I’d like to start with a few disclaimers. This is not an anti-psychiatry post. This is also not the place to ask or receive advice about your mental health, or what nowadays is called “mental health”.
For some time now I’ve been feeling like I live in a different world than most people I know. It has come to a point where I have to face an awkward alternative: Either most people I know are wrong (including learned men and experts) or I am insane. As I don’t believe I have lost my sanity, and as I believe that I have very strong arguments to hold my ideas against all reasonable counterarguments; I think it’s about time I sit down and share my ideas more or less publicly. This is one of such ideas. What follows is the summary of my academic studies, my professional experience working in the field of mental health, my own personal thoughts, and the influence of several authors, chiefly Georges Canguilhem and Jacques Lacan.
The APA defines psychopathology as “the scientific study of mental disorders, including their theoretical underpinnings, etiology, progression, symptomatology, diagnosis, and treatment”. It is a jurisdiction of medicine, although that does not exclude other disciplines from delving into it as well. It is intrinsically linked to psychiatry, to the point where one cannot exist without the other. But psychiatry itself is a rather contradictory branch of medicine, because while every other specialization of medicine has built its own object of study by exploring a specific organ or function from the body, psychiatry exists only by virtue of that which it ignores. In its origins, psychiatry was born to deal with what has been classically classified as insanity, those people described by Descartes who believed they were made of glass or who fancied themselves to be pitches of water. These outlandish delusions have always caused turmoil in society because nobody really knows where they come from, what they mean and, most importantly, what to do with them. Insane people clearly need help but they do not want it, or what help they are willing to receive it’s impossible for other people to give. They break the law but they are not criminals, or at least they are bening. They behave like savages but are human beings and deserve to be treated as such.
Now enter the Enlightenment: Lady Reason triumphs all over the Western world, everything now has or will have a place and an explanation in the encyclopedia of universal knowledge. And what we understand we control. There are now a bunch of physicians who have little evidence but little doubt that these people are sick and that it is their task to heal them. And that they’ll try with all their available resources, but with little success. So while neurology developed from the study of the brain, cardiology from that of the heart and so on, psychiatry was born out of sheer embarrassment. It is the branch of medicine that studies mental disorders. However, being a part of modern scientific medicine, it cannot but assert that mental disorders can be explained by studying the body, the contradiction being that the day psychiatry discovers the bodily cause of mental disorders will be the day that it ceases to exist as a specialization of medicine, for said cause would fall under the jurisdiction of another specialization: If it’s in the brain then it would be neurology, if it’s in the genes it would be medical genetics, and if we were to discover a new organ in the body then a new specialization will be born to study it, leaving psychiatry in the past.
Therefore, psychiatry exists only because we do not know what mental disorders are. In fact, we don’t even know if the mind is real or not, much less whether it can get sick. What do we actually know then? We know that 1. there are people who need help, and 2. that there are means to help them. So it becomes a matter of administering a scarce resource. This is what psychopathology really is: It is not a science of mental pathology, it is the art of distributing psychiatric drugs and psychological treatments.
There used to be psychopathology. Classic psychiatrists wrote impressive treaties on the subject, with thousands of pages explaining in detail and classifying the behavior of their patients. The mountains really were in labour, alas, only a mouse was born: No progress was made regarding the causes, and most importantly the treatment of such behaviors. This last problem was drastically improved by the invention of psychopharmacology. Suddenly psychiatrists had a powerful tool to treat the symptoms of insanity, so even though they weren’t any close to understanding these symptoms, they changed their ideas on the subject to reflect the influence of psychiatric drugs. These influences can be accurately gauged by the changes on the DSM. The first DSMs included theories about the origin and nature of mental disorders, the last DSMs only mention the clinical symptoms necessary to prescribe a treatment. When a patient is diagnosed with depression the only relevant information that is learned is that said patient will start a treatment for depression.
So are mental disorders real? Of course they are. Whether they are mental or disorders, that’s another question. They are real because they are a set of behaviors that have been observed to occur together: Feelings of sadness, self-harming ideas or behaviors, inability to feel pleasure, these are all things that are real, observable, measurable, and treatable. But are these symptoms a mental problem? Are they a medical problem, or a problem at all? This is highly debatable, and in any case, not a solid foundation for a science.
