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.

Madness: example: Schizophrenia; innate psychiatric conditions involving a disconnect with reality
Malaise: example: Long-Term Depression; innate psychiatric conditions involving low mood, apathy
Trauma: example: PTSD; psychiatric conditions caused by psychic injury
Neurology: example: Parkinsonism; psychiatric symptoms caused by well-defined neurological conditions
Retardation: example: Down Syndrome; psychiatric symptoms involving low intelligence caused by well-defined conditions
Eccentricity: example: Asperger's; pathologisation of personal eccentricity
Hysteria: example: Long Covid; psychiatric and other symptoms of highly-strung women, especially in middle age
Wickedness: example: Sociopathy; pathologisation of being a bad person
Reaction: example: Drapetomania; pathologisation of rightful reaction against intolerable living conditions

Of these, Madness (i.e. psychosis) and Malaise are mental illness-proper: innate psychiatric conditions. Trauma is psychiatric ill-health, but not illness any more than a broken leg is an “illness”. Neurology and Retardation are illnesses, but not primarily psychiatric ones: there is something else primarily the matter. These are all at least ill-health of some kind.

None of the other categories are even illnesses as such. Eccentricities are mental states, but not psychiatric ones except insofar as a society cannot accept them as part of the social order. Hysteria is a natural eccentricity that affects all women eventually to some extent, so is a sort of mass demographic eccentricity (and can apply to or amplify almost any diagnosis given to a woman, even seemingly straightforward neurological conditions). Wickedness is a specific eccentricity that is classified as psychiatric in an attempt to avoid placing moral blame. And Reaction is not an illness or psychiatric or even eccentric at all.

Implications

Diagnoses are often umbrella terms (“stomach pain disorders”) that actually cover many different categories. For example, “depression” is ostensibly the archetype of Malaise, but in practice it is often Trauma, in response to sad events, or even Reaction, in response to intolerable living conditions. If something bad happens, or if your life is bad in general, then you should feel sad. It is not even clear whether the Malaise category should even exist at all, once Trauma and Reaction (and Hysteria) have been accounted for.

That many of these categories are not ill-health or even psychiatric indicates that they should not primarily be dealt with by medics, let alone by specialist psychiatrists. Madness and Trauma should be treated by pschiatrists. Malaise, when really that, can't be treated at all, though care could be given by a psychiatrist but also anyone else.

Neurology and Retardation should be treated by specialists in their field. Eccentricity does not need to be treated at all. Hysteria is actively made worse by being treated or having any attention paid to it. Wickedness should be treated by the legal system where necessary or by society otherwise. And Reaction should be treated by family and friends, or even society, to improve the person's situation.

sum θoətiz abaʊt taipiz ov saikiiyatrik kəndiʃəniz

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 atribyʊʊt 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 probləmiz 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) astyʊʊt 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.

madnəs: egzampəl: skizəfriiniiəʸ; ineit saikiiyatrik kəndiʃəniz involviŋᵍ a diskənekt wið riiyalitiiʸ
məleiz: egzampəl: dipreʃən; ineit saikiiyatrik kəndiʃəniz involviŋᵍ loʊ mʊʊd, apəθiiʸ
trʊəməʳ: egzampəl: p.t.s.d.; saikiiyatrik kəndiʃəniz kʊəzəð bai saikik injíriiʸ
nyʊəroləjiiʸ: egzampəl: paəkinsənizəm; saikiiyatrik simptəmiz kʊəzəð bai wel-difainəð nyʊərəlojikəl kəndiʃəniz
riitaədeiʃən: egzampəl: daʊn sindroʊm; saikiiyatrik simptəmiz involviŋᵍ loʊʷ intelijəns kʊəzəð bai wel-difainəð kəndiʃəniz
eksentrisitiiʸ: egzampəl: aspuəgər-iis; paθoləjaizeiʃən ov puəsənəl eksentrisitiiʸ
histiəriiəʳ: egzampəl: loŋ koʊvid; saikiiyatrik and uðə simptəmiz ov hailii-striŋgəð wʊməniz, ispeʃəliiʸ in midəl eij
wikidnəs: egzampəl: soʊʃyəpaθiiʸ; paθoləjaizeiʃən ov biiyiŋᵍ a bad puəsən
riiyakʃən: egzampəl: drapiitəmeiniiəʳ; paθoləjaizeiʃən ov raitfəl riiyakʃən əgenst intolərəbəl liviŋ kəndiʃəniz

