Apparently. These drugs only need to function slightly better than a placebo to be approved. What does this mean? For some reason - which they don’t understand - some of these drugs help some people with x symptoms kinda.
Sometimes. I must point out the preciseness is not the same as accuracy, and you seem to be advocating the former, not the latter.
You seem to possess the notion that something called science prescribes a methodological cookbook accepted universally. The scientific method doesn’t require “causality and proof”; it requires predictions and testing. The exact predictions, and the manner in which one tests them, are to some degree always subjective. They may or may not require an explicit causal model.
So people could be lying. A physicist’s instruments could be wrong. If nothing else then you can at least demonstrate conditional knowledge: if the test subjects were not all compulsive liars, then so on and so forth.
The usefulness of knowledge is a non-decreasing function of its accuracy, but greater accuracy may be unnecessary or not worth the costs of obtaining it. It’s enough for me to know that there are about seven billion people in the world; I could do better, but there’s no reason to spend the time and effort to compute a more accurate number.
Not really. There may be proof (for some values of “proof” that nevertheless fall short of mathematical certainty). Perhaps some future team of researchers will develop a detailed software model of human neurohysiology, accurate to the minutest detail, the use of which allows extremely accurate behavioral predictions and precise chemical adjustments to cure any identified psychiatric illness. That doesn’t matter; I’m not making a statement about the in-principle possibility of proof, I’m saying that utter certainty isn’t a necessary criterion for scientific knowledge.
More broadly, yes, I suppose I do dispute the notion that empirical science can result in utter 100% certainty. But that’s about as controversial as chocolate cake. The tastiness of which is uncertain, let me add — my sister could ruin the most straightforward boxed cake, ugh.
Perhaps you might help me to more readily understand your point, pungi by proposing your alternate to the present classification system.
The slimness of federal approval criteria doesn’t factor into what I said. The combination of CBT and drug therapy has been repeatedly shown, in peer-reviewed journals, to be substantially more effective than alternatives.
Anyway, let’s just ignore that and examine your apparent thesis: a randomized trial concluding that Drug X is more effective than a placebo is not scientific knowledge, unless accompanied by a causal model describing its exact mechanisms. Why should that be the case? We have a randomized trial!
Oops, no, exactly the opposite: I think we have to accept the fact that our definitions will be fuzzy, sloppy, messy, and inexact.
For instance, define “Democrat” or “Republican” exactly. Does the person in question have to agree with every single plank in the party platform? What if he agrees with every single plank in the platform, but doesn’t like his town mayor, and votes for someone of the other party?
As Paranoid Randroid said: define “tumor” exactly. Show me a way to tell the exact, bright, precise outline of the tumor, where the tumor cells stop and normal body cells begin. I’m recovering from a cold right now; tell me exactly when I stop having it.
A lot of statistical knowledge is inexact. Drug A has a two per cent greater incidence of bad side effects than Drug B, and this figure is subject to an error of plus or minus 0.075% – and that figure itself is only a statistical entity, and has its own level of inexactness!
This could happen. Real-time brain scans of people undergoing certain behaviors, or symptoms – from choosing which sandwich they want to eat, to undergoing grand mal epileptic seizures – are giving us vast reams of information on the physical nature of the brain’s processes. Modern anti-depressant and anti-psychotic drugs are light-years ahead of what we had, not very long ago.
Who knows? If Prozac had been around, Howard Hughes might have lived a fairly normal life, rather than retreating into solitude, obsession, and insanity! All the counseling in the world couldn’t help him…but there are chemicals, today, that could have!
That’s a little insulting. Science is a method - I know you know that I know that…
Actually, I agree, technically, with much of what you said, disagreeing philosophically in regards to subjectivity and objectivity. A scientist, in my view, collects objectively observable data (psychiatry fails here), makes a hypothesis that explains ALL of the data and tests it. If you are dealing with subjective assumptions as data – as I thought I pointed out in my 1st post quoting Dr. A. Frances (chair of DSM-IV task force) “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” (you could also say “everyone has their own idea of a mental problem and therefore what is relevant data?”) - your hypothesis will be flawed, your tests will never be conclusive and your science will not offer fruit.
