Psychiatry’s Necessary Shadow

The Philosophy of Mental Illness

Andrés Ruiz
Aug 22, 2017 · 22 min read

“The power to give names to our pain is a mighty thing and easy to abuse . . . Psychiatry’s appeal is not just about the possibility of cure, which is why the profession continues to flourish even when it cures nothing and relieves symptoms only haphazardly. It’s in the naming itself.”

–Gary Greenberg, The Book of Woe

“Physicians think they do a lot for a patient when they give his disease a name.”

— Immanuel Kant

On February 18th, 2015, former president of the American Psychiatric Association, Dr. Jeffrey Lieberman, penned a letter titled ‘What Does the New York Times Have Against Psychiatry?in which he bemoaned the fact that:

The Biomedical Model And Its Critics

Critics of psychiatry have historically advanced numerous critiques of the field. General highlights of the types of criticisms offered are:

  • There is no meaningful distinction between mental diseases and physical diseases.
  • Pharmacological treatment is emphasized.
See Deacon, 2013.

Normalized Rorschach Blot

How The Debate Over Trump’s Diagnosis Refutes the Reductive Model

There’s a deeper problem here. During the recent public discussions surrounding Donald Trump’s mental health, Dr. Allen Frances objected to claims made by mental health professionals that the president suffers from Narcissistic Personality Disorder on the grounds that they:

  1. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  2. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
  3. Insomnia or hypersomnia nearly every day.
  4. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  8. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Neural Connections in the Human Brain

Treatment Approaches

Currently, only 11% of psychiatrists offer talk therapy to their patients. That amounts to only 1 out of 10 psychiatrists offering psychotherapy as a form of treatment for mental illness. The preferred psychiatric form of treatment is psychopharmacology. Antidepressants are the third most commonly used class of prescription medication of any kind in the United states (Deacon, 850). As psychiatrist Daniel Carlatt writes about his profession:

Photo: Jamie/Flickr


I have attempted to give a general overview of the biomedical model’s distinctive features and why adherence to this model has been one of the primary reasons why psychiatry stands apart from other mental health professions in having a history of sustained criticism. Why have psychology and neurology avoided this fate? One plausible reason is that psychology has historically opposed biomedical reductionism and continues to push back with each new edition of the DSM. On the other hand, neurology primarily focuses on conditions with known pathophysiologies, though the boundaries between the two are fuzzy, leading to many researchers calling for the two fields to merge.

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Andrés Ruiz

Written by

MA, MSW, LCSW-A. Zig, Zag and a bottle of Zen.

A network of business & tech podcasts designed to accelerate learning. Selected as “Best of 2018” by Apple.

Andrés Ruiz

Written by

MA, MSW, LCSW-A. Zig, Zag and a bottle of Zen.

A network of business & tech podcasts designed to accelerate learning. Selected as “Best of 2018” by Apple.

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