Sorry it took me so long to get back to this thread. Real life called. Ok I lie. I was sitting on my couch in a cheeto fueled stupor. But still...
Actually you can not level those criticisms at all aspect of medicine.
I can, and I do. As do most of my compatriots in the fields of bioanthropology and exercise science
Philosophically, psychiatry is distinct among the medical sciences namely because it deals with the mind. The medical sciences are largely based on reductionism and reductionism cannot provide all of the explanations needed to explain mental disorder. However, reductionism is great at explaining the other fields of medicine which is why it's hard for us to grasp that it won't deliver for psychiatry too.
No actually reductionism is great at getting low p values but not much else. The human body is an immensely complicated, intertwined, and adaptive biological entity that is quite frankly underappreciated by medicine as a whole, and our understanding of all diseases suffers for it.
Reductionism gives us a picture of human biology that is abjectly impoverished. It's the difference between looking at the score for Beethoven's 5th versus actually hearing it played by the New York Philharmonic. The result being that we fail to understand the complex interactions of the various aspects of our biology.
The 'cholesterol hypothesis' of heart disease, diabetes, obesity, proximal degenerative joint disease, and spinal disease are just a few of the areas in which the pathetic inability of reductionism to offer a meaningful perspective of pathogenesis or avenues of treatment.
Heck, just listening to an MD opine about the 'genetics of obesity' or the ineffectiveness of diet and exercise has been known to result in my projectile vomit forming an ugly grey-green-yellow crysanthemum on the opposite wall. Don't get me started on MSK or psych.
I've always envied the physicists in their commitment to the GUT. The desire to understand how the various physical phenomena and laws fit together to form an overarching theory of how things work.
In medicine, reductionism and our lack of commitment to epistemology and proper honest to god theory formulation has left us incapable of forming cohesive descriptions of the body in health and disease.
One of the problems is that monism (meaning the mind and body are one entity) is supported by the reductionist approach. Within monism disorders of the cognitive realm as perceived PRIMARY lesions in the brain...
The end result is that without a dualist model of mind mental life takes the backburner and we hunt and peck for biochemical lesions. Note that I am not saying that biochemical lesions are not important or do not exist, they are just not the answer to all of psychiatry's questions. It's just that we almost always look at these changes from the lesion-->mental state standpoint as opposed to the chronic mental state-->biochemical changes-->continued aberrant output.
See I would argue is that the problem is that we
do have a dualist mindset of the brain and mind, instead of a monist one. We treat thought as an epiphenomenon and essentially a nonbiological experience. Which is why our research has failed to even begin to attempt to address the issue of how, say....your mother dying and now you not having the purpose of 'primary caregiver' leads to a deep depression that expresses itself in biochemical and functional differences in brain structures. We've identified WHERE the pathology is, but we don't do such a great job of describing the WHY of the pathology. 'It's genetic' is self-evidently horseturds. Which may explain why no one is even attempting to explain the 'why'.
The status quo insists that only looking at the biochemicals is somehow more 'biological' than peering into psychodynamics and cognitive-behavioral issues. Which is hilarious because it ignores what is probably the most important 'biological' factor in the brain: namely biological adaptation and change, through all of its many, many, many mechanisms.
Another philosophical issue that dovetails into is the Western preoccupation with ahistoricity, which according to some schools of thought is essential to a well developed epistemology. Which I find hilarious because not only thought, life (at every level), and the very creation of our bodies, brains, and the world we live in today is fundamentally 'historical' in nature. I.e. What we are today is reflected in what we were in the past and the various vectors and forces that impact them, as well as the innate 'adaptive programming' that drives how these different factors will affect different individuals.
One could say in fact that the failure of much (not all) biological psychiatry research lies in the fact that it fails to take into account the most basic imperative of biology: to live is to change.
My counter to this is that the life of the mind, the thoughts we think, and our behaviors are fundamentally biological, and that all of those things impact the wetware of the brain, changing structure and function at the genetic, biochemical, functional, and structural levels, which in turn impacts all of the aforementioned things. As I have said a few trillion times, my interest in psychotherapy is so strong
because of my undergrad and grad education in neurobiology. Anyone with the simplest understanding of the adaptive nature of the nervous system cannot possibly hope to explain psychiatric disease without invoking the effects of behavior, experience, and action
and how they change neurons.
The failure of 'biological psychiatry' is that it attempts to take a snapshot of the brain at a single point in time, look for abnormalities, and then declare that those abnormalities are the 'cause' of symptoms that manifest as behavior, emotion, and thought patterns.
It's quite pathetic in all honesty and I would have been thrown out of grad school for using similar logic.
In closing, suppressing an output state (with meds) without fixing the cognitive processes that give rise to that mental state is an incomplete treatment paradigm for those whose biochemical aberrations are secondary.
In the other fields of medicine it does not matter if the mind is monist or dualist and that is why this criticism is very specific to psychiatry alone
Once again I must invoke the image of horseturds. 'Dualism' and a lack of historicity and contextuality hurts all aspects of medicine. And it is not only 'biological psychiatry' but most aspects of medicine that are rendered peurile by their inability to reflect in how behavior and action
drive disease.
We've always thought of osteoarthritis as coming as a result of 'wear and tear' on joints. Which does explain the rates of osteoarthritis in hands of people who do a lot of work with them, and hips and knees of the obese. But doesn't explain the fact that athletes (including weightlifters) have LOWER rates of OA than the general population. And that in the latter, traumatic injury in the affected joint, or habitually poor movement patterns are responsible for most cases of OA.
So maybe it's not wear and tear, but joint loading, vascularization, nutrition, trophic activities, and the relative contribution of active and passive structures during movement...
Or type 2 diabetes research. No one has stopped to consider WHY brown people (of all shades and geographical origins) seem to have such 'higher risks' of it. Why do we fare so much more poorly than white people, even if we eat the same and weigh the same? Oh hey look at that! It wasn't around 100 years ago!!! that's so weird!!!!!! And why would such a 'bad' gene exist???? You mean that 'brown' people can put on mass easier at equivalent protein loads and with less trophic activity? Could it be that they have a more anabolically-shifted metabolic equilibrium? That they traditionally had less protein and less grain in their diets and so maybe have a hormonal profile that results in a more efficient use of available complex carbs and protein????
And I am going to shut up before I start talking about the patheticity of doctor-led exercise research or the cholesterol hypothesis of heart disease.
Suffice to say that before the NIH or NSF existed, experimental results were seen as a means toward developing more robust theory, rather than ends in and of themselves. And that very few scientific disciplines remain that train in the classical model of theory and philosophy based learning in which one is taught to take data and experimental findings and either incorporate them into existing theory or explain how they refute existing theory and thus how existing theory must change to reflect new findings.
Perhaps nothing better illustrates the sad state of biomedical science than the fact that one cannot build a career on their ability to synthesize available data into new theories, or that no A-journal is willing to publish commentary and theoretical (in the scientific sense) work as primary publications.
How the hell can science advance without the proper framework of dissent and debate?