Clinical neuroscience seems to be concerned about addressing this problem of obtaining objectively observable data.
And, you are so right that science is only as good as the scientist performing it.
Consider a survey participant’s report on how depressed she feels on Day 10 rather than on Day 1. In what respect does this fail to count as objectively observable data? True, the researcher doesn’t have direct access to the participant’s mental state, but you can build a nuclear weapon with only indirect evidence that there’s such a thing as an atom.
An hypothesis to be tested doesn’t have to explain all of the data; it only needs to be a supposition the truth of which could in principle be contradicted by experiment (or a testable consequence of a more general scientific theory). If hypotheses had to explain all relevant data or no soup for you, one year, then research in literally every field would come to a grinding halt.
Day 1: Patient A describes feeling sad. Day 2: Patient A randomly assigned to treatment group. Day 10: Patient A describes feeling less sad.
Day 1: Patient B describes feeling sad. Day 2: Patient B randomly assigned to control group. Day 10: Patient B describes feeling a comparable level of sadness.
Rinse, repeat, take an average. “86% of patients reported feeling considerably less depressed after eight days of Treatment X, compared to 0.7% taking a placebo.” Where does this go wrong, specifically? Because the patients could be lying? Because it wasn’t a Grand Unified Theory of Human Behavior that led to the discovery of Treatment X? Help me out here.
Sorry for barging in. I think much of the opposition to psychiatry as a science results from a very deap-seated opposition to materialism. That is, mental diseases are problems of the “soul” and cannot be treated by physical substances. Also they cannot be investigated by the scientific method, itself being linked with a materialistic approach.
Now, to be clear, dualism is a “feature” very much basic to human perception, and at this time it has “migrated” to the problem of consciousness.
I would say that Freud was a scientist in some respects, but not a very good scientist. E.g., the EmmaEckstein busiiness with the nose surgery–he was basing his diagnosis in part on his friend’s (I’ve forgottent he name of the surgeon) experiments with the nasal reflexsurgery and that according to the surgeon the women improved after they had the procedure. Or his conclusion (in part the result of the fiasco with Eckstein’s near-death due to the botched surgery) that his neurotic female patients were fantasizing rather than telling the truth when they recounted sexual abuse by their fathers or father figures. The “experiments” were not controlled, nor was there a large enough sample to justify the conclusions–yet they were “science” in the sense of being based on observations of coming to conclusions based on data obseved/gathered.
There are still lots of circumstances where a scientist (a medical doctor for example) might prescribe a treatment because it has worked on other patients in the past, without having evidence that would meet modern scientific standards. Does that make the physician not a scientist?
Barge, barge! Your opinions are welcome!
I started to type a comment mostly in disagreement…and ended up discovering that I agree with you. Much of the popular opposition to recognizing mental illness as an illness at all is our deep cultural heritage of “free will.” We really do believe (as a culture) that we can “reason it out” or simply “grit our teeth and bear up.” These may be decent ways of dealing with a passing fad, or a sprained ankle, but in mental illness, the “reasoner” – the part of us that does “grit” – is, itself, malfunctioning.
So, yes, agreed: our society hasn’t fully come to grips with the fact that our minds are generated by our brains, and that our brains are structured, material, mechanistic objects. We still hear the little voice of the priest telling us, “But your soul cannot suffer from depression.”
Thank you, Trinopus.
Unfortunately though, I am not clear by myself on the mind-body question, or whether we can abstract the concept of soul. Now, make no mistake, I am a complete atheist, materialist, etc. I know that both “treatment of the body” with SSRIs and “treatment of the soul” with talk therapy are effective in depression and they both relieve symptoms and increase the level of serotonin.
