Is psychiatry a science of lies?

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BiscoDisco

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Came across this article and it got me reflecting on how I feel sometimes. Curious what other people think about the ideas in this article or the beliefs of Szasz in general.


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Like many psychiatrists, I had the privilege of knowing Dr. Szasz. He would be delighted to know you are willing to think critically about psychiatry rather than follow it dogmatically. He was no enemy of psychiatrists and his contributions to the development of how we view psychiatric diagnosis and treatment are important.
 
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Anesthesia would be even worse using some of those standards as the doctor decides who and who should not be conscious and uses methods without known mechanisms to render the patient unconscious.

The problem in psychiatry, and other fields, is saying you know something that you don't know. Not only do you lose trust, but you also lose curiosity.

I do think psychiatry is missing an element of philosophy. There should be a philosophy of humans and why they are the way they are in this particular era. If for example, you saw animals in a zoo trying to kill themselves or trying to abort their offspring, you might be more curious to what is wrong in the environment than being content to declare that there is a brain disease that can be treated with drugs. And why do certain mental illnesses exist today that didn't exist in the past and vice versa? It isn't simply that we know more or know things differently. We have recorded accounts of types of nervousness manifestations that were very particular to different periods of times. There are probably some biological diseases (I would assume schizophrenia) that are more constant over time, but still even today manifest differently depending on the culture the person is in.
 
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I'm reminded a bit of the "god of the gaps" concept. Are psychological processes just the things we don't yet understand on a causative biological level? How does one meaningfully separate structure ("biology") from function ("psychology") when it comes to the brain?
 
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I'm reminded a bit of the "god of the gaps" concept. Are psychological processes just the things we don't yet understand on a causative biological level? How does one meaningfully separate structure ("biology") from function ("psychology") when it comes to the brain?

Especially when you consider the difference between psychiatry and neurology over the years. When the mechanism is unknown or partially known it gets pushed to psychiatry, as soon as it's well understood neurology takes over (e.g. Huntington's, NMDA encephalopathy for the younger crowd). I'm not sure how anyone who is moderately well read in current functional and structural basic science of the brain can largely side with these criticisms. Now is there some merit to portions of the arguements and are they worth considering, sure, but that's a far cry from flying the Szasz flag.
 
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Especially when you consider the difference between psychiatry and neurology over the years. When the mechanism is unknown or partially known it gets pushed to psychiatry, as soon as it's well understood neurology takes over (e.g. Huntington's, NMDA encephalopathy for the younger crowd). I'm not sure how anyone who is moderately well read in current functional and structural basic science of the brain can largely side with these criticisms. Now is there some merit to portions of the arguements and are they worth considering, sure, but that's a far cry from flying the Szasz flag.

I totally concur. Any arguement that compares "psychiatry vs. medicine" in blanket form is junk. Within psychiatry there are clearly things (including diagnoses) that we can critique as less biologically understood and perhaps even as variations of normal but the same applies to many branches of medicine. Seizures were long classified more by their manifestations than their underlying cellular pathophysiology. Also, syndromes are almost always identified before the pathophys, aids before HIV, ect.

Any arguement that substance dependence and schizophrenia have no biology and that humans with them can't benefit from treatment is horseradish.
 
I actually like Szasz. I find myself thinking about him especially when it comes to acute hospitalization for suicidality. Obviously as a clinician I believe in intervening if someone is suicidal, but I'm not convinced that it should be the absolute responsibility of mental health professionals, at least to the extent that it is now.
 
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Any arguement that substance dependence and schizophrenia have no biology and that humans with them can't benefit from treatment is horseradish.
I've been trying to clean up my language as my kids are now pretty good at repeating what I say, and I'm absolutely stealing that one.
 
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I think Szasz's older work is worth reading and thought provoking.

On the other hand, I find Gary Greenberg, a psychologist who is a modern psychiatry critic, to be insufferable.
 
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As someone once pointed out, the difference between psychiatry and the rest of medicine is that no one ever wrote a book called "The Myth of Brain Tumors".

The fragmentation and rapid turn-over in diagnostic concepts in recent historical memory should tell you a) psychiatry/ clinical psychology remain very immature fields and b) our current diagnostic formulations are almost certainly wrong in important ways. An essentialist stance on any one of our current DSM disorders is probably not sustainable. At the very least, schizophrenia is not the same kind of thing as tuberculosis - tuberculosis doesn't give a great g***amn what you think about it, it will not change the course of the illness. This is not at all true about mental disorders, see Ian Hacking's work on looping kinds.

I of course prescribe dopaminergic antagonists to people with intense and unusual experiences that can be broadly described as psychotic all the time. But that's not because schizophrenia that has an independent existence. Telling that people actually doing basic science research have moved decisively away from basing these things on discrete DSM-style diagnoses.

The medical model is very useful for clinicians in many situations, but it's important to recognize the limitations and enormous blindspots. One scrap of a map ain't the territory.
 
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As someone once pointed out, the difference between psychiatry and the rest of medicine is that no one ever wrote a book called "The Myth of Brain Tumors".

No, but the guy who invented PCR did write a chapter in his book arguing against HIV as the cause of AIDS. (Granted, I'm almost positive it was a lesson in empirical skepticism).
 
