It’s not a bad definition as definitions of subjectivity go. But the most important part of this Wikipedia entry may well be the broom. Somebody thought this article didn’t live up to Wikipedia’s standards, though they couldn’t exactly come up with a reason. I’ll make a stab at a reason. Wikipedia’s quality standards are based on being objective, and subjectivity isn’t objective – by definition. I can’t even write a sentence about subjectivity without encountering that impossibility. That last sentence started with "I" which is the object "me" [there I go again, "I" and "me" are objects]. But enough of that or we’ll all go to sleep.
Subjectivity is the stuff of philosophy, religion, psychoanalysis, books like Douglas Hofstadter’s Gödel, Escher, Bach: An Eternal Golden Braid, not blogs, or dictionaries, or encyclopedias. But there is a practical point worth bringing up, "Is subjectivity in the domain of medicine, amenable to medical diagnostic classifications like the DSM-5 or the ICD-10 Chapter V?" Obviously a lot of people believe the answer is "yes," because those books exist and are the topic of much effort, worry, and controversy. The controversy part is in the background of many of the things discussed here as well as most of the comments. That’s not why this particular blog came into being or continues. It’s here because of something to do with objectivity. I discovered to my great dismay that people were tampering with the processes we use to approximate objectivity [clinical trials of medications] and perverting them to their advantage – a financial advantage. Objectivity is a precious enough commodity in psychiatry to deserve preservation at any cost. So I got noisy.
But back to the relationship between subjectivity and medicine. I came into psychiatry at a time of great turmoil, to put it mildly. The more bio-medical psychiatrists were criticizing the psychoanalytic types [with the same criticisms now leveled at our modern bio-medical psychiatrists – proof]. The post-60s experiential psychologists were attacking both kinds of psychiatrists, and the behavioral psychologists were after all three groups. And that’s a massive over-simplification of the complex circus that was everywhere around. I knew I was in the right place because all that same stuff had been swirling around in my head too. It was fine with me to be in a place where it was all being talked about out loud.
For many, reassurance was the finest of treatments. Like my often told story of the dermatologist who said when I raced to his office with a newly discovered malignant melanoma on my leg, "You think you psychiatrists are the only ones that can cure anxiety. Watch this! That ain’t cancer." But for a notable number of patients, that kind of reassurance didn’t help. And when I started nosing around, there was plenty enough to find that had to do with their subjective discomfort. So when I got to psychiatry and encountered the arguments of Dr. Szasz about the Myth of Mental Illness, I wasn’t much moved. His point is well known to all: because psychiatry operates with no objective markers of disease, mental illness is not medical, not science – it’s subjective. I didn’t miss his point about the legal position of psychiatrists giving opinions about involuntary hospitalization, testamentary capacity, legal competence or his ideas about the difficulties of the medical model of disease. In fact, I was already there. But the rest of it didn’t seem pertinent, at least to me. Patients with negative subjective experience without objective findings were the ones that drew me to psychiatry in the first place. They had come to my medical office in droves – close to the majority. I guess I saw psychiatry as the medical specialty that dealt with subjectivity and that was fine with me.
-
Psychiatry is a branch of medicine.
-
Psychiatry should utilize modern scientific methodologies and base its practice on scientific knowledge.
-
Psychiatry treats people who are sick and who require treatment.
-
There is a boundary between the normal and the sick.
-
There are discrete mental illnesses. They are not myths, and there are many of them.
-
The focus of psychiatric physicians should be on the biological aspects of illness.
-
There should be an explicit and intentional concern with diagnosis and classification.
-
Diagnostic criteria should be codified, and a legitimate and valued area of research should be to validate them.
-
Statistical techniques should be used to improve reliability and validity.
A science is not defined by it’s methods or its procedures. It’s defined by what it observes. Botanists observe plants. Zoologists study the things found in Zoos [AKA animals]. Physicists study the things that happen in the physical world. Neuroscientists study the things that have to do with the brain and nervous system. Entomologists study insects. Physicians study people who are sick, have diseases or dis-ease. I came to psychiatry drawn to study and to work with the people who had mental illness [hurt in their mental by their report]. And I learned about learning theory, and psychoanalysis, and existentialism, and brain chemistry, and hormones, and medicines, and sociology, and about war and its consequences, and about sex, and violence, and about human relationships, and a jillion other things. And I heard a library full of of narratives along the way, each one with its own twists, turns, and tangles. So I guess I see psychiatry as the science that looks at people who hurt in their mental, and its methods as anything that addresses that data field. By my read, that might be simplified to the study of painful human subjectivity. From my perspective, it’s part of medicine because I try to do something about it – just like I do when I put my Internist hat back on. Same basic rules. And what I do depends on the case, not my favorite basic science.
