[lbo-talk] Psychotherapy

Wojtek Sokolowski sokol at jhu.edu
Mon Apr 11 09:53:47 PDT 2005


Tully:


> Both my ex and I read a lot on the subject, and when I finally
> stumbled on DSM4, I realized that the field was simply a racket.
> That no one could escape being labeled mentally disabled to some
> degree. Everyone was a victim. That did it for me.

I think you are mixing up a few things, so let's sort them out.

1. Existence of quackery does not undercut the scientific foundations of medicine. Ditto for psychology. There are many quacks in the counseling business, but that does not undercut empirical research in the field.

2. DSM means diagnostic-statistical - with the emphasis on statistical - or probabilistic, if you will. That means that diagnostic procedure rests on evaluating statistical probability of a disorder based on coincidences of several distinctive symptoms. It does men that mentioning of a symptom signifies a disorder. To use an analogy - if you buy a lottery ticket it does not mean that you will be a millionaire - it means that you have a chance (not a very high one, but still a chance) of becoming one. Likewise, if you have something that resembles a symptom listed in DSM, it means that you merely have a chance of being a nutcase, not that you are one. That chance is determined by further testing that evaluate presence of other symptoms, etc.

3. The use of drugs have proven beneficial effects, even though the way they work is not always known. SSRIs are a good example. It has been determined how they work - by inhibiting the reuptake of the neurotransmitter seratonin (hence their name) and that the effect they produce can affect depression or bipolar disorder (both listed in DSM IV and neither having anything to do with psychoanalysis) - albeit it is not clear why and how. That is enough to justify using those drugs in treating patients suffering from depression or bipolar disorder who avail themselves of that treatment. Withholding these drugs on the ground that their effects are "unproven" would be indeed barbaric.

Of course that does not mean that everyone can benefit from SSRIs or that there is no risk - but the cost-benefit assessment can usually be made by a patient and a physician (or perhaps several physicians). It is taking a chance, like with everything else in life.

But again, that is different from unscrupulous quacks who push pills for a profit. The existence of the latter does not undercut the medicinal value of medication.

4. Nature vs nurture is a very blunt distinction - modern science can do much better than that. It is seldom either or, one or the other, but a combination of both.

Wojtek



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