April 11, 2007

The Trouble With Psychiatry-- "Not Even Wrong"

I recently read Martin Gardner's review in the New Criterion of Lee Smolin's The Trouble With Physics, and Peter Woit's Not Even Wrong: The Failure of String Theory.

I am almost finished Smolin's book, but I wanted to make a comment about Gardner's piece.  Writing in the New Criterion, he should have appreciated a wider view of the books, that they speak to more than physics.  They're just as much about psychiatry.

Because I suck at writing, I'm a much better speaker, I often have difficulty getting my ideas-- which are already baffling-- across to people indoctrinated in psychiatric mythology.  But Gardner does a great job, so I'm simply going to quote him verbatim.  I don't think he'll mind.  Just substitute the word "psychiatry" anywhere you see "physics."

He sees string theory as not a theory—only a set of curious conjectures in search of a theory. True, it has great explanatory power, but a viable theory must have more than that. It must make predictions which can be falsified or confirmed.

Consider that the terms "borderline" and "narcissist"  which have supposedly no predictive power, yet give you more information than the epidemiologically valid and "reliable" diagnosis "bipolar."


In a chapter on sociology, Smolin introduces the concept of “groupthink”—the tendency of groups to share an ideology. This creates a cultlike atmosphere in which those who disagree with the ideology are considered ignoramuses or fools. Most physicists tied up in the string mania, Smolin believes, have become groupthinkers, blind to the possibility that they have squandered time and energy on bizarre speculations that are leading nowhere.


The last part is key-- who among psychiatrists are willing to say, "holy crap, we just made this all up as we went along!"

The other book Gardner reviews is Not Even Wrong, the title coming from Wolfgang Pauli's quote that a theory was so ridiculously unscientific that it was "not even wrong."  Quoth Gardner: "By this he meant it was so flimsy it couldn’t be confirmed or falsified."

Gardner quotes another writer (Glashow), in an indictment of why the masturbatory nature of psychiatry is detrimental to its own practitioners.  Replace "string theory" with "bipolar model:"

Until string people can interpret perceived properties of the real world they simply are not doing physics. Should they be paid by universities and be permitted to pervert impressionable students? Will young Ph.D’s, whose expertise is limited to superstring theory, be employable if, and when, the string snaps?

And closing with a quote from the physicist Gerard ’t Hooft:

 Actually, I would not even be prepared to call string theory a “theory” rather a “model” or not even that: just a hunch. After all, a theory should come together with instructions on how to deal with it to identify the things one wishes to describe, in our case the elementary particles, and one should, at least in principle, be able to formulate the rules for calculating the properties of these particles, and how to make new predictions for them. Imagine that I give you a chair, while explaining that the legs are still missing, and that the seat, back and armrest will perhaps be delivered soon; whatever I did give you, can I still call it a chair?

I wish I could write better, more clearly.  I can't.   But at least read Gardner and Smolin-- if the problem of loose science and groupthink occurs in the hardest of the sciences, physics, it most certainly occurs in psychiatry.  The first step in recovery, of course, is admitting you have a problem.  We may never get past this step.  The second step is to stop pretending you're something you're not, stop trying to make judgments and pronouncements about which you know nothing: Wovon man nicht sprechen kann, daruber muss man schweigen.



A sure way to get people up... (Below threshold)

April 11, 2007 7:55 AM | Posted by Cheryl Fuller, Ph.D.: | Reply

A sure way to get people upset is to tell them that the whole diagnostic enterprise in mental health is metaphor and that in many ways it differs only in time and language from the the metaphor of the wandering womb to explain hysteria.

Count me as an eager fan of what you say here.

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great post, alone. i've bee... (Below threshold)

April 12, 2007 1:44 PM | Posted by Philip Dawdy: | Reply

great post, alone. i've been tip toeing around this dicotomy for ages and have been scared to write that the dsm--esp for many dx's--is essentially a book of metaphors. thanks for doing this. it's kicking me in the pants. metaphorically, of course.

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Oh, I thought you meant psy... (Below threshold)

April 14, 2007 7:33 PM | Posted by Anonymous: | Reply

Oh, I thought you meant psychics.

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As a fellow practitioner of... (Below threshold)

April 15, 2007 6:27 AM | Posted by Chris Gale: | Reply

As a fellow practitioner of the art of psychiatry, I'd suggest that we simply state the truth: the current classification of personality disorders (Axis II) is broken. Firstly, the diagnoses are not stable, Secondly, (with the exception of antisocial) they are not well validated.

It seems that there is a fetish about the diagnosis: I think it is better to say "I don't know" if we are still observing and doing a workup, and to delay definitive statements until we definitely know what is going on. (I'm aware most of the time this is not a problem, but at times it is).

A couple of niggles. Firstly, at least two atypical anti-psychotics are generic. Secondly, the NEJM article replicates (and contradicts) European, UK and ANZAC data that antidepressants work in bipolar depression. But then, the US is the only place where antidepressants are not used in this group -- often with anti-psychotics and mood stabilisers. I don't consider this will change practice.

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great blog -- i don't know ... (Below threshold)

April 15, 2007 1:35 PM | Posted by great blog: | Reply

great blog -- i don't know if you do "requests," or are willing to analyze celebs from a distance, but I'd love to see a post on angelina jolie. Her apparent "craziness" is fascinating to many.

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I love the post. Also, con... (Below threshold)

April 15, 2007 7:29 PM | Posted by John Christian, PsyD: | Reply

I love the post. Also, consider me a new fan. Regarding our diagnositic system, I have many complaints, my foremost being the application of the "disease model" to mental health. On another note, a psychiatrist friend of mine told me that he recently attended a conference on the upcoming DSM-V, where the speaker informed the group that five (!) categories of bipolar were being considered.

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There is some excellent exp... (Below threshold)

April 17, 2007 1:32 PM | Posted by Ozgur Sahin: | Reply

There is some excellent exploration of the root of this sort of issue in quantum mechanics in the book Quantum Questions by Ken Wilber (who himself deals with models of consciousness). It includes lengthy quotes from a number of the pioneering quantum physicists (including Pauli, I believe), though these quotes are primarily of a philosophical bent.

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Wilber is not trained or li... (Below threshold)

April 19, 2007 9:12 PM | Posted by AK: | Reply

Wilber is not trained or licensed as a mental health professional and does not have academic training or credentials in psychodiagnostics.

He also has a track record of endorsing gurus who have very troubled histories (A. Cohen, Adi Da and Marc Gafni) and associates mostly with young admirers.

Its best to stick with material from peer reviewed journals.

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Hey I was wondering if mayb... (Below threshold)

May 24, 2007 7:27 AM | Posted by Rebecca: | Reply

Hey I was wondering if maybe you would be able to offer a little advice. I have been accepted into med school but am now starting to think maybe I should turn it down. I have become disheartened by the research I have doen on my interest in Psychiatry for a career, there are many, many problems with it and I am not sure as to whether I should want a career in it anymore which in a way pans me to say. As you are as psychiatrist in particular a Forensic Psychiatrist (my interets area) I felt maybe you would the most suitable source of advice that I could get. I don't want to make the wrong choice. I know it is my decision ultimately but any advice atall would be greatly appreciated and may actually help.

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