Talk:Biopsychiatry controversy/Archive 2

Of course! Blogs and unmentionable people must be removed. I am not sure if the version I wrote with Bookish contained blogs (Bookish never allowed that). Do you approve about reverting to an earlier version, before tons of contend were removed? If so, which version? Cesar Tort 23:26, 5 January 2008 (UTC)

The problem is the "metaphors" and are used by practitioners, not researchers. The oversimplified theories appear in popular media and folk knowledge, not academic journals and text books. Most criticism you will find won't really be talking about "biopsychiatry" but some non-sequiturs used in misapplications of it. Much of what this article used to be was like that. As long as it stays with this name, it can't be re-added. At this point, this page is a dead-end as is. So I won't be endorsing any reverts now.

Voice-of-All

00:04, 6 January 2008 (UTC)

In that case just move the article: rename it. After that we could revert.

• "Most criticism you will find won't really be talking about "biopsychiatry" but some non-sequiturs used in misapplications of it".

Have you read the Szasz quotation I cited above that Hfarn censored (along with most of the article)? It is directed to the whole field of biopsych, not misapplications. And there are many mental health professionals who share his views.

Cesar Tort 00:53, 6 January 2008 (UTC)

I would point out that this claim is a bald untruth. As can be seen from this snapshot of the article before I made any edits to it, it does not contain this quote. To my knowledge, it has not been introduced since. Further, even if I had removed content that included that quote, to claim that this is "censorship" without further substantiation would still have been a clear violation of

WP:AGF. Hrafn^Talk_Stalk

03:33, 6 January 2008 (UTC)

Hrafn^Talk_Stalk 04:15, 6 January 2008 (UTC)

I have noticed since making these comments that VoA was talking about reductionism in the application of biopsychiatric research, not of reductionism of the research itself. This means (1) that my parenthetical caveat about titles in my last bullet-point above is therefore moot; but (2) that it may be that finding

WP:RSs documenting this reductionism may be more difficult (as by VoA's admission it resides "in popular media and folk knowledge"). Hrafn^Talk_Stalk

06:12, 6 January 2008 (UTC)

Yes, though I'd still express a mild preference to eliminating the "applied" if it isn't absolutely necessary -- to lower the word-count, and to avoid ruling out any theoretical biological psychiatry controversy that might turn up from inclusion in the article. Hrafn^Talk_Stalk 06:07, 7 January 2008 (UTC)

Since Hrafn removed tons of content after a couple of days without giving me a chance to source them properly (the amateurish sources I added from my job, without my library at hand, were not the best I could do), I would like to ask you a straightforward question, Rockpocket:

Is there a policy that impedes me to restore the deleted material of those two or three days, when the article was virtually emptied?

I very much doubt that that policy exists. Hrafn edited single-handedly the article when I was so overwhelmed by work (at least this Saturday is my weekend) that I couldn’t even discuss at length. It seems to me that Hrafn has hijacked the article and we have been behaving like lambs, if not in the talk pages, we have done it in the article itself. Hrafn will never agree with any article that explains the criticism that many scholars have done to biopsych because he believes in censorship and that only the orthodox pov can find a place in WP. Frankly, as busy as I am in real world I have not the time nor the patience to argue with such an editor anymore.

Benjaminbruheim is right that WP:undue is a provincial American pov. Just one example: the USA buys most of the

I iterate that if there is no policy that impedes me to revert the massive removals done without consensus since I placed the comment “Still another NPOV dispute” above in this talk page, I will revert. So please Rockpocket and Voice of All: tell me if what I plan to do is ok with policy.

Thanks!

—Cesar Tort 04:36, 6 January 2008 (UTC)

There is no policy the impedes you from reverting to a prior version if you believe that is an improvement over the current one, however that is something I wouldn't recommend for a number of reasons. Firstly, there is nothing stopping Hrafn from reverting it back, and then we risk an edit war. That is in no-one's interest and will not resolve the impasse. Secondly, Hrafn's edits were in good faith, I believe, and justified in policy, or at least his interpretation of it. They may have been done relatively quickly, but the were not unannounced, he spelled out his intention in advance.

I'm not sure I agree with all of his edits and his application of policy, and feel he may have gone a little too far in the opposite direction, but I don't think a mass revert to undo all his work is the answer. Many of his edits were good, and a mass revert would lose that good work. Besides, I may be an admin, but that doesn't mean my interpretation of policy trumps his.

