The Scientism of Psychiatry

[Allele]

Research and discourse in psychiatry are now dominated and infected by scientism — the promotion of a belief, sometimes intentionally, sometimes not, that because what you do and talk about sounds and looks like ‘science,’ it is ‘scientific’ — rather than a rational engagement with the nature and consequences of the actual scientific findings.

https://www.madinamerica.com/2018/01/the-scientism-of-psychiatry/

 

[Jonathan Edwards]

I think this guy has actually got his meanings wrong. Scientism is the belief that science provide the answers to all deep questions. The opposite is to reject science as a source of answers. It has nothing to do with whether or not the answers sound like science. The author is not suggesting that psychiatry is scientistic but that it is pseudoscientific. We want psychiatry to be scientistic.

 

[Valentijn]

Terminology aside, the article makes some very good points:

Psychiatric Scientism
Mainstream psychiatry has been afflicted by at least two types of scientism. Firstly, it parodies science as ideology, liking to talk in scientific language, using the language of EBM, and carrying out research that ‘looks’ scientific (such as brain scanning). Psychiatry wants to be seen as residing in the same scientific cosmology as the rest of medicine. Yet the cupboard of actual clinically relevant findings remains pretty empty. Secondly, it ignores much of the genuine science there is and goes on supporting and perpetuating concepts and treatments that have little scientific support. This is a more harmful and deceptive form of scientism; it means that psychiatry likes to talk in the language of science and treats this as more important than the actual science.

I have had debates with fellow psychiatrists on many aspects of the actual evidence base. Two ‘defences’ have become familiar to me. The first is use of anecdote — such and such a patient got better with such and such a treatment, therefore, this treatment ‘works.’ Anecdote is precisely what EBM was trying to get away from. The second is an appeal for me to take a ‘balanced’ perspective. Of course each person’s idea of what is a ‘balanced’ position depends on where they are sitting. We get our ideas on what is ‘balanced’ from what is culturally dominant, not from what the science is telling us. At one point, to many people, Nelson Mandala was a violent terrorist; later to many more people, he becomes the embodiment of peaceful reconciliation and forgiveness. What were considered ‘balanced’ views on him were almost polar opposites, depending on where and when you were examining him from. Furthermore, in science facts are simply that. Our interpretations are of course based on our reading of these facts. Providing an interpretation consistent with the facts is more important than any one person’s notion of what a ‘balanced’ position should look like.

 

[Valentijn]

I think this guy has actually got his meanings wrong. Scientism is the belief that science provide the answers to all deep questions. The opposite is to reject science as a source of answers. It has nothing to do with whether or not the answers sound like science. The author is not suggesting that psychiatry is scientistic but that it is pseudoscientific. We want psychiatry to be scientistic.

True, but I think he's also suggesting that psychiatry is not capable of being studied scientifically, when it's also (treated as) something entirely subjective.

So psychiatry could be the victim of both psuedoscience and scientism. In their failure to do the hard work and fully embrace science, researchers may be avoiding accusations of pseudoscience by claiming the subject of their work falls outside the realm of science and scientific evidence, but still seek to legitimize it with scientism.

We've seen that with a lot of ME/CFS research - psychosomatic researchers cry that they can't use good methodology because the disease is supposedly entirely subjective. But then also they claim a scientific basis for their conclusions about its mechanisms and treatment so that they will taken seriously by people too ignorant to know better.

 

[Trish]

I read the article with the case of ME firmly in my mind. I agree that he probably misuses the term scientism when he actually means pseudoscience, but I found much of interest in his critique of psychiatry and just how unscientific it is, while at the same time it dresses itself up in scientific language and pretends to be evidence based.

 

[Sean]

psychosomatic researchers cry that they can't use good methodology because the disease is supposedly entirely subjective. But then also they claim a scientific basis for their conclusions about its mechanisms and treatment so that they will taken seriously

Exactly. They can't have it both ways.

Their legitimacy and claim to authority and resources must be proportional to the quality of their methodology. It can't be any other way.

It may not be their fault that they run into inherent methodological limitations. But they then have to accept that this limits their claim to authority and resources.

And that is before we get into their claim that is is an entirely subjective disorder. I find that one of the most disturbing and objectionable claims of all from them, and a very good example of their ex cathedra style of science.

 

[Sean]

It may not be their fault that they run into inherent methodological limitations.

Though, to be honest, I think that is more of an excuse to not use objective measures, than a genuine limitation.

Even if it is entirely subjective, it still has objectively measurable consequences, e.g. for employment and physical capacity.

Once again (bold mine):

"in the later stages of treatment patients are encouraged to increase their activity (which must ultimately be the aim of any treatment)"

Wessely, David, Butler, & Chalder – 1990

If Wessely and Chalder say it is true, then it must be.

