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Philosophy of Psychiatry (2015)

plato.stanford.edu

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Re: Philosophy of Psychiatry (2015)

#41

Post by wu-ikkyu »

refill_request wrote: post #38
wu-ikkyu wrote: post #30

Earlier quoted context omitted.

1. Psychiatry is not bound to the medical ethic of patient autonomy. Medical doctors cannot lock someone in a cell and forcibly drug them because they have an STI. 2. Psychiatric illnesses are defined based on "fallible subjective judgments". Medical illnesses (pathologies) are defined based on objective biological tests.

You're exhibiting either a woeful lack of knowledge about medicine, or you have a particular axe you want to sharpen repeatedly here. 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…

>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

Sure it's okay, post mortem. Many scientists have tried this. Unfortuntely, you would not be able to make a conclusive diagnosis, because the science isn't there.

Re: Philosophy of Psychiatry (2015)

#42

Post by imperio59 »

phren0logy wrote: post #31

I'm a psychiatrist. Much of the valid criticism in this thread could be applied equally to all branches of medicine. For example, the number of good randomized controlled trials for surgical interventions is probably smaller than you think. Also, consider how changing the cutoff score for diabetes makes thousands of people diabetic with the stroke of a pen. The dilemma of an applied science is that I have to make a d…

Your profession is still largely a fraud. It votes into existence new "diseases" while the people that do the voting largely are on the payroll of the big pharma companies that will then market the same "diseases" via massive marketing campaigns to an uninformed public who thinks what you do is science. (https://en.wikipedia.org/wiki/DSM-5#Criticism)

In the medical field, no disease is ever voted into existence. There are lab tests, scans, x-rays, physical evidence of issues requiring medication. In psychiatry there are no tests to decide which medication to put someone on, and the profession largely admits to not knowing how the drugs they put patients on work.

Nevermind that most of these drugs cause horrible side effects in patients like massive weight gain, loss of sex drive, suicidal tendencies, psychotic episodes, etc...

Nevermind that most school shooters in the last 20 years were either coming off from or on some form of psychiatric medication.

Nevermind that over 100 000 toddlers are medicated, TODDLERS, with the same mind altering drugs in this country. How do you diagnose a toddler with depression?

Now your profession wants to go into prenatal and fetal psychiatry and start drugging the mother before the child is even born.

Nevermind you shamelessly do ECT, 450 volts through the brain which countless studies have proven is not a beneficial treatment once it is stopped and that patients do worse after (some who become complete human vegetables and require 24/7 care) as a form of "extreme treatment" when your pills don't work to numb the patient enough. (See http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citi... )

Your profession is a sham. The threads are coming loose and you can't hide it anymore. Please quit and go find another job.

Re: Philosophy of Psychiatry (2015)

#43

Post by refill_request »

wu-ikkyu wrote: post #41
refill_request wrote: post #38

Earlier quoted context omitted.

You're exhibiting either a woeful lack of knowledge about medicine, or you have a particular axe you want to sharpen repeatedly here. 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…

>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 Sure it's okay, post mortem. Many scientists have tried this. Unfortuntely, you would not be able to make a conclusive diagnosis, because the science isn't there.

Post-mortem doesn't do much for your current debilitating panic disorder that makes it impossible to leave your home, now does it?

Please. Give us your plan for relief of suffering while we sit around twiddling our thumbs waiting because "the science isn't there."

The history of the entire field of medicine (including psychiatry, which is as much science and medicine as any other medical specialty) is a march from partial understanding based on classification of symptoms to other measures. The brain, hidden away behind bone and blood-brain barrier, has been called the most complex object in the known universe.

That machine and it's foibles is a little more complicated than finding a buffer overrun or swabbing your throat for strep.

Re: Philosophy of Psychiatry (2015)

#44

Post by neuromantik8086 »

wu-ikkyu wrote: post #30
phren0logy wrote: post #29

Earlier quoted context omitted.

I'm a psychiatrist, and yes, we are. Psychiatrists are the same kind of medical doctor as every other medical doctor.

