[lbo-talk] Philip Mirowski - Social Physicist

Miles Jackson cqmv at pdx.edu
Fri Mar 5 08:33:26 PST 2010


Vincent Clarke wrote:
> Psychosis is similar. The reason (Lacanian) psychoanalysts differentiate so
> forcefully between psychosis and neurosis is because they have to make a
> call on it too - and the call they make could be the difference between
> psychiatric confinement and freedom. In fact once you get into that grey
> area of "well, you can't really differentiate between the two" you adhere to
> the diagnostic criteria put forward in the DSM - which leads to more
> confinement and an increased use of strong psychotropic drugs.
>
I don't have a dog in the Lacan fight, but I can't resist a side comment on this. Using the DSM-IVR criteria does not lead to increased psychiatric confinement and increased use of drug therapy. Prior to the widespread use of the DSM, people were confined in asylums and mental hospitals for all kinds of arbitrary reasons. The use of the DSM reins in the subjective judgment of psychiatric experts, so the overall effect is just the opposite than what you suggest.

On drug therapy: nothing in the DSM mandates or identifies appropriate treatments for a specific disorder. In fact, many of the disorders identified in the DSM are commonly and effectively treated using psychological rather than pharmacological interventions. I don't see how the existence of this diagnostic manual encourages drug therapy in particular.


> No, this is not the case at all. Psychoanalysts - at least most modern ones
> - don't claim that they have absolute knowledge of reality. What they claim
> is that they have specialised knowledge of what type of structures of
> thinking constitute psychosis and what type constitute neurosis/normality.
> Thus they can predict - usually with reasonable accuracy - whether someone
> will, in the future have a psychotic episode or not and they will cater
> their treatment accordingly.
Yeah, the "specialized" knowledge of psychoanalysts and three bucks will get you a latte at Starbucks. Clinicians are notoriously bad at predicting human behavior and treatment outcomes; there is a veritable mountain of research on this. One example: Prior to doing his famous obedience studies, Milgram described the procedure to some clinical psychologists and psychiatrists and asked them to predict how many people would go to the top of the shock panel because they were instructed to do so by the researcher. These clinicians confidently predicted that only a small number of people with serious mental illness (e.g., sociopaths) would apply the maximum shock level. In fact, about 2/3 of the participants obeyed the researcher and applied the maximum shock level. Moral: prudently ignore any predictions that clinicians make. They're typically claims based on authority rather than systematic evidence.

Miles

Miles



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