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Wow. I’m speechless.
More people need to hear this story.
The nature of psychological suffering is a lot more than an intellectual problem, it’s a human problem, which results in the pain of countless individuals, each with their own particular experience and story.
For this situation to improve, we have to challenge the current paradigm, battering away a it until it finally falls to pieces. To do so, we need to attack it on several levels.
If biological psychiatry is inhuman and uncaring, then we ned to fight for a more human and empathetic understanding of other people’s subjective experience.
If biological psychiatry is conceptually flawed and full of contradiction, then we need to point out those flaws, and try to search for a better understanding.
If biological psychiatry is based on flawed empirical evidence, then we need to challenge the interpretation of that evidence, and undertake studies that give a better account of the experiences of people treated with psychiatric medication.
Because Biological Psychiatry is firmly established as the scientific, political and economic and conceptual paradigm of mental ‘disorder’ it has to be challenged at all levels at once. We have to use every weapon we have to break it into pieces.
Mentally, I’ve had my own troubles, and my experiences don’t correspond to the way psychology or psychiatry have explain them. That’s why I decided to become a psychologist – so that I could do my part in trying to fix what I believe is broken.
So I’m not writing my comments as some sort of intellectual dick-swinging exercise (and if you read Bob’s writing carefully you’ll the same is true for him). I’m trying to improve my own understanding through discussion, so that I can play my part in trying undermine Biological psychiatry.
Everyone here is pulling in the same direction, we just have different ways of doing it.
Sorry, that comment was in reply to the comment above, I just don’t know how to use a message board!
(This comment is in reply to the comment below, which does not have a reply button.)
Thanks for taking the time to reply. This is obviously something we aren’t going to agree on. While that may be a frustrating outcome, it is no no reason to accuse your interlocutor of sophistry.
I’m not suggesting that there is no such thing as dysfunction. I make two points
1) that the term dysfunction be applied to its proper subject: the mechanism which fails to work as it is designed.
2) that the term is both practically useless and misleading unless we know how that mechanism operates, and what function it is designed to fulfil.
I believe that the misuse of this term is highly problematic in psychiatry. Sorry if my analysis got under your skin – I was just trying to make the discussion clearer.
All the best
My point is that it is really important to ascribe dysfunction to the thing that is not functioning, because that is what dysfunction means. To do so, we need to define scientifically what a function is.
Otherwise, if we’re not careful, we start to call people dysfunctional – and that is a dangerous thing to do. What, after all, is the function of a person?
Dysfunction is a very complex notion. As a word, it often inserts a lot of implicit meaning into a statement that is hard to spot. If something is functional, then it fulfils the role for which it was designed. For human artefacts, this role is often explicit – we know what pencil sharpeners are designed for, so we know what a functional pencil sharpener is supposed to do, so we know how to judge when a pencil sharpener becomes dysfunctional – it fails to sharpen our pencils.
Functionality in biology is much more complicated. Take the following statements
the heart circulates blood
the brain processes information and initiates behaviour
Such functions are usually ascribed to natural selection. The function of a biological system are defined by the role that system has previously played in increasing selective fitness, therefore this system was preserved (i.e. designed) because of its functional role. We judge such biological systems to be dysfunctional when they fail to function in this way.
More complicated still are functional ascriptions of human behaviour, for example:
The function of the brain is to process stimuli and control behaviour
The function if the limbic system is to regulate emotion
The function of a janitor is to sweep the floor
The function of a psychiatrist is to reduce the incidence of mental illness
These are functional ascriptions judged against our cultural values and norms, and they are implicit in just about every psychiatric diagnosis there is. At first glance, the first two may seem like scientific statements, but they are actually mixed up with our normative statements to such an extent that they are not really scientific at all.
Perhaps we have a different understanding of what dysfunction means. I know it probably sounds overly pedantic, semantic, and philosophical, but I think it’s important to be precise about the meaning of the words we use. If we are not, we will tend around each other in elegant circles forever without really achieving a meaningful dialogue. So, here’s the nub of my argument:
only things with a function can be dysfunctional
concussion does not have a function
concussion is not a dysfunction
I think this is a really important distinction, and here’s why: imagine that I hit ten people over the head equally hard with a baseball bat, and five of them developed a concussion. You could then say either: a) the five people with concussion were dysfunctional, or b) the five had a concussion, which is a dysfunction or c) five people had concussion (which is a normal response) and that this concussion led to a dysfunction (e.g. diziness, cognitive deficits, consciousness etc.).