1. Psychiatry is not bound to the medical ethic of patient autonomy. Medical doctors cannot lock someone in a cell and forcibly drug them because they have an STI. 2. Psychiatric illnesses are defined based on "fallible subjective judgments". Medical illnesses (pathologies) are defined based on objective biological tests.

2. Psychiatric illnesses are based on whether or not a patient meets certain criteria. Major depression, for instance: https://www.ncbi.nlm.nih.gov/books/NBK64063/

These criteria are, to some degree, subjective and also easily gamed since in many cases doctors are relying upon noisy / potentially flawed input from patients (i.e., it's possible to game the system to get adderall, etc). However, the DSM, in providing these criteria and the number that need to be expressed to constitute a disorder, are establishing some measure of objectivity. While it is certainly imperfect, it's far from the state of affairs in the 40s/50s and definitely not purely subjective.

More objective / less noisy and biased criteria would certainly be welcome, but they don't really exist and that's been a major goal of NIMH as late. Some people have attempted to predict the presence of mental illness using fMRI scans, with limited success:

http://fcon_1000.projects.nitrc.org/indi/adhd200/results.htm...

However, even without reliable diagnosis via fMRI, I've noticed some psychiatrists using tasks from psychophysics to aid in diagnosis. Unfortunately they aren't always as savvy as scientists with respect to test-retest reliability, but it's a start.

Re: Philosophy of Psychiatry (2015)

#45

Post by wu-ikkyu »

refill_request wrote: post #40
wu-ikkyu wrote: post #39

Earlier quoted context omitted.

1. You can murder your spouse with an STI. Mental illness do not necessitate murder. 2. It is the opinion on the behavior as being good or bad that is subjective

1) Yep, and you'll be locked up if you murder someone. Someone with dementia or frontal syndrome after a stroke or tertiary syphilis may become paranoid enough to cause/contribute to violence, but we don't lock people up based on diagnosis. 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 claim…

Is a mental illness diagnosis (i.e. schizophrenia) + a subjective pre-crime judgement + some signatures not the prerequisites for a 5150?

Re: Philosophy of Psychiatry (2015)

#46

Post by refill_request »

wu-ikkyu wrote: post #45
refill_request wrote: post #40

Earlier quoted context omitted.

1) Yep, and you'll be locked up if you murder someone. Someone with dementia or frontal syndrome after a stroke or tertiary syphilis may become paranoid enough to cause/contribute to violence, but we don't lock people up based on diagnosis. 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 claim…

Is a mental illness diagnosis (i.e. schizophrenia) + a subjective pre-crime judgement + some signatures not the prerequisites for a 5150?

Oh. You want to swab someone's throat to see if they should be detained to protect themselves or others.

Please let's you and I spend some time together in the emergency department. Last week we had a patient there who'd been brought in against his will by the police, and who claimed that the chip implanted in their brain was telling him to remove his eyes and everyone else's eyes with the spoon he carried in his back pocket.

He'd already removed his left eye, with the spoon he carried in his back pocket.

Please tell us your plan. I'm sorry that I can't find a throat swab to assist us.

Or perhaps we could have lunch down at the dementia care facility, where the neurologists would love you to tell them they're not legitimate medical doctors because they don't have a throat swab for dementia yet, and because they "lock up" dementia sufferers with a few signatures at the request of dementia-sufferer families so they, the dementia patients, don't walk onto the freeway. They actually lock people up protectively before "the crime" of actually walking onto the freeway.

Imagine that.

Aren't a few signatures (even sans diagnosis) all that's needed to place children in what in effect is protective custody?

Re: Philosophy of Psychiatry (2015)

#47

Post by wu-ikkyu »

refill_request wrote: post #43
wu-ikkyu wrote: post #41

Earlier quoted context omitted.

>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 Sure it's okay, post mortem. Many scientists have tried this. Unfortuntely, you would not be able to make a conclusive diagnosis, because the science isn't there.