ov ðiiz, madnəs (i.e. saikoʊsis) and məleiz bii mentəl ilnəs-propəʳ: ineit saikiiyatrik kəndiʃəniz. trʊəmə bii saikiiyatrik il-helθ, but not ilnəs enii mʊə θan a breikəð leg biiʸ an “ilnəs”. nyʊəroləjiiʸ and riitaədeiʃən biiʸ ilnəsiz, but not praimerilii saikiiyatrik umiz: ðeə bii sumθiŋᵍ els praimerilii ðə matə. ðiiz biiʸ oəl at liist il-helθ ov sum kaind.

non ov ðiiʸ uðə katəgriiyiz biiʸ iivən ilnəsiz az suc. eksentrisitiiyiz bii mentəl steitiz, but not saikiiyatrik umiz eksept insoʊfaəʳ az a səsaiətii kanot aksept diiʸ az paət ov ðə soʊʃəl ʊədə. histiəriiə biiʸ a nacərəl eksentrisitii ðat afekt oəl wʊməniz ivencəlii tə sum ekstent, soʊ biiʸ a soət ov mas deməgrafik eksentrisitiiʸ (and kan aplai tʊʊʷ oəʳ amplifai oəlmoʊst enii daiəgnoʊsis givəð tʊʊʷ a wʊmən, iivən siimiŋglii streitfoəwəd nyʊərəlojikəl kəndiʃəniz). wikidnəs biiʸ a spisifik eksentrisitii ðat bii klasifaiyəð az saikiiyatrik in an atempt tʊʊʷ əvoid pleisiŋ morəl bleim. and riiyakʃən bii not an ilnəs oə saikiiyatrik oəʳ iivən eksentrik at oəl.

implikeiʃəniz

daiəgnoʊsisiz biiʸ oftən umbrelə tuəmiz (“stumək pein disʊədəriz”) ðat akcəlii kuvə menii difrənt katəgriiyiz. foəʳ egzampəl, “dipreʃən” biiʸ ostensiblii ðiiʸ arkitaip ov məleiz, but in praktis it biiʸ oftən trʊəməʳ, in rispons tə sad iventiz, oəʳ iivən riiyakʃən, in rispons tʊʊʷ intolərəbəl liviŋ kəndiʃəniz. if sumθinŋ bad hapən, oəʳ if ðiis laif bii bad in jenrəl, ðen ðii ʃʊd fiil sad. it bii not iivən kliə weðə ðə məleiz katəgrii ʃʊd iivən egzist at oəl, umθ trʊəməʳ and riiyakʃən (and histiəriiəʳ) av biiʸ əkaʊntəð foə.

ðat meniiʸ ov ðiiz katəgriiyiz bii not il-helθ oəʳ iivən saikiiyatrik indikeit ðat dii ʃʊd not praimerilii bii diiləð wið bai medikiz, let əloʊn bai speʃəlist saikaiətristiz. madnəs and trʊəmə ʃʊd bii triitəð bai saikaiətristiz. məleiz, wen riəlii ðat, not kan bii triitəð at oəl, ðoʊ keə kʊd bii givəð baiʸ a saikaiətrist but oəlsoʊʷ eniiyum els.

nyʊəroləjiiʸ and riitaədeiʃən ʃʊd bii triitəð bai speʃəlistiz in diis fiiəld. eksentrisitii not niid tə bii triitəð at oəl. histiəriiə biiʸ aktivlii meikəð wuəs bai biiyiŋ triitedəð oə aviŋᵍ eniiʸ atenʃən pei tʊʊʷ it. wikidnəs ʃʊd bii triitəð bai ðə liigəl sistəm weə nesəseriiʸ oə bai səsaiətiiʸ uðəwais. and riiyakʃən ʃʊd bii triitəð bai familiiʸ and frendiz, oəʳ iivən səsaiətii, tʊʊʷ imprʊʊv ðə puəsəniis sicʊʊweiʃən.