Behavioural Geneticist Robert Plomin: “There Are No Disorders, There Are Just Quantitative Dimensions”

Jon Sedarati, MSc
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Behavioural geneticist Robert Plomin recently spoke with author Sam Harris on the Making Sense podcast (Episode 211 – The Nature of Human Nature). They covered a variety of topics related to the field of behavioural genetics with reference to Plomin’s latest book, Blueprint: How DNA Makes Us Who We Are (see Jay Joseph’s MIA article for an in-depth review).

Given my criticisms of behavioural genetics and its use in attempting to demonstrate the existence of discrete psychiatric “disorders,” it was a pleasant surprise to hear Plomin state the following during his conversation with Harris:

I really believe in psychiatry and psychology these diagnoses have held us back, tremendously. And all of the DNA studiesthese genome-wide association studiesare case control studies. So, the whole game is to find these people who meet thesewhat I think are arbitrary diagnostic criteriaand you call them cases, like schizophrenics. And everybody else is a control. And that’s really held us back because it’s just simply not true. . . . I’m basically saying, there are no disorders, there are just quantitative dimensions. And one implication of that, then, is if there’s no disorder, there’s nothing to cure. It’s not like you’re cured, yes or no. It’s all quantitative. It’s a matter of more or less. We’re alleviating symptoms rather than curing a disorder.

It is encouraging to hear leading scientists such as Plomin acknowledge that psychiatric diagnoses are fundamentally arbitrary and that the idea of a “cure” does not make sense with regards to psychological issues.

That said, throughout his discussion with Harris, Plomin repeatedly refers to “schizophrenia,” as if it were a discrete disease. Perhaps Plomin recognises “schizophrenia” does not exist and is simply using it as a shorthand for the behaviours and experiences that the label purports to represent. Unfortunately, reading Plomin’s book, Blueprint, did not clear up the confusion; if anything, his views on the matter became even less clear.

“Mental disorders do not exist . . . but causes of mental disorders do

In chapter 5 of Blueprint, Plomin acknowledges that “there are no genes ‘for’ any psychological disorder.” And, mirroring what he said to Sam Harris, he writes that “there are no disordersthey are just the extremes of quantitative dimensions.” However, Plomin also claims that “we all have many of the DNA differences that are related to disorders.” So, to sum up: There are no psychiatric “disorders,” and there are no genes “for” disorders, but we all have genes related to disordersdisorders that do not exist. This is getting confusing.

Later in the same chapter, Plomin again implies a belief in the existence of discrete disorders by stating: “common disorders, including all psychological disorders, are not caused by a single gene.”

Regardless of how many genes may be involved, how can one talk about causes of disorders after claiming they do not exist?

But because the genetic risk is continuous, it makes no sense to try to reach a decision about whether someone ‘has’ the disorder or not. There is no disorderjust the extremes of quantitative dimensions.

If it makes no sense to decide whether or not someone has a disorder, how can Plomin claim that certain DNA differences put people at risk for a given disorder? At best, one could make the case that specific genes correlate with types of experiences such as hearing voices, paranoid thoughts, depressed feelings, etc. But even then, are the genes that lead a divorcee to feel depressed the same as those that cause a child of neglect to feel depressed? If one person claims to hear the voice of God and another person claims to hear an abusive parent’s voice inside her head, are the same genes involved?

Since diagnoses like “depression” and “schizophrenia” are just a mishmash of behaviours and experiences that are by no means shared by all individuals diagnosed as such, and since current behavioural genetic research is so hopelessly confoundedin part, due to the fact that the criteria used to diagnose people are, as Plomin acknowledged, arbitraryit is difficult to determine the accuracy of the gene “discoveries” touted in Blueprint (or take seriously the idea that these collections of genes can be used to predict future mental states).

In the conclusion of chapter 5, Plomin argues that since there are no disorders, only quantitative dimensions, “there is no ‘us’ versus ‘them.’” His efforts to dismantle the arbitrary line between “mental health” and “mental illness” (that psychiatry draws in order to forcibly “treat” those placed in the latter group) are laudable. But Plomin’s devotion to genetics muddies his message, making it appear contradictory.

