Someday our grandchildren’s grandchildren are going to sitting in college classroom learning about the early 21st century and wonder how a society so seemingly advanced could have such primitive ideas about mental health.They will no doubt be shocked and appalled that our major diagnostic tool for psychiatry is a book full of subjective checklists—the Diagnostic and Statistical Manual of Mental Disorders (DSM versions I-IV).
I became all too familiar with the DSM in my college days, first as a psychology major and then as a behavioral science major (I switched because I believed behavioral science would be more scientifically rigorous. It wasn’t.) I was constantly shocked that such an utterly absurd book could be considered our primary mental health tool. The diagnostic criteria is often so vague that it is virtually impossible to determine if a patient truly has a mental disorder. Yet almost every diagnosis in America is made based on comparing a patient against the DSM’s checklist of “symptoms.”
Part of the reason the DSM is so flawed is because it is highly politicized. For example, homosexuality was classified in DSM as a sexual disorder until the 1970s. And until 1987, “ego-dystonic homosexuality” was still classified as a pathology. These “mental disorders” were later removed, not because of a change in empirical data (since there is none) but because of the protest of gay rights groups. I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder. But this example shows that the judgments made by psychiatrists are often highly subjective and are rooted more in speculative theories than in scientific fact. (Keep in mind that this is the same profession that, for almost a century, believed the Freudian idea that holding your feces in as an infant affected your personality as an adult.)
Such criticisms against the DSM have been made for decades (mostly by cranks like me) but they are gaining a new hearing because of who is now making them: Allen Frances, lead editor of the DSV-IV. As Frances says, “there is no definition of a mental disorder. It’s [BS]. I mean, you just can’t define it.” As Wired magazine notes:
Some of this disputatiousness is the hazard of any professional specialty. But when psychiatrists say, as they have during each of these fights, that the success or failure of their efforts could sink the whole profession, they aren’t just scoring rhetorical points. The authority of any doctor depends on their ability to name a patient’s suffering. For patients to accept a diagnosis, they must believe that doctors know—in the same way that physicists know about gravity or biologists about mitosis—that their disease exists and that they have it. But this kind of certainty has eluded psychiatry, and every fight over nomenclature threatens to undermine the legitimacy of the profession by revealing its dirty secret: that for all their confident pronouncements, psychiatrists can’t rigorously differentiate illness from everyday suffering. This is why, as one psychiatrist wrote after the APA voted homosexuality out of the DSM, “there is a terrible sense of shame among psychiatrists, always wanting to show that our diagnoses are as good as the scientific ones used in real medicine.”
Since 1980, when the DSM-III was published, psychiatrists have tried to solve this problem by using what is called descriptive diagnosis: a checklist approach, whereby illnesses are defined wholly by the symptoms patients present. The main virtue of descriptive psychiatry is that it doesn’t rely on unprovable notions about the nature and causes of mental illness, as the Freudian theories behind all those “neuroses” had done. Two doctors who observe a patient carefully and consult the DSM’s criteria lists usually won’t disagree on the diagnosis—something that was embarrassingly common before 1980. But descriptive psychiatry also has a major problem: Its diagnoses are nothing more than groupings of symptoms. If, during a two-week period, you have five of the nine symptoms of depression listed in the DSM, then you have “major depression,” no matter your circumstances or your own perception of your troubles. “No one should be proud that we have a descriptive system,” Frances tells me. “The fact that we do only reveals our limitations.” Instead of curing the profession’s own malady, descriptive psychiatry has just covered it up.
December 29th, 2011 | 9:19 am
Actually, Psychiatry is a legitimate medical specialty. Clearly, however, it went through a very darkn period, when Freud’s speculations were considered sacrosanct.
But now, especially, with the insights of neuroscience, psychiatry (specifically neuropsychiatry as it’s called) is becoming as as scientifically based as neurology in general is.
The brain is the cause of all thoughts and behavior. When it develops a disease process, signs and symptoms emerge, that can lead the clinician (and that’s what a psychiatrist is, a clinician, a medical professional) to an accurate diagnosis.
As long as it’s based on sound evidence and reasoning, concerning how the brain works, there’s no problem with it. The fact that efficacious treatments exist for Bipolar disorder, OCD, and depression among many other “mental” disorders, (brain disorders is a better phrase) shows phsychiatry is on the right track, but still in its infancy.
December 29th, 2011 | 9:43 am
Like all critics of the removal of homosexuality from the DSM, your complaints about the process reveal your own prejudices. I’ve read dozens of similar arguments, and all share the same fatal flaw. They never ask the essential question:
Why was homosexuality ever listed there in the first place?
Answer that, and the ground that your righteous indignation rests evaporates. The happy, successful, socially productive lives of hundreds of millions of homosexual people around the world have proven well that their affections have no place in a scientific document at purports to document mental illness.
December 29th, 2011 | 9:46 am
I don’t think future generations will be “shocked and appalled” looking back at the DSM-IV. If they are fair minded, they will realize that the exploration of mental and emotional disorders was in its infancy, and they will realize that, whatever advances are made over the coming decades, the DSM-IV was quite useful for its time.
. . . psychiatrists can’t rigorously differentiate illness from everyday suffering . . .
And why should they be able to? For example, grief over the loss of a loved one is expected and probably even a sign of emotional health. But what if the grieving person is so distraught he tries to kill himself? Or what if months and then years pass and the grief doesn’t diminish? Why should psychiatrists be able to draw a bright line between “normal” and “abnormal” grief?
The authority of any doctor depends on their ability to name a patient’s suffering.
I think it is probably a rare person who has not gone to the doctor for some physical ailment and received a vague diagnosis because the doctor (and medical science in general) didn’t really know what was wrong. There are countless “functional” disorders—for example, digestive disorders where a patient goes through a series of tests and nothing is found wrong. And often for these kinds of disorders, there is really not much in the way of treatment.
All the various diseases that are lumped together as cancer (over 200 different kinds) may actually be many, many different diseases. No doubt (and hopefully) in the distant future people will look back to the early 21st century and be amazed at how crude the approach to “cancer” was.
One further point. Psychiatry is kind of like philosophy, in that when a problem is definitively solved in either, it may very well move into another discipline. If a condition now in the realm of psychiatry is discovered to be the result of some chemical imbalance detectable by a blood test and well controlled by a certain drug, people with that condition may in the future be treated by a neurologist or even by a primary care physician. It is precisely because certain conditions are not well understood and are difficult to pin down that they fall into the area of psychiatry.
December 29th, 2011 | 9:56 am
@Tom Henning: You might want to reread what Joe Carter actually wrote, namely, “I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder.”
December 29th, 2011 | 9:59 am
I think there is such a thing as mental illness — bipolar, schizophrenia, and a few others. However, I think everyone is mentally ill in the “neurotic” sense, some just more so than others. This could be like the Christian notion of original sin — we are all mentally ill in the sense that we are all guilty of original sin. Doesn’t necessarily mean that excuses either. We should strive to minimize, mitigate, perhaps eliminate completely those emotions that relate to neurosis. They are the emotions of stress, of fight, flight, anger, anxiety, irritation, guilt. Those with the lowest levels of these are the healthiest mentally.
December 29th, 2011 | 10:06 am
Reading the entire Wired article, I couldn’t help feeling that the foundation of psychiatry itself — the very existence of the “mind” or “psyche” — is in jeopardy from the materialist onslaught of neuroscience and genetics.
December 29th, 2011 | 10:08 am
Tom, did you actually read Joe’s commentary?? “I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder.”
December 29th, 2011 | 10:26 am
Tom, did you actually read Joe’s commentary?? “I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder.”
Darel,
One wonders, though, how Joe arrived at his conclusion. He criticizes the removal of homosexuality as a disorder from the DSM-IV, but he says, “But this example shows that the judgments made by psychiatrists are often highly subjective and are rooted more in speculative theories than in scientific fact.” So he says homosexuality should never have been listed at all, and he apparently has no problem coming to that conclusion, but he criticizes the APA committee for (apparently) doing the right thing for the wrong reasons. What would the right reasons have been, and how is it that Joe Carter knows what they are but the psychiatrists who made the decision apparently didn’t?
December 29th, 2011 | 10:37 am
A few things I’ve noticed re mental health discoveries. 1. Almost all psychiatrists admit meditation and mindfulness exercises are good for mental health. And 2. relatedly a lot of insights of psychiatry can be found in thousands of years old works of philosophy. Particularly Eastern philosophy, but also Western like Stoicism. It’s also there in the Bible — the “Judeo-Christian” tradition. But in our culture war battles we tend to focus on things like same sex marriage, abortion, salvation issues, doctrinal heresy, but miss the “wellness” issues. I think a lot of the Christian mystics (from Meister Eckhart to Thomas Merton and perhaps Aquinas himself) were more concerned with these issues.
December 29th, 2011 | 10:43 am
Tom: Read the post again. Joe said explicitly that he is not a critic of the removal of homosexuality.
From the above post:
“I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder. But this example shows that the judgments made by psychiatrists are often highly subjective and are rooted more in speculative theories than in scientific fact.”
December 29th, 2011 | 11:34 am
The right has a history of making too much of the APA de-listing homosexuality as a disorder but even with medicine, there’s a lot of subjective judgement that goes into what is or isn’t a disorder. For example, aging is not usually considered a disorder yet it debilitates and kills many more patients than cancer ever has!
Where psychology has advanced as a science is the study of the dynamics of mental states and behavior. For example, all the major psychological illnesses like depression, schizophrenia, bi-polar, OCD and so on are almost certainly real. whether or not ‘almost everyone’ can be said to be ‘clinically depressed’ is kind of besides the point. Maybe almost everyone is at some point depressed. Fact is almost everyone gets an infection of some type in their lives as well. So what? If you probe deeply you’ll discover that some doctors try to treat almost every infection their patients get and other doctors often let the infection ride itself out and you won’t get consensus from the supposedly more objective medical community as to which approach is better. Why would it be shocking then if it turns out many of us experience a bunch of mild mental illnesses in life, most of which are self-correcting or not ameanable to clinical treatment?
December 29th, 2011 | 11:43 am
What would the right reasons have been, and how is it that Joe Carter knows what they are but the psychiatrists who made the decision apparently didn’t?
The “right” reason—since psychiatry claims to be based on empirical science—would be to have empirical scientific reasons for the change. They didn’t have that, as the APA admits.
I recommend listening to This American Life’s feature on the decision. It’s fascinating how they freely admit it was a purely political decision. Even the homosexual psychiatrists at the time bought into the idea that it was a mental illness.
http://www.thisamericanlife.org/radio-archives/episode/204/81-words
December 29th, 2011 | 11:51 am
Psychiatry has a lot of problems, some of which are amply on display in this article. Underlying all this though is a very basic problem, which is that we don’t have any serious theoretical basis for integrating the very disparate kinds of things we know about the (plausible) causes or influences of human behavior.
What I mean is this: Clearly local neurophysiology is part of why I, say, drink coffee everyday. But so is the fact that I grew up in the US rather than rural China. So is the fact maybe that my first taste of coffee was with a sample with lots of milk and sugar. And perhaps the fact that my parents drank coffee and saw nothing wrong. And perhaps the fact that I came to associate drinking coffee with the beatniks I was reading in high school and admired. And… We have no serious, scientifically well grounded way of sorting through all these (possible) causes, of weighting them, or of modeling their interactions. Until we do we have no way to either explain or predict on a psychological level even relatively simple behavior. Or to define “normal” or “healthy”. Or to explain why generally successful interventions work or why they often fail to work.
December 29th, 2011 | 11:55 am
Like all critics of the removal of homosexuality from the DSM, your complaints about the process reveal your own prejudices
No, what is really revealed is the root problem with having a so-called “medical” specialty using diagnostic criteria that (a) relies on value judgments to determine what is and is not “healthy” and (b) arrives at those value judgments through a process that basically consists of a committee that votes.
Just because homosexuality – or any other sexual deviance – is not curable does not mean it is healthy. Homosexuality is unhealthy. The people who have it have to go through a grieving process when they realize what it truly means. It means they will not lead normal lives and cannot have healthy families: for all that the left desperately wishes to pretend that we can just “make” a new lifestyle and a new family structure by pretending real hard, the truth is that homosexuals are doomed to have sexual desires that are in conflict with the normal and unchangeable order of things. You want to pretend that we could change the order of things if we all just went along with a few quote-unquote “harmless” lies, but the lies aren’t harmless.
