Welcome to Cedar’s Digest. This is where I blog about education reform, college teaching, history and philosophy of science and occasionally about books that I have recently read.
I am an assistant professor of Psychology at Randolph-Macon College, here in lovely Ashland, Virginia. The views expressed in this blog are my own.
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cedar, our paths cross yet again my friend. once it was grilled cheese and donkey kong video games. now it is philosophy of science and psychology. one of the components of the masters degree i did was philosophy of science. nothing groundbreaking, but some of the historical basics like falsifiability and i can’t remember a lot of the rest, but the gist of it has stayed with me. at any rate, i believe i recall that sciences such as psychology and psychiatry are on one end of the spectrum with physics and some others on the other side of the robustness spectrum. don’t get your guard up, i’m a big fan of psychology, but less a fan of psychiatry, and i also feel very comfortable with the notion that a science’s difficulty in achieving status as one of the hard sciences doesn’t make it less important, the real gauge of the importance of a science, of course, it how much it matters to humans, and, in my world, that puts psychology pretty far at the top and physics etc (i hate numbers) towards the other end. i’m rambling but stick with me cedar. i would be of the school of thought, to the extent there is such a school out there, that one of the shortcomings of psychiatry is that it seems to rely heavily on the concept of normalcy–behavior outside the norm quickly gets rolled into a “scientific” diagnosis of a mental disorder. as a person who you may recall does not spend most of his time within the realm of normalcy, this bothers me a bit. could you direct me to some books or better yet some articles that exist online (i will be back in the ghettos of kingston, jamaica shortly where i have pretty much permanently relocated and won’t have access to any books really) that discuss the shortcomings of psychiatry as a science? specifically, the idea that psychiatry, or better yet, psychiatrists, impose normative views on people. relatedly, their unfortunate tendency to take such a rough cut view of human behavior and overlook the nuances of social environment, etc. that determine behavior.
Rob! Great to hear from you!
I thought you were running for office in Connecticut?! Didn’t I contribute to your campaign?
Anyways, really interesting questions. I’ll do my best to answer, and to direct you to much smarter people than I who have struggled with these issues.
First, I’ll defend psychiatry (and psychology) just a bit. Yes, psychiatry does become bound up in cultural norms. We might call something schizophrenia, while another culture might celebrate mystical visions. But I think this actually happens in more of medicine than we would like to admit. Our conception of what is normal vision, dental hygeine, or even body odor are to some extent dependent on our culture. Which brings me to the other huge factor in psychiatric (or really any medical) diagnoses: pain or discomfort. If someone doesn’t feel pain or discomfort, and doesn’t cause any to other people, then we don’t often say that they are sick. On the other hand, if people come to the doctor saying that they are in pain, or their life has recently become horrible, then the doctor tries to help them.
There was a famous study called “On Being Sane in Insane Places” in which healthy people got committed to a mental institution by faking auditory hallucinations, but then once they were inside, becoming completely normal. The problem is that doctors take your word that you are in pain, and try to solve it using the medical model, the only one that they know. So, I’ll conclude my brief defense of psychiatry by saying that yes, it does rely heavily on normalcy, but it also relies heavily on the self-reported pain and suffering of patients. Is there a feedback loop, where psychiatry tells us how we should be in pain, why we should be suffering? Probably. But I don’t think it is as out and out evil as “One Flew Over the Cuckoo’s Nest” would have us believe.
Ok, so I don’t think psychiatry is evil, or out to define normal behavior and enforce norms. I also think the medical model is the best that we have, but still not really that great. One of the problems with the particular medical model that we now have is the perverse incentives to treat with drugs instead of therapy. This is well address in the books reviewed by Marcia Angell in her recent 3-part NYRB piece. Doubts about the medical model are also raised by John Ionnadis’ work, described in the Atlantic here. Despite this, I think that the medical model is better than the alternative. Before the rise of psychiatry, there were also crude and brutal ways of treating the mentally ill (or people who were outside of whatever we defined as normal). Right now, the biggest mental institution we have is the LA County Jail. This is not because of an activist psychiatry, but because of a ridiculous criminal justice system.
I’ll stop there, but suffice it to say that your criticism of psychiatry is an old one, and valid. The problem for me is: what’s the alternative? All of our cultural institutions define and enforce normalcy to some degree, and psychiatry (and all of medicine) is no exception. I am in favor of rolling back and regulating the free market approach to treating patients, in hopes of scaling back on prescribing drugs and expensive procedures that are not warranted. But I still think the scientific method is a pretty good tool, properly used, even if it is wielded by imperfect, culturally biased, human beings.
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I love the philosophies you share on pages “Research” & “Teaching” 🙂
Ok. I was an art major. No one ever explained to me when I was 18, 19, 20 the economic ramifications of getting a degree in something which left you with no marketable skills. I know countless people burned by this. Young people need to be told the reality. Art schools are only too happy to deceive students, while taking their money. To suggest that it isn’t important what people earn after investing in expensive educations isn’t helpful to anyone.
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