Biogenetic Explanations and Their Effects

Another well-intentioned but disputable view expressed by Plomin (in chapter 8 of Blueprint), is that by accepting that psychological experiences are (primarily) a consequence of genetic differences, people will become more accepting and less judgmental of both themselves and others who may be suffering.

Rather than blaming other people and ourselves for being depressed, slow to learn or overweight, we should recognize and respect the huge impact of genetics on individual differences. Genetics, not lack of willpower, makes some people more prone to problems such as depression, learning disabilities and obesity. Genetics also makes it harder for some people to mitigate their problems. Success and failureand credit and blamein overcoming problems should be calibrated relative to genetic strengths and weaknesses.

This is similar to the idea that viewing “mental illness as an illness like any other” (a belief promoted by SANE Australia and the American Psychiatric Association) reduces the stigma experienced by those diagnosed “mentally ill.” This view is generally unsupported by the available evidence (which actually suggests the opposite is true). Whereas evidence for Plomin’s view that understanding the role of genetics can help people feel better about themselves is, at best, mixed.

A 2013 meta-analysis found that biogenetic explanations do reduce blame but also induce prognostic pessimismthe view that psychological issues are unlikely to improve and are perhaps permanent“set[ting] the stage for self-fulfilling prophecies that could hamper recovery from psychological problems.” This latter finding was reported in an earlier study whose authors warned that

Individuals with a diagnosis of schizophrenia may themselves form deterministic interpretations of the genetic information they receive and subsequently be less likely to adopt behavioural advice or adhere to treatment.

More generally, a review of 33 studies examining the relationship between biogenetic explanations and public acceptance of “mental illness” reported that “in most instances biological or genetic causal attributions are not associated with lesser rejection of people with mental illness.” A 2010 study also reported that with regards to public causal attributions of “schizophrenia,” “depression’, and alcohol dependence, although endorsement of biogenetic explanations grew between 1996 and 2006, stigma did not decrease. The researchers concluded: “An overreliance on the neurobiological causes of mental illness and substance use disorders is at best ineffective and at worst potentially stigmatizing.”

Adopting a biogenetic view may also have implications for therapists and their clients. Research has demonstrated that clinicians with medical training are significantly less empathetic towards individuals diagnosed with “schizophrenia,” “social phobia,” “depression,” and “obsessive compulsive disorder,” compared to clinicians without such training. Moreover, biological explanations produce significantly less empathy in clinicians, regardless of training. Finally, a 2015 study found that, compared to psychosocially oriented clinicians, clinicians who framed psychological distress biogenetically were perceived as significantly less warm by all participants. These findings suggest biogenetic explanations pose a threat to the empathic relationship between client and clinician.

Afterword

The research concerning biogenetic explanations and their negative effects could perhaps be downplayed if the data undergirding such explanations were credible. But since psychiatric research is built on invalid assumptions and riddled with confounds, it does not seem accurate to talk of genes causing (or predicting for) “schizophrenia,” “depression,” or any other psychiatric “disorder,” even in the quantitative sense.

Searching for genes that contribute to easily quantifiable traits such as height and weight is one thing, but attempting to do the same for arbitrary categories like “schizophrenia” is an entirely different matter. As psychiatrist Nassir Ghaemi wrote in a 2016 paper titled Utility Without Validity Is Useless, “if we create diagnostic categories based on social, economic and political considerations, why should genes correlate with those categories?”

Plomin said “the whole game is to find these people who meet thesewhat I think are arbitrary diagnostic criteriaand you call them cases, like schizophrenics,” acknowledging that categorising everyone else as a control is “simply not true.” Indeed, it is not true. But neither is the claim that DNA differences predict for “schizophrenia.” The arbitrary nature of the “game” being played precludes such a conclusion.

If understanding how genes impact human characteristics is truly the goal, then a new game is needed; one that does not rely on arbitrary lines or labels.