Homosexuals are conflicted. Their lifestyle is inherently unhealthy, and attempts to mimic healthier hetero lifestyles through make-believe are inherently dysfunctional, because no matter how hard you try, you can’t really make a child have “two mothers” without hurting the child, and you can’t really ditch the truth without harming every single individual and institution that is touched by the lying. There is no argument for classing homosexuality as an “alternative lifestyle” instead of a “disorder” that does not equally apply to most mental illnesses
Think about it: what does it mean to be “disordered” (as opposed to simply living an “atypical life” or an “alternative lifestyle”)? You could equally say that bipolar, obsessive-compulsive disorder, autism, even schizophrenia wouldn’t be “disordered” if we simply realigned our values to redefine what is “normal”, ignore the harm done, and use social pressures to force everyone to play along with whatever behavioral changes or even outright lies are necessary to make the bipolar/obsessive-compulsive/autistic/schizophrenic person feel comfortable.
This has always been a problem with mental health: there is a fine line between helping people who want help vs. judging other people – classifying people as “normal” vs. “defective” – and there has never been a time in the history of psychiatry when the so-called “professionals” weren’t abusing their power.
December 29th, 2011 | 11:57 am
Psychiatry is a fraud. It is the biggest swindle of public money the world has ever seen.
December 29th, 2011 | 12:00 pm
The right has a history of making too much of the APA de-listing homosexuality as a disorder
No, because it shows that politics trumps “science”.
Voting on what is and is not “normal” is not scientific. It is abuse of power.
It is up to a society to define what is normal and acceptable behavior. But the Enlightenment teaches us that a small group of elite expert people has the right to override that process – those who are Enlightened have the right to decide values based on “science” and then the rest of us are supposed to conform.
Even if one accepts that premise (and the Enlightenment is not my religion, so I don’t), it still means we have a moral obligation to pay attention to what we call “science”.
The history of psychiatry is rife with abuse. <a href="url”>The USSR is not the only place where “mental health” was used as an excuse to incarcerate political dissidents.
December 29th, 2011 | 12:09 pm
One thing to keep in mind is that it is highly likely our grandchildren’s grandchildren will be absolutely appalled by our current practices in medicine. I have working in surgery since 1978. Even now, much of what we did then today is considered barbaric.
It’s the nature of even the most humane societies that we don’t know what we don’t know. The brilliant insight turns out to be more than false and a waste of time–it can also lead to misery and needless suffering. The chase after knowledge gives us great advances and better standards of living. In spite of it all, we should be humble. The chase after knowledge also has its costs. The sooner we accept that fact the better off we will be.
December 29th, 2011 | 12:15 pm
I’m with Katherine. As I’ve said elsewhere, psychology (and to a somewhat lesser degree, psychiatry) are similar to Marxism in that they are secular religions masquerading as science.
December 29th, 2011 | 12:29 pm
Think about it: what does it mean to be “disordered” (as opposed to simply living an “atypical life” or an “alternative lifestyle”)? You could equally say that bipolar, obsessive-compulsive disorder, autism, even schizophrenia wouldn’t be “disordered” if we simply realigned our values to redefine what is “normal”, ignore the harm done, and use social pressures to force everyone to play along with whatever behavioral changes or even outright lies are necessary to make the bipolar/obsessive-compulsive/autistic/schizophrenic person feel comfortable.
Blake there is a problem with this analogy — indeed what the term “disorder” means. OCD, bipolar, depression — they are viewed as blameless neutral categorizes and given civil rights protection under disabilities related legislation. Precisely because we view being “disordered” in this sense as civil rights category like race, gender or religion we DO go out of our way to make accommodations — indeed the law requires it — for the “disordered” person to make them “feel comfortable.”
The other meaning of “disordered” — the one you want to tar homosexuality with — means, apparently, sinful or wrong. A person who has the compulsion to turn the lights on and off 5 times every time he enters or leaves a room isn’t doing anything wrong. Though that person IS mentally disordered, I suppose. The fact that psychiatry lends itself to this kind of abuse by both the Left and folks like yourself on the Right is an indictment of system.
December 29th, 2011 | 12:40 pm
“Homosexuality is unhealthy. The people who have it have to go through a grieving process when they realize what it truly means. …
“Homosexuals are conflicted. Their lifestyle is inherently unhealthy, and attempts to mimic healthier hetero lifestyles through make-believe are inherently dysfunctional,…”
There is nothing unhealthy or wrong with same sex love between consenting adults. Though I don’t buy into the arguments from holy texts or the natural law which condemn homosexual acts. I understand some folks do.
Re “healthy” there are healthier and unhealthier ways to have sex. I’m not sure if I understand Blake’s “attempts to mimic healthier hetero lifestyles through make-believe” point. Do you think gays should be in committed monogamous pair bonded relationships? Or having promiscuous unsafe sex at bathhouses? The former is “healthy” the latter is not. Gay activists, disagree with them as you may, are on the forefront in promoting healthier ways to have homosexual sex.
December 29th, 2011 | 12:42 pm
The “right” reason—since psychiatry claims to be based on empirical science—would be to have empirical scientific reasons for the change. They didn’t have that, as the APA admits
But if empirical reasons were not listed for its original inclusion then the job is not to justify the change but to justify keeping it as an illness.
It’s fascinating how they freely admit it was a purely political decision.
“Purely political”? Since you yourself have stated there wasn’t justification for including it to begin with delisting it couldn’t really be ‘purely political’. Perhaps you’re confusing the motivation for considering delisting with the decision itself. Lots of emperical work is done based on the ‘purely political’. For example, a lot of research with breast cancer has been motivated by the ‘purely political’ activism of breast cancer patient groups.
Now I agree with you diagnosing based only on symptom checklists leaves a lot to be desired. But medical sciences exist both in theoretical form and sets of pragmatic rules of thumb. Ask a doctor how he really knows if someone suffering from mild to moderate cold symptoms has the common cold, the flu, a bacterial infection, food poisening or even an unknown virus or the beginnings of an autoimmune disease, and you’re probably going to discover he is using some type of system of checking off the symptoms and seeing what the most likely diseases are that line up to that. In fact a large amount of diseases are diagnosed and written off based on nothing but checklists of symptoms (or maybe some lab work) without ever really confirming its the ‘right’ diagnosis. You may like to think your medical doctor is more scientist than artist, but there’s still quite a bit of art in it.
Seen in that light the DSM is not much worse than that. In terms of science, it seems perfectly consistent with your opening statement:
Someday our grandchildren’s grandchildren are going to sitting in college classroom learning about the early 21st century and wonder how a society so seemingly advanced could have such primitive ideas about mental health
There’s a reason why philosophy textbooks written in 1910 can still be useful in ways that a physics or chemistry or biology textbook cannot. Even a biology textbook from 1980 leaves a bit to be desired. It’s not exactly shocking then, if psychology is science, that 80 years from now the knowledge of this age is seen as primitive. In fact, if psychology in 2120 or so happens to look a lot like psychology of 2010, that would be a dead giveaway that its foundations are poorly rooted in science.
December 29th, 2011 | 1:10 pm
Boonton, you say:
Ask a doctor how he really knows if someone suffering from mild to moderate cold symptoms has the common cold, the flu, a bacterial infection, food poisening or even an unknown virus or the beginnings of an autoimmune disease, and you’re probably going to discover he is using some type of system of checking off the symptoms and seeing what the most likely diseases are that line up to that.
You’re overlooking a critical point here. There’s a difference between diagnosing on the basis of a check list and defining a disorder on the basis of a check list. The worry with the DSM is that it does the latter. Yes a doctor might use use a check list to diagnose influenza. But having influenza isn’t defined in terms of its symptoms. Here we know the cause, and we can fit our understanding of influenza into a larger understanding of human physiology and biology more generally. This is not the case with the mental disorders.
December 29th, 2011 | 1:12 pm
Oh, and one more thing. Philosophy textbooks from 1910 are useless. Unless you’re a historian.
December 29th, 2011 | 2:19 pm
The best defense of psychiatry is the treatment of depression. It has been one of the great accomplishments since the 1980′s. Additionally, the treatment of schizophrenia and bipolar disorder has advanced, replacing the disabling drugs of a previous era.
For practical matters, “pattern-recognition” is the tool used by many physicians to diagnose. The second aspect is that science adds and alters its hypothesis. In science “truth” is best understood with a lower-case “t,” not an upper-case “T.”
Workers in psychology and psychiatry on a given day in NYC help more people than conservative punditry. I suggest the DSM IV has criticisms, but one needs to investigate the foundations a wee bit more than some undergraduate courses to appreciate where to begin the critique.
December 29th, 2011 | 2:23 pm
The problem Joe points to has far reaching implications. For instance, there was once a bill in my state’s legislature to add “mental illness” to the conditions covered by workers comp. In opposing the bill all I had to do was pull out the DSM and read the criteria for some of the “illnesses.” Depression, of course, is so vaguely defined that I suggested that most of the legislators in the room would have qualified before their first cup of coffee. I argued that the bill would open the spigots for frivolous mental health claims and premiums would skyrocket. The bill went down, but I am sure that battle is not over.
I look forward to the day when Freud’s musings are classified with the “humors” theory of medicine. Both were wild speculations with absolutely no basis in reality. And both caused untold misery. The problem is that any doctor who relied on the humors today would be drummed out of medicine; yet there are still many people who give Freud’s absurd pseudo-science credence.
December 29th, 2011 | 2:51 pm
Tristian
a doctor might use use a check list to diagnose influenza. But having influenza isn’t defined in terms of its symptoms. Here we know the cause, and we can fit our understanding of influenza into a larger understanding of human physiology and biology more generally. This is not the case with the mental disorders.
I think you mean to say some mental disorders as well as some medical conditions. Quite a few medical disorders were defined almost entirely by symptoms (for example, hysteria) before anything was known about their cause, dynamics and before any type of objective test existed for them. It would hardly be shocking then to imagine eighty years from now for a illness like schizophrenia to be initially diagnosed with a ‘symptom checklist’ but then confirmed and classified with a combination of brain scans and genetic matching.
Even today there are many medical illnesses defined solely by their symptoms as their ultimate causes are unknown (for example, chronic fatigue syndrome). It’s quite likely that they may turn out to be multiple diseases that appear as like collections of symptoms or may have totally different causes (such as the Epstein-Barr virus, genetics, age, and other things) in the same way that a single type of cancer may be traced to totally different causes.
December 29th, 2011 | 3:30 pm
BTW, what exactly does it mean to say the decision to delist homosexuality was ‘purely political’? I might as well say the Doctrine of the Tirnity is ‘merely political’ because pro-Trinitarians ‘played politics’ at the Council of Nicaea.
December 29th, 2011 | 4:36 pm
BTW2….I recommend Joe’s link to the This American Life audio file on the APA’s decision to change. It effectively refutes the ‘politics’ claim. Yes gay protestors did engage in outragerous theatrics such as disrupting official meetings and heckling doctors, but what’s interesting is that these efforts mostly failed. The APA didn’t really move until a concerted effort was put forth to present actual emperical evidence (see, for example, the Hooker study around the 36 minute part) and an actual scientific debate was held. The decision to change the listing was no different than any other major decision that has happened at dozens if not hundreds medical and scientific conferences.
December 29th, 2011 | 4:50 pm
Boonton The APA didn’t really move until a concerted effort was put forth to present actual emperical evidence (see, for example, the Hooker study around the 36 minute part) and an actual scientific debate was held.
Um, not it wasn’t. The Hooker study was not an empirically valid study. Hooker was a gay rights activist and so wasn’t exactly a disinterested researcher. Bu that isn’t the biggest problem with her work. As we’ve discussed on this blog before, the study relied on test that no one in their right mind would consider legitimate. For example, she determined that since she wasn’t able to tell who was a homosexual and who was a heterosexual from a Rorschach inkblot test, that it “proved” that homosexuality was not a mental illness.
The reason I rarely bother to respond to your comments, Boonton, is because you put so little thought into them. I am fairly certain that you would not consider Hooker’s methodology to be valid for any study. Yet you cite it as if it refuted my point. You have a knee-jerk reaction to take the opposite side on whatever I write that prevents you from making thoughtful comments.
December 29th, 2011 | 4:51 pm
By the way, the Hooker study was the “empirical” fig leaf used to justify a decision that was already decided. Even by the ridiculous standards of “research” in the 1960-70s, it’s hard to believe that anyone but a Freudian would have found Hooker’s study scientifically convincing.