Post-mortem doesn't do much for your current debilitating panic disorder that makes it impossible to leave your home, now does it? Please. Give us your plan for relief of suffering while we sit around twiddling our thumbs waiting because "the science isn't there." The history of the entire field of medicine (including psychiatry, which is as much science and medicine as any other medical specialty) is a march from pa…

>Please. Give us your plan for relief of suffering

"First, do no harm". Stop the dehumanization and torture that goes on in many mental institutions:

https://www.reddit.com/r/AskReddit/comments/29gr27/redditors...

>The brain... the most complex object in the known universe

This is the honesty I'm looking for. It is disingenuous for psychiatry to claim to be "just as scientific" as medical pathology, because medical pathology has far fewer variables to control for, whereas the mind has virtually infinite variables to control for.

Re: Philosophy of Psychiatry (2015)

#48

Post by 2309kdujj »

wu-ikkyu wrote: post #39
2309kdujj wrote: post #35

Earlier quoted context omitted.

1. Because an STI doesn't cause you to go murder your spouse. 2. A behavioral record is no less objective than a biological one. Facebook and Google make a ton of money this way; if you want to offer a biological alternative, no one is stopping you.

1. You can murder your spouse with an STI. Mental illness do not necessitate murder. 2. It is the opinion on the behavior as being good or bad that is subjective

Pertaining to (2), there's actually a lot of empirical data bout what behavior is predictive of good or bad outcomes. It's not just a subjective opinion.

Now, you can argue about what outcomes are good or bad, but that's a different issue.

In any event, these things aren't as different from other areas of medicine as you think.

For example, you're full of microbes at the moment. Some of them might make you feel a little off sometimes, some of them might make you incapacitated, and sometimes it might depend. The decision to seek care and/or intervene is a subjective decision, based on your subjective appraisal of how you're doing, and a provider's appraisal. Does that mean that infectious disease medicine is subjective?

Subjectivity enters into all medicine at some point, via ethical decisions about whether and/or how to intervene. Because ethics involves some level of subjectivity, it's unavoidable.

Re: Philosophy of Psychiatry (2015)

#49

Post by btrask »

imperio59 wrote: post #42
phren0logy wrote: post #31

I'm a psychiatrist. Much of the valid criticism in this thread could be applied equally to all branches of medicine. For example, the number of good randomized controlled trials for surgical interventions is probably smaller than you think. Also, consider how changing the cutoff score for diabetes makes thousands of people diabetic with the stroke of a pen. The dilemma of an applied science is that I have to make a d…

Your profession is still largely a fraud. It votes into existence new "diseases" while the people that do the voting largely are on the payroll of the big pharma companies that will then market the same "diseases" via massive marketing campaigns to an uninformed public who thinks what you do is science. ( https://en.wikipedia.org/wiki/DSM-5#Criticism ) In the medical field, no disease is ever voted into existence. Th…

Your post contains some good arguments, but it's couched in a tone that makes HN unwelcoming to professionals in all fields, not just psychiatry. When you try to put so much pressure on individuals (especially ones voluntarily spending their time here), they're less likely to see the error of their ways, and more likely to just disengage.

Re: Philosophy of Psychiatry (2015)

#50

Post by [deleted] »

imperio59 wrote: post #42
phren0logy wrote: post #31

I'm a psychiatrist. Much of the valid criticism in this thread could be applied equally to all branches of medicine. For example, the number of good randomized controlled trials for surgical interventions is probably smaller than you think. Also, consider how changing the cutoff score for diabetes makes thousands of people diabetic with the stroke of a pen. The dilemma of an applied science is that I have to make a d…

Your profession is still largely a fraud. It votes into existence new "diseases" while the people that do the voting largely are on the payroll of the big pharma companies that will then market the same "diseases" via massive marketing campaigns to an uninformed public who thinks what you do is science. ( https://en.wikipedia.org/wiki/DSM-5#Criticism ) In the medical field, no disease is ever voted into existence. Th…

[deleted]
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