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No, but the guy who invented PCR did write a chapter in his book arguing against HIV as the cause of AIDS. (Granted, I'm almost positive it was a lesson in empirical skepticism).

This is often the problem with people who genuinely innovate successfully - they have an unusual or contrarían idea and are completely vindicated. They thus learn that they are right and everyone else is wrong and that they will only go astray if they listen to feedback.

See also Linus Pauling and megadoses of Vitamin C.
 
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I think it is important to remember that at the time that Szasz began writing psychoanalysis was still king and people were being labeled and warehoused for years at the whim of professionals and family members...in a word, abused. Psychiatry was held up as almost a sort of religion for many people at the time, and wrongly so. In my discussions with Szasz, it became quickly evident that he wasn't really trying to destroy psychiatry or completely debunk the scientific understanding of mental illness, but rather act as a provocateur in response to the abuses of psychiatry. I'm glad someone was willing to do it, as it has made psychiatry stronger. The man was anything but ignorant about criticisms of his own writings, and some of it is tongue in cheek.
 
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I think it is important to remember that at the time that Szasz began writing psychoanalysis was still king and people were being labeled and warehoused for years at the whim of professionals and family members...in a word, abused. Psychiatry was held up as almost a sort of religion for many people at the time, and wrongly so. In my discussions with Szasz, it became quickly evident that he wasn't really trying to destroy psychiatry or completely debunk the scientific understanding of mental illness, but rather act as a provocateur in response to the abuses of psychiatry. I'm glad someone was willing to do it, as it has made psychiatry stronger. The man was anything but ignorant about criticisms of his own writings, and some of it is tongue in cheek.
He never really backed down from a categorical opposition to any kind of involuntary or coerced treatment, though.
 
To put it poorly, I think as a scientific field we're still in the relative dark ages, but my optimistic hope is that we're trying to do the best we can to address problems of enormous complexity. I think an attitude of humility and skepticism is crucial in this field, but I really dislike when critiques of the field are based in pessimism or have a deragatory view of the entire profession (not saying this article does).

Right now we have to settle with creating a common language (eg the DSM) and systems/models for things not fully understood, so of course it's going to end up proving over simplistic (or even completely wrong). I don't think it's a science of lies, I think it's just really really hard science.
 
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Szasz should be required reading for psychiatry residents. His most important text imho is Law, Liberty and Psychiatry. He was a consummate historian of the profession and charts psychiatry's long held influence on various legal aspects. As a libertarian, he did oppose coercion and did believe people have the right to kill themselves. He did not agree with repressive treatments (and historically american psychiatry has been used to suppress behavior threatening to late capitalism and to manage subjectivity) and promoted what he called autonomous psychotherapy. While I am not a libertarian by any stretch, his writings are a joy to read, and whether you agree with his conclusions, he makes some important points which continue to be relevant today as we consider the rights of the mentally ill, the incarcerated, sex offenders, and drug addicts. His arguments regarding the myth of mental illness ring more hollow (though there is course some truth to what he says, he gives too much weight to objectivity and diagnosis in physical medicine).

While he was not a scientologist, he allowed himself to be used by scientology, and I think this really hurt his credibility and undermined his standing.
 
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Through his writings, Szasz directly contributed (and still contributes posthumously) to a movement that causes immense harm to innocent people who are in the throes of mental illness.

I have a great deal of trouble believing that Szasz truly believed in what he said he believed (e.g., that schizophrenics are mentally healthy people who have simply convinced themselves to believe in unusual things). I think he was an extreme libertarian who desperately wanted to take his political philosophy to its full logical conclusions within the realm of medicine. I also think that he derived pleasure from being a provocateur and contrarian, and that this was his way of being a medical academic without actually having to practice medicine in any shape or form.
 
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Szasz is a BS artist.

He does bring up some legitimate issues, but these complaints were made to sell books, get him to talking-head status on news shows, get paid money to be a contrarian (kind of like one of those doctors that used to say there was nothing wrong with smoking), and not bring them up in their proper context.

Take for example a theoretical medication that has a 1% side effect risk. That's pretty good. Szasz was the type of guy who only would've mentioned the 1% cases without bringing up the context that it's 1% then go on to say how terrible the medication is and that we ought to rethink that med and maybe not even give out the medication at all.

Am I putting words into his mouth? No. He's done the above several times using the same equation. E.g. he'll bring up only the bad cases where someone got a side effect from a medication without putting them in their proper context.

Am I being unfair in accusing him of wanting to make money off of the above? No. He's sold books using the above BS, was a paid speaker at several events funded by seriously ethically questionable at best organizations to further propagate their own bad agendas where anyone with an average IQ who would've spent a minimum of time looking into it would've known they were up to no good. This is why I simply can't excuse him and must demand that people question his judgment in those seriously bad actions.

His most important text imho is Law, Liberty and Psychiatry. He was a consummate historian of the profession and charts psychiatry's long held influence on various legal aspects.