December 29th, 2011 | 5:31 pm
BTW, what exactly does it mean to say the decision to delist homosexuality was ‘purely political’? I might as well say the Doctrine of the Tirnity is ‘merely political’ because pro-Trinitarians ‘played politics’ at the Council of Nicaea.
Well, I’m not going to argue that any church doctrine is “scientific” just because it was decided at the Council of Nicaea.
Science is supposed to be more “objective” than just a bunch of people forming a council and voting on things.
December 29th, 2011 | 5:51 pm
Workers in psychology and psychiatry on a given day in NYC help more people than conservative punditry.
I dispute this. There is no objective measure that proves such a thing, and most of the objective measures that have been tried prove exactly the opposite.
Of course, it’s hard to be “objective” when there’s no clear-cut definition of what “success” looks like. But in cases where we do have some idea of what “success” might look like, psychology does not compare all that well against spiritual and religious approaches.
For example: if your problem is that you drink or abuse substances, you’re a career criminal who wants to change, you beat (or are beaten) by your spouse, your marriage is in trouble, your family is dysfunctional, and/or your kids are behaving badly, in all cases you’re probably going to be statistically more likely to fix your life according to defined goals if you join the right church, and statistically less likely to fix things if you rely on secular psychology.
In fact, in all these cases, going to a psychology professional any time throughout the 20th century was as likely to hurt as help you. And not all that much has changed. The same flawed approach is still prevalent today.
We don’t have the data in yet – the people whose lives will be destroyed haven’t yet experienced the consequences of their misplaced trust, but when the “scientific method” most psychologists rely on is really nothing but intellectual speculation, it’s highly unlikely that they’ll just accidentally hit upon The Truth. The problem is that there is no consequence for being wrong. The “client’s” life is wrecked, but the “professional” pays no penalty for misdiagnosis or ineffective “cures”. (Especially if the “cure” involves prescribing highly profitable medications.)
And, meanwhile, every person who pays for counseling is thinking they’re getting “professional help”, when really they’re just being used as a guinea pig.
If psychology were forced to live up to the same standards of accountability as real professionals in any genuinely trustworthy profession, it wouldn’t be able to.
Workers in psychology would be very upset if they were treated the way they treat others.
December 29th, 2011 | 7:28 pm
Even by the ridiculous standards of “research” in the 1960-70s, it’s hard to believe that anyone but a Freudian would have found Hooker’s study scientifically convincing.
Joe,
But psychiatry in the 1960s and early 1970s was dominated by Freudians! The theories Hooker was trying to test were largely based on Freudian thinking. And of course while no study consisting of 30 in the experimental group and 30 in the control group is going to be “scientifically convincing,” it was groundbreaking. Hooker’s study may not seem terribly earth shattering today, but the experts she engaged to evaluate the psychological profiles were convinced they could pick out homosexuals based on the three psychological tests, and they couldn’t. Perhaps we aren’t so impressed by psychological profiles based on TAT and the MAPS and Rorschach tests, but they were taken seriously at the time. I know both TAT and the Rorschach test are still being used in various places today.
I agree with Boonton, by the way, that the radio program you link to demonstrates—for me, in any case—just the opposite of what you claim it does. (It is a great story, too. I recommend it to anyone who has an hour.) Of course, Boonton and I no doubt have our own biases, but so do you—very much so.
You have a knee-jerk reaction to take the opposite side on whatever I write that prevents you from making thoughtful comments.
I am quite sure you feel the same way about me as you do about Boonton (probably more so), but I assure you that it is not the mere fact that your name appears with your posts that causes me to disagree with them. Your perspective is very different from mine. There is no personal animosity involved (on this end, anyway). When my mother—an extremely conservative Republican—was still alive, if she opened her mouth to give a political opinion, I didn’t have to wait to hear it before knowing I disagreed! I don’t know if I have mentioned this before, but interestingly, only some years after my mother died did we find out my father was a Democrat. He was not much for political discussions, and we took his silence on matters of politics to indicate he was in general agreement with my mother for 50-plus years. As it turns out, they were kind of precursors of James Carville and Mary Matalin, except my father, wisely I am sure, thought it better to keep his mouth shut.
December 29th, 2011 | 9:07 pm
Here’s an interesting perspective not just on the removal of homosexuality from the diagnostic and statistical manual, but on the whole issue Joe is raising. Its from What Is Mental Illness? by Richard J McNally:
So, this to a large extent is in conformity with Joe’s contention that psychiatry is an unscientific mess. However, McNally goes on to say that Spitzer, in the wake of this embarrassing mess, Spitzer became the “the leader of the DSM-III process and wound up transforming the field of psychiatry.”
The DSM-I and DSM-II did not even contain a definition of what a mental disorder was. Beginning with DSM-III, an explicit description is given.
So, in a nutshell, up until the early 1970s, including the time when homosexuality was removed from a printing of the DSM-II, psychiatry was not organized along coherent, fact-based lines. But in the aftermath of the declassification of homosexuality as a disorder, and beginning with the creation of the DSM-III, psychiatry put itself on a much sounder, objective, empirical footing.
December 29th, 2011 | 9:09 pm
In fact, in all these cases, going to a psychology professional any time throughout the 20th century was as likely to hurt as help you. And not all that much has changed. The same flawed approach is still prevalent today.
Blake,
Although you say “in fact,” there is not one fact in this long message of yours—just a host of unsupported assertions.
December 29th, 2011 | 9:55 pm
It seems that the problem faced by psychiatry is its apparent intrusion into the realm of wisdom. Once you begin to distinguish “good thoughts” from “bad thoughts,” you enter some pretty deep waters.
Certainly, psychiatrists have helped many people overcome neurological disfunctions, but, as David noted, once the neurological basis is understood, these problems are often relegated to different subfields. So, does psychiatry have an intrinsic purpose apart from being a staging ground?
As useful as psychiatry may be, it’s hard to ignore the hubris involved in postulating (as it would have to do) a kind of “perfect thought.” For example, are less intelligent people less mentally healthy? Are selfish people? The DSM would seem to say no to the former, but yes to the latter. But shouldn’t intelligence be a criterion of mental health? What is the mind for?
December 29th, 2011 | 10:08 pm
This reminds me also of Freud’s quip about the Irish: “This is one race for whom psychoanalysis is of no use whatsoever.” I wonder what he meant by that.
December 29th, 2011 | 10:24 pm
Boonton, I meant what I said, as I was following you in comparing psychiatric disorders to influenza and the like. Of course there are medical problems with unknown etiologies, and as a stop gap these may be characterized by the symptoms used to diagnose them. The point is the same: a bag of symptoms and label not does not amount to genuine understanding, and it’s not a good basis for effective treatment. It’s one thing for generally successful medicine to have such cases. But for it to be typical–as it seems to be in psychiatry–is a problem. This is not to say it will alway be like this. Hopefully we will some day have a psychiatry and a psychology more rooted in solid science.
December 29th, 2011 | 11:14 pm
Reading Joe’s slam, one might be under the impression that Evelyn Hooker was a gay activist, she wasn’t. She wasn’t even gay, she did however had gay friends and doubted the standard position that homosexuality was a disorder.
Her study used 3 different psychological tests, the TAT and ‘make a picture’ test in addition to the Rorschach. All 3 tests were part of the standard psychology tool kit and are still used today despite criticisms. As noted, the experts she had evaluated the unmarked profiles and they could not tell a difference between the two populations.
Joe slams Hooker for not being ‘disinterested’, this betrays a misunderstanding of the scientific method versus actual scientists. The method concerns the larger scientific community, actual scientists themselves are hardly disinterested. If researchers were really disinterestd, then no research would get done, after all why bother if you have no interest in it! Scientists on a personal level are hardly dispassionate. Often they will persue research not for ‘disinterested’ ‘logical’ reasons but quite passionate ones. Maybe they want to win the favor of more senior scientists by affirming their theories, maybe they want the fame of being the one to overturn the established theory and have the new one named after them, maybe they just have a hunch the current theory is wrong.
Even by the ridiculous standards of “research” in the 1960-70s, it’s hard to believe that anyone but a Freudian would have found Hooker’s study scientifically convincing.
Actually she presented her results in 1956. But this is an interesting criticism because its amusing to contrast this with the ‘other study’ that supported the classification.
That was Toby Bieber’s study which took 77 doctors who had gay male patients and asked them contribute information about them. From this it was ‘discovered’ that homosexuality in men was caused by ‘over bearing mothers’ and ‘detached father’s’.
Nowhere were the doctors asked to define an objective measure of what was meant by a ‘overbearing mom/detached dad’. Nor were doctors asked to try to predict whether a patient was or was not gay by only looking at the profile of a patient’s parents. Nor was it the fact that the only gays examined were ones who had either sought out mental help or were being given counseling in an institutionalized setting like a mental hospital countered by examining the parents of gays who did not seek out the mental health system. Nor was cause and effect really questioned….for example were the mothers close and the father’s distant because being homosexual caused the mother’s to become protective and the father’s to distance themselves from their sons? In other words, you have pure Freudian ‘analysis’ here where each doctor basically comes up with subjective opinions on his patients but convinces himself that these opinions are objective. You can see the Freudianism in another notable doctor who advocated for keeping the listing:
Notice what he says between the lines. What can actually be seen appears ‘quite normal’. The pathology is there because he is able to see beneath the surface into the patient’s ‘unconscious material’, into his ‘dream material’. Err but no one else can do this. It can only be done after one on one, painstakingly long multiple sessions of Freudian analysis. Take his word for it though, he’s done it and he knows it. I’m sure he was being honest but what he does not account for is his own biases. If he thinks homosexuality is caused by overbearing moms, will he not seek to steer the conversation towards examples of the patient’s mother being overbearing (and if pressed, don’t all of us have at least one or two examples?). If he thinks its a pathology that can be revealed in disturbing ‘dream material’ won’t he seek out examples of ‘disturbing dreams’ in his homosexual patients?
At least Hooker’s study blinded the doctor from this bias and made him test whether or not pathology was being picked up without being told the patient’s sexual orientation ahead of time. And it remains exceptionally valid. If psychology cannot detect a pathology, then how can it list it as one? Imagine Hooker’s study was repeated but using, say schizophrenics as the test population. Somehow I suspect blinded experts would do better picking out the test results of the schizophrenic patients versus control ones.
Look Joe asserted the decision to delist was ‘purely political’. Fact is, the actual evidence marshelled for delisting was better than the evidence marshelled for it. Yes in the gold standard of emperical research would be a double blind, multi-arm randomized clinical trial. But a lot of emperical evidence is used in medicine from less than gold standard material. Case studies, for example, are essentially ancedotes yet they are used all the time by doctors. Yes the decision making process does not look like the philosophical deliberations of the Athenian Academy what with ‘committees’ and ‘votes’ and ‘personality clashes’ and so on….but that’s not unusual for medical conferences. In fact, quite a few ‘big decisions’ at such conferences end up taking place in bars and side conversations and parties than the actual formal deliberations.
You have a knee-jerk reaction to take the opposite side on whatever I write that prevents you from making thoughtful comments.
Really, I do think you can do much better than that. I think you take a lot of talking points as right-wing gospel and then get very snippy when ‘wisdom’ that is normally not challenged gets some scrutiny and is found wanting.
Consider the odd thing you’ve choosen to argue here. You’ve said the APA never had the evidence to merit listing homosexuality as a disorder to begin with, yet at the same time you’re also trying to argue that the APA delisted due to ‘pure politics’. Think of how obtuse that position is. No emperical evidence to merit listing (and let’s face it, you’ve asserted a very high bar for emperical evidence here! not only does the study have to be nearly perfect, but even the researcher herself must be as well) means dismissing delisting as ‘purely political’ would require demonstrating that all those ‘activists’ simply engaged in only ‘politics’ (whatever that means) and didn’t even bother to note that there was no emperical merit to the listing to begin with!
December 30th, 2011 | 12:10 am
There is nothing unhealthy or wrong with same sex love between consenting adults.
Wrapping up the matter in euphemism does not exactly help your claims. No one has the slightest objection to “love.” Perhaps you should either not say it, or annouce, without the euphemisms, “There is nothing unhealthy or wrong with consenting adults of the same sex sodomizing each other.”
December 30th, 2011 | 2:47 am
If Katherine and Fred are correct, one would wonder why psychiatrists are required to not only graduate from a four year college/university, but graduate from four years of medical scool, and then complete at least three to four years of psychiatric residency.