The internet is littered every which where with commenters like that.
I’ve always viewed it as former patients or other indivduals who used or received mental health services in the past and were either hurt or exposed to ilegal activity. Commonly it seemed to be about drug dependence from off-label prescriptions, or involuntary treatment.
They get very upset, as I did, and the deeper they probe into the things the more angry they get. Eventually they start to see how large and complicated the problem actualy is and the comments start to stop or slow down.
The turth is, Psychiatry is big. “Mental Health services” encompass more then just psychiatry, they also include the profession of psychology and counteless bureaucrats. Over 100k people work in mental health services, less then half are psychiatrits. The treatments that psychiatry uses come from the industry (pharma) and beurocrat regulators. Psychiatry just gets to use the end product. All the research and clinical trials are funded almost exclusivly by the industry, and sometimes by the goverment itself (like CATIE).
Involuntary treatment.. the hosptials force psychiatrists pretend to be doctors who can make those risk to benefit decisions. The hosptials make them treat patients with medications, deives like ECT, or surgury. They can’t just have people sit around until they feel better, or the psychiatrits in charge will be fired. It’s not suprising the people who choose to perform that function appear arrogant. They don’t have much of a choice, if a patient is released and attempts sucide or has psychotic episode and is injured, the psychiatrits is disciplined by the hosptial. So treatments are forced..
Psychiatry as a profession isn’t going away soon. There are reasons it’s still here, and an author named Dain N. wrote a good article on it entitled “Critics and dissenters: reflections on ‘anti-psychiatry’ in the United States.”
http://www.ncbi.nlm.nih.gov/pubmed/2647837
(Found the full paper uploaded here)
http://www.chronicstrangers.com/history%20documents/Anti-Psychiatry.pdf
The way i always looked at it myself, Doctors historically had patients they couldn’t diagnose or treat. Technology had limits, and still does. They passed those persistently suicidal or psychotic people off to psychiatry because psychiatry was the ‘medical profession’ running asylums for the ‘mentally ill’. Doctors usually didn’t really know what psychiatry was or does, but on the surface it sounded like they treat the symptoms and held people where they were safe from hurting themsleves or others until they were ‘safe’ to release. That sounded fair and reasonable.
So in reality, psychiatry was just there to ‘treat’ the untreatables who would otherwise be dumped back in the street. Psychiatry was viewed as neccassary, even if it didn’t work well.
Unfortunatly psychiatry was a spin off of psychology, and believed the patients had a sort of philosophical ‘mental illness’ and not merely yet undiscovered biological illness. Psychiatrits treated ‘psychological’ problems along with those patients, such as drug addicts. As such, patients were effectivly removed from ‘medicine’ and treated under a guise that made little sense.
As medicine advanced, it discovered what was causing some of those mental illnesses and removed them from psychiatry, e.g epilepsy and neurosyphilis.
Psychiatry went though internal termoil every so often, back in the 70’s and again in the 2000’s. This was because philosphy is not really compatible with science. The underpinnings of psychology and therefore psychiatry require that ‘Mental illness’, disroders, or symptoms are not merely random. If they are random, then they cannot be diangosed or made into disorders. If biological illness alone can produce seeminly random symptoms of mental illness though CNS dysfuction, they psychiatry has no real basis as a field.
Ultimately thats what the controversy was about from the 70’s to the DSM5, ‘reliabilty of diagnosis’ and ‘Neuroscience’ discoverys that symptoms can be caused soley by biological dysfuction, such as a vitamin deficiency casuing depression or somtimes psychosis.
The APA took a half step each time, not willing to go all the way. Because then, perhaps the edifice would collapse. Or perhaps psychiatry would have to severely narrow it’s focus to, say, drug addicts. Either way it threatens the interest groups which sell products though psychiatry, and they will fight changes that threaten profits.
People can be very sick. Psychotic, or suicidal. War veterans get pretty messed up over there. Doctors can’t treat those people sometimes. There’s a lot of those ‘untreatable’ patients. We need a profession to treat the unknown that does not have an incompatible belief system with what they are actually doing. Until something like that comes along, psychiatry isn’t going anywhere.
