Stapelia

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There exists a certain number of people that are useless or even harmful to society. The connecting factor is the inability to participate to society in a meaningful way. They simply are unable (or unwilling) to perform necessary functions or some part of their behaviour is considered too aberrant. If the latter reaches a certain point, we just outright kill them, or banish them. The part of the spectrum that we tolerate enough to avoid punishment is the territory of psychiatry. Same with the people who are not up to challenges of societal life. Hunter-gatherers leave useless people to die, but after surplus accrues this is deemed immoral.

So, what is to be done? The authorities; religion, medicine, philosophy etc. try to tackle the problem. The instinct of the common man is to punish them, and the worst of this must be curtailed by the powers that be. Hence the ”sick” are absolved of their agency in their problem. They are possessed  or wrought by illness. Now society can sacrifice a part of their surplus and the people are content with the arrangement. The aberrations are controlled, and anger sedated.

As the progress of society means the increasing prevalence of science, also the role of medicine in this social control is increased and psychiatry begins to appropriate the language and methodology of science.

The changing moral standards also mean that psychiatry must change, as more and more of our treatments are beginning to be considered as too cruel. Naturally the envelope of acceptable behaviour also grows as the modern capitalistic society does not need the values of the agrarian society.

A clear sign of this is the demedicalization of homosexuality and now transgender people. If you can be valuable taxpayer, the moral standards that we once held people to are much laxer. You must understand that this is not in the hands of psychiatry, but the society. In the same way, politically inconvenient people were confined to mental institutions in the Soviet Union.

The introduction of drugs into psychiatry is partly due to the wild success of them in other fields of medicine. Another factor is the dire need of more humane treatments. The often-forgotten truth is that many drugs were introduced to replace things like lobotomies. Even though I don’t give much value to modern psychiatry, it’s still light years ahead of the earlier state of the field, where people thought they could just analyze schizophrenia away.

The fact is that drugs are somewhat efficient in some conditions and to a certain percentage of patients, arguably the best treatment that exists and much much cheaper than therapy. Especially if viewed through the societal lens, where normal performance is the golden standard. So naturally a lot of money floats in to this, and the new drugs don’t have to be good, because the previous ones are not either.

Psychiatry can never be scientific or probably even very efficient. This is simply since the problems and the phenomena exist only on a psychological and a societal level, in the ontological sense. You can imagine and measure the brain as much as you want, but before you can pin down the ways that consciousness and the underlying muck affect the physiology it’s all just hot air. Nothing will come of it, due to the mangled nature of psychiatric nosology and the lack of aetiology. And the system is far too big that we could ever just stop it and pull out the rotten foundation. Nothing else will ever take the place of psychiatry, because if it did, it would simply become psychiatry. There is no way to science out these extremely complex societal issues. The society decides what is the problem, we just try to come up with a humane and efficient solution to enforce its standards.