Agree, but that's what made him so dangerous. An outright liar is easy to spot. The one that mixes it with some truths and quite effective ones at that are the ones that can cause some real damage. I do not disagree that he was at times right and brilliant. I theorize at one point he may have had no bad agenda, especially given that he was born and raised in country with a then totalitarian regime that used mental health to justify atrocities, but later on did too many things that transparently revealed he either lost it (maybe in his older age he didn't know he was being used by some of the above organizations while they paid him large sums of money) or fame and money was his goal all along.

Kind of like the equivalent of a brilliant researcher who did some good work for a few years then big tobacco hires him to be their guy to say there's nothing wrong with smoking. "But but but he did some very good research so cigarettes can't be bad for you!" No.

People want their heroes to always be right, and their villains to always be wrong and when you present someone outside that black and white people have a problem going anywhere in-between. There's no question he had some great accomplishments, there's also no question he took quite a bit of money from advocating some provably false statements.
 
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If you're interested in more, Mad in America has contemporary perspectives on anti-psychiatry worth reading. Though Szasz would not have called himself an anti-psychiatrist, he gets lumped into that era. Honestly what snatches of Myth of Mental Illness I've read in the past turned me off enough that I haven't reconciled that initial distate to try him again.

Following the theme of critical psychiatry/radical psychiatry: This paper on Psychiatry & Capitalism by U'ren is a favorite of mine. Asylums by Goffman is another one from the 60s I vibed more with--written by a sociologist who planted himself as a mole inside an asylum in DC. Papers on Soteria house (now closed, however have inspired similar settings) and other alternatives to conventional psychiatric hospitalization are also fascinating to me and may be to you, too. Happy hunting
 
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He may have brought up valid criticism of psychiatry but he profited mostly from selling his books. He had a YouTube video of how he treats all of his patients without medicines. I encourage everyone to try exactly that, especially psychiatrists. That way you will know in your heart that, this man is a fraud. Send all the most difficult and dangerous patients to him. Oh, yes, he only accepts cash patients, carefully screened.
 
What I've always told students is a good psychiatrist knows when not to medicate. E.g. Borderline PD and other cluster B personality disorders.

There are of course several psychiatrists that rely too much on medications. I'd say 1 in 10 new patients I get I outright tell them they don't need medication. E.g. the person comes into my office for the first time and tells me their problem is they hate their job and a PHQ-9 score is in the mild depression range. Or the person has seasonal depression, I tell them to get a SAD lamp.

Of course it's the right thing to point out that there are several bad psychiatrists out there, and anyone whose read my posts on this forums over the years have read me time and time again complain of bad psychiatrists. This doesn't invalidate the entire field just like there's bad police officers out there, so to use a Szasz argument, that must mean all police are bad, that a police-force is an "institution of lies" and now all police cannot carry firearms or batons.

If Szasz was the real-deal he wouldn't have taken money for speaking gigs for the Church of Scientology. He would've mentioned medications in their proper context, e.g. he could've rightfully brought up legitimate concerns and side effects with medications, but then also mention that they do work for some people and then use the argument that perhaps some psychiatrists over-rely on them. If the real-deal he never would've said some outrageously and obviously false statements such as, "there's no such thing as mental illness." No he did not do the things that would've proved his sincerity without a profit-motive and so many comments he made showed he was playing the profit-and-attention angle hence why my opinion of him is he either is a brilliant fraud who brought up some legit arguments but mixed them with a self-selling agenda, or at one time may have been the real-deal but then lost it either due to selfishness and/or loss of cognitive faculties.
 
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What I've always told students is a good psychiatrist knows when not to medicate. E.g. Borderline PD and other cluster B personality disorders.

There are of course several psychiatrists that rely too much on medications. I'd say 1 in 10 new patients I get I outright tell them they don't need medication. E.g. the person comes into my office for the first time and tells me their problem is they hate their job and a PHQ-9 score is in the mild depression range. Or the person has seasonal depression, I tell them to get a SAD lamp.

Of course it's the right thing to point out that there are several bad psychiatrists out there, and anyone whose read my posts on this forums over the years have read me time and time again complain of bad psychiatrists. This doesn't invalidate the entire field just like there's bad police officers out there, so to use a Szasz argument, that must mean all police are bad, that a police-force is an "institution of lies" and now all police cannot carry firearms or batons.

If Szasz was the real-deal he wouldn't have taken money for speaking gigs for the Church of Scientology. He would've mentioned medications in their proper context, e.g. he could've rightfully brought up legitimate concerns and side effects with medications, but then also mention that they do work for some people and then use the argument that perhaps some psychiatrists over-rely on them. If the real-deal he never would've said some outrageously and obviously false statements such as, "there's no such thing as mental illness." No he did not do the things that would've proved his sincerity without a profit-motive and so many comments he made showed he was playing the profit-and-attention angle hence why my opinion of him is he either is a brilliant fraud who brought up some legit arguments but mixed them with a self-selling agenda, or at one time may have been the real-deal but then lost it either due to selfishness and/or loss of cognitive faculties.

"There's no such thing as mental illness" is a very superficial reading of Szasz and off-the mark. There is more to what he was saying than that, much more about disputing the medical model's applicability than dismissing the existence of relevant behaviors/symptoms.
 