In my opinion, the former two are nonsensical for this reason: some of the symptoms of concussion result from the body’s natural response to trauma – and may aid recovery (i.e. concussion can be caused by astrocytes mopping up damaged brain cells). In this case not having a concussion may lead to worse outcomes than having concussion.
So where does the dysfunction lie? Does it lie in having concussion? No, I don’t think it does. Does dysfunction lie in the concussion itself, no it does not. Can the concussion lead to other dysfunctions (i.e. cognitive impairment)? Yes, I think it can.
So concussion itself is not a dysfunction (although you might argue that it is a disorder
I have lots more to say about dysfunction, if you’re interested. I think it’s the veil behind which psychiatry hides much of its pseudoscientific claptrap.
Attribution bias is a nice way of looking at it and, of course, it’s a very human trait – so we shouldn’t single out psychiatrists for it (that would be meta-attribution bias!) .
But isn’t it the case that attribution bias arises because of the different heuristics (rules of thumb) that we use to determine the causal factors of behaviour? That is, we tend to ignore the external factors that contribute to other people’s actions and at the same time ignore the internal factors that lead to our own behaviour. As a result, we tend to hold others more responsible for their failings, while diminishing our own responsibility by blaming external factors instead.
What I am suggesting is that there is a structural attribution bias built into the medical model. The DSM codifies this bias by classifying disorders according to symptoms (the domain of the individual) while ignoring aetiology (the domain of the environment). I’m not suggesting that this form of classification was the result of an attribution error (psychiatrists didn’t suddenly choose to blame the patient) as I don’t believe that is the case. What I am suggesting is that this classification system is the cause of the attribution error that exists today, in that it underlies the prevalence of the biological model, which elevates biological dysfunction over environmental stress.
And one last thing. Concussion is not itself a dysfunction, because it is not dysfunctional to suffer a haemorrhage when hit on the head by a baseball bat!
thanks for your great reply!
i don’t think that is quite what Corrina is getting at, although I could be wrong.
It is certainly true that the normal response to being hit on the head with a baseball bat is concussion. So:
concussion is a disorder.
concussion causes a dysfunction in biological processes in the brain.
It does not follow, however, that concussion is a dysfunctional response to being hit over the head with a baseball hat. Or that concussion itself is a dysfunction
This is an important distinction. At the beginning of WWII, for instance, it was believed that war neurosis, battle fatigue etc. resulted from an inherent vulnerability in the soldiers that experienced it. As a result, the U.S. Army used a screening process to exclude those deemed neurotic – from memory I think it was about 7% of draftees. After some time, however, it became clear that a large proportion of ‘fit’ soldiers continued to suffer from War neurosis and battle fatigue, when exposed to extreme battle conditions for extended periods of time. As a result, war psychiatrists hypothesized in 1942 that battle fatigue (while remaining a dysfunction) was a normal reaction to abnormal conditions, and focussed efforts instead on maintain regular periods of rotation, R&R etc. At this point psychological screening was almost totally abandoned.
Moving back to the present topic, it should be clear that any sort of disorder, be it biological, psychological or behavioural can be judged to be either disordered or dysfunctional in itself – yet still be considered a normal response to abnormal events. Erectile dysfunction is a normal response to abnormal event such as advanced prostate cancer. Hypervigilance, reactivity and insomnia can be normal responses to abnormal events such as exposure to war and sexual abuse. Prolonged periods of sadness and depression can normal responses to abnormal events such as bereavement and loss of livelihood.
It goes without saying (for me at least) that all judgements about disorder or dysfunction have to be made against an implicit judgement of what constitutes normal or proper function. Such a judgement is easier in some cases than others, but it is particularly hard to make in psychiatry. It’s difficult because when it comes to human behaviour we have no concept of normal or proper function that is independent of social and cultural value judgements.
Sorry to have come the long way round to make my point, but this is why I think it is important to acknowledge that every disorder and dysfunction is a normal and natural consequence of some sort of insult, whether it is biological, psychological, social or emotional.
When we fail to make this distinction, we implicitly place the ‘blame’ squarely on the individual experiencing psychlogical distress (i.e. genetic vulnerability, psychological pre-disposition, neurotransmitter dysregulation etc.) and fail to acknowledge the external causes of psychological suffering. It is no coincidence that a psychiatric classification system (the DSM) that is based on symptoms and not aetiology has led to medical establishment that pathologizes the person and largely ignores their circumstances and history.
thanks for you post by the way, Bob. Totally awesome, and I look forward to part 2.
Goodness. Your writing is beautiful. Clear, precise and at the same time both moving and evocative. What a fantastic talent you have. Can’t wait to hear more of your inspirational story.