Friday, October 13, 2006

Dubious psychiatry

When it comes to disorders affecting human physiology we all understand what a clinical entity is. It can be a disorder adhering to Koch's criteria, such as tuberculosis, where the agent is a bacillus, or it can be a response to the environment, as in hyperthemia.

Psychiatry has often claimed to be a medical discipline, and indeed psychiatrists (unlike psychologists) are usually MDs. However, we need to look critically at their tranfer of medical concepts to their discipline.

Until 1973 the American Psychiatric Association regarded homosexuality as a disorder. Then, after a vote was taken, the category was replaced--or rather modified, since for a time "ego-dystonic homosexuality" continued to rank as a disorder. Yet who ever heard of taking a vote to decide whether tuberculosis or cancer are disorders? Needless to say, I am glad that the denigration of same-sex behavior was modified, and later eliminated. Yet the way in which is was done seems strange. The fact that changes can be made so cavalierly, as it were, ought to elicit suspicion about the claims of the psychiatric establishment.

The results of this change and others were incorporated in the official APA volume, the Diagnostic and Statistical Manual (DSM). It was widely recognized that this compilation left a good deal to be desired, and a further revision was undertaken. Dr. Robert Spitzer labored intensely for seven years to make the work more comprehensive and precise. The result is known as DSM-IV (sometimes accompanied with other sufficxes to indicate the particular state).

Despite this effort many observers note that the DSM definitions are still lacking in transparency. That is to say, a patient who may be diagnosed by one clinician as bipolar may not be so regarded by another. As a rule such problems do not occur with disorders that are physiologically sited.

My learned friend on the Adriatic has said that ethnic self-hatred is a clinical entity. As I have shown, however, the category was invented by Theodor Lessing in 1930 and has since undergone various vicissitudes. It will not do simply to label ethnic self-hatred and gay self-hatred clinical entities without further discussion. By whose definition and under what criteria?

I do not doubt that there are some African Americans, for example, who suffer from a crippling sense of racial inadequacy. But is "self-hatred" the best way to characterize this condition? When one gets right down to it, how can one hate oneself in any fundamental fundamental sense? If one does, how can one stop? Yes, I am acquainted with the Freudian concept that depression is internalized aggression, and other such notions. But not one distinctively Freudian idea has survived the powerful acids of criticism that have been applied in the last few decades.

May I suggest that another way of addressing the matter of group low esteem in individuals who have this problem is the idea of false consciousness. In this concept, which arose in Marxist circles in the 1920s, the individual is seen as having come to entertain a distorted idea of his or her actual social situation owing to having assimilated ideas diffused by the power structure. These ideas have precisely the function of disabling those subaltern individuals who have accepted them. The remedy is to encourage the victim to acquire a more adequate understanding of his or her actual situation, setting aside the false beliefs that serve the interests of an alien authority, disempowering those who have been suborned to adopt them.

In the gay-liberation circles of the 1970s we formed many consciousness-raising groups. They functioned effectively, I believe, in throwing light on these disabling mechanisms--mechanisms that had been implanted in us in one way or another by the host society. We had not come, by some mysterious process to hate ourselves, but had been induced by various forms of propaganda and social cueing to embrace an inferior status. Through careful study the malign influence of such motifs can be exorcized. However, a diagnosis of self-hatred may persist, beyond hope of permanent cure. For if one has mysteriously fallen into such a state it may be that one can never get out of it. Or it may recur.


Anonymous Anonymous said...

What's allowed under the rubric of "psychiatry" consistently fails the "evidence-based" medicine that everyone else in the field must master. The culprit is Freud and his psychoanalysts, who shifted from a "biological, chemical, and physical" model to superstitious metaphysics. Maybe Freud's arcane metaphysics of the mind may hit pay dirt, but the irreparrable damage has already (and continues) to be done. Homosexuality as a "pathology" is actually the least of the problem; as the APA demonstrated, they can vote to change course (as if science and medicine are "democrats"). Yesterday's "sickness" becomes a new day's "statistical difference from the mean."

Unfortunately, the "problem" is much more difficult than democratic psychiatrists can overcome. The "medical model" has always been pathologically-oriented (cf. "health" oriented), but other than psychiatry and pyschology, the model appealed to "empirical evidence." Even surgery, a medical "art," has appealed to surgical evidence of its successes and failures to hone it skills.