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"There's no such thing as mental illness" is a very superficial reading of Szasz and off-the mark

He has on several occasions stated there is no such thing as mental illness, and in situations where that was his exact point. You can bring up that he at times was more sophisticated than this but at other times he's stated the above, or things to the same effect and in front of audiences where his intention was not to give the sophisticated claims you allege. I'm not oversimplifying him when he has brought up the exact thing I mentioned and in the appropriate context I presented him.

SUCH AS BELOW.


The audience? CCHR, a branch of the Church of Scientology. An organization whose goal is to discredit THE ENTIRE FIELD OF PSYCHIATRY, and has spread wild conspiracy theories proved false such as alleging that psychiatry was responsible for the 9/11 terrorist attack. CCHR's co-founder? Thomas Szasz.

You can say that Szasz has said so many brilliant things. I've written this above and I'm repeating myself. I don't disagree.

But he's said so many things off the mark and so inexcusably off. Even the best and most sincere experts can be wrong, but when wrong did those experts try to profit off of it? Get paid to endorse a wrong idea? Sell books? No. When they were wrong it was based on a process, and the process later showed them to be wrong, and they took responsibility and corrected their claims.

Does a sincere physician go in front of a crowd of ardent anti-vaxxers and throw them praise and further evidence that their beliefs are right? NO. HE DOES THE EQUIVALENT IN THE VIDEO ABOVE.

A broken clock is still right 2x a day and one can tell me a thousand times it was right twice without mentioning the context that it's been wrong every other time. Like I said, the times he was off he was so so so glaringly and repeatedly wrong, and profited off of it that there's no excuse. Did I say he was always wrong? No I likened him to the example of a researcher that did some prior good work but then, for whatever reason, pretty much just lost it.

If you think there's nothing wrong with what he did in that video, well then defend that, cause he's done stuff like in the video several times and got paid to do so. I am not doing anything wrong by stating something he did, repeatedly did, profited off of it, and did not present him in an inappropriate context, something that he did quite often.

Or defend CCHR and Szasz's association to it. Remember he's their co-founder.
 
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As someone once pointed out, the difference between psychiatry and the rest of medicine is that no one ever wrote a book called "The Myth of Brain Tumors".

The fragmentation and rapid turn-over in diagnostic concepts in recent historical memory should tell you a) psychiatry/ clinical psychology remain very immature fields and b) our current diagnostic formulations are almost certainly wrong in important ways. An essentialist stance on any one of our current DSM disorders is probably not sustainable. At the very least, schizophrenia is not the same kind of thing as tuberculosis - tuberculosis doesn't give a great g***amn what you think about it, it will not change the course of the illness. This is not at all true about mental disorders, see Ian Hacking's work on looping kinds.

I of course prescribe dopaminergic antagonists to people with intense and unusual experiences that can be broadly described as psychotic all the time. But that's not because schizophrenia that has an independent existence. Telling that people actually doing basic science research have moved decisively away from basing these things on discrete DSM-style diagnoses.

The medical model is very useful for clinicians in many situations, but it's important to recognize the limitations and enormous blindspots. One scrap of a map ain't the territory.

That's because in psychiatry we treat and manage syndromes. Something like tuberculosis is a disease.
 
That's because in psychiatry we treat and manage syndromes. Something like tuberculosis is a disease.

Ok, thanks Dr. Scientology. Tabes was a syndrome by these definitions long before mycobaterium were discovered. Even if you buy this argument, which probably holds for some psychiatric conditions (as well as many established medical conditions) but certainly not for many (I think there is enough biological evidence for schizophrenia and bipolar disorder, for example)... it's a straw man. In every branch of medicine we treat syndromes as well as "diseases." One can make a reductionist argument that any *organ name* cancer is a syndrome and that every individual cancer itself is a completely unique entity and that we rarely understand the entire pathophys of a single cancer nor do we know if it will respond to a treatment... I would also argue that DNA replication errors are an expected and normal biological function, such that cancer is just a variation of normal physiology. I'm sure he'd have told his kids to stop taking their chemo.

If you had acquired immunodeficiency syndrome via early diagnostic criteria but no HIV test was available, I bet you'd take HAART. We treat syndromes as well as diseases when there is evidence that a particular treatment improves quality of life.
 
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Does a sincere physician go in front of a crowd of ardent anti-vaxxers and throw them praise and further evidence that their beliefs are right? NO. HE DOES THE EQUIVALENT IN THE VIDEO ABOVE.
My goal is not to defend Szasz. But I would like to underscore a few points:

What he is saying is the opposite of the example you chose. He is explicitly stating that illnesses are different from problematic behaviors. To call ADHD or mania an illness may be more harmful than helpful. There is a decent body of literature to support that.

I think he could have said those things more clearly without dumping on the whole field of psychiatry.

And it does seem he profited a great deal from being less specific and more provocative.
 
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We treat syndromes as well as diseases when there is evidence that a particular treatment improves quality of life.
I think the point is how you treat them and the harmful consequences of conflating the two.
 