If a person feels sad all the time, it is only natural for them to think that this life is not worth living. But the opposite is also true: If a person is convinced that there is nothing good in this world, then they will feel sad and hopeless all the time. So what comes first? Should we treat the sadness or the thoughts? And what if the person likes to feel sad, if they don’t want any help? Should we force them? And to make matters worse, it turns out that both psychiatric drugs and psychotherapy are effective*. And this is only to talk about those treatments that have empiric evidence to back them up and are approved by psychiatry, because, under the right circumstances, literally everything can be therapeutic: There’s horse therapy, art therapy, music therapy, dog therapy, video-game therapy, you name it.
There are some who believe in the demon deceptor, a person, or a group of people, who control our reality and make lies pass for truth, usually with malicious intent. These people believe that the pharmaceutical industry has created mental disorders only to sell drugs, and that psychologists and psychiatrists are their accomplices. For my part, I think it is overly optimistic to believe that someone has such a degree of control over the situation as to make it bend to their will. I believe that people are just confused, and with good reason, because being human is quite a bizarre experience. There are of course those who profit from the confusion of their fellow man, and prey on their ignorance. But even evil has its limits, and nobody can summon such perfect wickedness that no good may come of it. The truth is that for all the confusion that our idea of psychopathology entails, the treatment and the care for people with mental disorders has progressed a great deal in the last decades.
On the other hand there are the encyclopedists, who will argue that the fact that we haven’t discovered the bodily sources of mental disorders does not mean that we won’t succeed in the future. We have certainly made discoveries in this direction: Not only do we know now that it is impossible to be sad or mad without a brain, but we also know what specific brain part or substance is required. But even after all the advances in neurology, still no neurologic exam is indicated for the diagnoses of mental disorders, and for good reason. Because ultimately, what decides if someone has a mental disorder or not are arbitrary criteria. The fact that homosexuality is no longer a mental illness is only because of the fact that society has shifted its values towards the acceptance of diverse sexual orientations, were it not for that fact we would speak about the “homosexual brain” just as we know speak about “the depressed brain”. We could also speak about “the carpenter brain” or “the the writer’s brain”, and treat all of those conditions as illnesses.
In conclusion, I believe that contemporary psychopathology is a case of finding a hammer and suddenly realizing we are surrounded by nails. If something can be treated as an illness it will be treated as an illness, because that is l’esprit de l’époque. Classifying something as an illness, assigning it a part of the brain, and prescribing it a drug as treatment makes it real and important, so politicians, scientists, and the general public are aware of its existence and direct resources its way. This is why everyday we “discover” that there are more things linked to mental health: Poor housing, poor nourishment, the weather, sexual orientation, racial discrimination, political ideologies… and as there is no psychopathology there’s no limit to psychic pathologies. There’s a drug for everything or a therapy for everything. It’s no coincidence that we now have the most effective treatments in history and the highest rate of accessibility to mental health services ever, but the rates of mental disorders are soaring well. And despite all the advances in psychotherapy and psychopharmacology, no breakthroughs have been made in psychopathology.
I’m convinced that in the future people will look at our ideas on psychopathology as we now look at humorism.
Sources:
APA Definition of Psychopathology: https://dictionary.apa.org/psychopathology
*Psychotherapy just as effective as pharmacotherapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244449/
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Notes -
Sorry for the late response. I'll try to hit all the main points and drop the things that I don't think are important, but if I miss responding to something you think is important then let me know and I'll address it.
I think the core of your questions can be summarized like this:
The basic answer is that people are complicated, hypnosis doesn't negate that complexity, and problems are separable from that complexity to varying degrees with the biggest most important problems being not very separable. From a control theory point of view, you need a model of the system before you can control it. It doesn't do you any good to have big powerful actuators which can greatly influence the process if you don't know which way to push to create the desired output. "Hypnosis" can solve the "I need an actuator" part of the problem, but it can't solve the "Where do I hook it up and which way do I push?" part of the problem. The naive perspective we all go into it with is "I just need an actuator, then I could fix these damn undesired behaviors", and it's not until you have one and start trying to actually solve problems that you start to realize you don't know what to do with it and the "undesired" has a lot more connection to reality than people give credit for.
You suggested marriage counseling as an example, and I think that's a perfect example to show the problem. Say we have a couple come in for couples hypnotherapy because they both want to get along. I swing my magical pocket watch at them, "hypnotize" them so that everything you say becomes interpreted as truth through and through, and then say "here you go FC, fix them up!". What suggestions do you give to fix everything?