Editor’s Note: To view the complete list of footnotes, click here.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

53 COMMENTS

  1. And so what if you find “genes”?
    My great great grandfather was a man who broke away from the catholic church and became part of a minority religion/faith/belief that believed in running away or turning the other cheek. They were persecuted by the CC and were on the move, of course always having to etch a living on new lands, barely surviving and if caught, perhaps burned. So this continued for generation and the stress was difficult, laced with hopelessness, yet hope that god would see them through.
    My own grandfather continued and escaped Russia, because the lands were being taken, lands they worked through want of peace.
    My own father at a year and half was on a boat to a third world country, again by his father looking for a piece of land where they could be “free”. Each generation was an “immigrant” in a strange land, each generation experienced the power inequality. Through the immigration to this strange land, many died. My grandparents lived in tents for six months, etching rows into the hard dry earth, praying for rain, watching babies die. My gramma lost 4 babies.
    I remember my dad hardly making a living, he was still the result of his father and the fathers before that, on the move.
    I looked back and saw generations trying to escape the power inequality.
    So yes, there was “depression”. My gramma must have found it difficult to lose four babies and see crop failure, no medical care, no money.

    So we can do “genes” in this persecuted people. And we can then call them “ill” and brand them further, control them, “medicate them”.

    And the bottom line remains. Why would psychiatry pretend to be something involved in “health”, when they are involved in EXACTLY what the CC was involved in? Psychiatry is nothing more than a powerful religion that is looking for “original sin”. They want to “cure” that original sin by putting the sinners through purgatory.
    Psychiatry was started by fucked up people and continues to be run by very fucked up people. But hey, it’s a living.
    One thing I noticed along the way, that my ancestors died, and so did their persecutors, which is somehow the final equality.

  2. “If understanding how genes impact human characteristics is truly the goal, then a new game is needed; one that does not rely on arbitrary lines or labels.”

    They know they need to flush the DSM, so why don’t they already?

    As to “schizophrenia” … the treatments can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome. And the antipsychotics/neuroleptics can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome.

    Which means that most so called “schizophrenia” is likely an iatrogenic illness, created with the treatments, not an illness with a “genetic” etiology.

    • I think it must make most or all shrink’s eyes roll and their body cringe when they know it’s time to revise that bible. They are mostly embarrassed by it, any normal “mental health worker” would be. That monkey they isolated from it’s mother, was that a genetic study? Because that monkey never was able to be a good mother monkey, and neither were it’s offspring. So woohoo, they all share the same genes.
      My gosh, it takes a lot of brainwork to come up with these pretenses, of “looking” for “something”.

      • Personally, I think it’s past time to flush their DSM billing code “bible.” But I do understand, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

        And “mental health” workers salaries usually depend upon them not understanding the scientific fraud of their DSM billing code “bible.”

        • Money isn’t the most important factor. It is deeper than that.
          It is difficult to get a man to understand something when his moral and social status depend on his not understanding it.
          The mental health profession forces drugs on people and drugs kids. For them to admit their whole profession is a pseudoscience that kills and tortures people’s; they have to accept the horrors they’ve done.

    • Discretion is the better part of valour so to speak. How are we supposed to address someone whose daily workload must have exposed them to the conceptual and methodological errors in adoption studies and the genetic assumptions underpinning their prejudices. These guys prejudices seem to be impervious to evidence.

  3. How does one distinguish between “…no disorders but quantitative dimensions…” and the possibilities of qualitative dimensions? There seems to be gap in the interview process that left the gate wide open? Even the term “Behavioral Geneticist” triggers images of Pavlovian thinking, Skinner and others that seemingly are adept at forging conclusions that are inaccurate.

    • True. It would be more accurate to say, “We are trying to eliminate emotions” or “we are drugging reactions” instead of “alleviating symptoms.” Unless symptoms is used in a very broad sense to mean “effects of an underlying cause,” not implying anything medical. It seems to buy into the pseudo-medical way of thinking, doesn’t it?