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Ok, thanks Dr. Scientology. Tabes was a syndrome by these definitions long before mycobaterium were discovered. Even if you buy this argument, which probably holds for some psychiatric conditions (as well as many established medical conditions) but certainly not for many (I think there is enough biological evidence for schizophrenia and bipolar disorder, for example)... it's a straw man. In every branch of medicine we treat syndromes as well as "diseases." One can make a reductionist argument that any *organ name* cancer is a syndrome and that every individual cancer itself is a completely unique entity and that we rarely understand the entire pathophys of a single cancer nor do we know if it will respond to a treatment... I would also argue that DNA replication errors are an expected and normal biological function, such that cancer is just a variation of normal physiology. I'm sure he'd have told his kids to stop taking their chemo.

If you had acquired immunodeficiency syndrome via early diagnostic criteria but no HIV test was available, I bet you'd take HAART. We treat syndromes as well as diseases when there is evidence that a particular treatment improves quality of life.

Yeah as @splik pointed out Szasz makes a fundamental error in assuming that his criticisms don't apply to most of medicine. The disease concept as traditionally understood works really well for infectious diseases and is an approximation with varying degrees of poor fit when applied to almost anything else.

I do not think there is any real reason to believe in schizophrenia as currently defined as corresponding to an entity with any ontological reality or corresponding to a specific and singular pathophysiological process. At best we have various schizophrenias.
 
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Ok, thanks Dr. Scientology. Tabes was a syndrome by these definitions long before mycobaterium were discovered. Even if you buy this argument, which probably holds for some psychiatric conditions (as well as many established medical conditions) but certainly not for many (I think there is enough biological evidence for schizophrenia and bipolar disorder, for example)... it's a straw man. In every branch of medicine we treat syndromes as well as "diseases." One can make a reductionist argument that any *organ name* cancer is a syndrome and that every individual cancer itself is a completely unique entity and that we rarely understand the entire pathophys of a single cancer nor do we know if it will respond to a treatment... I would also argue that DNA replication errors are an expected and normal biological function, such that cancer is just a variation of normal physiology. I'm sure he'd have told his kids to stop taking their chemo.

If you had acquired immunodeficiency syndrome via early diagnostic criteria but no HIV test was available, I bet you'd take HAART. We treat syndromes as well as diseases when there is evidence that a particular treatment improves quality of life.
Dr. Scientology? LOL!!!!!

I think you misunderstood....

From:
Diagnoses, Syndromes, and Diseases: A Knowledge Representation Problem
Franz Calvo, MD,1 Bryant T Karras, MD,1,2 Richard Phillips, MD,1 Ann Marie Kimball, MD,1,2 and Fred Wolf, PhD1

A syndrome is a recognizable complex of symptoms and physical findings which indicate a specific condition for which a direct cause is not necessarily understood. Thus in practice doctors refer to the infamous “viral syndrome” as such because of the uncertainty regarding the legion of viral agents that is causing the illness. Once medical science identifies a causative agent or process with a fairly high degree of certainty, physicians may then refer to the process as a disease, not a syndrome. Mucocutaneous lymph node syndrome became Kawasaki syndrome which in turn metamorphosed into Kawasaki disease; the latter is properly a disease, no longer a syndrome, by virtue of its clearly identifiable diagnostic features and disease progression, and response to specific treatment.
Albert et al.1 catalogued six general views or concepts about what types of conditions may be said to constitute a disease. These views range from nominalism and cultural-relativistic theories (i.e. some conditions become a disease when a profession or a society labels it as such) to a “disease realism” view (objectively demonstrable departure from adaptive biological functioning). The latter model is the one best suited to the present state of medicine; it emphasizes that the clinical signs and symptoms do not constitute the disease and that it is not until causal mechanisms are clearly identified that we can say we have “really” discovered the disease.
Medical literature, even that from governmental organizations and institutions authorized to implement standards, is plagued with misleading assertions such as “a syndrome is a disease …”, “a syndrome indicates a particular disease…” and “Lyme disease syndrome” (It is inappropriate to apply “syndrome” to Lyme disease because its causative agent is known).
Some syndromes such as “heart failure” are useful medical concepts but are not diagnoses, whereas more specific syndromes such as “congestive heart failure” or “right heart failure” are diagnoses2. Due to the imprecision of natural language, some syndromes could also imply a simple pathological finding (vasculitis) or just a physical finding. Frequently, for example, arthritis syndromes are simply referred to as “arthritis”.
 
Ok, thanks Dr. Scientology. Tabes was a syndrome by these definitions long before mycobaterium were discovered. Even if you buy this argument, which probably holds for some psychiatric conditions (as well as many established medical conditions) but certainly not for many (I think there is enough biological evidence for schizophrenia and bipolar disorder, for example)... it's a straw man. In every branch of medicine we treat syndromes as well as "diseases." One can make a reductionist argument that any *organ name* cancer is a syndrome and that every individual cancer itself is a completely unique entity and that we rarely understand the entire pathophys of a single cancer nor do we know if it will respond to a treatment... I would also argue that DNA replication errors are an expected and normal biological function, such that cancer is just a variation of normal physiology. I'm sure he'd have told his kids to stop taking their chemo.

