Psychiatry indeed has a pretty bleak history, and it's fair to criticize that history. It is true that the DSM as it categorizes mental disorders is not biologically valid in general, however, most psychiatrists today recognize it just as a communication tool. Two psychiatrists with patients exhibiting similar symptoms can be concisely described using DSM vocabulary.
It is also necessary for billing purposes. Insurances want to put labels on things so they can price and track things. This is true of all medicine, however. When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons.
"The pathological basis of almost all mental disorders remains as unknown today as it was in 1886" (article quote) I don't think this is true. We don't know enough to make targeted treatments quite yet, but we do know a lot more about the brain now and have much more reliable theoretical conceptions of mental illness.
There is a ton of research going on in understanding mental illnesses at computational and circuit levels, and we're already starting to see the fruits of that research. Researchers are developing targeted treatments using transcranial magnetic stimulation (TMS) and similar modalities to directly perturb circuits that are believed to be deranged.
I think psychiatry will change significantly over the next decade or so as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level. I don't see how drugs will play a major role in this as it is very difficult to develop a drug that could target specific circuits.
This time really is different.
(Psychiatrist in training here)
> When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons.
We have no choice but to stratify disease into low, medium and high when there are only low, medium and high dose interventions.
For the most part, this works because individualisation is such a pain.
But if individualisation wasn’t, you’d get 1 of a thousand different doses to optimize and eek out slight additional benefits.
We could apply high frequency trading algos to an implanted infuser, or deep brain stimulator or wearable TMS when we get around to accepting/funding them for more common and non-extreme diseases.
Well neural computations happen at the level of individual neurons up through complex multi-neuronal circuits, cognition and behavior are the result of neural computation, therefore if cognition is abnormal then computations at the level of neurons up to circuits must be deranged. Nothing fancy.
>cognition and behavior are the result of neural computation
That's like saying if someone gets shot and dies it's because they merely had a faulty brain -- it's ignorant of the actual cause.
Neurons don't exist in a vacuum, they respond to social, environmental, and biological inputs.
How does psychiatry scientifically decide if a persons deranged mental behavior is due to mere deranged circuits or deranged social, environmental, or biological inputs?
I see where you’re coming from. I think a great deal of mental illness is social and environment. We did not evolve to live in the circumstances of developed societies. So absolutely if we could change environment and social factors that would help a lot.
But just take depression for example. Let’s say Bob goes to a psychiatrist with depression. Bob recently lost his job and his girlfriend left him. He has every reason to be depressed. He would probably feel a lot better if he had a job he likes and wasn’t so alone. The problem is he’s too depressed to look for a job or to go out and meet new people, the things that would help his depression. This is where I think psychiatry can be helpful; some people just need something to break them out of their depression for long enough to be able to make the social/environmental changes in their life that will help them in the long run. Therapy alone may be enough for some people but not for everyone.
>some people just need something to break them out of their depression for long enough to be able to make the social/environmental changes in their life that will help them in the long run
It is also necessary for billing purposes. Insurances want to put labels on things so they can price and track things. This is true of all medicine, however. When do you call high blood pressure too high? Greater than 140 mmHg? 130? Someone has to pick an arbitrary threshold for practical reasons.
"The pathological basis of almost all mental disorders remains as unknown today as it was in 1886" (article quote) I don't think this is true. We don't know enough to make targeted treatments quite yet, but we do know a lot more about the brain now and have much more reliable theoretical conceptions of mental illness.
There is a ton of research going on in understanding mental illnesses at computational and circuit levels, and we're already starting to see the fruits of that research. Researchers are developing targeted treatments using transcranial magnetic stimulation (TMS) and similar modalities to directly perturb circuits that are believed to be deranged.
I think psychiatry will change significantly over the next decade or so as we learn what is wrong with a specific individual's brain and intervene directly at the circuit level. I don't see how drugs will play a major role in this as it is very difficult to develop a drug that could target specific circuits.
This time really is different. (Psychiatrist in training here)