        • If our kindred spirits are experiencing a vast violation of our civil rights while we remain civil, in an augmented way, but one in which we would like to add value and values within our respective communities, then at what point does an attorney step forward that says our lives matters, crazy as they can be at times? See 42 USC § 1983 in the search engine. How can one expect to realize a business, a life, a career, if the programming is void of dollars shaped by our needs. Howard Gelding would voice this frustration many times. Hence, if we are going to protest, do we continue protesting the conditions in these posts, or do we take these issues to the financial community, the comptroller of the currency, and others , for some folks are creating great wealth at our expense and future generations. There appears to be a collective direct and indirect effort to murder or impoverish people, at least as I have experienced. I am sure this was not the intent of the founding principles of our governance.

    • “It never ceases to amaze me how intelligent people who claim to critique or even reject the biomedical model still cannot help themselves from thinking in biomedical terms.”

      The brainwashing runs really deep, and the awakening to the truth is a really “bitter pill” to swallow. These people are trying to awaken to the reality that everything they were ever taught, all the research and treatments they’ve trusted and participated in, are based upon scientific fraud and lies.

      They “can’t handle the truth.” The truth being, of course, the “mental health” industry has been creating “mental illnesses” in innocent others for profit, and murdering millions with their psychiatric neurotoxins, for decades.

      A reality that is a “bitter pill” to swallow, for all those ‘omnipotent moral busy bodies’ who deluded themselves into believing they were actually “helping” others. As one attacked, and neurotoxic poisoned by these highly delusional “helpers,” it took me years to mentally come to grips with the magnitude of the medical betrayal, too.

      You just don’t innately assume the medical/pharmaceutical industrial complex will betray all Americans, including its own members, with systemic ways for the entire “mental health” industry to actually create “mental illnesses” in people for profit. But that is exactly what the medical/pharmaceutical industrial complex has done.

      And, yes, those working within the “mental health” industries do need to wake up to the egregious harm they are doing, repent, and change from their evil ways. Even if the evil they have been, and still are, perpetrating against innocent others was done out of ignorance, misinformation, greed, and/or delusions of grandeur that they are “helping” others. Thus they didn’t even realize their “helping” work was based totally upon evil scientific lies and fraud.

    • Only James Hillman spoke about psyche in its proper language. Monotheistic science and medical empiricism is beyond the topic. Monism does not care about psyche. (Materialism + theology/spiritualism without psyche.)
      It is hard to imagine what people feel after reading his books. This is ideological prison. Many are going to be killed in the name of monotheistic status quo.

    • “Symptom” is not a biomedical term. I used to use it in the process of repairing electronic equipment.
      Quibbling about terminology results in a lot of tail chasing, from my point of view. There are more basic concepts at stake here, as well as the lives and well-being of real people.

    • Which direction does your perception of the vortex rotate? For the whole of thinking? Prior to touching these keys to send a worded message? (This seems to be a certain level of work, trying to convey some degree of query? (Did you here the inflection in the typing?) I wonder if Robert Whitaker has ever realized a Congress or Gathering of participants to a location, Covid sanctioned, that is designed for optimum learning and approved? So, a year or two out, with a potential format different if travel becomes even more problematic.

    • No, we mostly don’t work with parents to make them better parents. We mostly target abused and neglected kids for treatment.

      There is definitely an element of oppression affecting many parents. I have experienced such. I’ve also experienced being the identified patient in a broken family with affluent parents who were NOT held accountable for their abuses and neglect. I know this system from both ends.

      • Does your system only embrace two ends? There seems to major problems when one moves the family in a physical way. To pick up their stuff, pack, load and unload and then weigh the truck on a scale suggests that gravity might be an oppressor to a truck engine, a human body, that often are not cared for in an appropriate manner. When one thinks about a system, are you including the monies allocated to rocket building, the pressure’s to create a more precise and accurate way of delivering a little bitty capsule with humans inside (and maybe some germs) back to earth? If one travels up into the workings of investment companies, think back to Bert Lance and Jimmy Carter’s bid for the Presidency. Seemingly an investment company in Arkansas provided the bridge over troubled waters. When one works for said operations, if you leave their employment, one does not return, just ask Wesley Clark, a former candidate for President. Finally, can their be “effective oppression”? If so, what does one like to oppress with Liberty and Freedom?

