This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
Define "work great"? Leaving aside the drugs end of things, does psychotherapy/counseling reliably deliver good results compared to much cheaper alternatives like, say, talking to a priest or a volunteer who's completed a two-hour course on active listening?
But the treatments, and the academy that developed them, have very obviously oversold their "solutions" to the point of actively and chronically aggravating the political and ethical problems. They have made a habit of claiming that that old, well-tested, workable solutions should be replaced by new and improved solutions that will fix everything, and then when these new solutions don't actually work they and their allies pointedly ignore all the consequences.
Would you disagree that if we want to answer the question of why this murder happened, the answer is that Psychology as an industry didn't do its job? If you disagree, could you explain why?
You can't separate out the medication side of things and call it done. This is where a large part of the evidence base is. Medications are what's indicated for most moderate to severe pathology for example (with therapy as an adjunct if at all).
As a physician I'm obvious more familiar with the medication side of things, but my understanding of therapy is that narrowly tailored therapy regimens work fantastically well. OP mentioned exposure therapy. DBT for Borderline is another classic. Therapy research is more complicated for much of the usual reasons - you can just give a patient Amlodipine and watch what their BP does. Standardizing therapy care for research is nearly impossible. That standardization applies to general clinical practice - you have a huge variation in proficiency of practitioners. Anyone who has exposure to high quality (read: expensive) therapy will tell you it is an incredibly effective modality and temporary. For many manifestations of things like Anxiety and Depression high quality therapy will be more effective than medication. This is not an indictment of medication.
Don't make the mistake of looking at the online conversation about the discipline and assume that is at all applicable to the reality of things, for instance the criticism "they have made a habit of claiming that that old, well-tested, workable solutions should be replaced by new and improved solutions that will fix everything" is an extremely common patient fear but is incredibly rare thing in most practice settings. Yes shady high volume people are out there but most surgeons fetishize outcome metrics, most PCPs get a hard-on for saving their patients money and most psychiatrists want their patients to take easy to afford and obtain stuff so they actually take the medications. As a poster here you are probably higher education and income so you are more likely to encounter someone who is better at customer service than care who will sell you the new thing. That's out there. That's a small fraction of the care and overall pathology.
Psychiatry has a specific problem - many mentally ill people are mad, can't understand they have a mental illness, believe they just have a medical problem, want Adderall or Cannabis as a drug of abuse and so on. These people complain about the field. They are not reliable narrators.
The killing of Iryna and other similar events is a political problem. America has a very individual rights oriented approach to managing mental illness. Also things that are mental illness adjacent but not quite mental illness (like heavy substance use or personality disorders). If the judge says the patient has to be released, if there aren't state hospitals beds, psychiatry has limited options. Many severely mentally ill people get discharged and immediately stop taking their medication (which was working!) and go do drugs. An antipsychotic can't help with that. Send them to jail or lock them up for good in hospitals or give the doctors more rights to do things against their patients wishes. These all have costs. I don't know what's best, that's a complicated topic. Historically societies just killed them if they were poor. We don't do that anymore (which is good!) but we've replaced it with the actuarial risk of murder and other bad outcomes.
More options
Context Copy link
More options
Context Copy link