I would suggest instead, that there is some kind of complex merge where disputed material can be included, appropriately sourced in in context, after discussion. One way of doing that is to embrace my suggestion above where you work on sections of the old version of the article in your user space. I noted with enthusiasm that Hraf's welcomes sections on 'Overmedication in psychiatry', 'Drug company capture of the psychiatric profession' and 'Reductionism in biopsychiatric research'. These seem to me like areas that could be fleshed out to give the article context, and an area to focus on and find common ground.

I hate to sound like a hippy here, but looking backwards is a bad idea. Whats done is done. If this article is to get better then I think we have to accept the article, as it is, as a starting point and move forward to improve it. Thats not to say that bits of the old article may not be used, just that they should be discussed and, where appropriate, sourced anew while writing the new sections. Rockpocket 05:00, 6 January 2008 (UTC)

Is the majority viewpoint of the psychiatric profession, and particularly of the psychiatric research community, that the biopsychiatric model of psychiatry is, by and large, accepted or rejected?
In correctly allocating

1. that the issue for which comment is sought is on the question of the majority viewpoint of the psychiatric profession, and particularly of the psychiatric research community, not the individual viewpoints of editors on this issue; and
2. that, as always in wikipedia discussions, greater weight will be placed on comments containing (preferably
   WP:RS
   sources).

Hrafn^Talk_Stalk 06:41, 6 January 2008 (UTC)

View from Casliber

Speaking as a psychiatrist, no-one really talks of themselves as a bio-psychiatrist other than the few who specialise in neuropsychiatry or those who are particularly interested in psychopharmacology. Others would generally consider themselves merely as psychiatrists and many I would hazard a guess see themselves as balanced or not preferring one model over another. Thus answering the question "The Majority" probably would not consider themselves as bio-psychiatrists.

However there is documented concern from psychiatrists within the profession and including notable ones at that, that as a whole the profession has headed in a biological direction since the late 1960s or early 1970s. The reasons cited have been varied. cheers, Casliber (talk · contribs) 08:51, 6 January 2008 (UTC)

PS: I'll have to muse upon good sources for this. I saw something recently but have momentarily forgotten where. There will be sources though. cheers, Casliber (talk · contribs) 08:53, 6 January 2008 (UTC)

If I may ask you a few follow-up questions, Casliber:

• Which formal/theoretical model of psychiatry has widest acceptance in the profession (even if as theoretical models they have little direct relevance to day to day treatment):
  Trauma model
  /some other model?
• Has the "biological direction" that the "profession has headed in" been sufficiently substantial that this "biological direction" could be legitimately considered to be the "majority viewpoint"? Are there any competing directions/counter-currents/resistances that could instead be legitimately considered to be that "majority"?
• Do the majority of the profession consider that those researching the problem from a Biopsychiatric standpoint have taken things too far, that time and money being spent on biological mechanisms, genetics and drugs would be better spent on other lines of enquiry?

Hrafn^Talk_Stalk 11:10, 6 January 2008 (UTC)

Ok, in the main, most psychiatrists would admit they use a

Trauma model is held as important by many but probably not a majority. biological psychiatry as highlighted on the page predominates alot of published research and practices, however, the problem is I don't know that anyone within that sphere would call themselves as such. I'll ask some colleagues.cheers, Casliber (talk · contribs

) 20:02, 6 January 2008 (UTC)

Finally, it is almost impossible to judge if it is a majority that are concerned as per point 3 above. Only a minority of psychiatrists publish in journals. I am not sure of any opinion polls or surveys, as these may provide the best evidence - and an article summarising the same. I'll see what I can dig up.cheers, Casliber (talk · contribs)

About point 3: The article I linked from the president of APA states directly that more effort should be used on non-biological treatment, research and education --Benjaminbruheim (talk) 23:00, 6 January 2008 (UTC)

Comment from User:Una Smith

As it stands now, this argument turns entirely on opinion. It needs to be verified. To make a valid statement either way (majority or minority), I think the article would need to cite a high quality source on this point. Eg, an opinion poll within a major professional society, or a broad practices survey of the profession, or data on the per-client drug prescription rate. Perhaps a sociology researcher somewhere has data on this? --Una Smith (talk) 15:15, 6 January 2008 (UTC)

