Philosophy of Psychiatry (2015)

There's good psychiatrists and bad psychiatrists, good and bad psychologists, and the pharm industry has done a lot of good for society as well as harm.

I'm not even sure where to start. Take, for example, psychologists: a lot of whatever progress has been made in mental health comes from psychology (quantitative measurements, moving away from monolithic, homogenous diagnostic categories, lots of research, even neurobiological research--hell, the head of federal mental health research recently was a psychologist with a neuroscience research focus); the pushback is often from entrenched MD political groups who play off the "trained doctor" stereotype. Pharm research, too, often complains about the overly simplistic disease models, but are required by the FDA to follow them in clinical protocols, further entrenching them (a different former head of NIMH has complained about this). Psychiatrists often are screwed by the health care industry, trying to care for the most ostracized segments of society (see the recent GOP health care bill, which basically gutted mental health care services completely).

These sorts of discussions are always frustrating, because they're full of armchair, backseat scientists who are all too-happy to declare bad science, etc. without any solutions themselves. Behavioral health is a very challenging subject, and slapping on physics, chemistry, or mech engineering as some kind of perfect model just doesn't work. The irony is that it's more challenging than those fields in a lot of ways; if someone could just drop down from their physics throne and solve all the mental health problems, it would have been done already. It's been tried, believe me, and what usually happens is they grossly underestimate the complexity of what they're getting involved with.

2. Many aspects of diagnosis are subjective, even when tied to objective measurements. For example, cutoffs for high blood pressure, diabetes, and hyperlipidemia.

1) Medical doctors (including psychiatrists), police, social workers, judges, and other trained personnel all can lock someone up for a brief time (and with all sorts of legal protections and due process) if:

a) They are a danger to themselves or others.

b) They are unable to care for themselves.

Please tell us your alternative plan for dealing with those issues.

2) I'd love to be drill a hole in your well-protected cranium and stick a needle in your brain to obtain a sample to diagnose major depression, schizophrenia, or PTSD. Just a small sample, ok?. Let me know if you're ok with that. And if you think there are "objective biological tests" for most common illnesses that are diagnosed and treated, day in and day out, by physicians, I'd invite you to accompany me to clinic where, off the top of my head" we'll see tons of upper respiratory infections, real chronic pain without any demonstrable pathology, "ear infections", etc. This is the bread-and-butter of primary care physicians, and we don't order "objective biological tests" in order to diagnose and treat "medical illnesses" - in many cases because the tests simply don't exist, or are too expensive or too invasive.

But perhaps you'd care to explain to the sufferers and their families that we can do nothing for them without your "objective biological tests".

Nobody is locked up simply because they are diagnosed with a "mental illness" which is what you apparently want people to believe - you edited your parent comment, where you claimed that a diagnosis of schizophrenia was grounds for 5150. It's not.

2) No, there is no opinion about "good or bad" in diagnosing mental illness. The almost ubiquitous criteria is significant impairment - which almost always is an impairment the patient themselves identify (not someone else) and are seeking help for.