Psychologists shoot themselves in the head

The psychologists who are taking aim at the DSM-5 (the list of symptoms and statistics used mainly by American psychiatrists as a diagnostic manual) have got the right target, but are using the wrong weapon.  Unfortunately, the serious discussion that needs to happen about our approach to diagnosing and treating people with mental disorders will not be stimulated by this volley; it’s just another turf war, aimed at getting column inches rather than inching closer to some truths. 

One problem is a disorderly charge.  The psychologists say that the problem with psychiatry is that it wants to treat everything as a biological disorder, where the causes are genetic, biochemical processes, whereas they see disorders as things that happen to people because of their experiences.  However, the criticism as laid out in their statement talks about categorisation; their real problem is that the diagnostic system makes the mistake of trying to put everyone in a clearly labelled pigeon hole, whereas reality is messier than that, and everyone is unique, because their experiences are unique.

Here’s a quote from the statement from the website of the British Psychological Society: “psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias”.  Apart from the bit about self-reporting, that is true of virtually all types of categorisation in science, apart from perhaps the more elemental and elementary ones like physics.  And self-reporting is just another kind of behaviour anyway.  If a psychiatrists does claim his diagnosis to be an objective stamen of fact, then he is not a very good scientist, but he smells like a straw man to me.

In their first charge, that of biologism, they are right to criticise the trend in recent years of some health professionals to treat everything as a biological medical condition, but their mistake is just as grave if they think that they can ignore bodily reality and explain everything in terms of personal experiences, and apply a talking cure.  The truth is we are a complex interaction of bodily and mental forces – we are bodies that have experiences in a complex social world.  A good approach to treatment should accept this reality.  

In their latter charge they seem even more naïve.  Categorisation of any collection of objects is never clean cut; an individual object will always be unique, but may resemble other objects in various ways to various degrees.  A useful categorisation is just one that allows us to group things together in such a way as to use our experiences of one object when dealing with another.  These categories are a work in progress, always.  The fact that there may be several distinct disorders captured by our present-day concept of schizophrenia, doesn’t mean that the category is meaningless, or that some of those currently classified as such don’t share an underlying physical cause of their condition.  In fact, the act of categorising says nothing about the cause.  Causal hypotheses are distinct.  It may be that all schizophrenics shared similar experiences, like having parents who were failures in a particular way (we used to make such hypotheses, but they went out of fashion, because they were wrong and based on prejudice).  So, even if the psychologists are granted their desire to have all disorders caused by life experiences, that doesn’t affect the usefulness of categories; we are similar, after all, and will react similarly to similar experiences.

I suppose it’s just a turf war.  But it’s a shame that they will only further muddy the waters of this particular debate.  The truth is that in order to understand ourselves, we have to consider how our experiences affect us, which includes how they physically change us, and also how our bodies affect our experiences.  Why doesn’t anybody remember to call a philosopher when you need one?  This is basically the old dualist debate.  They are both making the mistake of thinking that there are 2 things in my head, one body and one mind.  But they are the same thing; an experience is a physical event, and the kinds of physical events that can happen in me are constrained by certain facts about my body and the world it is in.