Couldn't have said it better myself. cheers, Casliber (talk · contribs) 20:03, 6 January 2008 (UTC)

View from User:Chupper

Disclaimer: Realize this is all OR and just a viewpoint and it probably has tons of spelling mistakes. :)

This is an interesting discussion. Let me say though that these terms "biopsychiatric model" and "medical model" don't have much meaning (that I have witnessed) in academic and clinical psychiatry/psychology. These model classifications seem to be something that critics (and I don't necessarily mean that in a negative tone) have created. I think these terms are sometimes vague and don't really apply to whats going on. There are mental health professionals who use only psychoanalysis (psychotherapists are the only ones I've seen do this - and most of them don't just use psychoanalysis) and there are others who only use biological theories to direct their research (usually neuroscientists). Most psychiatrists and clinical psychologists (probably 90%) take a healthy look at both social and biological mechanisms that relate to psychopathology. There are those who specialize in certain fields - neuropsychiatry/psychology, social psychiatry, anthropology, etc. - but I don't think any of those people in those fields wholeheartedly discount other methods of study. It just comes down to what they specialize in. A pathologist who studies biopsies doesn't always just believe that his specialty is the only method of diagnosis and treatment. Same goes for a neuropsychologist or any of these academic "specialties."

Another issue with these terms is that they imply absolutes; both from a treatment perspective and understanding perspective. Most researchers (psychiatrists, neuropsychologists, psychologists, statisticians, neuroscienctists) that I've seen and read about understand that we know practically nothing about mental disorders and are usually, at bare minimum, open to any hypothesis about anything.

Finally, I think this biological perspective comes across as being more prevalent than it really is for two reasons. One, most researchers and a lot of professionals, IMO, believe that social influences (whether having biological predispotions or not) can lead to neurophysiological changes which can be measured. Two, these researchers like presenting objective results in their papers, and IMO, for good reason. If we can discover objective physiological markers which classify or help a diagnosis for a disorder, wouldn't we prefer that over a battery of personality inventories or subjective interviews? Most would probably say yes. In other words, if we could run a blood test instead of administering a questionnaire, wouldn't those in the clinical setting prefer the objective blood test? And biological and medical treatments for disorders are usually new and therefore welcomed. This is the case because if a biological problem can be detected (which they realize is not usually at the root of the problem) than a medical treatment could be used to directly treat that issue.

Again though, I think most MHPs subsribe to both theories. And just because an academic specializes or has PhD in a specific area, that doesn't mean they reject all other theories. Both clinically and academically I think this is the case and I think others do as well. Check out Guze, S. B. (1992). Why Psychiatry is a Branch of Medicine. New York: Oxford University Press and take a look at page 130. Guze has a few good words about this "balance" of perspectives. Chupper (talk) 16:02, 6 January 2008 (UTC)

View from User:Jfdwolff

I suspect most practicing psychiatrists will not be particularly interested in underlying theoretical frameworks to their practice, but rather whether their pills help their patients. Amongst researchers, a casual stroll through PubMed on any relevant topic (think depression, schizophrenia, bipolar disorder) will show immediately that almost all research in psychiatry makes extensive mention of "biopsychiatry" concepts, e.g. the dopaminergic systems in schizophrenia, serotonergic systems in depression, etc etc. To suggest that there is a significant dissenting community amongst psychiatry researchers would be a bit of a stretch. A few noisy characters, yes. JFW | T@lk 21:26, 6 January 2008 (UTC)

Comment from User:WhatamIdoing

I wonder whether you actually meant to ask this specific question. I seriously doubt that you could find even a single licensed psychiatrist who believes that personality changes after a head injury, or due to Alzheimers, are essentially non-biological. Similarly, there's reasonable evidence that most people with borderline personality disorder have a problem that is primarily (or possibly entirely) non-biological.

