1/ I do think a lot of problems with current practices in psychiatry have to be do with system issues, however, these system issues have been synergistic with a variety of conceptual, scientific, & ethical problems that have to do with reductionism, diagnostic reification...
2/ ... eclecticism, manipulation of "evidence-based" medicine, neglect of phenomenology, lack of attention to power imbalances and systemic coercion, neglect of iatrogenic harm, & unreflective reliance on medicalization as the default for mental health care.
3/ An examination of these issues is not about blaming individual clinicians or researchers, or even about blaming psychiatry as a medical profession isolated from other disciplines, law, and society. These are larger forces that transcend any single individual or profession.
4/ People may disagree with my assessment & many do. They may think that baring system issues, everything is hunky-dory from a conceptual, ethical, and scientific perspective. I can only state that my assessment is different & articulate why I think so.
5/ These issues alluded to in the tweets above have been discussed in greater detail in my on-going series for @PsychTimes, "Conversations in Critical Psychiatry". I would welcome you to check out the discussions:
1/ "it is overwhelmingly likely that the differences in symptomatology which the DSM taxonomy captures reflect the contribution of the neural, neurochemical, and genetic differences, *plus* differences in higher-level factors: broadly, social and cultural factors." Neil Levy
2/ "These include (but are not limited to) the ways in which different mental illnesses are conceptualized in a society, the ways in which social roles are assigned & understood,...
3/ "... and perhaps idiosyncratic facts about the individual and her history which result in her having beliefs that modulate the form that her illness takes."
1/ "Whereas symptomatology is strictly illness oriented, psychopathology is also person oriented, since it attempts to describe the patient’s experience and her relationship to herself & to the world."
2/ "The patient is an active partner in the diagnostic process, capable of interpreting her own complaints. Symptoms are conceptualised as the outcome of a mediation between a vulnerable self and the sick person trying to cope with and make sense of her complaints."
3/ "The existing classifications of mental illnesses are merely provisional diagnostic conventions... if psychopathology is conflated with nosography, only those symptoms that are supposed to have diagnostic value will be investigated,...
1. Great paper by @HengartnerMP & @Altostrata, based on quantitative analysis of a case series. Given the paucity of previously published literature on this, this is an important contribution. Some thoughts and questions that come to my mind:
2. Chouinard & Chouinard criteria also specify criteria related to reversibility of symptoms & partial/total response to reintroduction of discontinued drug. It is unclear if these criteria were also applied as selection criteria.
3. To the best of our knowledge, unless future studies show otherwise, PWS appears to be a rare occurrence, but even rare occurrences can become common if the number of people being treated is large enough, & this is no reason to disqualify the suffering of those afflicted.
Some weeks back I had asked for articles on how to best understand & approach "treatment resistance" in psychiatry. I was preparing for a talk & wanted to see what ppl thought. It was interesting to see the mere mention of TR provoke some emotionally-charged responses! /1
Anyway, here are 3 articles I really enjoyed and found very useful on the topic of "treatment resistance" in psychiatry (mostly focused on depression) which offer a non-mainstream, critical view of the concept. /2
i) Treatment-resistant depression: problematic illness or a problem in our approach?
Malhi, et al. British Journal of Psychiatry. /3
Interview with Peter Zachar from my @PsychTimes series has been reprinted in @IntRevPsych in a slightly abbreviated form (will appear in print as part of an issue on the theme of Conceptual Psychiatry). /1
"The imperfect community is a non-essentialist idea, namely, that the various members of the class of psychiatric disorders have many things in common, but there is no one thing (an essence) that they all have in common that distinguishes them as a group from non-disorders." /2
"The resulting domain is, however, not random or arbitrary – new constructs have been introduced for reasons that reflect our scientific goals and pragmatic interests. Zachar is sceptical about the possibility of a single correct and privileged psychiatric classification..." /3
There is much about antidepressant withdrawal that requires on-going scientific investigation (it has been a neglected area of research at all), but there is little doubt in my mind that it is a serious problem that requires to be acknowledged & addressed without evasion. /1
As an early-career psychiatrist in the US, what is striking to me is the disconnect between what I learned abt AD withdrawal during my training & what I learned abt AD withdrawal from the literature being shared & discussed on social media, often by patients & critics. /2
I am reminded of the 2018 New York Times story on AD withdrawal which prompted replies from several psychiatrists as letters to the editor. Some of these replies have not aged well, to say the least. /3