However, at least we should have the means to deal with forces of overwhelming fraud and corruption of knowlege that is tearing the legitimacy out of all medcial specilities, including psychiatry.
I’m of course addressing Pharma, creating fake patient advocacy groups, fake medications, fake illnesses to push in medicine, data manipulation, and the destruction of all competetion threatening to remove their monoply on keeping people sick forever for profit.
—
This blog is my favorite place to get a lot of information on that subject, and comments like the previous ones just sort of detract from real discussions.
I’ve already read plenty of antipsychiatry aguments, many of us have, some things are realistic, others are not. The real problems extend out further then just one profession and are much more complicated, and that’s why things are the way they are today.
Just as Mickey once said, “We shouldn’t spit on eachother” for differences in views, the real problems are ilegal activity. That’s an argument everyone, even the goverment cannot ignore. That’s worth fighting the same regardless of views.
Mickey can say ‘we shouldn’t spit on each other’, but he’s stated recently that he allegedly has a ‘sixth sense’ for deciding which innocent people are going to commit crimes and should be locked up and drugged. If Mickey doesn’t want to be spat upon, maybe he shouldn’t have made his living forcibly spitting inside people’s neurons with forced drugging. There are human rights abuses in the Western world, and forced psychiatric drugging is one of them. The mindless speculation Mickey has engaged in about the inner subjective mental state of the Navy Yard shooter, someone he never even met, is just pathetic, worthless. Mickey’s nothing but a lightweight half baked critic of psychiatry who still believes in total garbage. It is well that he’s too old to be locking anyone up and forcing himself upon them. Opponents of force simply want the right to be safe from having their brains spat in by quacks. That is all we ask.
Mickey–
I think you’ve shown great restraint. After a barrage of negativity, I thought of asking you to block said commenter; but then thought, “He has the RIGHT to his opinion; and I have the RIGHT to surmise how he came by them and/or to ignore him.” As TinCan says above, we are all familiar with favorite blog sites being trolled and used as a bully pulpit by some zealot who disagrees with the blogger. Please keep up your educational and thought-provoking articles–your efforts are greatly appreciated.
Mickey – I wonder if you could write further about your opposition to Szasz. I have read most of his works and admire his intellect. I don’t think his position is any different to yours. Of course people expressing Szasian views tend to get banned as deniers etc. What is it you have against Szasz because I do not understand.
Just to state the Szasz position which I would sum as; The treatment of mental distress or human suffering as if it were a medical disease is both unscientific and inappropriate. Of course Szasz used the proper meaning of the word myth – not that something is untrue but “”A myth is, of course, not a fairy story. It is the presentation of facts belonging to one category in the idioms appropriate to another.”
“To explode a myth is accordingly not to deny the facts but to re-allocate them.”
Nick,
” I wonder if you could write further about your opposition to Szasz.”
I don’t recall opposing him, but I don’t want to join up and that’s the only position his advocates seem willing to accept. I read several of his books years ago, and have heard his points for 40 years. I would hardly be a person who would talk about making medical-diagnoses of mental illness except in certain conditions, read anything in the volumes I’ve written about the DSM-5. My practice career was as a psychotherapist using little medication. I haven’t signed a commitment form since I left training in 1977. I’ve never been involved in involuntary medication. But I’m not opposed to short-term hospitalization for acutely suicidal or psychotic people. I agree that matters mental are subjective, and just wrote a long post about that.
The reason I don’t talk about Szasz is simple. I’ve never been in a discussion with anyone advocating his position that doesn’t end like the one I just ended. I’m the opposite of the people who medicalized psychiatry and if you read what I write, that is abundantly apparent. I didn’t use medical insurance to pay for my own analysis even though I had it and if my patients used medical insurance, that was their business. I wasn’t involved. So no, I won’t write such a thing. I’ve been a straw man in those discussions more than I’d like already. I’m just tired.
Mickey – ok fair enough. I hope our discussions wont end like the one you ended either.
It’s your house, Mickey. I started skipping his posts because they were getting to be repetitive, demanding, and abusive; which sets off alarms for me and doesn’t really do anyone much good.
All Szasz had to say was that treating human suffering and mental distress AS IF it was a medical disease was a bad idea. Some people may get very passionate in attempting to express this – well I hope we can forgive a little….
And when the passion dies (or is banned) then I feel sorry.
Nick,
No chance of such an ending for us – any us. That was an unwanted exception. And I’m serious when I say it wasn’t the Szasz. I doubt I have to explain the why of it…