If your question is whether there is significant agreement about a biological model for some psychiatric conditions, then the answer is yes: this is a widely accepted model, it certainly explains some conditions entirely, and even people who are widely regarded as quacks would laugh at you if you claimed that great-grandma's advanced dementia was socially constructed. If, instead, you meant to ask whether biopsychiatry explains a particular condition, then it would be helpful to know which condition you really want to hear about. WhatamIdoing (talk) 22:35, 6 January 2008 (UTC)

The criticism is relevant for the major problems. Schizophrenia, bipolar disorders, depression etc. Now, nobody is arguing that physical traumas can't trigger mental disorders, but that is not really relevant. Dementia is not considered a major psychiatric disease either. Hrafn is asking this because he wonder what weighing this article is; however I feel he uses it to remove criticism against psychiatry because they doesn't represent the view of the majority. Now, the "majority" public don't know much about psychiatry and often have false preconceptions so I think this is problematic. And a lot of the critic against biopsychiatry is from psychologists and psychotherapists, so that makes the notion of weighing it in favor of a specific science is kinda bunk. I already tried establishing that the majority of psychiatrist uses biopsychiatry with a statement from the president of APA who implies that biopsychiatry is often used in favour for the dominating bio-psycho-social model. To me it seems Hrafn is weighing it against his personal preconception of psychiatry as mainstream and criticism as fringe. That's like writing about the Green Party from the angle of Republicans. --Benjaminbruheim (talk) 22:52, 6 January 2008 (UTC)

Comment Davidruben

I find the question naive; in summary for what follows, not even "conventional" psychiatrists would adhere just to being labelled as "biopsychiatry model" or indeed exclusively "psychopharmaceutical" in their treatment approach, and the term "biopsychiatry" seems terminology of a minority opinion. As pointed out above there are clear examples of direct physical events causing psychiatric changes (but also of overwhelming psycho-social trauma also having psychiatric effects). But asking whether a field of medicine as a whole has a single cause/approach seems daft - lets take something clearly physical, namely a twisted ankle. Is this a bio-traumatic model ? Of course, we don't subscribe to the "uneven pavement (US=sidewalk) stone God" being angered at us stepping on it and in revenge striking down the trespasser's offending foot. Yet neither would any orthopaedic/trauma-medicine/GP doctor agree that bio-trauma exclusively describes a patient's overall experience (i.e. twist any number of anaesthetised animal's ankles and record time to resolution of swelling, does not map 1-to-1 with clinical scenarios). People differ in their pain tolerance, need for pain relief, response to any given analgesic, ability (physical, temperament, external factors) to appropriately rest or then re-exercise the ankle, social factors such as affordable time off work or need run-about after ones children to look after them. Indeed one can also add quality of advice and instruction from their doctor or physiotherapist, or indeed family & friends that the patient will also interact with.

So ask the question "does bio-trauma explain ankle injury" and the answer will be 100% doctors, but ask the question "does bio-trauma on its own explain totally (i.e. predict) single patient's precise clinical course" and the answer would probably be 0%. Of course the final outcome needs very lateral thinking to also embrace whether a patient will write and complain, instruct a solicitor, likely outcome of legal action and how much councils spend on municipal repairs to prevent injuries in general from ever happening. None of this though would resolve an attack on conventional medicine for not recognising the role for say reflexology as a valid treatment modality for a twisted ankle, and the resulting "anti-biotrauma" would be pointless in raising the question "Is the majority viewpoint of the medical profession, and particularly of the orthopaedic research community, that the biotrauma model of pavement injuries is, by and large, accepted or rejected?" - it should be self-evident that most doctors follow a scientific basis for understanding the underlying principles, with physiological model in approach at conversing and advising their patients to facilitate the optimised communication and best patient concordance for the problem, and all under a sociological framework which dictates limited resources (not all ankle sprains irrespective of mildness can warrant the time and cost of an MRI scan, nor supply of a physiotherapist living 24/7 in a patient's home to offer best guidance, nor expect return to work to not be influenced at all by pressures from work or financial needs).

Just as no orthopaedic doctor or physiotherapist would ever self-refer using the made-up term of "biotraumatist", yet we understand that there is an underlying acceptance of biological-trauma to their work. The problem with the question is twofold:

