The project of psychiatry¹ is an exercise in classification. It does not, for the most part, concern itself with measurable causes. Even when researchers attempt to do this, they quickly find that their efforts were in vain—see, for example, the long history of failed attempts to prove the “hormonal imbalance” theory of depression. Instead, psychiatry consists of listing and grouping symptoms.
The biggest problem with this is what I call “stomach pain disorder” conditions. If you presented to a real doctor with “stomach pain”, he would investigate further. The difference between indigestion, food poisoning, stomach cancer, etc, is very great, and an appropriate remedy for one would be inappropriate, perhaps even harmful, for another. But if you presented to a psychiatrist, she would confidently diagnose you with “stomach pain disorder” and immediately prescribe you a life-long course of anti-stomach pain pills, plus perhaps a talking therapy where you could discuss your lived experience of stomach pain. The majority of stomach pain patients, with mild conditions like indigestion, would recover naturally and falsely attribute their recovery to the miraculous anti-stomach pain pills. The minority of stomach pain patients, with conditions like stomach cancer, would ail further and further until death as the psychiatrist prescribed them more and more anti-stomach pain pills and longer and more frequent talking therapies.
Another problem is social or political interference in the classification process. This can go in both directions. On the one hand, real psychiatric problems can be not classified as psychiatric problems. On the other hand, fake non-conditions can be classified as psychiatric conditions. Both of these problems can be at least somewhat mitigated by having a realistic taxonomy of types of situation that might or might not be classified as psychiatric conditions.
When looking at the types of situation that might be classified as a psychiatric condition, it becomes clear that the pre-moderns had, as usual, a generally (though not infallibly) astute understanding of nature. I present below a rough classification of these situations / conditions. It is important to note that conditions in their different aspects can fall under multiple categories. These categories are not mutually exclusive, though I hope they are at least close to collectively exhaustive with broad definitions.
- Psychosis
- example: Schizophrenia
- innate psychiatric conditions involving a disconnect with reality
- Malaise
- example: Depression
- innate psychiatric conditions involving low mood, apathy
- Trauma
- example: PTSD
- psychiatric conditions caused by psychic injury
- Neurology
- example: Parkinson's
- psychiatric symptoms caused by well-defined neurological conditions
- Hysteria
- example: Long Covid
- psychiatric and other symptoms of highly-strung women, especially in middle age
- Badness
- example: Sociopathy
- pathologisation of being a bad person
- Eccentricity
- example: Asperger's
- pathologisation of personal eccentricity
- Reaction
- example: Drapetomania
- pathologisation of rightful reaction against social conditions
sum θoətiz abaʊt taipiz ov saikiiyatrik kəndiʃəniz [wip]
ðə projekt ov saikaiətrii¹ biiʸ an eksəsaiz in klasifikeiʃən. it not, foə ðə moʊst paət, kənsuən itself wið meʒərəbəl kʊəziz. iivən wen risuəcəriz ətempt tə dʊʊ ðis, dii kwiklii faind ðat diis efətiz did biiʸ in vein—sii, foəʳ egzampəl, ðə loŋᵍ histəriiʸ ov feiləð ətemptiz tə prʊʊv ðə “hʊəmoʊnəl imbaləns” θiiəriiʸ ov dipreʃən. insted, saikaiətrii kənsist ov listiŋᵍ and grʊʊpiŋᵍ simptəmiz.