Sorry, Katherine, and Fred, psychiatry may not be in as advanced a stage of development as other medical specialties, but it’s certainly not a “fraud”, or a philosophy like marxism.
With respect to the discussion concerning whether homosexuality should be classified as a “disorder”, there’s no evidence, empirical or otherwise, that it should be.
As long as homosexuals are consenting adults (the same as heterosexual adults) there’s nothing harmful or immoral about their relationships.
December 30th, 2011 | 7:42 am
To expand a bit on Barry Arrington’s point–there’s an important reason to have mental disorders named and described in some consensus manual, and an important reason why the criteria for “disorders” must be vague. That is, insurance $.
How many times have I overheard a therapist tell a patient, I’m gonna call your condition [such and such] for the sake of insurance coverage? In other words, the DSM is a necessary part of a mechanism which plunders the rest of us for our insurance premium dollars (or tax dollars in the case of government-funded health care.)
December 30th, 2011 | 9:03 am
“Wrapping up the matter in euphemism does not exactly help your claims. No one has the slightest objection to ‘love.’ Perhaps you should either not say it, or annouce, without the euphemisms, ‘There is nothing unhealthy or wrong with consenting adults of the same sex sodomizing each other.’”
Mary: And your term “sodomizing” is just as much of an “anti-euphemism” as my term and it doesn’t exactly help your claim.
There is nothing wrong with two consenting adult individuals of the same sex having sex with one another. And if they love one another, it’s a great thing.
December 30th, 2011 | 10:43 am
That’s very true Joe De Vet. But its also an improvement over the old regime. There is some ability to steer a diagnosis code towards something more likely to be covered by insurance (the same thing happens with medical conditions too), but at the same time the system of codes with applicable symptoms and tests limits just how much steering can happen and how much can be charged for services.
Contrast this with the old regime of Freudian analysis. Note the statement of the Freudian doctor who opposed the change:
They’d never delved into his unconscious material, or his dream material, or his transfers. They don’t know what goes on in the mind of homosexuals. All they see is the homosexual who appears quite normal. But underneath they don’t know the dynamics and the meaning ….
Leaving aside homosexual patients, exactly how does an insurance company handle this? The gist is basically saying, “the patient needs care if I say he needs care and will continue to need hour long sessions billed at whatever rate I charge until I say otherwise and there’s nothing you can do to verify or confirm this diagnosis unless you want to pay another Freudian doctor to spend hours and hours with the patient just like I did.”
The coding of illnesses does put some boundaries on this. It would take a brave doctor to falsely put a schizophrenic code to a patient who is merely mildly depressed over his marriag ending just to bill more sessions. Doing so is likely to be easily detected and subject the doctor to civil and even criminal charges.
You’re right, its easy for ‘almost anyone’ to get a relatively mild diagnosis code for some type of mental illness or problem. But most insurance will not pay much for such treatment. Most insurance plans limit your mental health visits each year and put a higher co-pay on them than regular doctors appointments (or steer the patient to lower cost group sessions or sessions with ‘therapists’ rather than full psychiatrists) They will pay for anti-depressants and other relatively mild drugs but again with co-pays (the wisdom of that is another debate of course). You’re probably not going to be able to bill your insurance big bucks for mental health treatment unless you have something really serious.
December 30th, 2011 | 10:49 am
Tristian,
I agree with you that it is a stop gap measure, where I disagree is charcterizing it as ‘not grounded in science’. It’s grounded in science if the best theory/model is being used for the available facts. For the most part we don’t have blood tests, brain scans or other tests that can definitively spot the cause of mental illnesses and detail out their mechanisms of action. Given that lack of data, groups of symptoms is probably the best that can be done just as for some medical illnesses all that can be done is list the known symptoms that seem to appear together. I think they should aspire to do better and in many areas are working hard at making progress but to me it seems a little uncharitable to chuckle over the science being ‘primitive’. It’s like laughing at Newton for not ‘getting’ relativity, electricity and numerous other things. Yea he didn’t get it, but he did get off to an excellent start.
December 30th, 2011 | 11:38 am
why the criteria for “disorders” must be vague. . .
Joe DeVet,
Actually, the criteria for specific disorders in the DSM-IV are quite specific.
In other words, the DSM is a necessary part of a mechanism which plunders the rest of us for our insurance premium dollars (or tax dollars in the case of government-funded health care.)
Most psychiatrists don’t take insurance. Many do charge on a sliding scale and base their fee on a patient’s ability to pay, taking into account whether a patient has insurance and, if so, how much the insurance company will reimburse the patient for.
Also, health insurance plans are not required to cover mental health. If they do, under the Mental Health Parity Act, “employers retain discretion regarding the extent and scope of mental health benefits offered to workers and their families (including cost sharing, limits on numbers of visits or days of coverage, and requirements relating to medical necessity). Furthermore, “MHPA does not apply to a group health plan or group health insurance coverage if the application of the parity provisions results in an increase in the cost under the plan or coverage of at least one percent.
In short, insurance doesn’t have to cover psychiatric care, and if it chooses to cover it, the insurer can pretty much determine how much or how little it will pay for.
By the way, do you believe there is no such thing as a mental (emotional, psychiatric) disorder? If you believe the notion is a valid one, I challenge you to come up with a definition better than the one in the DSM-IV.
December 30th, 2011 | 12:03 pm
How many times have I overheard a therapist tell a patient, I’m gonna call your condition [such and such] for the sake of insurance coverage?
Joe DeVet,
You may choose not to answer, but how do you hear therapists telling their patients what their diagnosis is? That is a confidential matter. (Are you a doctor?)
Also, the most common diagnosis made by primary care physicians is essential hypertension (high blood pressure with no known cause), which has its own billing code. Exactly how “scientific” is measuring high blood pressure and saying you don’t know what the cause is?
December 30th, 2011 | 12:17 pm
Boonton, I’m not one for chuckling at psychiatrists or psychologists–it’s not their fault the human mind is very difficult to figure out, and it should go without saying that many are brilliant theorists and/or experimentalists. If I would find fault it would be in their pretending to know more that they do.
The problems with psychiatry and psychology run deeper, I think, than you suggest. With the science underlying most the rest of medicine we know where to look for causes. More precisely, we have a very good idea what kinds of entities and processes are generally involved in producing physical illness. And this what psychology is still lacking. There are certainly lots of ideas on the table, and these ideas often lead to very interesting research and results, and a lot of these are useful in various ways. What we don’t have, however, is a reasonably unified theoretical framework for tying it all together. For any identified mental disorder what kinds of entities and processes do we look at for a possible cause? Neurons, neurotransmitters and synapses? Evolved computational modules? Patterns of learned behavior? Interactions between the subjects and situations? Unconscious thoughts and desires? Do we look at how subjects were parented? Prenatal conditions? It’s possible to limit the options in an ad hoc way by treating disorders one at a time–disorders that produce truly weird behaviors seem intuitively more biological perhaps than, say, feelings of excessive guilt. But this approach results in something that looks a bit like having a medicine that uses germ theory for colds and humor theory for strep throat and demon possession theory for pink eye.
December 30th, 2011 | 12:56 pm
There is nothing unhealthy or wrong with same sex love between consenting adults.
Wrapping up the matter in euphemism does not exactly help your claims. No one has the slightest objection to “love.”
How do you prove “scientifically” that there is nothing “unhealthy” or “wrong” with a behavior?
Since when does science have the power to prove or disprove value judgments and moral claims?
December 30th, 2011 | 1:02 pm
that is normally not challenged gets some scrutiny and is found wanting.
Consider the odd thing you’ve choosen to argue here. You’ve said the APA never had the evidence to merit listing homosexuality as a disorder to begin with, yet at the same time you’re also trying to argue that the APA delisted due to ‘pure politics’.
Right or wrong (scientific or not), we do have standards by which we do initial diagnosis, and by those standards, homosexuality is disordered.
It’s atypical, is directly linked (causative) to unwanted negative health outcomes, interferes with the sufferer’s ability to lead a normal life, and people who suffer from the disorder have expressed strong, sincere desires wishing to be cured.
December 30th, 2011 | 1:17 pm
Although you say “in fact,” there is not one fact in this long message of yours—just a host of unsupported assertions.
You seem confused about what a “fact” is and is not. More importantly, I wonder why you complain about my quote-unquote “unsupported” assertions, without equally complaining about all the other people who dare to assert things without providing links to the right sort of peer-reviewed research?
One particularly glaring omission: where’s your criticism for the unsupported idea I was directly responding to?
Why do you consistently try to single my assertions out to be held to a higher standard (a standard that is IMO not appropriate to this forum)?
December 30th, 2011 | 1:49 pm
Blake,
It’s atypical, is directly linked (causative) to unwanted negative health outcomes, interferes with the sufferer’s ability to lead a normal life, and people who suffer from the disorder have expressed strong, sincere desires wishing to be cured.
Except maybe for being atypical (and if that alone is sufficient, then we can say that any and all religions that have a place for those who take vows of chastity are all simply hosting the mentally ill), all of these failed emperical testing. (BTW, I encourage you to either listen to the American Life program or read the transcript if you want to dive into this discussion deeper).
December 30th, 2011 | 4:52 pm
all of these failed emperical testing.
Um…by that standard, so does everything else in the field of mental health.
See, that’s the real problem – mental health isn’t about helping people who want to be helped. It’s about using misleading claims of “empirical testing” to justify stigmatizing and controlling people.
You may think “oh but you can’t do that to gay people, because gay people deserve dignity and respect; they should have the right to choose their own lifestyle as long as they’re not a threat to themselves or other people!” …..
….now explain to me why someone suffering from bipolar disorder or autism spectrum disorder or schizophrenia is any less worthy of dignity and respect, any more deserving of stigmatizing labels, any less deserving of the right to decide and control one’s life?
“Empirical research” when applied to value judgments is the stuff of Kafka.
December 30th, 2011 | 6:24 pm
Blake:
I wonder if according to YOUR definition of “disorder” lefthandedness doesn’t also qualify. No analogy is perfect. If it were, we wouldn’t be dealing with an analogy but a duplicate. Lefthandedness I find a very useful analogy to homosexuality. Apparently, southpaws are likelier to suffer from other mental disorders like like “dyslexia, schizophrenia and attention deficit hyperactivity disorder, or ADHD,…” Southpaws also seem to demonstrate more “special” talents than righties. Ditto for homosexuals (i.e., homosexuals, men particularly, seem particularly overrepresented among artistic geniuses).
http://online.wsj.com/article/SB10001424052970204083204577080562692452538.html
December 30th, 2011 | 8:12 pm
Blake,
People, not just Boonton, complain about your unsupported assertions because so often you are merely making up things. Make up fewer facts, and you won’t be called out on them.
December 30th, 2011 | 11:08 pm
Blake,
You forgot to mention that homosexuality is not only disordered, unhealthy, and abnormal, but is also bestial. You also forgot to mention that you have nothing against gays, think they are fine people, and like them.
December 31st, 2011 | 1:13 am
And your term “sodomizing” is just as much of an “anti-euphemism” as my term and it doesn’t exactly help your claim.
What homosexuals do to each other is, by definition, sodomy. That you consider it a dysphemism reflects how deeply your euphemisms have clouded your thinking.
There is nothing wrong with two consenting adult individuals of the same sex having sex with one another.
That’s like saying there’s nothing wrong with a square circle. Two people of the same sex can not have sex with each as it is anatomically impossible.
December 31st, 2011 | 10:43 am
Then according to Mary sodomy is not sex, which is fine I suppose….Bill Clinton agreed with her when questioned about his relationship with Monika Lewinsky.
December 31st, 2011 | 10:53 am
The “Wired” article discusses the possible over-diagnosis of childhood mental illness—ADD, ADHD, bi-polar, etc. and the consequent drugging of kids. I think this is another area that might damage the reputation of psychiatry sooner or later. Certainly, it is worrying Al Francis.
Coincidentally, I was just reading about the Watergate scandal and was reminded of the “Martha Mitchell Effect”. It’s an example of the slippery nature of psychiatric diagnosis, and the damage it can cause. Such an outrage, and it makes one wonder how often this happens.