  4. The world of biology is very caught up in genetics right now. That’s partly because they see behaviors transmitted from parents to children that can’t be accounted for as “learned” behaviors and therefore must be “genetic.” This conundrum is very real in biology and psychology. They need a better model for transmission of behaviors between generations and they don’t dare go in the direction their data is pointing to (mind separable from body).

    Yet, that is the best explanation. They just won’t go there. And that refusal has screwed things up for a long time now.

    I don’t care that much about “disorders” versus “illnesses” and all the problems of who decides what is “normal.” Those aren’t the major problem. A broken arm isn’t “normal.” Real problems of the mind and body aren’t that hard to see and aren’t that hard to agree with. The problem with psychiatry is in using a medical approach to a problem that clearly isn’t a medical problem. Psychiatrists are doctors because in the old asylums that’s all they could do for the “insane.” Amazingly, in the better asylums of those days, many patients recovered on nothing more than good food, good rest, and a calm environment. If psychiatrists had stayed with that plan, they’d be modern-day heroes. Instead, they face a dedicated effort to wipe their “profession” off this planet.

  5. Rosalee, thank you for your kind words! I plan on blogging again soon.

    Steve, I think when the word “symptom” is used in the mental health system where the biomedical model reigns, it is typically used in a literal medical sense, not a general, metaphorical, non-medical sense. People in the system are told by professionals (particularly psychiatrists) their psychological experiences are “symptoms” of “mental illness.” I think the word “symptom” is powerful, insidious, and absolutely essential to the telling of the “mental illness” story. Psychiatry has successfully sold to society and its “patients” that psychological struggles are manifestations of real illnesses, caused by biogenetic abnormalities, which are no different to other medical illnesses. The word “symptom” is essential to this way of thinking. In fact, the entire “mental illness” story is embedded into this word.

    We think in words. When the word “symptom” is applied to psychological experiences, it conveys the message that such experiences are pathological and deviant manifestations of a real illness from which the person suffers. “Symptoms” are inherently bad and need to be “treated” and alleviated. A person who has “symptoms” is fundamentally different from normal, healthy people who are not ill. That person’s psychological struggles are abnormal expressions of a medical illness presumably rooted in abnormal biology, whereas the psychological experiences of normal, healthy people are reactions to their environment and are just part of life. I think all of this meaning is built into the word “symptom.” And MH professionals are taught to think using the word “symptom” early and often, so much so that it strikes them as bizarre to question the use of this word. Even people like the behavioral geneticist described in this article, who acknowledge that the concept of mental disorders is invalid, can’t help viewing psychological struggles as pathological. Indeed, a commonly used term for the study of psychological problems is “psychopathology.”

    Indoctrination into thinking in terms of “symptoms” occurs in college where students take “abnormal psychology.” All commonly-used abnormal psychology textbooks follow the DSM in lockstep and treat DSM diagnoses as scientific fact. Students are not taught to think critically about diagnoses or the biomedical model and are instead encouraged to think about psychological issues in terms of symptoms and disorders/illnesses. They are tested on their ability to recognize and memorise DSM symptoms and disorders. The graduate training of MH professionals emphasizes this narrative even more. The more highly educated MH professionals are – as in PhD clinical psychologists and psychiatrists – the more their education emphasizes DSM-based thinking about psychological experience.

    In my experience, very few MH professionals are capable of thinking about psychological experience without thinking in terms of “symptoms” and disorders/illnesses. They literally can’t wrap their head around the idea that psychological struggles might not be “symptoms.” They have no knowledge, training, or philosophical/theoretical framework for an alternative perspective. They have no alternative vocabulary. If psychological struggles are not “symptoms,” what are they? To answer that question, a MH professional has to have a clear philosophy of what it means to be a human being living in a challenging world, and theoretical knowledge of the causes of and maintaining factors of psychological struggles that is independent from the DSM-based biomedical model. The only MH professionals I know who can do this got there by educating themselves.