"You don't hate your husband, because he's not a POS"? But what if he is? How do you know he's not, and why would she hate him if he isn't? If you think you have a compelling answer to that, then why isn't she compelled? You say they both want "to get along", but what does that look like, exactly? Is his "to get along" compatible with her "to get along"? If he thinks she's spending too much on shoes, do you hypnotize him to stfu about it, or her to stop buying so many fucking shoes? How do we know there exists a type of "get along" that would be mutually agreeable? How do we even know a solution exists? We could go on forever with these kinds of questions because relationships are complicated. If you try to brute force things by installing the bottom line "We don't fight anymore" without addressing the structure of the problem, then the points of conflict will still exist, they'll still run into them, they still won't have a solution or means for generating a solution. Whatever ends up happening it probably won't be "solved", because how could it be? By the time you understand the system well enough that you understand which bits could be flipped so as to get the desired results then yes you can use hypnosis and fix up their relationship. But that's no trivial task so good luck demonstrating it reliably and scalably, and by the time you've disentangled things enough that you can see the answer it's likely that they can as well so you won't even need hypnosis.
Getting results in any real world example is largely art. You're 100% right about that. But it's an art built on rules that can be understood and engineered with at low levels.
"Martial arts" are arts too. Yet physical bodies obey laws of leverage, and in certain entanglements the vast complexity of possible response sequences can be narrowed down to very few which can then be mapped out systematically. The idea that you can "scientifically solve fighting", and then go win all the UFCs simply by virtue of being a decent scientist is obvious nonsense. At the same time, it's no surprise that the guy who brought heel hooks from "that shit don't work" to one of the most prevalent no gi submissions (and was wrecking everyone with them in competition) was a physics PhD student. And it's no surprise that he used science/engineering type thinking to figure out the principles of control and map out the leg lock game deeper than his opponents -- allowing him to engineer responses to whatever they threw at him so long as he could suck them into his simplified game first. The power of heel hooks is simultaneously "scary" and "not an immediate solution to all fighting problems ever", and the analogy fits well. How well are you able to simplify this example of human interaction into something you understand?
The reason things "wears off" sometimes is that the person is bigger than your simplified model, and those outside complexity can come creeping in. Why do your Wikipedia edits "wear off" when they do? Well, you're not the only editor. Did you back up your edits such that when all the Wikipedians look at the resulting conflict, they take your side? Or did you just write the bottom line and neglect to reinforce it with anything? If the latter, then it will "wear off" because someone else will put in something different. It's like that.
If you think of hypnosis as "hacking" (and there's a group who called themselves "head hackers"), then you can get a feel for the practical difficulties there. People are going to generally try to revert unwanted changes. Security teams are going to patch exploits as they're noticed. You either have to continually outsmart the people whose computer you're trying to change against their will, even as they learn your tricks and they have the defensive advantages, or you have to suggest changes they're happy to keep around and go through the front door -- in which case you're not really a "hacker" anymore. So "does hacking work"? It depends on your context and goals. Are you trying to harm grandma? Then sure it works. Are you trying to steal information from a bank? Maybe if you're really good at it and the bank is caught slipping, and you're willing to risk jail time. Are you going to pull it off long term against a competent target by following steps you read in "Hacking for Dummies"? Hell no.
Similarly, does hypnosis work well enough to allow people to sexually assault women, have them forget it ever happened, and then repeat it a half dozen times before it all falls apart and the perp ends up in jail? Absolutely. The proof of this is Michael Fine. Does it work well enough to have someone hallucinate a dick as a popsicle, get the person to "suck on the popsicle", and have hypnosis researchers back them up in court based on their wishful-thinking/unfalsifiable-victim-blaming stance of "You can't be made to do anything you don't want to do, so if you say you didn't want to do it you're a liar and you really wanted it"? The Oxford Handbook of Hypnosis documents such a case. Does it work well enough to get you "happily ever after"? Not with the myopic/oversimplified/non-cooperation-focused methods those men used.
The science shows good results on simple things like pain control. You can probably find evidence of worthwhile effect on weight loss/smoking (prepublish edit: I wasn't intending to look, but I stumbled across this one when looking for something else: https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-4679(198501)41:1%3C35::AID-JCLP2270410107%3E3.0.CO;2-Z), and plenty of people make their living helping people with that kind of thing. But you're not going to find a reliable "snap of the fingers" cure to "alcoholism" or "marriage difficulties" because those problems just aren't that simple.
