NYTimes Letter: Chairman of DSM-IV committee says Trump isn't crazy, just a dangerous asshole

Well put. And this is the origin of much of the confusion about what psychiatry is and isn’t.

Psychiatry is considered a medical profession yet is the only branch medicine largely defined by phenomenology rather than empiricism. In less nerdy terms: its taxonomy of clinical disorders is defined by signs and symptoms without a biologically-based etiology or pathophysiology.

This phenomenological aspect of psychiatry is both intrinsic and extrinsic. Psychiatry intrinsically phenomenological in that it has to also deal with an organ who self-modification processes are in part psychological. In terms of biological mechanics, psychiatry will never be a tractable branch of medicine like cardiology and it shouldn’t be.

The phenomenological aspect of psychiatry is extrinsic to the extent that its diagnoses have material pathophysiologies not yet known or understood. With more advanced understanding of the biological underpinnings of psychiatric disorders, it’s plausible–likely, on a long enough timeline–that the DSM could be eventually rewritten using a joint set of phenomenological and materialist criteria for each diagnosis.

The DSM is a clinical handbook and with caveats not seen in that for any other branch of modern (read: material) medicine. It is not a neuroscience encyclopedia. It is not intended to be a taxonomy of human behavior which is why I bristle whenever someone uses one of its disorder acronyms as an adjective.

I love you so much for saying this. It can’t be said enough, thank you. The dynamic between the intrapersonal and one’s external environment cannot account for everything for any given disorder but it’s an essential vantage point and one that any good psychiatrist will always visit.

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Translation No. 2: “The truly mentally ill are nicer than Trump.”


Well, all I have to say is that if anyone wants to declare 45 sane, that’s a pretty fucking generous definition of sanity being employed.


Killing a loved one because your momentary anger overpowers the extent to which you value their life: sane.
Killing a loved one because you have a delusion they are plotting to kill you: insane.

Turns out sanity means doing things that make absolutely no sense based on correct information while insanity is doing things that make perfect sense based on incorrect information.


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