    • Being a “dictionary nut” I just want to put forward that I don’t see any immediate evidence in my dictionary that the medical sense of the word “symptom” is the original, basic, or “literal” meaning of the word. From my point of view, it is one of many many general English words that have been co-opted by medicine over the years to the point where many don’t realize that it ever had a broader meaning.

      That “mental health” professionals see what they are looking at as mental illnesses that have symptoms that assist in diagnosis is obvious, but I think largely imposed on them with the help of the incredible marketing job that medicine has done, over hundreds of years really, that captured the hearts and minds of the general population on the subject of how life works. All that psychiatry had to do was hitch their oxcart to this wagon train. Embodied in this concept is a process that is used by technicians, engineers and scientists, not just doctors. But those other fields must take it a step further. They need to find root cause, or at least get closer to it. Because people and the human body are so good at repairing themselves, doctors have been able to get away with not taking that final step. But that kills the workability of psychiatric drug and surgical treatments entirely.

      It goes without saying that you can’t learn psychology by reading the DSM; that’s not what it’s for. Unfortunately, it’s very difficult to learn the fundamentals of human psychology even after you study it for two or four years, and even less possible if you are being trained to be a doctor. The subject deserves to be better understood. It underlies everything.

      • Hi Richard. That’s great to hear! I found that forcing myself to 100% eliminate biomedical language like “symptom” and “disorder” in my work with clients changed my perspective in a way that was really helpful and clarifying. But its was also difficult because I had just spent almost 20 years thinking in those terms. I taught “abnormal psychology” for a decade and published articles in journals that wouldn’t accept your paper unless you used DSM concepts and treated them as valid. I’ve been fully free of biomedical terminology now for about 4 years. It’s been great except for the year I spent working in a psychiatry clinic where most of my clients first saw a psychiatrist who loaded them up with drugs and labels. It was a struggle to do right by my clients – always my #1 priority – and deal with the politics (and eventually, threats of retaliation and losing my license and career) of working with psychiatrists whose dangerousness to their clients is matched only by their arrogance. I hope to start a blog series about that year here soon. Keep up the great work, mate.

        • “It was a struggle to do right by my clients – always my #1 priority – and deal with the politics (and eventually, threats of retaliation and losing my license and career) of working with psychiatrists whose dangerousness to their clients is matched only by their arrogance.”

          Dr. Deacon, wow, a profoundly true and powerful comment. Thank you for your ethics and integrity, and for speaking out on this! So happy to hear you will be writing not just another blog but a whole blog series. I very much look forward to that.

          • In trying to understand “the mind” of these posts, the “heart” of learning, to what extent is there relevance to the time and date of the posts?

            That signifier is in light gray, which is difficult to see at times, the indenting and following what comments are subordinated to a previous line or not, and then what if a comment/question is raised that might redirect a discussion?

            (I am sure that I do this, in part a response to bring a broader reality where my schooling to make no little dreams prompts me to the questions/concerns). I do have difficulty in discerning the intentionality of some comments, as if they are being “heard” correctly in my reading while wondering if we were to meet, then greater clarity might occur.

            I feel the pain, Rosalee. To have survived where the ACLU, in a community, city, and state where the Bar Association does not have attorneys who would understand the experience of what we have endured while wanting to take on the Powers of both Church and State, when off camera they think they are getting away with walking/stomping on another’s civil rights…… and life, then what Team will do the work?

          • Bill, it is disgusting to realize many of the organizations that claim to “oversee” patient safety/rights are nothing of the sort and are just paper pushers who are as corrupt as the medical people that cause harm. And although advocacy agencies may have good intentions they have no power to hold anyone to account or provide any resolutions.
            The amount of embedded corruption and fraud in this world is scary.