Some in the mental health field have had enough of the "scam" perpetuated by Freud and his legion of metaphysicians. Michael McGuire and Alfonso Troisi are two of many physicians insisting the DSM-IV be scrapped as a hangover of Freudian metaphysics "with symptoms." (Neither, by the way, is "gay.") But the entrenched establishment simply won't budge. The Therapeutic Industry has already been financially decapitated by the insurance industry, and since the former has NO empirical evidence to support its intervention, the latter has determined psychoanalysis is a luxury the pool cannot afford to subsidize. If one wants to "talk through his/her problems," then pay the costs of your psychoanalysis just as you pay for your own astrologer. The social costs are too great to reward this non-evidence-based industry; psychiatry, chiropractic, homeopathy, phrenology, tarot cards, etc. may be grand entertainment, but not at OTHERS' expense.

McGuire and Troisi have a much better idea: "Proximate events, genetic mistakes, predispositions, adverse environments, psychosexual stress, wrong or inadequate training, dysfunctional physiological systems, and intraphysic conflicts are SOMETIMES, but not always, part of explanations. . . many conditions turn out be be minimally adaptive; some turn out to be adaptive, and some features of conditions atempts to ACT adaptively." Only within the biological constraints of an organism's adaptation (or maladapatation) can FUNCTIONAL conditions be evaluated.

The mental health profession has it backass backwards; they observe "symptoms" (however ambiguous) and fit them into "theory" (often, but not always, Freud's). If Patient A's five symptoms comport with the DSM's eight, viola, the patient has X. (Exactness is NOT required. Closeness is close enough.) The question of "intervention" is not an empirical matter, rather it is left to the "clinician" to use his/her "art" as best trained. All this language is so laughably absurd that it flies only in the "mental sciences" (and other occult disciplines to which it is related).

But mental health is no laughing matter! People suffer and the mental professional offers panaceas of placebos instead of solutions. Now that the legacy of the Freudian "establishment" is entrenched and needs to survive, confronting the discordant nonsense is not an option. But the insurance industry is no longer willing to pay for such flights of fancy. Psychoanalysis has finally been "tested" in science's terms (not Freud's), and it is all hocus-pocus drivel that often exacerbates the illness, or those with enough capital can talk their way to "health." The Freudian-Marxist nexus (Lacan and Eagleton, notwithstanding) has been exposed by the rigors of the scientific method, and the ideology of the new Jewish Messiahs fall far short of any empirical mark. The riposte is that it's all another capitalist exploitation of the proletariat and the pyschosexual invert, but the cadences have been ringing false and empty so long, that many question all of it (as they long should).

What lies over the horizon, and fights the entrenched interests even now, is the simpler, less-dogmatic, non-ideological, non-metaphysical understanding that some of us "adapt" and those who don't go "mad." That's an obvious over-statement, but even in extremis it rings true. Biology, not ideology, is our modern inheritance, and the Platos, Aquinases, Freuds, and Marxists are just plain wrong and wrong-headed. Even in the Marxist diatribe against Darwin, Charles is finally prevailing, but the opposition remains perniciously stubborn. Even at this late date, science, not ideology, is rearing its head in those last bastions of privileged interests. But the battle is far from over. Self-interested psychoanalysts cannot afford to make their patients healthy, unless the Therapuetic State intervenes and subsidizes their witchcraft.

In a boldness not lays this nonsense to waste, McGuire and Troisci are succinct and admirably above the therapists they hope to depose for their fraud: "'The function of Trait T is F' requires that Trait T has been shaped by selection; that it serves Function F; and that Function F increases individual fitness . . . most mental conditions are conditions of failed functions." In simple lay language, mental health problems arise from the organism's failure to adapt to its environment." This Darwinian insight is not limited to the "physical," but to the "mental" in the same fashion. A "gay" individual may feel comfortable is his own skin, even proud, but if he cannot "fit" himself into his environment (whatever the reason, often because others won't acquiesce), he will not adapt to his niche, and develop a mental dissonance to his physical makeup. Such incongrueities, not an ego-id-superego fallacy of psychosexual repression, is the FUNCTIONAL source of his dissonance. Being "gay" is entirely natural, but expressing "nature" in a "culture" of opposition creates a dissonance that the mental health professions need to help him remedy. When he finds his "fit," he'll be spectacularly "adapted" and without dissonant incongrueties. If not, he'll sabotage himself for the sake of others' definition of "fit" that rings hollow and untrue. As a "freak, rebel, and subversive," he'll never find his adaptive "fit," and the mental health professions will have failed yet another, only to ply him with psychotropics.

It may seem odd that scientists understand these dynamics better than ideological theorists. But, the persecuted, reprehensible, and immoral queer is only acting out his failure to "adapt" and "fit" to his biological nature. Even if Freudians don't understand the dissonance, and then only enslave him to his dysfnction, Darwinian scientists very definitely do understand the dynamic, and THEY are willing to help.

8:04 PM  

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