December 31st, 2011 | 11:26 am
And let me add and anticipate, no Mary, you haven’t answered my question when you wrote “What homosexuals do to each other is, by definition, sodomy.” I’m looking for a more specific understanding of the term. This will help me as I am a law professor and I teach, very briefly in a few courses, what sodomy laws (declared unconstitutional in Lawrence v. Texas) used to cover. As far as I can tell I know what sodomy ISN’T. It ISN’T when a heterosexual couple has uncontracepted couitus. As far as what it IS, it could be ANYthing beyond that. There are certain understandings of sodomy where no lesbian is a sodomite and a great deal of gay men are not either. Under this definition, the CENTRAL homosexual act is arguably not sodomy. And this act — practice by all lesbians, gay men, and 90% of heterosexuals — I have been told by two preeminent natural law authorities may even accord with the natural law if done properly by a married heterosexual couple. I know these are difficult questions, but they come when tar homosexuals with the term “sodomy.”
December 31st, 2011 | 11:28 am
You forgot to mention that homosexuality is not only disordered, unhealthy, and abnormal, but is also bestial. You also forgot to mention that you have nothing against gays, think they are fine people, and like them.
Thank you for proving my point.
Psychology is not about “helping” people, but about judging them, stigmatizing them, and controlling both them (as individuals) and society (in terms of what is considered acceptable and unacceptable).
I suppose you think that a person with bipolar disorder is bestial? You don’t want gays to be classed with those nasty autistic people, who deserve the electric shocks that are used to control them? Perhaps you think schizophrenics are sub-human? Surely, if they’re disordered, that means they’re not like the rest of us, right?
This is why Christianity is better than trusting those of you who need to label and diagnose. The left wing says Christianity is bad because it sets limits on behaviors and stigmatizes certain people for behaving in antisocial ways, but when it comes to controlling behaviors, stigmatizing, dehumanizing, and using electric shocks to punish non-compliance, nothing beats a lefty who just wants to “help”.
December 31st, 2011 | 11:32 am
People, not just Boonton, complain about your unsupported assertions because so often you are merely making up things.
I believe my argument was more than adequate to rebut the claim that psychology does more to help people than Christianity.
December 31st, 2011 | 11:48 am
I wonder if according to YOUR definition of “disorder” lefthandedness doesn’t also qualify.
“My” definition of “disorder” is what I was taught by a licensed psychologist, in a college course on psychology.
But, no, lefthandedness would not qualify, because it does not interfere with the ability to lead a normal life, is not correlated with any negative health outcomes, and there are few or no cases of lefthanded people who wish they could be cured of it.
Homosexuality, on the other hand, is a serious problem for those who are affected. You can’t lead a normal life; family life is one of the central facts of human life, and yet homosexuals have this conflict that interferes with their ability to have a normal, healthy, intact family. They have to deny the importance of biological kinship, build a family out of lies, and create all sorts of tensions and dysfunctions in order to pretend to be like other people.
There are places where homosexuality is normal – little enclaves (such as San Francisco). This is not unlike how there are little enclaves where autism or asperger’s is normal (such as Silicon Valley and certain universities). The problem with this is that to make it the norm nationwide would require changing the majority of the population – forcing them to relinquish their values and their way of life to accept yours. It would be better for everyone if you just let go of the desire to believe that there’s nothing “wrong” with homosexuality. I think what is called for is grief, healing, and then learning to live with it – not through lies, or trying to pretend that being gay doesn’t have to mean conflict in the family, but through accepting that you do have limits, and you are going to have to live without something. Your lover can’t ever be your child’s other parent; the most s/he can ever really be is a stepparent. You do in fact owe it to your child to honor his or her other real parent. You do in fact owe it to your family to honor the integrity of the family tree. These things do matter. You can’t just demand everyone pretend they don’t, so that you can live out a fantasy. That’s childish. We pretend for children, to spare them pain, but you’re not kids, and it’s backward and messed up when children have to pretend to spare the grownups pain.
Does that mean I hate gays and want them to suffer? Why would you assume that?
Do you think referring a person with suicidal tendencies to a psychologist is about hating the suicidal person, judging them, and wanting them to see harm? That’s not what we say – we say it’s about helping the person, because the person is in pain. Are you saying we don’t really mean that? That we really have contempt for that person, and psychology is really a ghetto?
Do you think we classify obsessive-compulsive people that way because we’re judging them and we think less of them?
There is the real problem, don’t you think?
The entire question does sort of highlight the problem with mental health diagnoses, doesn’t it? Yes, you’re playing with peoples’ lives when you label them. Yes, you can wreck their lives if you aren’t keeping in mind that mental health services is about helping – not judging, stigmatizing, ghettoizing. Yes, psychologists ARE in fact misusing that power, and people ARE being hurt! Those of you who don’t want gays to be classed as “the same as” bipolar feel that way because you recognize that bipolar people aren’t being treated fairly, isn’t that true?
December 31st, 2011 | 1:35 pm
“Those of you who don’t want gays to be classed as ‘the same as’ bipolar feel that way because you recognize that bipolar people aren’t being treated fairly, isn’t that true?”
LOL. I suggest you talk to some bipolar folks, indeed some bipolar religious conservatives and try telling them that their bipolar condition is “the same as” homosexuality and see what they make of it.
December 31st, 2011 | 2:47 pm
What I am trying to figure out is what people who denounce psychiatry, psychiatric drugs, the DSM-IV, and so on, propose as an alternative. Suppose a soldier returning from Iraq has symptoms of PTSD so classic that a layman can diagnose him. Suppose someone can’t leave her house because she has panic attacks. Suppose someone feels absolutely compelled to spend an hour and a half before leaving for work every morning checking and rechecking that all the windows are closed, the faucets are off, the stove is off, all the books on the shelves are perfectly positioned, and so on. Suppose someone is so deeply depressed he or she cannot get out of bed. Should these people not see a psychiatrist or other mental health professional, and should they not be given a diagnosis? Should schizophrenics see priests or ministers instead of seeing psychiatrists and taking antipsychotics?
What is the alternative to contemporary psychiatrists and clinical psychologists? If you personally started hearing voices and having hallucinations, would you avoid seeing a psychiatrists?
December 31st, 2011 | 3:11 pm
But, no, lefthandedness would not qualify, because it does not interfere with the ability to lead a normal life, is not correlated with any negative health outcomes, and there are few or no cases of lefthanded people who wish they could be cured of it.
Blake,
Not according to this:
Or this:
Or this:
My late aunt, like many born in the early 1900s, was naturally left handed and was forced to learn to write with her right hand. It was quite routine in times past to force left-handed people to function as right handed.
December 31st, 2011 | 5:09 pm
What I am trying to figure out is what people who denounce psychiatry, psychiatric drugs, the DSM-IV, and so on, propose as an alternative.
An ethical model. The current model is not ethical.
A model that requires and is based on truth, rather than one that has a high tolerance for questionable assumptions and downright deceptive practices.
A model that starts with “first do no harm” – and therefore has zero tolerance for misleading, misguiding, or otherwise harming the clients, as opposed to a model that doesn’t even try to keep track of whether its advice causes unintended negative consequences.
A model that is client-centered – that is, it measures success in terms of goals defined by the clients (or their guardians where appropriate), and judges success or failure according to things like whether the clients are helped, feel satisfied, are happier or experience concrete, objective, measurable improvements (as measured according to the goals the clients themselves set). The current model has no such definition of success – and in fact has no mechanism to even record client satisfaction, let alone “cure rates”. (But it’s highly profitable – and I think psychiatric drugs may be a serious contender for “highest profit industry ever”?)
December 31st, 2011 | 5:11 pm
I suggest you talk to some bipolar folks, indeed some bipolar religious conservatives and try telling them that their bipolar condition is “the same as” homosexuality and see what they make of it.
I was referring to the category “mental health (ghetto)”, not the category “sexual deviations/abnormalities”.
December 31st, 2011 | 9:18 pm
Go ahead and use your left hand to write several lines of prose on a clean sheet using a quill and an ink pot. The side of your hand will smear the sentences.
What is pragmatism in the face of a juicy (constructed) conspiracy against purported individualism?
January 1st, 2012 | 9:23 am
Blake,
Joe has made the silly claim on this thread that Boonton just says the opposite of whatever Joe says. But sometimes I get the impression that you say the opposite of whatever you think a liberal might say, or at least the imaginary liberal that haunts your mind.
On previous threads, you have claimed that cognitive behavioral therapy is the only kind that works, but here only Christianity works.
On previous threads, you have claimed that gays are fine people who are capable of being good parents. On others, you say they are bestial. And on this, you say they are disordered and unhealthy.
No matter what argument you make, it is fact free and either distorted or lying. You’ll notice that David provides facts and links when refuting your bald assertion of the moment. Perhaps you can add a resolution to your list.
January 1st, 2012 | 9:33 am
David Nickol–OK, I was engaging in a bit of hyperbole. I’ve heard it a few times (can’t say where) when a provider said they would list a certain coverable diagnosis, because it’s coverable. And yes, it happens in medicine as well. (In a sense, my question to myself [how many times have I overheard...?] was an honest one. Do I exaggerate when I extrapolate to the broader community?)
As for whether DSM-IV is very specific, I was simply accepting the major premise of the post, and drawing conclusions from it. Here’s a guess–the DSM could be written very specifically, but it may be dicey in practice to apply it rigorously to real people with their real complaints, and that may be where the issue of vagueness, or malleability of criteria, lies.
I do believe that there is such a thing as mental illness. But I am willing to believe that there’s much more that we don’t know about it than what we do know. Also that, in general, it eludes reduction to empirical scientific practice of the kind that I, as a chemical engineer, would apply in my field.
January 1st, 2012 | 3:25 pm
Go ahead and use your left hand to write several lines of prose on a clean sheet using a quill and an ink pot.
This is why hand bridges exist.
I’m just not seeing the point. If lefthandedness does cause more trouble than I see it as causing, then maybe it should be classed as a physical disability. But what has that to do with anything anyone has said?
If we really want to it as being like homosexuality, then I would ask whether homosexuality – or more specifically the inability to feel desire for an appropriate spouse – has a physical cause, as impotence sometimes does?
Perhaps we don’t know. But that is not my point. My point is not what homosexuality is or is not. My point is that honesty is better than lies, and honesty suggests that homosexuality is not a normal state, it is a highly undesirable one that interferes with a person’s ability to build a healthy family. I do not believe that pretending changes reality, and anyone who does believe that should be classed as religious, not scientific.
There are many possible arguments about the best way to handle homosexuality, because it’s in essence the same as asking what is the best way to live? What are the highest priorities? But whether you believe that homosexuals should just “live with it” or whether we should seek a cure (and by the way there are some homosexuals who would welcome a cure, just FYI), whether we should define “living with it” one way or some other way – these questions are not scientific questions. They are value judgments. They are not questions for psychologists to answer. Psychologists should not be setting the goals for us, but should be helping us meet the goals we ourselves set.
Homosexuals should be able to get real help from counselors without fear of being stigmatized, labeled, put into a computer program under a special code number – because nobody should fear these things. We should stop maintaining a boundary between “normal” and “disordered” — we should, in fact, start practicing some of that “tolerance” toward “diversity” that the left keeps yammering about, and stop defining one single “right” way to live and every other lifestyle, every other brain type or personality type or choice in music as being defective. We should reserve our judgements for actions and choices (“people shouldn’t rob banks” “being mean to old ladies is bad”) instead of judging types of people by category we’ve invented to cover “people like that” (“schizo”, “sped”, fatso”, “flyover country” are every bit as destructive and mean-spirited as any epithet aimed at any other minority).
January 1st, 2012 | 6:40 pm
Blake,
I think a problem I and a few others have here is the seemingly loaded definition of “normal” being used here. That’s one reason why I raised the left-handed analogy. There are conditions that aren’t normal in either a statistical or social sense but that nonetheless are “neutral” when it comes to our “oughts” or social norms. Homosexuality is normal and abnormal according to various definitions of the term. For those of us who believe in gay equality — I think we can make an analogy or use the reductio absurdum to connect every single instance of homosexuality’s “abnormality” to things that are generally regarded as neutral like left-handedness or redheadedness or being Jewish.
January 1st, 2012 | 6:54 pm
“Then I would ask whether homosexuality – or more specifically the inability to feel desire for an appropriate spouse – has a physical cause, as impotence sometimes does?”
Very interesting: What’s often left unsaid or not specifically defined enough is what IS the homosexual orientation? It’s a positive attraction to a member of the same sex but also a lack of attraction to members of the opposite sex.
So what is it that’s wrong with homosexuality? Is it the affirmative act of eterning into same sex relationships or negative act of NOT entering into an opposite sex relationship?