  6. This article ( https://adaptivetherapy.com/chemical_imbalance_myth.html ) is a deep dive into the “genetics” of “mental illness.” It delves into big pharma influence on the research and how German financed research comes up with different conclusions. Further details include how the NIMH has been biased toward a biological model, with the head of NIMH going so far as to suggest that we drug more kids.
    (Disclosure: I am the author)

  7. Let’s see, in the last months or so I’ve had about a dozen interactions with police, crashed my motorcycle three times (still fixing it to ride again after 110MPH wipeout/ditched the bike at a surprise curve), started using AAS again, broke a double ply window backhanding a fly in rage as I was chasing it around, cops came and put me under medical arrest and during all this time, psychiatry has been, for the first time in my life when things have been like this (they’ve been like this a few times before), completely absent. Around here at least, psychiatry appears to be dead. It’s almost like heaven.

    Oh I just realized that doesn’t make sense without more information. Yeah, that’s life! Damn near lost my finger though but refused to go to the hospital because you can’t bleed to death from losing a chunk-to-the-bone of your finger. It squishes blood but there’s no artery, not even a vein. I argued and argued… and now if I get covid…

    • One an get a host of other infections, as science as proven. What is AAS? When you write, “…around here at least, psychiatry appears dead”, do you mean where you are living physically in a geographical location or do you mean this website? (The practice, that is the art of a trying to realize a better social justice, science, and a psychiatry to be understood and questioned, is maybe akin to Pirsig’s writing about qualities, in Zen and the Art of Motorcycle Maintenance).

      • Anabolic-androgenic steroids. What I mean about psychiatry being dead is that throughout my 20’s, before I spent years being sick and under the radar from ulcerative colitis, every time I’d get in trouble with the law, the police and/or courts would involve psychiatry. It was beyond enraging, and led to more raging alcoholism. It’s been especially “crazy” the last year or so, but not a cricket so-to-speak from/about psychiatry. I can only hope it stays that way, cause I’m probably doubling down on the burnout this fall.

    • I realize a lot of commenters here want the whole concept of “mental illness” to just go away. But it will likely survive in some form for the foreseeable future. I know most doctors who want to treat the mind are currently very fond of drugs and surgeries and things like that. But there are a few – just a few – who are a lot closer to having it right. And they are just as busy as other psychiatrists. We have to admit, I think, that there is a demand for services in this area. And this demand is not just from miscreants who want to get people they don’t like locked up or “legally” killed.

      I know that people here see how the “illness” concept feeds into the “medical model” of care. But if we can decouple that care model from the research on causes, it would be helpful. That research (as misguided or self-serving as much of it is) does relate to a real demand for real solutions. The indicated model of care is NOT medical, although it’s always good to get a checkup, maybe even some blood work, if you’re feeling “off.” The model of care that is helping people involves nutrition, life choices, and strengthening of core spiritual abilities. For the people getting real help, whether someone decides what brought them to seek help was an “illness” or a “disorder” or a “condition” or an “experience” doesn’t matter that much to them. The point is that real research, done by well-intended researchers, actually resulted in a desired outcome for them.

      Those who embrace the “medical model” of treatment are trying to hide that research and its good results from the rest of us. They certainly support the term “illness,” although they use the term “disorder” in the DSM now. But I think we need to keep these two areas decoupled, because I think we will see at some point that the correct causes for many “real” illnesses will also involve nutrition, life choices, and core spiritual abilities. I think we are going in the direction of ditching the “medical model” of treatment for many “illnesses” of the body, as well as all “illnesses” of the mind.

      • It is true, people who get pulled into psychiatry are looking for something, some way to change or improve their lives. It is the deception and chicanery that characterizes psychiatry that is problematic. Lying to people in order to make money does not improve their mental/emotional/spiritual condition.

