On Constructs and Mental Illness

Constructs are abstract concepts we use to organize available information for the purpose of (scientific) description and/or explanation. Constructs are ubiquitous in science in this sense; “gravity” and “temperature” are constructs, so are “intelligence” and “self-esteem”. Constructs can be immensely powerful when they capture features of the natural world (vs merely reflecting features of human interest), such as elements of the periodic table or fundamental particles in the standard model. But many scientific constructs do not map onto the world in such a powerful way as to “carve nature at its joints”. These constructs, while they do reflect features of the world (they are organizing information after all) also reflect human interests and goals to varying degrees.       Diagnostic constructs in psychiatry are typically ways of organizing observed behaviors and reported experiences into particular categories or dimensions. To emphasize, for instance, DSM categories as “constructs”

Conversations in Critical Psychiatry

" Conversations in Critical Psychiatry " is my interview series for Psychiatric Times  that explores critical and philosophical perspectives in psychiatry and engages with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo. Following interviews have been published so far. I will continue to update this page as new interviews are published. The list below is in the order of the original online publication. 1)  Conversations in Critical Psychiatry: Allen Frances, MD 2)  The Structure of Psychiatric Revolutions: Anne Harrington, DPhil (published in print with the title 'The Many Histories of Biological Psychiatry') 3)  Skepticism of the Gentle Variety: Derek Bolton, PhD 4)  Explanatory Methods in Psychiatry: The Importance of Perspectives: Paul R. McHugh, MD 5)  Chaos Theory With a Human Face: Niall McLaren, MBBS, FRANZCP 6)  The Rise and Fall of Pragmatism in Psychiatry: S. Nassir Ghaemi, MD, MP

Common Conceptual Mistakes in Psychiatry & Psychology

Some common conceptual mistakes in psychiatry and psychology, in my opinion: 1. Thinking that scientific explanations must necessarily reside at a certain level of explanation [good scientific explanations are not constrained by reductionism or holism] 2. Thinking that the mental/psychological and the physical/biological are mutually exclusive [we need to avoid false binaries between mind and body] 3. Thinking of the mind in terms of entities and "mental stuff" rather than dynamic interactions and regulatory processes 4. Thinking that we can infer the nature of specific phenomena from definitions of disease concepts [ we cannot ] 5. Thinking that if a phenomenon exists on a continuum, we can't/shouldn't categorize it [we can categorize based on our pragmatic goals] 6. Thinking that if a phenomenon exists naturally on a spectrum, there cannot be qualitative differences between two ends of the spectrum [quantity becomes quality] 7. Thinking that meaningful scientific pr

Types of Psychiatry Papers (xkcd spin off)

xkcd recently made a comic about types of scientific papers, which went viral on social media. Inspired by it, here's a spin off that I made about types of psychiatric papers; I shared it on twitter and facebook earlier with quite an enthusiastic reception!

Understanding Depression: A Pluralistic Approach

The controversy surrounding the report “ Understanding Depression ” by British Psychological Society has prompted much reflection on my part. In particular, it appears to me that it is no longer sufficient to criticize. What is needed is an alternative answer, one that can do some justice to the complexity of the issue at hand. What is also needed is not a medical answer, for that is already dominant and pervasive. Rather we need an answer that goes beyond the medical, and that provides a space for societal dialogue. In this blog post, I attempt the beginnings of such an answer. While I have confidence in the earnestness of my attempt, I have less confidence in its success.   Understanding Depression: A Pluralistic Approach Depression is a common human experience characterized by feelings such as unhappiness, despondency, dejection, sadness, despair, or misery. However, the depression that is the subject of our discussion, the depression that comes to the attention of clinical p

The Users and Abusers of Psychiatric Criticism

This post continues the dialogue between James Barnes and me on the topic of criticisms of psychiatry. See last post by Barnes here . I am going to respond to some of the specific points raised by Barnes, but in order for this exchange to be more meaningful, I want to do so in the context of some larger theses about the common ways in which criticisms of psychiatry can be problematic. In line with my previous post, the intention is not to shut down or suppress criticisms, but rather to encourage more thoughtful and more nuanced criticisms.  1) On analysis, many (certainly not all) criticisms about psychiatry are actually about the current system of mental health care, but these criticisms are often directed at psychiatry as a medical specialty . By conflating the two, critics often ignore or downplay the “market forces” and systemic influences in shaping contemporary practice. 2) Many criticisms that apply to psychiatry also apply to psychology, but psychiatry is typically single

Critics and Their Psychiatry

This is a guest post by James Barnes , who offers a response here to my earlier blog post Psychiatry and its Critics . Your response-blog was much appreciated and clarifying. I wanted to respond in kind to some of what you said, partly to explore certain misunderstandings and identify differences, but also to highlight degrees of agreement. I do want to just say, though, that I disagree with your premise. I do not think this should be characterized as a conversation that is being had “over and over again.” The implication is that what is/has been missing is some sort of better appreciation of a set of facts about what psychiatry actually is or does. I think that is a serious underestimation of what is going on. Ultimately, this debate concerns a clash of ‘world views.’ Similar themes can of course be traced back to the “antipsychiatrists” of the 1960’s — though they are not simply regurgitations of those arguments — but that movement itself can and should be located within the p

Psychiatry and its Critics

This blogpost is in response to a blogpost by James Barnes on Mad in the UK : Are critics of psychiatry stranded in a ‘Jurassic world?’ I am not interested in framing my response as a refutation . I am not interested in any claims of victory or proclamations along the lines of “Hah! Arguments by critics of psychiatry have been refuted!” That would be the wrong way to think about this. I think there are many valid criticisms of psychiatry to be made, and it is important and essential to engage with criticisms. As I explain below, any framing that frames this discussion in terms of psychiatry vs its critics is problematic in my view. Refutations and counter-refutations are neither the best way to advance a debate nor the best way to learn from each other. My hope, in offering this as a response, is that we can move away from having the same arguments over and over again . 1) Psychiatry and the Critics of Psychiatry First thing I want to note is the framing of debate, the way the ti