By Committee

I've had cause to have the furies with Will Self in the past, but he's written a fine article on the mess that is the psychiatry /big pharma axis. He's not exactly breaking new ground. But says what he has to say more astutely and honestly than most;

what do psychiatrists have to offer....beyond their capacity to legally administer psychoactive drugs, and in some cases forcibly confine those they deem to be mentally ill?

Exactly, legitimizing what would be deemed pushing if it was illicitly bought drugs. Represented in some quarters as primitive superstition against mental illness, the suspicion of psychiatrists is that they have greater powers available to them than the police. And look how folks feel about the poh-leece.

Moreover psych docs can be okay at sniffing out cray, cray. Not always so good at being able to tell if you aren't, especially if you've already been labelled thus. As we are seeing replicated in the medical profession and their difficulty telling the difference between the pathologization of bodies and 'disease'.

That's what got me most, Self's observations could be applied to doctors, enough to give one pause. It's something I don't think could readily have been said a few decades ago. It was the mind doctors who used medical practice as the template for how they wished their specialty to be seen;

the major mental pathologies – schizophrenia, bipolar disorder, depression inter alia – cannot be defined in the same way as physical diseases,

They tried though didn't they? Strangely, docs seem to be returning the favour;

there are more and more new "diseases" with each edition of the DSM: it isn't a function of scientific acumen identifying hitherto hidden maladies, but of iatrogenesis: doctor-created disease. 

And;

the criteria for what constitutes ADHD (attention deficit hyperactivity disorder), or autism, or indeed depression, are not arrived at by any commonly understood scientific procedure, but rather by committee

Familiar, natch. Both, the criterion for 'obese' and its status as disease were arrived at this way. It's 'treatment' was arrived at by hypothesis. No wonder its found to be "complex."

WS speaks of the "peculiar mystique" of psychiatry and how it "exerts an enormous pull on our collective self-image". Well, doctors save lives, we all trust them with ours. It's an enormous responsibility/privilege.

.....it becomes somewhat easier to understand how the tail can begin to wag the dog: rather than arriving at a commonly agreed set of symptoms that constitute a gestalt..... psychiatrists become influenced by what psycho-pharmacological compounds alleviate given symptoms, and so, as it were, "create" diseases to fit the drugs available.

 Oh boy. The construct of 'obesity' has always been formulated around its supposed remedy, calorie restriction. And that has shaped the definition and interpretation of certain elements of human biology. To this is being added yet another tranche of 'diet drugs'. The only reason this route hasn't been pursued is the naked lack of efficacy of them.

There's no, "I feel better". You've either lost weight or you haven't.

He goes on to talk of  the "currently fashionable view of......seeking to understand mental maladies through the tripartite lens of the social, the psychological and the biological." So that's where that was coming from.  I thought it sounded a bit portentous.

It's au courant.

This emerging pattern of treating being human as a pathology that needs to be tweaked with pills. The norm set is increasingly distorted becoming something akin to a junkie athlete.

Someone who's slim and superfit enough to survive the very system that is apparently not compatible with fitness. Our "happy" specimen has an upbeat mood and constant energy akin to that of a drug high. If not, one can be branded in some way disabled, mentally ill or physically sick. 

He points to the way we've colluded in the process;

.....our responsibility is just as difficult for us to acknowledge because we are largely unaware of it. We don't consciously collude in the chemical repression of the psychotic..... any more than we consciously collude in the fiction of depression as a chemical imbalance that can be successfully treated with SSRIs.

The highlighted is increasingly admitted, though not everywhere. Yep, a get out clause for those who want to do what drug users do, but without being cast in the spoiled identity we've all helped to cast users of illicit drugs.

Self speaks about the search for new world's to conquer. Which I take to refer to my own long term disquiet about the way the medical profession has instinctively seen itself as a replacement priesthood. Taking confessions about our "lifestyles", advising us on how to live right. And how most people seem happy to go along with this.

You can see before and with the AMA ruling that the 'obesity' construct reflects so many of the desires of this urge. The way it wants to be able to know us from a cursory outside glance, without any reference to any messy intellectual, emotional communion with us.

It wants the upper hand from the beginning. Like religions, where your life and morals are submerged in its holy tomes, there's a wish to submerge you in a version of what they deem "science". In this instance that functions as a sort of sanctification of their opinions, notions and prejudices.

Real science is unquestioned, by hoi polloi, and not understood by said, either.