 

[erin]

I don't get it, once psychiatrists who wanted to explain psychiatric illness scientifically failed and found anti-psychiatry movement. According to them mental illness did not existed and could not be explained and treated. I don't know what happened to the anti-psychiatry movement. It feels like everything is related to psychiatry nowadays. We're living at the era of the "psychiatry movement".

 

[Inara]

I don't know what happened to the anti-psychiatry movement.

I, too, have the impression the anti-psychiatry movement had its peak in the 70s and 80s. Although there still are organisations who are involved. But it's not easy for them, I'd say, because most people don't understand what psychiatry is. And they don't care. Most people think only those who "deserve" it (i.e. are strange, non-conform, have "weird" opinions) end up with psychiatry.
It's a power complex, to say it with a Professor of Psychology's words.

It feels like everything is related to psychiatry nowadays. We're living at the era of the "psychiatry movement".

That's how I see it, too. And that's a huge problem.

 

[Samuel]

I think this guy has actually got his meanings wrong. Scientism is the belief that science provide the answers to all deep questions. The opposite is to reject science as a source of answers. It has nothing to do with whether or not the answers sound like science. The author is not suggesting that psychiatry is scientistic but that it is pseudoscientific. We want psychiatry to be scientistic.

the term is used in different senses. philosophers might have a more narrow and agreed-upon definition.

[which is kinda funny since we're talking about philosophers.]

one common sense of the term is closely allied to the behavior of many pseudoskeptics, who excessively defer to science as an authority [they frequently are, but deny being, strongly authority-oriented while preaching that science is orthogonal to authority] and fail to be skeptical of their own misuse of science, or pseudoscience, in argumentation.

note also that they frequently conflate what science should be with what it is as a real-world institution -- and at all the wrong times.

frequently this is in defense of corporations or in bigotry [specifically misopathy] toward people with not-accepted diseases like m.e.

a good test for a pseudoskeptic is: somebody in the skeptic movement who denies the existence of pseudoskeptics. [note: this is a joke. also a comment on the catch-22 that psychiatrists often impose on people wrt "no insight, which confirms the diagnosis". also contains a grain of truth.]

 

[Hoopoe]

Not sure if pseudoskeptics is a good term. Maybe a better term is people who would like to be a skeptic but lack some of the required qualities. Anyone can be skeptical, and good skepticism is valuable, but many so called skeptics don't impress me much (neither am I a good skeptic myself, despite being very skeptical about some things). I like to think that I have become better at being skeptical thanks to this community though.

 

[Samuel]

people who would like to be a skeptic but lack some of the required qualities.

sounds good to me.

eta: on reflection it's insufficent, as there are some who pose as skeptics but do not care about being good skeptics -- they have an axe to grind.

 

[Barry]

Seems to be two meanings, and the first one here seems relevant:

https://en.wikipedia.org/wiki/Scientism

1. The improper usage of science or scientific claims.[8] This usage applies equally in contexts where science might not apply,[9] such as when the topic is perceived as beyond the scope of scientific inquiry, and in contexts where there is insufficient empirical evidence to justify a scientific conclusion. It includes an excessive deference to the claims of scientists or an uncritical eagerness to accept any result described as scientific. This can be a counterargument to appeals to scientific authority. It can also address the attempt to apply "hard science" methodology and claims of certainty to the social sciences, which Friedrich Hayek described in The Counter-Revolution of Science (1952) as being impossible, because that methodology involves attempting to eliminate the "human factor", while social sciences (including his own field of economics) center almost purely on human action.

No matter if the word is exactly right, it's a good article. Interested to note Dr. Sami Timimi belongs to something called the Critical Psychiatry Network.

 

[Jonathan Edwards]

No matter if the word is exactly right, it's a good article. Interested to note Dr. Sami Timimi belongs to something called the Critical Psychiatry Network.

I agree that he says some sensible things. I worry a bit at the end. He seems to be saying that whereas most psychiatrists give their patients drugs (presumably implying that might be as scientific as they think) he talks to them. That would presumably be 'psychotherapy'. He does not indicate whether or not he has any basis for thinking he is doing any good. I am not sure he is in a position to criticise others for shaky evidence if he has none of his own! Maybe at least he is not claiming to know what he is doing!

 

[Barry]

I agree that he says some sensible things. I worry a bit at the end. He seems to be saying that whereas most psychiatrists give their patients drugs (presumably implying that might be as scientific as they think) he talks to them. That would presumably be 'psychotherapy'. He does not indicate whether or not he has any basis for thinking he is doing any good. I am not sure he is in a position to criticise others for shaky evidence if he has none of his own! Maybe at least he is not claiming to know what he is doing!

I agree, but I also feel nothing and no one is completely right. He at least seems to be a psychiatrist wanting to rattle his establishment's cage, and wake his colleagues up to so much that is wrong with his profession. I would hate to deter/discount strong advocates without adequate reason. He gives off signals he might be more prepared to listen than his colleagues.