Iranian born Dr. Nassir Ghaemi in a MedScape piece, Fallacies of Psychiatry, actually only succeeds in revealing his own bias.
His first conjectured fallacy, the psychological fallacy, he would answer with a fallacy of his own. Namely, the flat earth fallacy. If enough people think a person “needs” psychiatric “help”, in other words, it must be so, and this makes the difference between a biological basis and a psychological, social, or psycho-social origin for “mental disorder”. If the person makes his way into the doctors office, at his friends and associates bequest, his or her “illness” must be biological.
These psychological judgments are essentially made on the basis of common sense. But if common sense were enough to explain things, then our patients would have convinced themselves, or been convinced by their friends and family. If a patient crosses the threshold of a clinician’s door, then common sense has failed — no need to keep using it. What is needed is scientific sense, which is quite different than common sense.
Suddenly because a doctor has entered the picture, we’ve got science. Really? Conventional wisdom may not apply here, but reason doesn’t cease to apply. I wouldn’t be beyond suggesting that our mad doctor’s uncommon sense was a little tainted with an unreason of his own. If a pseudo-scientific credentialed elite says it is true, it must be true. Right? I’d say, reasonably, that it isn’t true until it is proven true. Here we have one theory in competition with others. The winner is only a poser. The scientific method is about disproving, not proving.
Dr. Nassir would then debunk such a biological reductivist view for certain “mental illnesses” that, in his view, have a psycho-social basis. This creates an even more serious dilemma for our doctor because now we have two entirely distinct species of “mental illnesses”, those with a primarily biological basis, and those with a primarily psycho-social and environmental basis. I would suggest that if “mental illness” is not actually “brain disease”, but erroneous ways of thinking, you don’t need two species of “illness” at all to explain it. Simply put, removing consciousness from the equation does not, at the same time, remove consciousness from the organism.
The doctor’s view is a pretty conventional one, but it asks many serious questions about the profession of psychiatry today. He establishes the psychiatric divide. His examples of biologically based disorders is pretty orthodox, as are his examples of more psycho-socially based disorders. On one side we’ve got schizophrenia, bipolar disorder and major depression, the holy trinity of the “mental illness” belief system, and on the other side, we’ve got PTSD, adult ADHD, and borderline personality disorder. I’ve seen this divide presented before. Recently I encountered a person attributing minor disorders to stress factors and major disorders to heredity and biology. In psychoanalytic theory, what has become the divide between major and minor “mental illness”, constituted the division between psychosis and neurosis. If these “disorders” existed on a continuum–big if, but they could–you’ve still got the psyche in psychosomatic. I don’t think it has, by any stretch of the imagination, been proven that they don’t exist on a continuum.
Big problem, little problem. Major “disease”, minor. The big secret is that diagnosis doesn’t represent the eternal biological curse that some professionals would have it represent for people given serious diagnostic tags. Some people manage to get out of the system, and to cope, and even to flourish, despite the cynicism of professionals. The devastating statistics actually represent a systemic challenge. When you’ve got a system based on unequal power relationships, that’s what happens. The success and independence of professionals is based on the failure and dependence of patients. Step back a little bit, and consider, the success of the professional actually depends on failing his patients. You’ve got more job security when your job is keeping a junkie supplied with dope (and this dope could be methadone, heroin, haldol or clozapine) than you would have if your job was getting him or her off drugs entirely.
Initially asylums were set up to segregate and imprison lunatics, i.e. people believed afflicted with any earlier version of the holy trinity in the psychiatric belief system. The advent of psychoanalysis expanded that field a great deal to include people suffering from more minor afflictions and offenses. General anxiety disorder, for instance, is in many ways the mental health equivalent of a skinned knee. Recently, psychiatry has been accused, due to the absolutely absurd number of “diseases” proliferating in the DSM, of pathologizing “normal”. Since the genesis of psychoanalysis, utilizing professional services has been put forward as a way of life. I’d suggest that there are other roads to take besides that of treatment, and maybe we’d better look to them. Take the case of what used to be called hysteria, or the case of what used to be called hypochondria, when a crutch is imaginary, perhaps a person would do better to get along without it.
Filed under: ADHD, antipsychiatry, Biological Psychiatry, DSM, Military Veterans, Oppression, Psychiatric Drugs, Recovery, Research, self help, State Hospital | Tagged: biological basis, fallacy, mental illness, mental illnesses, Nassir Ghaemi, psychological fallacy |