There are folks out there who don’t seem to have an attraction or don’t care to purse relations with either gender. But “chastity” — or NOT behaving sexually at all — doesn’t seem viewed as a “problem” in orthodox Christianity, especially NOT in Roman Catholicism. So accordingly, I would ask, IS lack of attraction to the opposite sex really a “problem” (if we understand that such condition will affect only small % of the population; if no one had a sexual attraction to the opposite sex we wouldn’t reproduce)? Didn’t Jesus seem to have that orientation?
On a personal note, I don’t accept traditional Christian morality; so I see affirmative hetero and homosexuality, both as good things; I see heterosexuality as having more utility because it is procreative. I think the full and even perfect bisexuals are in the best position for the reason Woody Allen comically gave. I don’t necessarily see chastity as a bad thing as I observe some folks genuinely flourishing in it. Though chastity seems to work better for smarter, more creative folks who seek to sublimate whatever sexual energy they have into creative and philosophical pursuits.
January 1st, 2012 | 7:24 pm
Perhaps we don’t know. But that is not my point. My point is not what homosexuality is or is not. My point is that honesty is better than lies, and honesty suggests that homosexuality is not a normal state, it is a highly undesirable one that interferes with a person’s ability to build a healthy family.
we also know then that deep religious motivation that can cause one to desire to take a vow of lifetime chastity will also interfere with a person’s ability to build a healthy family. Therefore down Blake’s path we find a straight line to ‘psychology’ as it was practiced in the USSR and other authoritian countries, as a tool to weed out those who don’t fit in and label dissent and differences not as the natural diversity of human nature but as a ‘mental illness’. It never fails, whatever Blake says he wants to protect (children, families, freedom, religion, etc.) is really what he is willing to sacrifice for his dogmatism.
Joe De Vet
I do believe that there is such a thing as mental illness. But I am willing to believe that there’s much more that we don’t know about it than what we do know. Also that, in general, it eludes reduction to empirical scientific practice of the kind that I, as a chemical engineer, would apply in my field.
I think this perspective is a bit uncharitable. Chemical engineering has the good fortune to have had many fundamental discoveries made a long time ago. It also has the good fortune of allowing quite a bit of experimentation without a lot of ethical questions coming into play. For example, you’re free to do just about anything you want to a bag of sodium to see what you can discover about it. If, though, you have a hypothesis that a child’s ability to learn a language is lost forever if not used by age 8, well you can’t just lock a bunch of newborn babies in a cage and deny them access to humans to see if that’s true. Given the difficulty of making discoveries, the ‘science’ is going to be far behind other more lucky fields.
Which is why I bristle at the criticism of listing illnesses by checklists of symptoms. Good science isn’t necessarily about getting it right. The 19th century physicists who were formulating theories about ‘ether’ were wrong but still practicing good science. They were trying to build the best possible theory given the available data. To the degree you have something better than ‘symptom checklists’ to define illnesses then they should be utilized, but if you don’t then we have to make the best with what we have. Before chemists could understand how the structure of atoms drove their properties, all they could do was develop ‘checklists’ of properties of various elements.
January 1st, 2012 | 7:49 pm
Jon Rowe : “There is nothing wrong with two consenting adult individuals of the same sex having sex with one another.”
You mean there is something wrong with three consenting adult individuals having together? Four? Five?
You mean there is nothing wrong with a consenting adult individual having sex with 300 others in one week, if they do it two at a time?
You mean if an adult wants to have sex with someone of the same sex because they are full of psychological problems, this should still be called proper mental health?
You mean if an adult pays another for sex and it’s “consensual,” there’s nothing wrong?
You mean if one adult sexually harasses another adult, the harasser is mentally ill?
You mean if two perverted and perverse adults have consensual sex with each other , there is nothing wrong with either of them?
You mean if adults knowingly and consensually spread STDs through sex, there is nothing wrong?
January 1st, 2012 | 8:03 pm
Jon Rowe: “There is nothing wrong with two consenting adult individuals of the same sex having sex with one another. ”
Since a lot of homosexual dynamics have nothing to do with love, they are deformed, dysfunctional, and perverted, there is no way that anyone can define sexuality as being equal to or reduced to love.
This is just a harmful, irresponsible euphemism, and a constant problem with people having a homosexual problem. Always lying about every single problematic aspect related to homosexuality.
Isn’t constant lying and denial of reality a type of psychological dysfunction?
January 1st, 2012 | 8:28 pm
“You mean there is something wrong with three consenting adult individuals having together? Four? Five?”
Nope. You are just putting words in my mouth. One thing doesn’t have anything to do with the other.
Same sex love — erotic, pair bonding romantic and sexual love — does exist. Deal with it.
“Isn’t constant lying and denial of reality a type of psychological dysfunction?”
I suspect I’m speaking with someone with a psychological dysfunction.
January 2nd, 2012 | 7:02 am
Harriet:“You mean there is something wrong with three consenting adult individuals having together? Four? Five?”
Jon Rowe: Nope. You are just putting words in my mouth. One thing doesn’t have anything to do with the other.
I’m not putting words in your mouth at all. I am addressing you the question: is there something wrong with three consenting adult individuals having sex together? And if you think there is something wrong, what it wrong about it? Is there something wrong with an adult having sex with two people in the same day, even if it’s just one sexual partner at a time?
Jon Rowe: “Same sex love — erotic, pair bonding romantic and sexual love — does exist. ”
Is it a result of having problems that disorient these feelings from a heterosexual relationship? Can you give an explanation of why someone develops a homosexual psychology? There are pedophiles who have a sexual and emotional love for children. I think it’s you who needs to deal with the fact that just because someone claims to develop some romantic feelings about another person, it does not mean these feelings are healthy or unproblematic. Deal with it, as you say.
Jon Rowe: “I suspect I’m speaking with someone with a psychological dysfunction.”
Which dysfunction is that?
January 2nd, 2012 | 10:37 am
You mean there is nothing wrong with a consenting adult individual having sex with 300 others in one week, if they do it two at a time?
300 in a week? That’s 43 a day which means they would have to have sex with nearly two people every hour 24 hours a day with no breaks for eating or sleeping. But that’s just quibbling, you’re asking is there ‘anything wrong’ with someone who has a huge amount of sex with others. I’ll say quite possibley no.
Let me remind you we are talking about psychological illnesses here, not general morality. It sounds like this discussion is confusing ‘anything wrong’ meaning “does the person have a mental illness” with ‘anything wrong’ meaning “should this person behave like this”. Is there ‘anything wrong’ with a 19 yr old kid who doesn’t have a job, doesn’t go to school, sits home all day playing video games and keeps hitting his parents up for spending money? It may be he is suffering from some type of mental problem but it is just as easy to believe he is lazy and taking advantage of his parents and his parents are indulging him. A person who racks up 300 sexual encounters in a relatively short period of time may be suffering from some compulsive disorder, or they may simply be a porn star who are in it for the money. You may deem the latter as morally deficient but that doesn’t necessarily mean that their behavior is due to an illness rather than their choices.
January 2nd, 2012 | 12:27 pm
Jon Rowe: “I suspect I’m speaking with someone with a psychological dysfunction.”
Ever notice that the left spends a lot of time “diagnosing” the right?
Conservative attitudes toward sexuality are defined as “repressive”, where “healthy” is defined as corresponding to left wing ideals.
Conservative attitudes toward family are defined as “enmeshed”, where “healthy” is defined as corresponding to left wing ideals.
Conservative attitudes toward political ends and means, appropriate life goals, and economic prosperity demonstrate that we suffer from a host of cognitive, sexual, and anxiety-based disorders.
Something to think about when you think about mental health, stigma, and power. The left wins a lot of arguments (or at least scores a lot of political points) through diagnosis.
January 2nd, 2012 | 12:31 pm
So what is it that’s wrong with homosexuality? Is it the affirmative act of eterning into same sex relationships or negative act of NOT entering into an opposite sex relationship?
The actual homosexuals I have spoken with are more troubled by their inability to marry and have a healthy relationship with a spouse than they are by their desires. Of course, this is in no way a representative sampling, but it does lead back to the question of how we define what is or is not “normal” or “healthy” vs. “disordered”.
How do we choose what needs fixing?
Do we let the individual with the problem define his own problem (and define his own desired outcome), or do we let the Experts impose their own definitions on us as universal rules, and then pressure everyone to be what they’re told, even if it means trying to fix things that aren’t a problem or trying to accept things that are a problem?
January 2nd, 2012 | 1:21 pm
Boonton “You may deem the latter as morally deficient but that doesn’t necessarily mean that their behavior is due to an illness rather than their choices.”
My first point is that the term “mental illness” doesn’t begin to cover all the destructive, psychologically/physically harmful problems that a person can develop, even if they do not become mentally ill.
And this is true for every part of life, including sexuality. To what extent people with a homosexual problem are mentally ill will depend on their individual psychological profile and what is comprised under the category “mental illness.”
To what extent they may have all kinds of psychological and emotional problems that cannot be categorized as a mental illness, but are still real problems and are at the root of them having developed a homosexual problem is what Jon Rowe is avoiding.
People’s psychologies are much more complex than these two simple binary categories “mentally ill or “mentally sane.” There are many serious, profound psychological/emotional/social/relational dysfunctions that are real, and yet cannot be categorized under the standard “mental illness” categories.
It’s not because the APA took out “homosexuality” from the mental illness category that homosexuals/bisexuals do not have profound psychological/sexual/personality/social problems.
Boonton: “Let me remind you we are talking about psychological illnesses here, not general morality. ”
Apparently you don’t realize that harmful attitudes and behaviors, which morality criticized, would not occur if people weren’t having some kind of problem.
Taking out homosexuality from the “mental illness” category serves to create a lie that there are no problems with it. That’s where the APA is quite mistaken.
Boonton: “you’re asking is there ‘anything wrong’ with someone who has a huge amount of sex with others. I’ll say quite possibly no.”
I wasn’t looking for an irresponsible, dysfunctional take on the issue.
January 2nd, 2012 | 1:42 pm
Blake: “Do we let the individual with the problem define his own problem (and define his own desired outcome)”
Asking homosexuals/bisexuals to define what is healthy for sexuality is like asking Bernie Madoff to define what should be the rules for the SEC.
Asking homosexuals/bisexuals to be forthcoming about all the problems related to them and homosexuality (including issues of violence and harassment, perverse and perverted attitudes and behaviors) is like asking Corzine to be forthcoming about where the money went.
January 2nd, 2012 | 1:52 pm
“Ever notice that the left spends a lot of time “diagnosing” the right?”
Blake: I am not “the left.” I never said anything about all anti-gay folks.
January 2nd, 2012 | 1:56 pm
Blake: Conservative attitudes toward sexuality are defined as “repressive”, where “healthy” is defined as corresponding to left wing ideals.
Irresponsible, harmful people do not want any accountability for their thoughts or actions. This is what liberals call “repression” in terms of sexuality or personal relationships. They must incessantly legitimize destructive sexuality attitudes and behaviors to avoid any and all accountability, and being conscionable in terms of ethics.
What liberals call sexual freedom is often nothing more than being able to do violence and harm with no accountability, such as is the case of people who want to legalize and promote prostitution, pornography or those who carelessly spread STDs at epidemic levels.
January 2nd, 2012 | 2:09 pm
Rowe: So accordingly, I would ask, IS lack of attraction to the opposite sex really a “problem”
In order to answer this question, you need to know why an individual claims not to have any sexual attraction.
It’s questions like these that liberals hate to investigate concerning homosexuals. The researchers and therapists who have investigated them, however, have uncovered mountains of psychological/personal experience problems at the root.
To note, attraction is far from the only sexual feeling possible, so in order to know an individual in their sexual psychology, you need to investigate all their sexual and relationship feelings. Many people have perverse sexual feelings which are not “attraction,” yet they are sexual. Just how deformed sexuality can be is not something most liberals want to face.
Liberal discourse about sexuality and personal relationships is mostly an idealized tale where problems (and especially serious ones) are an anomaly. Social reality is quite the opposite.
January 2nd, 2012 | 3:19 pm
Blake,
“Homosexuals should be able to get real help from counselors without fear of being stigmatized, labeled, put into a computer program under a special code number – because nobody should fear these things.”
And yet you have called homosexuals “bestial.” Can you explain how calling them “bestial” is neither “stigmatizing” nor “labeling” them?
