Psychiatric Psychodrama

“The maddening ambiguity of our position is what leads to the titular psychiatric psychodrama. One cannot reconcile oneself to psychiatry because it constantly pulls in two directions – it presents one with an ideological narrative that speaks of humanism and pluralism, and a material structure that witnesses biomedical hegemony. At some level this profession just does not make sense to itself, its own ideology out of whack with the plain facts of its own existence. There are those who are tempted to focus only on the positives, and see in this a story of triumphant progress towards a scientific future. And there are those who are inclined to see in it a story of eternal recurrence, single message mythologies ever reinventing themselves. But both of these perspectives are too tidy to capture the phenomenon. For this story is of a profession in contradiction with itself.” The above passage is a modification of a particularly memorable paragraph from Liam Kofi Bright’s brilliant article

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

Beyond Grammar: On the Appearance and Reality of Prediction in the Brain

This blogpost is a continuation of a dialogue with Richard Gipps that started with his comments on Anil Seth's book 'Being You'. Here is his latest response . I am grateful to Richard Gipps for his continued engagement with me on this issue. I questioned the value of extending this exchange further, particularly since I greatly admire Gipps and have no desire to prolong a dialogue just for the sake of it. However, I think I do have meaningful things to say in response to the points brought up by Gipps in his last post, and this offers an opportunity for further clarification. #1. Orbits What I have been trying to say is that when it comes to movements of objects, there are aspects , or relationships , or facts (if you will) about how things are that transcend any grammatical rule we may employ to talk about something.  For instance, take this rule as expressed by Gipps: “What's properly said to orbit what (the sun orbits the earth, or the earth orbits the sun)

Language, Science, and Perception

The dialogue continues! Responding to Richard Gipps's post  contra aftab contra gipps contra seth Gipps is quite right to point out that Seth (and other neuroscientists) have not been entirely clear about the sense in which they are using the terms such as "inference" and "prediction" when applied to neurological processes, how this usage departs from "ordinary" usage, and that this lack of clarity leads to confusion, inconsistency, and yes, possibly erroneous inferences. On this issue I am in agreement. While the project of bringing philosophical clarity to these neuroscientific terms is not necessarily easy, it is not impossible. Where I disagree with Gipps is that he seems to think that the entire project of explaining perception is muddled because there is no meaningful question to be answered, and that there is no meaningful way in which brains can be said to "infer" anything other than in a completely metaphorical manner. My own view is

Gipps vs Seth: The Muddle of Predictive Processing

          “without a constant misuse of language, there cannot be any discovery, any progress”           Paul Feyerabend,  Against Method This blogpost is written in response to a  blogpost by Richard Gipps  in which he critiques the account of perception as a form of prediction and “controlled hallucination” as presented in Anil Seth’s book  Being You . Gipps takes a Wittgensteinian approach here and is concerned with the ways in which Seth fails to define crucial terms and argues that the account as presented by Seth is philosophically confused and muddled to the point of being  not even false . Gipps is very incisive in his analysis and I would encourage readers to read his post in detail. He particularly zeroes in what is ambiguous and murky in Seth’s descriptions and shows how this murkiness leads to philosophical problems.   When I read Seth’s   book last year, I enjoyed it considerably, and found it intelligible in an intuitive way that Gipps apparently does not. While I have

Understanding the "Understandable" in "Understanding Depression"

A twitter thread by Dr. Gipps prompted me to look at the use of the term "understandable" more closely in the document " Understanding Depression " by the British Psychological Society. It appears to me that the term is used in an ambiguous and polysemous manner in the document, drawing on multiple themes and analogies, that are not only different but also generate different implications and subsequent questions. In this post I identify some of the different ways in which this term is used. A recurrent theme in the document, at least implicitly, is that depression being "understandable" poses some sort of a problem for a medical approach to depression; there is a crude sense in which it can be the case, but not necessarily. I briefly discuss this aspect of the problem as well.  1) "Another idea is that, rather than being an experience thrust upon us by biology, depression, like other emotions, is often an understandable human response to the world ar

On Disease Attribution and Medical Legitimacy

In this blogpost I am collecting some of my recent tweets on the topic of attribution of “disease” or “disorder” in medicine and psychiatry, and whether legitimacy of medicine depends on that. I have edited the tweets for clarity. (Also see the post Beyond Definitional Disagreements  for additional background.) Suffering, impairment, harm, neurobiological and psychological differences, these exist independent of anyone’s wishes, but whether we see them through the concept of “disease” is a different issue that can be validly debated without committing a philosophical or scientific error. ( link ) There are indeed truths out there, but “disease” is not among those truths. What does exist is suffering, impairment, harm, and various sorts of neurobiological and psychological differences, etc., but our conceptualizations of these phenomena do not constitute fundamental truths. ( link ) While characterization of distress/incapacity as “disease” is coherent and historically respectable

The Laws of Ambiguity

Something I posted on twitter First Law of Ambiguity: What happens in vagueness stays in vagueness, unless acted upon by a clarifying force. "What happens in vagueness stays in vagueness" is a common enough phrase that it even appears on some t-shirts. It is also a play on the "What happens in Vegas stays in Vegas". So I can't take credit for this particular phrase. But as I came across it a few days ago, my mind immediately made a link to Newton's first law of motion, resulting in my specific version articulated above. Allen Frances proposed in response to my tweet the Second Law Of Ambiguity : Often there is no clarifying force and we must learn to live vagueness. In response to that, Dariusz GalasiƄski proposed the Third Law of Ambiguity :  Ambiguity is hard to spot, certainty prevails. Even when spotted the desire to reject it and replace it with certainty prevails.

Beyond Definitional Disagreements

This blog post is derived from a twitter thread , in response to this blog by Mark Ruffalo . I’ve been thinking a lot about how to navigate debates where participants strongly disagree on definitions of concepts such as “disease” and “pathology.” These concepts don’t have a single, privileged definition, so if we are confronted with two internally consistent definitions it seems rather futile in my opinion to insist that one definition must be abandoned in favor of the other. In this scenario, on one hand we have a biological essentialist notion of disease as a demonstrable neurobiological abnormality or lesion, on the other hand we have a notion based on distress and impairment, defended by Ruffalo & Pies. Mark Ruffalo does a good job showing that the prospect of symptoms being “meaningful” does not pose a threat to the internal consistency of the notion of disease as severe distress and impairment. However, the authors of Understanding Psychosis don’t deny that psychosis can be

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”