I wrote the following two comments under an article by the Critical Psychiatrist Joanna Moncrieff:
You write the following: “We should acknowledge, however, that neurological conditions cannot always be detected in the brain, and may only be identified through the characteristic way in which they are manifested in publicly observable behaviour. This does make judging what is and is not a brain disease a complex and imprecise matter in some cases.”
Surely a “neurological condition” is absolutely always potentially detectable in the brain (or nervous system) – by virtue of its being a physical neurological condition. What “is and is not a brain disease” is not really a question of judgement, but of science. Until a disease is categorically scientifically identified, how can it be said to exist at all?
Surely a “neurological condition” is absolutely always potentially detectable in the brain (or nervous system) – by virtue of its being a physical neurological condition. What “is and is not a brain disease” is not really a question of judgement, but of science. Until a disease is categorically scientifically identified, how can it be said to exist at all?
Also – how can a “neurological condition” be completely “identified” by its manifestation in behaviour? Surely this is a category error. Surely a “neurological condition” can only be fully and unequivocally identified by a physical examination of the B.C.N. – brain and central nervous system – of some kind.
Joanna Moncrieff's reply to my comments was as follows:
Hi citizen sofa,
This is not the case. Dementia, including Alzheimer’s disease, is not diagnosed by brain imaging or any other physical tests. As a group, people with a diagnosis of dementia have more of the brain pathology associated with aging than those who do not (plaques and tangles and infarcts identified in brain scans), but most people at a certain age have some of this pathology and there is overlap (ie. a person without dementia may have more pathology than an individual with it). Brain imaging cannot therefore be used to make a diagnosis, and no other physical tests specifically identify dementia either. Dementia is diagnosed by someone’s behaviour and performance on tests of cognitive function.
This is not the case. Dementia, including Alzheimer’s disease, is not diagnosed by brain imaging or any other physical tests. As a group, people with a diagnosis of dementia have more of the brain pathology associated with aging than those who do not (plaques and tangles and infarcts identified in brain scans), but most people at a certain age have some of this pathology and there is overlap (ie. a person without dementia may have more pathology than an individual with it). Brain imaging cannot therefore be used to make a diagnosis, and no other physical tests specifically identify dementia either. Dementia is diagnosed by someone’s behaviour and performance on tests of cognitive function.
I think people do not realise this because if you look at information on diagnosing dementia it is very vague and does not make this clear. When someone is being investigated for possible dementia, they will have various blood tests and other examinations, but these are for the purpose of excluding other diagnoses (like hypothyroidism) that may be producing the symptoms. Dementia is diagnosed when no other physical explanation of the symptoms (behaviour and cognitive deficits identified on testing) is found.
Source:
https://joannamoncrieff.com/2017/11/27/philosophy-part-6-are-mental-disorders-brain-diseases-in-waiting/
What I wrote in my comments is indeed the case, in spite of what she says above.
Her reply seems to ignore my basic point.
A neurological condition can indeed only be neurological.
Her reply seems to ignore my basic point.
A neurological condition can indeed only be neurological.
Her reply to my comment shows why Szasz's perspective is absolutely vital, even in areas that are not related to so-called "mental illness".
Szasz was a true upholder of the spirit of science and the Enlightenment.
Szasz was a true upholder of the spirit of science and the Enlightenment.
If dementia is merely degeneration then it is not strictly speaking - and hence not scientifically speaking - a disease. If dementia is not identified in pathology of some kind then it is not a disease - it is merely an observed behaviour.
If it is only observable in behaviour then we cannot say it exists at all. If and when that behaviour is demonstrated to have been directly caused by physical pathology, then we could possibly say that a behaviour has been caused by an illness. We can never say that a behaviour is an illness. It is indeed a category error.
I have already made a similar point in my blog on neuroscience.
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http://nervescienceisnonsense.blogspot.co.uk/2014/05/clueless-about-alzheimers-disease.html
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http://nervescienceisnonsense.blogspot.co.uk/2014/05/clueless-about-alzheimers-disease.html
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Szasz's basic point is absolutely right and absolutely vital. A behaviour is not in itself a disease.
A diagnosis can only mean a disease in the light of the evidence of medical science.
My obvious point is that cancer - for example - would never be diagnosed solely on the basis of changed behaviour. Neither would treatment for it be initiated. You would not give someone oncological brain surgery, merely because they had slurred speech and were very confused. Cancer would only ever be diagnosed on the basis of scientific evidence. Neither should any other disease be diagnosed on the basis of anything other than scientific evidence.
My obvious point is that cancer - for example - would never be diagnosed solely on the basis of changed behaviour. Neither would treatment for it be initiated. You would not give someone oncological brain surgery, merely because they had slurred speech and were very confused. Cancer would only ever be diagnosed on the basis of scientific evidence. Neither should any other disease be diagnosed on the basis of anything other than scientific evidence.
If people need a diagnosis of dementia in order for them to receive the help they need, then I don't believe in sacrificing science for social reasons. If people need a diagnosis for social reasons, then we have a social problem, not necessarily a medical problem. Why should people need a diagnosis to get help? A diagnosis should be a scientific question and nothing else.
People should get all the help that they need. This applies to everyone and every possible problem. There is simply no need to sacrifice science to the social institution of what remains of the medical profession.
This compromising of science has been going on for too long. And Szasz seems to have been one of the few people aware of it.
People should get all the help that they need. This applies to everyone and every possible problem. There is simply no need to sacrifice science to the social institution of what remains of the medical profession.
This compromising of science has been going on for too long. And Szasz seems to have been one of the few people aware of it.
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"The Critical Psychiatry Network's position is not in my view psychiatric criticism at all.
It is a plea for what I have long called prettifying the psychiatric plantation.
Psychiatrists either have the right to forcibly molest persons or they do not have such a right.
Some things are either-or. You are either arrested or not arrested.
You are either sitting here or you are in jail."
Thomas Szasz, 2011.
"The Critical Psychiatry Network's position is not in my view psychiatric criticism at all.
It is a plea for what I have long called prettifying the psychiatric plantation.
Psychiatrists either have the right to forcibly molest persons or they do not have such a right.
Some things are either-or. You are either arrested or not arrested.
You are either sitting here or you are in jail."
Thomas Szasz, 2011.