Psychiatry and psychology are frustrating because their subject is of such great interest and potential value, yet their results so far are so unsatisfactory. A good part of the reason seems to be the difficulty of making objective, replicable observations. So much diagnosis is based on presence of k out of n subjectively judged attributes. The author touches on this, mentioning that clearly false beliefs used to be clear signs of delusion, but now many of the observers understand reality to be much more 'nuanced' and subject to enlightened interpretation. This kind of evidentiary weakness predisposes a field to ideological capture.
Excellent article. We definitely live in times where we do not address what is really going on. I wrote about this concept in a slightly different way a while back when I addressed the word anosognosia. https://thetranstrain.substack.com/p/what-is-anosognosia
We need to return to Sigmund Freud's "reality principle," which he described as the ability of the mind to assess the reality of the external world and to act upon it accordingly. Freud proposed that the "I" part of the mind (he did not use the Latin term "ego") is what enables people to navigate reality in such a way as to meet their instinctual needs within the requirements of their culture. Freud thought of mental health as the capacity for "love and work."
I think of optimal identity development as the formation of a self image that is both realistic and positive, and that enables a person to function successfully within the contexts he or she inhabits. All abnormal psychological processes involve varying degrees of difficulty in perceiving oneself and others realistically, and related impairments in successful functioning.
The "trans" experience results from a profoundly negative image of the body, which is the most basic reality of human life. This negative self-image then results in attacks on the body, leading to objective physical damage and inability to satisfy instinctual needs, as well as impairments in the ability to succeed in interpersonal relationships. Viewed from this perspective, the "trans" type of distortion in identity development is abnormal, dysfunctional, and is therefore classifiable as a mental illness in and of itself.
"Diagnostic labeling in psychiatry is likely to remain an inexact science, influenced by social beliefs. Yet psychiatry has always considered beliefs wholly at odds with objective reality as pathological."
"Pathology (def. from internet search of Oxford Languages): "the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes."
As an Atheist, I view some beliefs of religious people as delusional and not based in objective reality, but I don't see a lot of psychiatrists diagnosing those people as "pathological" because of them. In a free society, we agree to live peacefully amongst those who have different beliefs - with the limitation that people cannot use those beliefs to harm others. As an Atheist in the American Midwest, where most everyone I know and care about is religious, I navigate this respectful coexistence on a daily basis.
I, personally, do not think the field of psychology had any business taking on medical models and language to the extent that it has. The few clinically successful therapeutic modalities I've seen have been successful due to being (purposely or by chance) aligned with our scientifically observed evolved needs as a species. I think that if psychology wants to have more scientific or professional legitimacy, it should move more toward studying evolutionary psychology/biology, and be much more judicious in its use of medically pathologizing frameworks.
The metaphysical belief in gender identities is just as delusional to me as the faith-tradition beliefs of my religious family, friends, and neighbors, but I value their right to hold those beliefs.
However, I do not think it's ethical or okay for their lived practices associated with those metaphysical beliefs to infringe upon other people's (or developing children's) rights to safety and fairness in society. This is where gender identity ideology is causing real world harm. The gender identity true believers (and those who utilize the ideology for nefarious means) have forced their belief onto society with practices that harm the vulnerable and infringe on gender-identity-nonbelievers' rights.
As gender identity ideology continues to buckle under the mounting weight of reality, we will most likely see the belief go more fringe, but there will probably still be its true believers who we'll need to coexist with. I think we'll make more progress now by addressing the real world harms of certain aspects of the "ideology-in-practice" than we will by trying to convince everyone to allow the experts to diagnose the believers with a disease.
Thank you for your comment. You might find the work of Lucy Johnstone interesting (https://www.youtube.com/watch?v=qrcV4xDTLh0). She poses a challenge to my take on things here and may be closer to your view of psychiatric diagnoses. She spoke at the SEGEM conference in Berlin.
Thank you. Yes, I listened to her talk and it resonates with my perspective. :-)
My view was inspired by life observations and Dr. Chuck Ruby's book, Smoke and Mirrors. He's director of the International Society for Ethical Psychology and Psychiatry.
I've noticed that the most effective therapy modalities, regardless of their particular methods, are those where the therapist takes on the role of surrogate attachment figure by which, and until, the client internalizes the ability to self-regulate (like they would have been able to do sooner had this very basic, primal, human need been adequately met in their lives). Like a plant that won't survive and thrive well without the appropriate soil and sun conditions, humans have certain conditions necessary for our species to survive *and* thrive too. I feel that it takes away shame and blame to view this through unmet human needs, and it actually elicits more compassion from others - also a human need when we're wounded - than does a pathologizing label. Obviously, there are cases where appropriate medical intervention can aid the therapeutic process. I appreciate that there are professionals attempting to find that balance.
Psychiatry and psychology are frustrating because their subject is of such great interest and potential value, yet their results so far are so unsatisfactory. A good part of the reason seems to be the difficulty of making objective, replicable observations. So much diagnosis is based on presence of k out of n subjectively judged attributes. The author touches on this, mentioning that clearly false beliefs used to be clear signs of delusion, but now many of the observers understand reality to be much more 'nuanced' and subject to enlightened interpretation. This kind of evidentiary weakness predisposes a field to ideological capture.