If you had acquired immunodeficiency syndrome via early diagnostic criteria but no HIV test was available, I bet you'd take HAART. We treat syndromes as well as diseases when there is evidence that a particular treatment improves quality of life.
"A syndrome is a term that refers to a disease or a disorder that has more than one identifying feature or symptom.
In other words, a syndrome is defined as follows:
Definition of syndrome: A collection or set of signs and symptoms that characterise or suggest a particular disease."
 
Dr. Scientology? LOL!!!!!

I think you misunderstood....

From:
Diagnoses, Syndromes, and Diseases: A Knowledge Representation Problem
Franz Calvo, MD,1 Bryant T Karras, MD,1,2 Richard Phillips, MD,1 Ann Marie Kimball, MD,1,2 and Fred Wolf, PhD1

A syndrome is a recognizable complex of symptoms and physical findings which indicate a specific condition for which a direct cause is not necessarily understood. Thus in practice doctors refer to the infamous “viral syndrome” as such because of the uncertainty regarding the legion of viral agents that is causing the illness. Once medical science identifies a causative agent or process with a fairly high degree of certainty, physicians may then refer to the process as a disease, not a syndrome. Mucocutaneous lymph node syndrome became Kawasaki syndrome which in turn metamorphosed into Kawasaki disease; the latter is properly a disease, no longer a syndrome, by virtue of its clearly identifiable diagnostic features and disease progression, and response to specific treatment.
Albert et al.1 catalogued six general views or concepts about what types of conditions may be said to constitute a disease. These views range from nominalism and cultural-relativistic theories (i.e. some conditions become a disease when a profession or a society labels it as such) to a “disease realism” view (objectively demonstrable departure from adaptive biological functioning). The latter model is the one best suited to the present state of medicine; it emphasizes that the clinical signs and symptoms do not constitute the disease and that it is not until causal mechanisms are clearly identified that we can say we have “really” discovered the disease.
Medical literature, even that from governmental organizations and institutions authorized to implement standards, is plagued with misleading assertions such as “a syndrome is a disease …”, “a syndrome indicates a particular disease…” and “Lyme disease syndrome” (It is inappropriate to apply “syndrome” to Lyme disease because its causative agent is known).
Some syndromes such as “heart failure” are useful medical concepts but are not diagnoses, whereas more specific syndromes such as “congestive heart failure” or “right heart failure” are diagnoses2. Due to the imprecision of natural language, some syndromes could also imply a simple pathological finding (vasculitis) or just a physical finding. Frequently, for example, arthritis syndromes are simply referred to as “arthritis”.

I'll stop you right there insofar as this pertains to psychiatry because there are two very basic problems with the definition they provide of the model they prefer, namely "objectively demonstrable departure from adaptive biological functioning." The first and probably less important is the "objectively demonstrable" part being used to describe diagnoses in a field where bread and butter like MDD ends up with a kappa of like 0.4 (from the DSM-V field trials); clearly it is not equally objectively demonstrable to all clinicians.

The second and more profound is the idea that you can independently specify "adaptive biological functioning" in a non-circular way. Jerome Wakefield has been pushing this line for a long time but it just doesn't work. Either you predicate your idea of adaptive on occupational and social role functioning, in which case your "diseases" vary significantly between differently organized societies and who counts as "diseased" changes dramatically over time, or you base it on some statistical average in which case you are going to have a hard time balancing between not labeling minority groups of all sorts as diseased and having sufficiently broad reference groups for your statistical definitions. and you would need a well-defined reference group for your averaging - after all, an AST of 250 would be perfectly normal in the group of people drinking a fifth of vodka daily.

This is not just idle navel-gazing. Imagine a black person or a woman in the 19th century United States trying to pursue a medical career. They are likely not going to be functioning as well professionally or socially as most persons pursuing such a career and while of course they might achieve some success they will also clearly be experiencing significant distress due to their experiences. Does this represent a disease?

I don't think being psychotic is the same thing as being female or anything ridiculous like that but when you start insisting that what we are doing is treating diseases, by God, real live no-foolin' medical conditions, you get into really problematic territory really quickly. I am proud to be a psychiatrist (mostly) and certainly feel like I help people on a regular basis but you either hold the disease model lightly or deliberately blind yourself to the multitude of other and frequently more useful perspectives on this work.
 
"A syndrome is a term that refers to a disease or a disorder that has more than one identifying feature or symptom.
In other words, a syndrome is defined as follows:
Definition of syndrome: A collection or set of signs and symptoms that characterise or suggest a particular disease."

My point was that it doesn't matter if we treat syndromes or diseases. It's simply a semantic arguement. If you want to explain *why* it's particularly important, I'd love to hear you out.

In empirical medicine, we take subsets of populations that can be defined by a set of signs/symptoms and try treating them with x and y and see what has a better outcome.

And the medical litterature is replete with non-disease diseases, Alzheimer's *disease*, to the point where the word can clearly be used more broadly...

Finally, I ask this question: how heritable must a syndrome be to be almost certainly a set of diseases? No pathogen causes disease in every host human that it contacts as far as I'm aware...
 
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I'll stop you right there insofar as this pertains to psychiatry because there are two very basic problems with the definition they provide of the model they prefer, namely "objectively demonstrable departure from adaptive biological functioning." The first and probably less important is the "objectively demonstrable" part being used to describe diagnoses in a field where bread and butter like MDD ends up with a kappa of like 0.4 (from the DSM-V field trials); clearly it is not equally objectively demonstrable to all clinicians.