On questions like "Can you get kids to get along", my kid gets along with others quite well so far. I'd love to claim that it's totally on purpose and I'm just an amazing dad, its a bit nebulous and not that uncommon so it's hard to prove an effect there. The clearer effects are on the simpler/easier problems where ~100% of people fail anyway. Liver is healthy, so your kid should enjoy eating liver; my kid loves it. Getting your shots isn't a bad thing, so your kid shouldn't be averse to it; my kid has enjoyed it so far. These are things where if you understand how this shit works, you stop making kid shows that systematically instill fear of needles into kids when you're "trying to help", and instead can systematically work to undo such nonsense. It's still a dance, and knowing the rules of the game doesn't mean you play perfectly. I was all proud that I was able to get my two year old excited to get her shots and that I didn't have to drag her there, but jokes on me because I had to drag her away when she was crying about not being able to get more. But hey, it's a problem I'm happy to have and I certainly wouldn't have gotten there if I hadn't learned which way to nudge to get the response I wanted.
It's usually fairly easy to resist things if you see it coming and you have already recognized the thing as something you coherently don't want to do. That's a lot of qualifications. It's enough to prevent things from scaling beyond a certain point, but not enough to prevent cases like Michael Fine. Richard Feynman's account is interesting too. He saw it coming and walked right into it anyway to see what would happen, then found it more difficult to resist than anticipated and ended up playing into the stupid trick he had resolved to reject. He certainly would have rejected it if the stakes were higher, but then again hypnosis can get much more insidious than that.
So there's significant truth to it, but without those qualifications it's mainly a "lie to children" that hypnotherapists tell to reassure their clients (and which the dumb ones believe, to reassure themselves), which is conveniently repeated by sexual predators in order to get their victims guard down and defend themselves from allegations of wrongdoing.
For the most part they didn't know what I was going to try to do and that would have prevented it from working. The one that failed was sloppy, and the person seemed to pick up on where I was going with it. The process was mostly hypnotizing them, adding a single layer of misdirection by suggesting things that would lead to them holding an atheist perspective but which weren't labeled as such, and then suggesting that this is what they've always believed. For example, "Let's just pretend to be atheist, so as to better understand the mind of a nonbeliever and reach them better. Okay, so why don't you believe in God? And you've always believed this? You definitely weren't hypnotized to have this perspective right? Like, for reals for reals? You've never been hypnotized before in your life? Okay, cool. Later!" -- to oversimplify a bit.
The last one was a bit different in that it was all above board and I asked for a volunteer for an experiment using hypnosis to find out what happens when a conversation about religious beliefs is conducted with hypnotically enforced honesty. The religious beliefs crumbled immediately upon accepting the suggestion for honesty about her beliefs, and it was a viscerally painful experience for her. She admitted that it was basically a way to not have to deal with her fear of death, and then eventually (after 1-2 months) she picked up her religious beliefs again because that load needed bearing still, but she didn't pick up the same denomination of church since that part wasn't load bearing and was actually causing her problems.
The big take away for me was that people believe things for reasons -- even when they don't know what those reasons are and all the justifications they give are clearly nonsense that even they don't believe. I thought it might have been something where it's like "I believe X because I believe X, and its embarrassing to change my mind so I'm not gonna", and if you change X to Y they just stick there instead. And they did stick for a while, but there really are forces that pulled them towards X in the first place and if you want long term results you have to understand and work with those forces (e.g. provide an alternate way of handling fear of death, or whatever) rather than attempt to bypass them so that you don't have to deal with the complexity.
I want to be clear that I feel pretty bad about it and wouldn't do it again; it wasn't a very nice thing to do. I did some other experiments too, including stuff like trying to get people to download and run a program named "virus.exe" which was actually harmless (for which the antivirus software was a more difficult hurdle), and trying to just walk up to people and hypnotize them without asking permission (which I eventually succeeded at, but which contained other difficulties), etc. It really did help show in an unmistakable way that there's no such thing as "dark arts for good", and that the skills needed for long term stable results require working in a different direction. So I got a lot out of it even though I wish I would have found a better way to learn some of it.
Anyway, I hope that explains things enough to get a sense of what I'm getting at, and feel free to ask any questions about things I didn't cover or didn't explain well.
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