COMMENTARY

Fallacies of Psychiatry

Nassir Ghaemi, MD, MPH

Disclosures

October 04, 2013

In This Article

Psychiatric Fallacies: Introduction

When approaching the complexities of psychiatry, I've noticed that many people bring with them assumptions about how closely related fields, such as psychology and biology, should apply. These assumptions are often fallacious, leading to mistaken attitudes in psychiatry. Here, I want to expose some of those psychological and biological fallacies and suggest another way of thinking that provides a perspective that can be psychologically and biologically valid.

The Psychological Fallacy

Some critics of psychiatry, especially among sociologists and psychologists, take a seemingly erudite position that psychiatry simply diagnoses everyone with such conditions as depression, while ignoring the many "causes" in life that produce those symptoms. How many times do we hear the redundant and overworn critique that psychiatry has medicalized everyday life?

The critique is not false; it's more than half true. We do overpathologize, and always have, even before the claims of today's biologically reductionistic psychiatry: For a century, psychoanalysts overpathologized even though they were anything but biologically reductionistic.

The problem with these critiques and beliefs is that they reflect a deep fallacy in psychology and psychiatry, a far deeper fallacy than the oft-repeated claim of biological reductionism. There is no worse risk in psychology/psychiatry than the psychological fallacy.

How many times has a patient told me when I ask about depressive or manic symptoms, "Yes, but I was depressed because of x, y, and z"? Or, "I get manic when I get really interested in things"? How many times have I seen mental health clinicians downplay a mood illness diagnosis because they were associated with many psychosocial stressors?

These psychological judgments are essentially made on the basis of common sense. But if common sense were enough to explain things, then our patients would have convinced themselves, or been convinced by their friends and family. If a patient crosses the threshold of a clinician's door, then common sense has failed -- no need to keep using it. What is needed is scientific sense, which is quite different than common sense.

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