. How about if the provider has information of harm by the relatives? So, a patient cannot in principle “authorize” that all info is provided to the relatives. How about something that should be told to the police? Etc., “tell my relatives all info” is NOT a blanket, IMO…

      I was digressing, but I was trying to paint some picture of WHY it is important to have information, and in my experience what is the dilemma when information and relatives mix. Aware it sounds like not your case.

      And I was trying to explain why the provider, IMO, cannot decide what info to provide the patient in most situations, and I mean most, really. In the sense of at least omitting, concealing, fudging, minimizing, maximizing, or lying.

      Is there a moral/legal obligation, a duty to say that to the niece? Dunno, sounds a moral and or legal question. And a family one, and I have no particular advice on that because, I never read about that situation and I always talked to the patient, and fully informed him or her of the posible outcomes, even from a “simple” diabetes test. Let alone a long, expensive, painful, etc.,l treatment, even if it’s just “talk”. Even if it was just a possibility down the road.

      So, sadly, the only one who can say if it’s okay is the one who doesn’t know, and the dilemma is if and how, and probably why to tell her, and she cannot say before hand “ok, tell me”. So in medicine, that looks like an incidental discovery, and most of the times the patient has a right to know, particularly because rarely it will be discussed in the informed consent process. Those are rare, but I’m making an analogy. “Incidental discovery”…

      But! there is a column of moral dilemma questions in The New York Times, and to me sounds quite good. I’ve disagreed rarely, to me the writer tends to weight more one person over another, and tends to ommit certain considerations, but other than that I liked it. Some people even comment on those from lived or professional experience I think.

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  9. I agree with 27/2017. Lack of trust is not, in and of itself, a problem. Sometimes an “inability to trust” is the absolute most healthy response in a world of scammers, grifters, exploiters, users and abusers. Because it’s not, really, an inability to trust. It’s an awareness and an understanding that many people, institutions, and professions are not, in fact, at all trustworthy. This awareness and understanding can be life saving.

    Looking back on my life at 57, I wish I had trusted people less, myself more.

    I wish I had protected myself from every single person who hurt me and then blamed me for being hurt because I was “a borderline”. What an evil crock all that was, and a waste of precious time and energy.

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    • Yeah, inability to trust is not inability to be trusted.

      In fact inability to be trusted is related to “moral standing”, is part of being decent and I think honest, and even psychiatrists, top KOLs, admit they have none of that.

      So that sounds to me like an implicit admission that in the eyes of the rest of the community they appear untrustworthy. As far as the psychiatrist can see, which sounds limited.

      Taking the concepts honest/decent and trusted in backward analysis mode.

      But, typical! typical! blame the victim/patient!.

      Hence the victimization auto labeling of psychiatrists, they can see how that’s used to benefit them, and how to use it against a victim…

      Some shameless providers have even asked me why I don’t “trust” their simple statements, and explaining why never bodes well, in my experience. But it’s fiesty, not taking in the ground, like a belly up cat, and sent the provider to bark on another rhetorical tree… Not advising though…

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