“We should stop maintaining a boundary between “normal” and “disordered” — we should, in fact, start practicing some of that “tolerance” toward “diversity”
But earlier on this thread you called homosexuality “disordered.” So which is it, is homosexuality disordered or not?
January 2nd, 2012 | 3:46 pm
Blake,
“Do we let the individual with the problem define his own problem (and define his own desired outcome), or do we let the Experts impose their own definitions on us as universal rules, and then pressure everyone to be what they’re told, even if it means trying to fix things that aren’t a problem or trying to accept things that are a problem?”
This is a good question, but you seem to want to have it both ways. You don’t like how psychological “Experts” have “imposed their own definitions,” but you’re quite happy to trust certain church “Experts” to impose their own definitions.
January 2nd, 2012 | 6:10 pm
you’re quite happy to trust certain church “Experts” to impose their own definitions.
Humanists insist they aren’t a religion – they claim to be “science”.
Humanists, unlike the Catholic church, refuse to submit to the limitations and restrictions that go with being a religiously oriented charity provider.
We talk a lot about whether allowing the existence non-humanist service providers such as Catholics is a rights violation for gays, because it is so dreadful to be stuck with with a service provider who does not share your core values. But the same people who argue most fervently that “obviously” it is harmful to be stuck with an ideologically incompatible service provider do not care about whether it is harmful for Christians. They want 100% humanist counselors, and their rational for justifying this is that it’s not about ideology or values, it’s about “science”.
They are the ones who wants to have it both ways.
The solution is to start being honest about where we draw the line between objective fact vs. subjective value.
For all that people want to make me out to be some sort of bigot, I have never argued that gays have less right to their freedom of belief than I do. I recognize their right to be humanists or Unitarian Universalists or whatever they choose to call their belief. I don’t say they shouldn’t have their unions recognized, though I do ask that I not be forced into lies so that they can pretend their union is the same as a marriage. I don’t say they should be barred from adoption, I do argue that they are morally obliged recognize that their lover can’t be the child’s other parent, but in reality can be no more than a stepparent. Mine is the true live-and-let-live position: you are free to live your life your way, but you are not free to make up your own reality and then demand other people play along.
But that is exactly what humanists are trying to do: force everyone to accept their interpretation of reality, even when it is in conflict with observable facts.
January 2nd, 2012 | 6:21 pm
And yet you have called homosexuals “bestial.” Can you explain how calling them “bestial” is neither “stigmatizing” nor “labeling” them?
I am not a counselor.
I may call anyone anything I like.
And incidentally, I discern between individual and behavior. I think that being ruled by your lust is bestial. I think all human beings are part bestial and part noble. This is my ideology. I am no more obliged to apologize for my ideological beliefs than a gay man is.
And, because I do not recognize that having homosexual desires automatically makes you a special class of person, I also do not believe that I am more obliged to refrain from insulting “anti gay” speech than the gay man is obliged to refrain from insulting “anti Christian” speech. I believe we all have the right to a certain level of freedom from harassment, bullying, and fear, but to expect to never encounter something that makes you feel bad about your behavior, when your behavior is genuinely controversial, is un unreasonable request.
As far as finding a counselor, it is the client’s responsibility to find a counselor that they feel comfortable with. That is the difference between “counseling” (which is inherently unscientific, even though it dishonestly presents itself as if it were scientific) vs. self-help approaches that are focused on impartially teaching skills. You have the right to go to an anger management class and expect the teacher to teach you a set of skills – ideology has nothing to do with it, and nobody of any ideology should be inserting ideology into it unless they advertised that it was a class that would be geared toward that ideology. But counseling is personal, and demanding that every counselor in the land accept the gay man’s ideology as truth just so that gays will never be made to feel bad about themselves is not a reasonable request.
As a general rule, here is a handy test by which you can see whether something is ideological rather than objective: if a gay man wants X, and a Jehovah’s Witness came along and wanted X too, would you be able to accommodate both? Or would it be a zero-sum situation?
“I want all the counselors in the world to be friendly to gay lifestyle” is ideological.
“I want counselors who are friendly to gay lifestyle to have access to government resources equal to what Catholic counselors get” is not, though one might argue what constitutes “equal” (total dollars or percentage-based? and so on)
January 2nd, 2012 | 6:23 pm
It is a shame that this discussion deteriorated from being about what is wrong with the DSM-IV to being a restatement of familiar positions regarding what is wrong about homosexuality.
January 2nd, 2012 | 6:28 pm
But earlier on this thread you called homosexuality “disordered.” So which is it, is homosexuality disordered or not?
I agree with the general point you’re trying to make (or I think you’re trying to make anyway), which is that the word “disordered” is a value judgment and is therefore not compatible with the assertion I was making earlier, about value judgments being inappropriate.
It’s currently the word that is in use. But I think we would all be better off if we rethought what it means to use this particular metaphor to describe the boundary between norms and deviation.
January 2nd, 2012 | 7:40 pm
about value judgments being inappropriate
Blake,
Not every judgment is a “value judgment,” and if no one made judgments in either general medicine or psychiatry, it is difficult to imagine what doctors or psychiatrists would do.
Doctors and psychiatrists have to make distinctions between health and disease, pathology and non-pathology, because it is their job, if they can, to help people who are not well get better, or at least help them deal with whatever health issue they have. It is not their job to treat people who don’t require treatment.
When anyone goes to a doctor or a psychiatrist for help, they generally hope for a diagnosis, or alternatively, they want the doctor to say something like, “I don’t see anything to be concerned about.” They want to know either that they have something that medical science knows how to treat, or they have something with no well-understood cause but something that poses no danger.
Without diagnosis, how is treatment to be determined? If a psychiatrist doesn’t diagnose bipolar disorder correctly, he or she may prescribe antipsychotics. I used to know someone who had an attack of shingles in the nerves of her face that was so intensely painful she could hardly communicate when she got to the emergency room, and based on a misunderstanding of her behavior, they had a psychiatrist examine her. A correct diagnosis can be absolutely critical. So it makes no sense to say people shouldn’t be “labeled” (meaning diagnosed).
January 2nd, 2012 | 7:44 pm
But I think we would all be better off if we rethought what it means to use this particular metaphor to describe the boundary between norms and deviation.
Blake,
So would you like a system that classified a severely mentally retarded person the same way it classified a genius? Say, three standard deviations distant from the mean?
January 2nd, 2012 | 10:35 pm
Without diagnosis, how is treatment to be determined?
If there’s a physical problem, then diagnosis can and should work the same way other physical illnesses work.
If there isn’t, then what is happening here is not a “diagnosis”, and mental health practitioners should stop pretending that what they are doing is the same in kind. It isn’t, and ethically they ought to stop deliberately blurring the boundaries between the sort of knowledge that arises from physical fact vs. the sort of philosophical supposition that arises from ideological judgments and speculation.
The entire concept of the DSM is about classifying and legitimizing “illnesses” that don’t actually meet the much higher standards that real medical professionals use. Some of these “illnesses” are physical illnesses that we don’t yet know how to identify or treat properly. Others are merely behavioral descriptions. In either case, we do not have what it takes to actually treat these problems according to real medical standards, so what we have instead is the DSM – a book where a bunch of ideologically conformist “experts” have voted on what is and is not “normal” and “healthy”, freely blurring scientific fact with ideological opinion, and from these value judgments have derived checklists which are used for what they misleadingly call “diagnosis”.
They pretend that these checklists are somehow similar in kind to real diagnosis, but they’re not. They’re about as “scientific” as a religious tribunal. (Remember that in America, today, we still have people receiving lobotomies and electric shock treatments against their will. People are tied to tables and pain is used as a method of forcing compliance.)
This matters because real medicine is not ideological. We recognize that doctors have an obligation not to impose their own value judgments over their patients; we rightfully frown at doctors who claim they can “cure” homosexuality in unwilling teenagers, or who do breast implant surgery on girls who are too young.
What is in the DSM is presented as if it were scientific , but in truth it is riddled with value judgments . That is a line that should not be blurred, but should rather be made very distinct. I realize that granting to the client the power to set his or her own goals rather than submitting meekly to preconceived categories of “types” (or “stereotypes”) of people means rethinking the entire way we do mental health treatment, but really, it is necessary if we are ever going to start seeing mental health patients as people we want to help (as opposed to just seeing them as people we want to sell drugs, books, and therapies to.
January 2nd, 2012 | 10:37 pm
links that got omitted include: diagnostic criteria for ADD, defiant disorder, conduct disorder, etc.; youtube video (http://www.youtube.com/watch?v=Y9MFltetzlw); profits from drugs and therapies.
January 2nd, 2012 | 10:57 pm
Blake,
“Humanists insist they aren’t a religion – they claim to be “science.”
Who are you talking about? This thread is about psychiatry and the DSM. Are all psychiatrists humanists? Are all scientists humanists? Is science synonymous with the Enlightenment? Are all gays humanists, scientists, and believers in the Enlightenment? You throw around terms for which you have concocted private meanings and then act surprised when no one has a clue what you’re saying.
“Humanists, unlike the Catholic church, refuse to submit to the limitations and restrictions that go with being a religiously oriented charity provider”
The Roman Church wasn’t always content to submit to limitations and restrictions but instead wanted to impose them on others. What changed its mind?
“But the same people who argue most fervently that “obviously” it is harmful to be stuck with an ideologically incompatible service provider do not care about whether it is harmful for Christians.”
Really? How fascinating. I’d love to hear a story about a Christian who has been harmed because a humanist forced him to work with an ideologically incompatible service provider. Can you give me an example?
“For all that people want to make me out to be some sort of bigot, I have never argued that gays have less right to their freedom of belief than I do.”
My dictionary makes no connection between bigotry and freedom of belief. Perhaps yours does.
“I do argue that they are morally obliged recognize that their lover can’t be the child’s other parent, but in reality can be no more than a stepparent…you are not free to make up your own reality and then demand other people play along”
I’ll inform my adopted children that my wife and I are not their parents but are in fact their stepparents. When my children return from the dictionary, asking how I could be their stepfather when I didn’t marry their birthmothers, I will explain that Blake made up his own reality and then demanded that I play along.
“I may call anyone anything I like”
Then you’ll stop getting upset when I tell you that calling homosexuals “bestial” makes you a bigot.
“As a general rule, here is a handy test by which you can see whether something is ideological rather than objective: if a gay man wants X, and a Jehovah’s Witness came along and wanted X too, would you be able to accommodate both?”
So if I’m willing to let a gay man marry a man and I’m willing to let a Jehovah Witness marry a man, then I pass the test. I’m not ideological. Hooray!
“I agree with the general point you’re trying to make (or I think you’re trying to make anyway), which is that the word “disordered” is a value judgment and is therefore not compatible with the assertion I was making earlier, about value judgments being inappropriate”
Excellent. I look forward to you informing the Roman Church that its use of “disordered” is inappropriate in the catechism.
January 2nd, 2012 | 11:20 pm
quote-unquote: Ever since Freud described religious faith as an illusion and a neurosis there has been tension and at times hostility between religion and psychiatry. Psychiatrists are less religious on average than other physicians, according to previously published data from the same survey, and non-psychiatrist physicians who are religious are less willing to refer their patients to psychiatrists.
This report found that although they may be less religious than other physicians, psychiatrists appear to be more comfortable and have more experience addressing religious or spiritual concerns in the clinical setting.
“Recent efforts have begun to bridge the divide between religion and psychiatry,” said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. “In the past, manuals of psychiatry tended to identify religiosity with mental illness. Now they distinguish normal religious and spiritual ideas and behaviors from those that result from mental illness.”
http://www.sciencedaily.com/releases/2007/12/071210163123.htm
January 2nd, 2012 | 11:23 pm
IN RESPONSE TO: “I look forward to you informing the Roman Church that its use of “disordered” is inappropriate in the catechism.”….I must say: why shouldn’t the church use the “order/disorder” metaphor to refer to people who reject God’s order?
January 3rd, 2012 | 9:35 am
” I used to know someone who had an attack of shingles in the nerves of her face that was so intensely painful she could hardly communicate when she got to the emergency room, and based on a misunderstanding of her behavior, they had a psychiatrist examine her.”
And what was the psychiatrist’s diagnosis?
January 3rd, 2012 | 9:55 am
And what was the psychiatrist’s diagnosis?
Bay,
I don’t know if the psychiatrist actually diagnosed shingles, but he realized my friend was acting the way she was (crying, difficulty communicating coherently) not because she had a psychiatric problem, but because she was suffering intense pain in her face.