The second and more profound is the idea that you can independently specify "adaptive biological functioning" in a non-circular way. Jerome Wakefield has been pushing this line for a long time but it just doesn't work. Either you predicate your idea of adaptive on occupational and social role functioning, in which case your "diseases" vary significantly between differently organized societies and who counts as "diseased" changes dramatically over time, or you base it on some statistical average in which case you are going to have a hard time balancing between not labeling minority groups of all sorts as diseased and having sufficiently broad reference groups for your statistical definitions. and you would need a well-defined reference group for your averaging - after all, an AST of 250 would be perfectly normal in the group of people drinking a fifth of vodka daily.

This is not just idle navel-gazing. Imagine a black person or a woman in the 19th century United States trying to pursue a medical career. They are likely not going to be functioning as well professionally or socially as most persons pursuing such a career and while of course they might achieve some success they will also clearly be experiencing significant distress due to their experiences. Does this represent a disease?

I don't think being psychotic is the same thing as being female or anything ridiculous like that but when you start insisting that what we are doing is treating diseases, by God, real live no-foolin' medical conditions, you get into really problematic territory really quickly. I am proud to be a psychiatrist (mostly) and certainly feel like I help people on a regular basis but you either hold the disease model lightly or deliberately blind yourself to the multitude of other and frequently more useful perspectives on this work.

LOL. I'm simply using the terms as is generally accepted in medicine. For example, Autism is a syndrome. It's real. It has a biological cause that's likely multi factorial--genetic, environmental triggers, neurodevelopmental. It's has a set of signs and symptoms that tend to cluster...I'm unclear why the other person says this makes me Dr. Scientology. But it gave me a good laugh!
 
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My point was that it doesn't matter if we treat syndromes or diseases. It's simply a semantic arguement. If you want to explain *why* it's particularly important, I'd love to hear you out.

In empirical medicine, we take subsets of populations that can be defined by a set of signs/symptoms and try treating them with x and y and see what has a better outcome.

And the medical litterature is replete with non-disease diseases, Alzheimer's *disease*, to the point where the word can clearly be used more broadly...

Finally, I ask this question: how heritable must a syndrome be to be almost certainly a set of diseases? No pathogen causes disease in every host human that it contacts as far as I'm aware...

Because what are currently considered syndromes may have different causative factors. That implies one syndrome may need to be approached in different manners in terms of medications, therapy, etc....
 
Because what are currently considered syndromes may have different causative factors. That implies one syndrome may need to be approached in different manners in terms of medications, therapy, etc....

Maybe we're not completely as far apart as I took your original post to be... but how is this different from any disease? Again, there are lots of variations within individual pathogen species and within host species that lead to a need for different treatments for the same "disease" as well as considerations like side effects of treatment that may warrant an individual choosing a less effective treatment.

So a single syndrome (most seizure disorders, MDD, MS, HTN, ect) may have people who respond to X only and others who only respond to Y only and some who response to X + Y only and some X or Y and some refractory... just like a single "disease." How does this make psychiatry unique? There are very, very few diseases that respond perfectly to any treatment. I can't think of one.

Again, I don't get the point of your argument here, why the whole syndrome issue discredits psychiatry as a field or if you are even trying to do that...
 
Maybe we're not completely as far apart as I took your original post to be... but how is this different from any disease? Again, there are lots of variations within individual pathogen species and within host species that lead to a need for different treatments for the same "disease" as well as considerations like side effects of treatment that may warrant an individual choosing a less effective treatment.

So a single syndrome (most seizure disorders, MDD, MS, HTN, ect) may have people who respond to X only and others who only respond to Y only and some who response to X + Y only and some X or Y and some refractory... just like a single "disease." How does this make psychiatry unique? There are very, very few diseases that respond perfectly to any treatment. I can't think of one.

Again, I don't get the point of your argument here, why the whole syndrome issue discredits psychiatry as a field or if you are even trying to do that...
What gave you idea I’m trying to discredit psychiatry? LOL. Heck I’d like to think of myself as a neuropsychiatrist! My point is that because we deal with syndromes that don’t necessarily have one identifiable cause that what we treat is often misinterpreted as not being biologically based, which isn’t true. It lets quacks be able to say all kinds of wacky things
 
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... one identifiable cause that what we treat is often misinterpreted as not being biologically based, which isn’t true. It lets quacks be able to say all kinds of wacky things

got it. concur. sorry for the dr. scientology comment ;)
@wopper posted a Scientology brochure above including their criticisms "1. Psychiatric disorders are not medical diseases 2. Psychiatrists deal exclusively with mental "disorders" not proven diseases" and your post followed with "that's because we treat symptoms not diseases" sounded a bit like you were just regurgitating that nonsense in defense of CCHR... I now see what you meant, your initial *that* was very vague.
 
got it. concur. sorry for the dr. scientology comment ;)
@wopper posted a Scientology brochure above including their criticisms "1. Psychiatric disorders are not medical diseases 2. Psychiatrists deal exclusively with mental "disorders" not proven diseases" and your post followed with "that's because we treat symptoms not diseases" sounded a bit like you were just regurgitating that nonsense in defense of CCHR... I now see what you meant, your initial *that* was very vague.
Whoops! I was supposed to write we treat syndromes not diseases!!! LOL! That’s what I get for trying to write on the forum between dealing with my catatonic patients! Probably why I don’t post here that often anymore. My point was that syndromes are often misinterpreted as not having a biological cause. But actually saying we treat symptoms not disease is not too far off at times, at least with what I do...
 