Excellent article. We definitely live in times where we do not address what is really going on. I wrote about this concept in a slightly different way a while back when I addressed the word anosognosia. https://thetranstrain.substack.com/p/what-is-anosognosia
We need to return to Sigmund Freud's "reality principle," which he described as the ability of the mind to assess the reality of the external world and to act upon it accordingly. Freud proposed that the "I" part of the mind (he did not use the Latin term "ego") is what enables people to navigate reality in such a way as to meet their instinctual needs within the requirements of their culture. Freud thought of mental health as the capacity for "love and work."
I think of optimal identity development as the formation of a self image that is both realistic and positive, and that enables a person to function successfully within the contexts he or she inhabits. All abnormal psychological processes involve varying degrees of difficulty in perceiving oneself and others realistically, and related impairments in successful functioning.
The "trans" experience results from a profoundly negative image of the body, which is the most basic reality of human life. This negative self-image then results in attacks on the body, leading to objective physical damage and inability to satisfy instinctual needs, as well as impairments in the ability to succeed in interpersonal relationships. Viewed from this perspective, the "trans" type of distortion in identity development is abnormal, dysfunctional, and is therefore classifiable as a mental illness in and of itself.
A very good insight -- thank you for tracing some of the origins of this collective madness.
"madness", indeed. Though more like rank insanity, bedlam, the madwoman's (transwoman's?) underclothes even if Greer might have had a point or two:
https://www.goodreads.com/book/show/118117.The_Madwoman_s_Underclothes
But ICYMI, something from Charles MacKay's "Extraordinary Popular Delusions and the Madness of Crowds":
“Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, one by one.”
https://www.goodreads.com/quotes/289693-men-it-has-been-well-said-think-in-herds-it
https://www.amazon.ca/Extraordinary-Popular-Delusions-Madness-Crowds/dp/1539849589/
Though speaking of Amazons, I'm reminded of a sweet youngish English lass I once knew, even if from a distance ...
"Diagnostic labeling in psychiatry is likely to remain an inexact science, influenced by social beliefs. Yet psychiatry has always considered beliefs wholly at odds with objective reality as pathological."
"Pathology (def. from internet search of Oxford Languages): "the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes."
As an Atheist, I view some beliefs of religious people as delusional and not based in objective reality, but I don't see a lot of psychiatrists diagnosing those people as "pathological" because of them. In a free society, we agree to live peacefully amongst those who have different beliefs - with the limitation that people cannot use those beliefs to harm others. As an Atheist in the American Midwest, where most everyone I know and care about is religious, I navigate this respectful coexistence on a daily basis.
I, personally, do not think the field of psychology had any business taking on medical models and language to the extent that it has. The few clinically successful therapeutic modalities I've seen have been successful due to being (purposely or by chance) aligned with our scientifically observed evolved needs as a species. I think that if psychology wants to have more scientific or professional legitimacy, it should move more toward studying evolutionary psychology/biology, and be much more judicious in its use of medically pathologizing frameworks.
The metaphysical belief in gender identities is just as delusional to me as the faith-tradition beliefs of my religious family, friends, and neighbors, but I value their right to hold those beliefs.
However, I do not think it's ethical or okay for their lived practices associated with those metaphysical beliefs to infringe upon other people's (or developing children's) rights to safety and fairness in society. This is where gender identity ideology is causing real world harm. The gender identity true believers (and those who utilize the ideology for nefarious means) have forced their belief onto society with practices that harm the vulnerable and infringe on gender-identity-nonbelievers' rights.
As gender identity ideology continues to buckle under the mounting weight of reality, we will most likely see the belief go more fringe, but there will probably still be its true believers who we'll need to coexist with. I think we'll make more progress now by addressing the real world harms of certain aspects of the "ideology-in-practice" than we will by trying to convince everyone to allow the experts to diagnose the believers with a disease.
Thank you for your comment. You might find the work of Lucy Johnstone interesting (https://www.youtube.com/watch?v=qrcV4xDTLh0). She poses a challenge to my take on things here and may be closer to your view of psychiatric diagnoses. She spoke at the SEGEM conference in Berlin.
Thank you. Yes, I listened to her talk and it resonates with my perspective. :-)
My view was inspired by life observations and Dr. Chuck Ruby's book, Smoke and Mirrors. He's director of the International Society for Ethical Psychology and Psychiatry.
I've noticed that the most effective therapy modalities, regardless of their particular methods, are those where the therapist takes on the role of surrogate attachment figure by which, and until, the client internalizes the ability to self-regulate (like they would have been able to do sooner had this very basic, primal, human need been adequately met in their lives). Like a plant that won't survive and thrive well without the appropriate soil and sun conditions, humans have certain conditions necessary for our species to survive *and* thrive too. I feel that it takes away shame and blame to view this through unmet human needs, and it actually elicits more compassion from others - also a human need when we're wounded - than does a pathologizing label. Obviously, there are cases where appropriate medical intervention can aid the therapeutic process. I appreciate that there are professionals attempting to find that balance.