Very interesting read but I think it mischaracterizes how academic psychologists/neuroscientists understand the problem. Our system is like Beccaria's because it has to be given the current state of knowledge. We have to define mental illnesses in terms of syndrome (behavioral effects), rather than underlying pathology (causal biological mechanisms), because we don't understand the underlying pathology yet. People need help, SSRI's save lives, and if you're a clinician it doesn't matter if you know why they work or not—they work often enough. And we have to apply general diagnostic labels because our understanding of individual differences is not nearly precise enough (yet) for idiopathic tailoring of interventions.
I cannot wait for the day when we can understand the mechanisms that produce depression or OCD well enough to target our interventions more precisely (or understand why current treatments work and in whom). But we're not there yet. The root of the problem is scientific, not philosophical. I grant that while we wait for better scientific understanding (which could be a long time), we need to be clear-eyed about what these diagnostic categories actually represent. I don't love the DSM either. But I wouldn't go so far as the author, suggesting that "scientists appear to be confused" and are trying to solve the problem by "aimlessly throwing data at the wall." That is not my experience of clinical neuroscience at all.
neuro_otter t1_jbzj32t wrote
Reply to The philosophy of Beccaria is relevant to understand the current mental health crisis. The idealistic abstractions of the legal system are akin to the ones used in psychiatric discourse. by carrero33
Very interesting read but I think it mischaracterizes how academic psychologists/neuroscientists understand the problem. Our system is like Beccaria's because it has to be given the current state of knowledge. We have to define mental illnesses in terms of syndrome (behavioral effects), rather than underlying pathology (causal biological mechanisms), because we don't understand the underlying pathology yet. People need help, SSRI's save lives, and if you're a clinician it doesn't matter if you know why they work or not—they work often enough. And we have to apply general diagnostic labels because our understanding of individual differences is not nearly precise enough (yet) for idiopathic tailoring of interventions.
I cannot wait for the day when we can understand the mechanisms that produce depression or OCD well enough to target our interventions more precisely (or understand why current treatments work and in whom). But we're not there yet. The root of the problem is scientific, not philosophical. I grant that while we wait for better scientific understanding (which could be a long time), we need to be clear-eyed about what these diagnostic categories actually represent. I don't love the DSM either. But I wouldn't go so far as the author, suggesting that "scientists appear to be confused" and are trying to solve the problem by "aimlessly throwing data at the wall." That is not my experience of clinical neuroscience at all.