A Myth in Creation

Takeaway: The societal dominance of biomedical narratives requires physicians to practice medicine with epistemic humility and in a deeply collaborative manner.   How medical explanations shape our self-understanding individually as well as collectively has increasingly been on my mind, and over time I have become acutely aware of medicine’s complicated relationship with epistemic justice. According to philosopher Miranda Fricker, epistemic injustice occurs when someone is wronged “specifically in their capacity as a knower.” (1) This comes in two forms, testimonial and hermeneutic injustice. Testimonial injustice happens when a person is assigned lower credibility due to prejudice and not based on any reasonable concerns about the testimony. The person belongs to a certain negatively stereotyped social group, and this creates a credibility deficit for members of that group. A common example would be not taking the testimony of someone as seriously as is warranted because th...

“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 " 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. ...

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...

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...

James Barnes is a psychotherapist, mental health advocate, and writer. He lives in Exeter in the UK. He is on twitter: @psychgeist52 Discussion Background This discussion started on Twitter in the context of the last blogpost in which Mark Ruffalo and Ron Pies discuss their views on psychiatric diagnoses and on the definition of “disorder”. James Barnes objected that a non-essentialist, pragmatic definition of disorder misses the entire point of the term “disorder” or “disease”, which for him is to discriminate an empirical object of/in the organism, as it does in the vast majority of cases of unquestioned physical disorders. I responded by saying it is possible to define disease/disorder is many different ways, that each definition has its internal logic, and each has pros and cons, and different implications. A common goal of most definitions is to try to capture the everyday use of this term in general medicine, but other definitions may not care for this goal. ...