January 3rd, 2012 | 11:51 am
“I do argue that they are morally obliged recognize that their lover can’t be the child’s other parent, but in reality can be no more than a stepparent…you are not free to make up your own reality and then demand other people play along”
Again? Really? Again? Being that something like 70% of same sex couples do not even have any kids (biological, adopted, foster, whatever) must we be spammed by this every time any thread touches homosexuality even tangentally?
January 3rd, 2012 | 12:30 pm
Boonton,
Perhaps First Things should give Blake a separate, permanent space where he can expound on his theory that there is no way for gay people to have families without lies, lies, and more lies. Then he could just link to it instead of retyping it in every thread. I still for the life of me can’t figure out why it is not a condemnation of everyone who adopts, uses in vitro fertilization or artificial insemination, and so on.
January 3rd, 2012 | 2:46 pm
David,
Just this morning, I told my adopted children to stop lying by calling me “dad.” I explained that they should always call me “adopted dad.”
The elder then explained that he hadn’t adopted me because he had had no choice in the matter. He explained further that I had behaved selfishly by pretending that I could ever be his father. Instead of calling me “adopted dad,” he proposed that he should call me “dad who pretends to be my dad.”
At that point, I spanked him and sent him back to bed.
January 4th, 2012 | 12:36 am
Allan Bloom (a gay man!) described well the concerns that poor old Blake – backed into a corner by accomplished, predictable contrarians Boonton and David Nickol – raised earlier. Psychiatry and psychology are parasites, whose best moments come from either the hard science contributions of physiology or the humane contributions of philosophy (and it’s distant practical cousin, counselling). It must be this way, because the hard science permits them to make no value judgements, and the humanities forces them to do just that.
Hence the shame referenced earlier: they are working in a discipline that must, to assert it’s very legitimacy, develop procedures and treatments to lead a person to “health” without the courage of stating clearly what health actually is.
Without acknowledging its debt to Aquinas common physiology nevertheless still acknowledges the essential properties of, say, an arm, can identify when those properties are malformed, and can thus diagnose and fix a broken one. What are the essential properties of a psyche or a soul, and where in the various DSMs are its description? How can this be defined without, as Blake asserts earlier, a value judgment, and what self-respecting modern scienctific discipline wants to pin its legitmacy on something as unrigorous as a value?
True, conventional medicine works in grey areas, but it certainly isn’t defined by it. The same cannot be said of Psychology and Psychiatry, who must work from the fringes in: adept (and useful) at diagnosing the obvious malady (an area that biology and physiology have increasing dominance), and then pulling those fringes as far into the middle as possible. A Psychologist and (especially) a Psychiatrist loves a bad case, because it’s the best way to prove their utility: that poor person compulsively turning the light switches on and off is the best thing that ever happened to the disciplines. Anything more subtle – and what is more subtle than sexuality? – and it is, at best, savvy observationalism. At worst it’s elaborate guesswork based on unprovable theories.
The conversation (and, in my browser anyway, the page formatting) has degenerated in a predictably internet sort-of-way. The two camps are formed – the homosexualists, for whom a bad word about homosexuality is the one true sin – and the moralists, for whom a good word about homosexuality is the one true sin. But the argument isn’t essentially about psychology, it’s about philosophy (and theology): what is the good life?
And that’s why Joe was quite right to point out (clumsily) the hypocrisy and shame of confidently declaring something healthy or unhealthy without, alas, being able to define “health”. The enterprise is fatally flawed at it’s premise: why should we be surprised that this beknighted science can’t make up it’s mind about what’s worth treating and what isn’t? This isn’t a function of the discipline’s youth, it’s a function of it’s premise.
One of the cagiest insights into modern psychology was a skit that SNL used to run where Barbara Walters interviews Ronald Reagan. Despite herculean efforts (including smoke machines) Barbara just can’t make old Ron cry: he’s too optimistic, too cheerful, too happy. This being SNL, the joke was supposed to be on the poor dumb Reagan, because so much of our culture is premised on examining, teasing and exposing the precious Id. Only modern Psychology and Psychiatry would diagnose a happy, optimistic man as a sick man and make him an object of pity.
January 4th, 2012 | 10:03 am
predictable contrarians Boonton and David Nickol
ERB,
This made me smile. I don’t think there is an antonym for contrarian (protrarian?), but if there were, I think it would apply more to Boonton and me than to most of the people and ideas we disagree with here. First Things is a very, very atypical site, where (as one example) what amounts to a conspiracy theory is embraced by many who post here as the explanation for modern psychiatry. I think if a poll was taken of educated people who knew enough about modern psychiatry to comment on it, Boonton and I would be in the majority, and you and Blake would be in a small minority.
I was telling a friend about this discussion, and he asked, “What do they want?” If someone has schizophrenia, or bipolar disorder, or post-traumatic stress syndrome, or clinical depression, or obsessive-compulsive disorder, would you and Blake discourage them from seeing a psychiatrist?
I think you are correct (and in fact, I lamented this myself a couple of days ago) that the thread has deteriorated into a discussion of homosexuality, with familiar positions being restated for the umpteenth time. That was predictable, however, when Joe threw in the 40-year-old decision of the APA to remove homosexuality from the DSM-II as an example of what is wrong with the DSM-IV, which takes an entirely different approach than the DSM-II did, in no small part as a reaction to how inadequate the methods of psychiatric diagnosis were in 1973.
Psychiatry does not try to answer the question “What is the good life?” any more than other branches of modern medicine do. It tries to identify and correct disorders. I have known a few therapists (and a couple of people studying to be therapists) personally, and what they all shared in common was a desire to know “what makes people tick” and a desire to alleviate suffering. Some were people who believed they had been helped tremendously by therapy and wanted to help others the way they had been helped.
The question of what health is presents a problem not just in psychiatry, but in the type of medicine practiced by primary care physicians and others caring for physical conditions. For example, is a person with high cholesterol unhealthy or sick? To the best of my knowledge, all insurance covers rather expensive drugs (like Lipitor) to lower cholesterol. Is menopause an illness or a normal stage of life that women should just suffer through like their grandmothers did?
January 4th, 2012 | 1:16 pm
If Blake feels ‘backed into a corner’, he has no one to blame but himself. He whips his hobby hoarse (gays who are raising children) on every thread he can find, refusing to apply his improvised principles to anyone other than his pet beef and refusing to honestly address criticisms. Maybe Allen Bloom did a better job ‘expressing’ Blake’s concerns, but Blake is no Allen Bloom and just because Allen Bloom was more honest and intelligent than Blake doesn’t give Blake excuse when he’s exposed here manufacturing facts and making insipidly poor arguments.
The conversation (and, in my browser anyway, the page formatting) has degenerated in a predictably internet sort-of-way. The two camps are formed – the homosexualists, for whom a bad word about homosexuality is the one true sin – and the moralists, for whom a good word about homosexuality is the one true sin
The true sin in my book is making a bum argument or presenting false facts. Let me just give you a small hypothetical. Suppose I conducted a ‘study’ of Christianity. Suppose I were to call up my friend who is a psychologist working for a state correctional system, I ask him if he happens to have any Christian patients. Why yes, he informs me. I ask if they have anything in common and he says well they’ve all been convicted of crimes. I call up a few more psychologists who have private practices. They inform me that they have various Christian patients seeing them for a host of mental issues. Likewise I call up another whose running a mental hospital….and lo and behold the Christians there all have serious mental problems. From this I announce that Christianity is a mental disorder and the profession should seek to find ways to treat and cure Christians.
Laugh if you will but this was the core of the ‘emperical evidence’ that justified the original inclusion of homosexuality. Imagine a defender of Christians conducting the following counter study: She assembles some profiles of Christians and non-Christians and asks so-called experts to identify who the disordered Christians are. When they are unable to do so at rates better than simple chance, it’s concluded that the decision to include Christianity as a disorder was ill founded.
The second was actual emperical evidence in support of dropping the diagnosis, and I was trashed here by the argument that it wasn’t a ‘perfect’ study, couldn’t prove beyond doubt….and the person who conducted the study was an ‘activist’. So yea like I said the sin in my book is making a bum argument or false statement which is what I try to pounce on, not merely ‘a bad word about homosexuality’. I think what’s causing you to make the charge against me is the unfortunate fact that many here who are obsessed with bashing gays also seem to be unable to hold together a coherent argument or in some cases don’t even care to hold off making false statements that are easily demolished.
The same cannot be said of Psychology and Psychiatry, who must work from the fringes in: adept (and useful) at diagnosing the obvious malady (an area that biology and physiology have increasing dominance), and then pulling those fringes as far into the middle as possible. A Psychologist and (especially) a Psychiatrist loves a bad case, because it’s the best way to prove their utility: that poor person compulsively turning the light switches on and off is the best thing that ever happened to the disciplines. Anything more subtle – and what is more subtle than sexuality? – and it is, at best, savvy observationalism. At worst it’s elaborate guesswork based on unprovable theories.
But this seems to counter your criticism. Saying a person has some type of mental illness because he has a compulsion to turn light switches on and off is a pretty good example of an ‘obvious malady’ and one that is not obviously the domain of biology and physiology (although ultimate treatments for such maladies may come from those fields). Why shouldn’t a psychiatrist ‘love’ a bad case’ like this in the same way a doctor will ‘love’ a case of cancer he is able to cure? This sounds like what psychology should be addressing and it should be avoiding ‘philosophy’….it shouldn’t be trying to classify as ‘mental illness’ unorthodox political or religious beliefs, or nonconformity. Instead it should be asking what may be inhibiting the patient from enjoying the complete freedom of his own judgement and that should be treated. Beyond that the individual should be turning to philosophy to advise him on how he should use his judgement.
Without acknowledging its debt to Aquinas common physiology nevertheless still acknowledges the essential properties of, say, an arm, can identify when those properties are malformed, and can thus diagnose and fix a broken one. What are the essential properties of a psyche or a soul, and where in the various DSMs are its description?
I would say the essential properties of a psyche should be to take in information from the outside world and make accurate conclusions about it. Exercise judgement without being clouded. Most DSM issues seem to have that concept in mind. A schizophrenic who perceives the world as conspiring against her is objectively different than, say, a perfectly sane person who decides that he hates Jewish people. The former has her judgement clouded by her brain’s inability to properly process external information, the latter has simply made a poor judgement that he should be responsible for. The line gets blurred because we know that many elements of what we like to think of as ‘being us’ are in fact the functioning or disfunctioning of our brian. But this ‘ultimateness’ comes into play elsehwere too. Physiology may delinate the ‘essential properties’ of an arm and thereby identify a broken one, but that doesn’t explain why people should have arms as opposed to, say, tentacles and what people should be doing with their arms!
January 4th, 2012 | 2:04 pm
No, the line gets blurred because we confuse psychology with legal guardianship. When a person is not capable of taking care of themselves (or is a threat to others), the law already allows for the assignment of a legal guardian. There is no need for psychologists to appropriate authority over other peoples’ lives – the right to decide other peoples’ fate should stay with the person who actually has responsibility for the outcome. (And that is the big problem with psychology/psychiatry, as with all the great left wing “helping” projects: they appropriate the power to decide other peoples’ fates, but they don’t accept the responsibility that goes with that power.)
January 4th, 2012 | 4:08 pm
No, the line gets blurred because we confuse psychology with legal guardianship.
We do? Legal guardianship is no easy task to pull off when its just for psychological reasons and against the will of the patient. But its rarely disputed in mass. Most people who have been ruled legally unfit to run their own affairs appear to be really unfit to handle their affairs.
There is no need for psychologists to appropriate authority over other peoples’ lives – the right to decide other peoples’ fate should stay with the person who actually has responsibility for the outcome
That would make a lot of sense, if you weren’t just arguing against removing homosexuality from the DSM…or sounding like you were. Get your story straight….if you can.
January 4th, 2012 | 10:23 pm
The reason legal guardianship is hard to pull off is that taking control of someone else’s life above their objections is a serious thing to do. The standard SHOULD be high. The burden of proof SHOULD be a significant burden. But how typical of a left winger to think that because due process is difficult, that somehow justifies “ends justifies the means” shortcuts, however unethical.
January 5th, 2012 | 7:25 am
Does anyone here even know what he’s talking about? Or am I supposed to believe he is saying something coherent because 20 years ago Allan Bloom wrote something worth reading? I’m asking that as a serious question, not simply to be rude (although rudeness has its virtues in some cases).
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