ðə bigist probləm wið ðis bii wot mii koəl “stumək pein disʊədə” kəndiʃəniz. if ðii did prizent tʊʊʷ a riiəl doktə wið “stumək pein”, hii wʊd investigeit fuəðə. ðə difrəns bitwiin indijeʃcən, fʊʊd poizəniŋ, stumək kansəʳ, ets, bii verii greit, and an əproʊpriiət remədii foəʳ um wʊd biiʸ inəproʊpriiət, pəhaps iivən haəmfəl, foəʳ anuðə. but if ðii did prizent tʊʊʷ a saikaiətrist, ʃii wʊd konfidəntlii daiəgnoʊz ðii wið “stumək pein disʊədəʳ” and imiijətlii priskraib ðiiʸ a laif-loŋ kʊəs ov antii-stumək pein piliz, plus pəhaps a toəkiŋ θerəpii weə ðii kʊd diskus ðiis livəð ekspiəriiəns ov stumək pein. ðə məjoritiiʸ ov stumək pein peiʃəntiz, wið maild kəndiʃəniz laik indijeʃcən, wʊd rikuvə nacrəliiʸ and folsliiʸ atribyʊʊtr diis rikuvərii tə ðə mirakyələs antii-stumək pein piliz. ðə mainoritiiʸ ov stumək pein peiʃəntiz, wið kəndiʃəniz laik stumək kansə, wʊd eil fuəðəʳ and fuəðəʳ əntil deθ az ðə saikaiətrist did priskraib dii mʊəʳ and mʊəʳ antii-stumək pein piliz and loŋgəʳ and mʊə friikwənt toəkiŋ θerəpiiyiz.
anuðə probləm bii soʊʃəl oə pəlitikəl intəfiərəns in ðə klasifikeiʃən proʊses. ðis kan goʊʷ in boʊθ dairekʃəniz. on ðiiʸ um hand, riiəl saikiiyatrik problemsəmiz kan bii not klasifaiyəð az saikiiyatrik probləmiz. on ðiiʸ uðə hand, feik non-kəndiʃəniz kan bii klasifaiyəð az saikiiyatrik kəndiʃəniz. boʊθ ov ðiiz probləmiz kan biiʸ at liist sumwot mitigeitəð bai haviŋᵍ a riiəlistik taksonəmiiʸ ov taipiz ov sicʊʊweiʃən ðat mait oə mait not bii klasifaiyəð az saikiiyatrik kəndiʃəniz.
wen lʊkiŋᵍ at ðə taipiz ov sicʊʊweiʃən ðat mait bii klasifaiyəð az a saikiiyatrik kəndiʃən, it bikum kliə ðat ðə prii-modəniz did hav, az yʊʊʒʊʊəl, a jenrəlii (ðoʊ not infalibliiʸ) ascʊʊt undəstandiŋᵍ ov neicə. mii prizent biloʊʷ a ruf klasifikeiʃən ov ðiiz sicʊʊweiʃəniz / kəndiʃəniz. it biiʸ impʊətənt tə noʊt ðat kəndiʃəniz in diis difrənt aspektiz kan foəl undə multipəl katəgriiyiz. ðiiz katəgriiyiz bii not myʊʊcəliiʸ eksklʊʊsiv, ðoʊ mii hoʊp dii biiʸ at liist kloʊs tə kəlektivliiʸ egzoəstiv wið broəd definiʃəniz.
- saikoʊsis
- egzampəl: skizəfriiniiəʸ
- ineit saikiiyatrik kəndiʃəniz involviŋᵍ a diskənekt wið riiyalitiiʸ
- maleiz
- egzampəl: dipreʃən
- ineit saikiiyatrik kəndiʃəniz involviŋᵍ loʊ mʊʊd, apəθiiʸ
- trʊəməʳ
- egzampəl: p.t.s.d.
- saikiiyatrik kəndiʃəniz kʊəzəð bai saikik injíriiʸ
- nyʊəroləjiiʸ
- egzampəl: paəkinsən-iis
- saikiiyatrik simptəmiz kʊəzəð bai wel-difainəð nyʊərəlojikəl kəndiʃəniz
- histiəriiəʳ
- egzampəl: loŋ koʊvid
- saikiiyatrik and uðə simptəmiz ov hailii-striŋgəð wʊməniz, ispeʃəliiʸ in midəl eij
- badnəs
- egzampəl: soʊʃyəpaθiiʸ
- paθoləjaizeiʃən ov biiyiŋᵍ a bad puəsən
- eksentrisitiiʸ
- egzampəl: aspuəjər-iis
- paθoləjaizeiʃən ov puəsənəl eksentrisitiiʸ
- riiyakʃən
- egzampəl: drapiitəmeiniiəʳ
- paθoləjaizeiʃən ov raitfəl riiyakʃən əgeinst soʊʃəl kəndiʃəniz