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I think he could have said those things more clearly without dumping on the whole field of psychiatry.

Agree.

Like I said before. Read my last 100 posts and you'll see I criticize lots of aspects of psychiatry.

But I don't go in front of an organization that espouses that psychiatry was responsible for 9/11, get paid by these people, and then just reinforce their ignorance with a smile on my face and only bring up the worst of the worst of psychiatry without putting it in the proper context. Then do it again, and again and again and again......

Again utterly indefensible and so glaringly wrong it cannot be defended. Szasz has at times said some brilliant things. A broken clock is right 2x a day.

And BTW, several disorders in psychiatry such as Schizophrenia show data that it is as much physiological as a biological disease such as Multiple Sclerosis.


He is explicitly stating that illnesses are different from problematic behaviors. To call ADHD or mania an illness may be more harmful than helpful. There is a decent body of literature to support that.

Fair point, but again the audience (Church of Scientology)? a group of people where he has said mental illness doesn't exist. I brought up that his context is a major reason of why he is wrong. You bring up the nuanced and better argument Szasz has presented in the past, but in the context of this audience like I said it's the equivalent of only reinforcing ignorance.

And you don't contextually acknowledge that this is the same group that blames psychiatry for 9/11. Kind of like a physician going in front of a group of anti-vaxxers and only bringing up the side effects of a vaccine without putting the proper context while being paid by anti-vaxxers. This would obviously violate almost every medical ethic regarding expert medical testimony. There is no room for argument there.

The worthwhile message Szasz brought up in prior works, and I strongly agree with him in this regard, is just because a psychiatrist diagnoses doesn't mean it's correct, and it's far easier for a bad psychiatrist to get away with bad practice in several instances vs say a pathologist (though there is room for subjectivity in that field too).

But then he takes the leap of instead going from the logical from point A to point B, jumps off to point Z without good evidence to back that leap while the leap from point A to B was worthwhile.
 
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My goal is not to defend Szasz. But I would like to underscore a few points:

What he is saying is the opposite of the example you chose. He is explicitly stating that illnesses are different from problematic behaviors. To call ADHD or mania an illness may be more harmful than helpful. There is a decent body of literature to support that.

I think he could have said those things more clearly without dumping on the whole field of psychiatry.

And it does seem he profited a great deal from being less specific and more provocative.

Just curious - what does the research say about the harm of calling ADHD or mania an illness? Are you referring to studies suggesting that the medical model of mental illness increases stigma/helplessness or something else?
 
@whopper agreed that he did some very shady things. I wouldn’t use him as an exemplar. But when starting a convo about the utility of the purely biomedical model in explaining mental disorders, his name must be mentioned.
 
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But when starting a convo about the utility of the purely biomedical model in explaining mental disorders, his name must be mentioned.

I'd rather point students to better, more responsible people in the field who have critiqued psychiatry in a far more balanced manner. E.g.make the Rosenhan Experiment required reading. Kind of like trying to get Ted Bundy to teach law classes (who by the way was working on a law degree). Why let him teach it when there's others who could give the arguments without the baggage?

And while someone could accuse me of hyperbole, ask yourself this. Would you add as required reading an endorsement from a psychiatrist who was paid by the pharmaceutical company, in a manner that violated medical ethics, whose been known to say highly incorrect statements? If the answer is no, then why allow Szasz to be required reading when he's done pretty much the equivalent? There have been other people who questioned psychiatry who haven't so blatantly violated ethics.

Other alternatives, make psychometric testing part of psychiatric training.

Szasz is worthwhile, IMHO, for his criticisms of psychiatry, and the context of when he made those statements before he proverbially sold his soul. E.g. back in the 60s to 70s when psychiatry was much more Freudian and a psychiatrist without much hard evidence would say someone has schizophrenia because of their mother, and was basically unchallenged cause of his degree, of course this type of backwards practice should be brought up to innoculate those in training to not practice like this. But if mentioned, the teacher will have to mention the baggage of Szasz and why his later comments are not worthy of serious consideration other than being an educational treatise on a once famed physician who fell into a continual pattern of violation of medical ethics.
 
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I'd rather point students to better, more responsible people in the field who have critiqued psychiatry in a far more balanced manner. E.g.make the Rosenhan Experiment required reading.

I take it you didn't read nature this week?


Sorry to bust your bubble... Perhaps you could try to replicate his work!
 
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Didn't read it but will take the time to read the above. I can tell you this. Even if the study was fabricated, I've seen psychiatrists so bad they would've replicated the results in their own units.
 
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Oh no!
First the Stanford Prison Experiment, now this! I’m starting to think that we should just assume every flashy psychology experimental finding is bogus until proven otherwise.
 
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