        It does seem to me that differentiating between treatments for the BODY need to clearly be separated from efforts to help someone make sense out of his/her life and be more effective in living. I think the term “mental illness” implies a “wrongness” that is pseudo-medical in nature, which is why I think we need to strongly object to the term. Offering someone help with “life goals” or “spiritual distress” or “dealing with the effects of historical trauma” allows for some differentiation in both apparent cause and in what approach might be taken. A person who is depressed due to having a dead-end job but being too finanically strapped to quit requires a very different approach than a person who is long-term depressed due to having been abused as a child and developing some unhealthy ways of avoiding further damage, and yet a different approach from someone who feels depressed due to a thyroid condition or anemia. I also believe that allowing/encouraging the person in need to both define the nature of their problem and to fully agree with the strategy to address the problem is going to be far more helpful than having someone “diagnose” him or her (absent any actual, objectively observable illness or injury). These things will not happen as long as “mental illness” is something handled in the medical system.

        There are also some major philosphical problems that are ignored or hidden by the DSM diagnostic process. The question of “what is the mind?” is one that no one really talks about. The psychiatrists assume the mind is the brain, and therefore they try to “fix the brain” by mechanical means, which makes as much sense as fixing a computer program by removing transistors or capacitors or deleting memory chips. But they are doctors (or claim to be), and doctors deal with bodies. If we are something more than a body, then we don’t need medical personnel dealing with our challenges in planning and executing our lives.

        • All the more reason, it seems to me, to decouple the treatment model from research about causes. See, I don’t think most psychiatrists think they are trying to “fix the brain.” I think most psychiatrists are just trying to look like doctors. Their self-image and social image is much more important to them than fixing anything! Meanwhile, psychiatrists who have moved beyond that, like Kelly Brogan, are building real relationships with the people who come to them for help, and are really helping them. (She doesn’t use drugs, ever, as most here should be aware.) Kelly has spoken to the “medical model” of treating any illness, which is one reason I bring it up. Although research into causes should inform us and should inform doctors, we should all become more aware of the limitations of the medical model of treatment, whatever words we use for the complaint that resulted in the person requesting treatment.

          • Oh, I’ve talked to more than a few psychiatrists who are convinced they are fixing brains, or that the brain is the cause of all forms of distress. The usual argument is, “It has to be, because if it’s not the brain, what is it?” A complete denial that a mind may be something that transcends the operations of the brain. I really do believe they are taught that, a reductionistic philosophy that disguises itself as “science.” Naturally, I’d love to do all I can to support the Kelly Brogans of the world who are trying to do something different, but they’ve got a lot of money and power aligned against them. But I really think removing the idea of mind=brain has to be central to undermining the mindless drugging and surgery that is proliferating under the guise of “treatment,” because if we are not “treating” problems in the body, the idea of drugs and surgery immediately stops making any sense at all.

          • They present to be fixing. They also present one’s troubles as “illness”.
            I don’t want “treatment”. In fact it’s difficult not to have biases and prejudices for anyone, so how could one “treat” the subject or content one is biased against.
            Some people are so beaten up that they just want to lay their head down and not be talked at, even though they sought you out. I think mostly people are on the hunt for a secure feeling.
            Psychiatry and many or most therapists have no idea on how to provide that security, because often it involves in helping to remove obstacles for the person.
            How can people feel secure in a system that is mostly overpowering.

  8. Steve, you made some great points in your last post. The psychiatrists I know and have worked with believe they are fixing broken brains. They view their drugs as chemical imbalance fixers that restore health to malfunctioning brains. They believe the mind is the brain, which means that a mind problem (i.e., any DSM diagnosis) is by definition a brain problem. What else could it be, right? They are so certain of this reductionistic argument that there is never any perceived need to actually test for brain pathology – it is simply and confidently inferred. Anyone who questions it is smugly viewed as ignorant and/or having an irrational vendetta against psychiatry. Ultimately, I think the most central aspect of psychiatry is that in order to justify its existence, psychological problems are required to be medical problems. They *have* to be. If they are not, then it makes as much sense for medical doctors to “treat” problems of the mind as it makes for priests to do surgery.

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