Showing posts from 2021

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”

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!