However, since the brain is just a hugely complex computer, it can be approximated by any other one, or just a universal Turing machine. So basically our mind, soul or whatever not we call it, is just a sequence of bits that can have any physical appearance.
There is some similarity here to the relationship between DNA and an actual organism or the question of whether a virus can be considered alive.
I found myself digressing far from the original post, so I will stop here.
Actually, psychology was by and large strictly materialistic (“somatic”) before Freud came along.
For a while there, Freud did his best to play along with the ruling consensus, but he gave up after a while - this is why his Entwurf einer Psychologie, an early work wherein he attempted to anchor his theories in strict materialism (by way of neurology), went unpublished.
Indeed, for much of the 19th century, non-somatic explanations of mental illnesses were considered anathema both by Christian theologians, who generally held that “the soul can not be ill”, and by strict materialists, for whom all talk of an “invisible inner realm” (Freud’s theories included) smacked of the “animal magnetism” of the previous (18th) century, not to mention the trendy “Spiritualism” of their own age.
(As a sidenote: Actually, the strict materialism of the age sometimes makes for pretty good unintentional comedy. This one dude, for example, tried to explain the extraordinary sensibility of poets by way of heart disease - and furthermore believed that August Strindberg’s scandalous interest in occultism could best be explained by the presence of Mongolian genes left over from the times of Ghengis Khan! It’s all in the body, see!)
I realize that I’m furthering a digression, but I want to point out that these statements are not in opposition:
- The mind is not a complex computer (or any kind of computer except in a very broadly analogous sense), cf. the work of Searle and others.
- The fields of psychiatry and psychology can provide scientific knowledge.
Indeed, in my view the conscious mind simply cannot be reduced to a purely mechanistic interaction between hardware and software. I’d even go so far as to doubt the coherence of that supposition. That isn’t to pick an argument with you about the nature of subjective experience — I know full well that the work I cite is controversial, and my point of view a minority on these boards — but nothing about “the mind is in some respect immaterial” precludes systematic investigation into human behavior.
FWIW I tend to an Aristotelian hylomorphism, on which account the soul is just the form of the body. (That’s a pretty pregnant “just”, of course.) Whatever its other problems this view avoids the mind/body problem — there is no interaction between immaterial ghost and material machine.
Tricky; the argument is that there is nothing the brain does that cannot be emulated by any other “computational universal” device. (A group at MIT proved that you can make a c.u. device out of tinker-toys!) The brain is a “machine,” made up of smaller “machine parts.”
A lot of us disagree with Searle… I particularly love the way his argument about “The Chinese Room” has been turned right back against him. (A very great many of us believe that, yes, the room does comprehend Chinese!)
It’s becoming fairly well established that quantum effects play a role in many biological processes.
Since we are only at the threshold of discovering the actual extent of these influences, it is certainly fair to speculate that some of the biochemical processes critical to consciousness depend upon such effects and therefore are by their very nature probabilistic and unpredictable.
deltasigma: it is possible to make too much of this.
After all, the hard-disk read and write heads in your computer make use of quantum effects…and are still very directly logical and predictable. The tunnel-effect-diodes in stereo systems make use of quantum effects…and are also very predictable.
Sure. And to the extent that they’re used in biological systems there’s a good chance that’s also true, but it’s also likely that as with all biological processes, they’ll almost certainly not be 100% predictable.
So let’s say that you need a certain neuron to fire in response to some stimulus to set off a cascade that produces some result. BUT, the firing is dependent upon say a receptor that needs as one of it’s inputs a reaction that depends on some quantum effect. That effect will in turn be dependent on the convergence of other factors in proper configuration at the proper time.
Odds are that if that is a critical process, we will have evolved a way to make sure that convergence happens a very healthy percentage of the time but it’s a near certainty that it won’t be 100%.
Fair enough. Heck, I’m still trying to cope with simple Neural Net programming! It, too, involves huge amounts of feedback, with gradual convergence, and is wonderfully non-linear.