1. It seeks self-labelling to a single concept as proof of total working approach (compare say "does belief in Judaism make for a good religious leader ?" Whilst the belief is required for a religious leader in a Jewish community, clearly there are shared additional qualities of compassion, counselling (marital, bereavement, post-trauma) and social support to link in with social services or charity organisations that will be true for a religious leader of any particular belief). In other words the question has a flaw of logic in seeking to use an answer to a specific to explain a generalisation.
2. The choice of term "biopsychiatry", which at least in the UK, is not a term used. The term "biopsychiatry" is (again in UK at least) itself hopelessly POV by the anti-psychiatry movement. This is similar to
   WP:N
   and the article starts its description as "Scientology is a body of beliefs and related practices..."; which is how Scientologists, and not its opponents, would self-identify.
   • So on a similar vein most conventional doctors would not agree they are "allopaths" (indeed in UK I suspect few doctors ever heard this term), yet allopathy is term applied by non-conventional medicine (mostly homeopathy I believe) to them. To again rephrase the question "Is the majority viewpoint of the medical profession, and particularly of the clinical medicine research community, that the allopathy model of disease is, by and large, accepted or rejected?" is a meaningless question - most (UK) doctors in their ignorance would not self-identify as allopaths, and of those that do know of the term, the majority would still not self-describe with this term.
   • Returning to psychiatry, here in UK I would more recognise "psychopharmaeutical" as an approach at treating say severe depression (ie giving of drugs rather than prolonged psychotherapy analysis). Yet no psychiatrist would ever exclusively think that alone resolves severe suicidal depression for a patient who also has undergone a number of recent bereavements, has long term unemployment, has as a refugee limited English language and UK social-networking, has unruly children, an alcoholic abusive partner and issues from a neglected upbringing - but these issues do not detract from whether most psychiatrists might not at least consider a partial role for say Prozac for such a patient whilst a more multidisciplinary team approach can be set up and have its influence over the coming months or years.

So do most UK Psychiatrists mostly follow a biopsychiatric model - yes, but it is only part of their approach. Do most UK Psychiatrists class themselves under the specific term "biopsychiatry", I doubt it, yet their practice is rooted in biopsychiatry. The question remains naive, attempts to over-simplify a whole therapeutic discipline and uses a term the profession itself does not largely self-identify with. David Ruben ^Talk 03:21, 7 January 2008 (UTC)

View from Ursasapien

I agree that the question is naive and demonstrates an ignorance of the state of the profession. The biopsychiatric model of psychiatry is neither accepted nor rejected by the majority of psychiatric professionals. It is a small part of the whole of their approach. The question is similar to asking if physicians, by and large, accept or reject holistic medicine. First, it would be impossible to determine. Second, the medical research community has a tendency to explore only a narrow range of inquiry. The medical community, on the whole, supports a variety of approaches and chooses interventions based on the efficacy of the particular treatment with the particular patient. On the whole, I find

• Thank you for your input Ursasapien. If the naiveté of my question offends you, then I apologise. However, as it seems to have yielded relevant and nuanced responses, it would seem to have achieved its aim. The bulk of responses, including their own, appear (and I apologise in advance if my summary is naive or otherwise inaccurate) to express a middle ground: that a 'biopsychiatric model' is neither endorsed over all other models nor rejected outright. If this consensus renders "idiosyncratic" my earlier objections, on the grounds of
  WP:UNDUE, to the article being almost solely written from, and sourced to those of, a viewpoint rejecting biopsychiatry, then I am happy to wallow in my idiosyncrasy. Hrafn^Talk_Stalk
  08:08, 8 January 2008 (UTC)

I found an online version of this paper entitled "The biopsychosocial model in Anglo-American psychiatry: Past, present and future?". It can be found here and it contains tons of relevant material. I find it to raise all the issues that I've heard over the years. However, it does suggest we should broaden the scope of this article and/or the relation to other articles. I think a NEW article called "controversies in psychiatry" would be a good article, whereas the Biopsychiatry Controversy could be a subtopic which might be expanded into its own article (and given the material this article had earlier I think this is plausible). --Benjaminbruheim (talk) 21:28, 6 January 2008 (UTC)

Although, by and large, I do not object to the general thrust of this section, I do most emphatically object to the poor sourcing of it. I could have, under

• As the first sentence is otherwise unsourced, it needs to stay very close to
  chemical imbalance theory
  (and effectively 'ride the coattails' of that article's sourcing), so I have replaced it with language taken directly from that article. If the original wording is demanded, it requires independent sourcing.
• Breggin's unreliability has previously been discussed and is heavily documented on the article on him.
• The 'Pharmaceutical industry influence' paragraph is only tenuously related, so I've moved it into its own section-stub (as we were discussing a section on this in any case).

I will close by quoting the main point of

Thanks for some of the language edit. But the source given at the end of the section states all the claims that you ask for citations. I will thus remove these unless you object. --Benjaminbruheim (talk) 12:47, 7 January 2008 (UTC)

Yes, I do object. Elliot Valenstein is clearly a partisan, if expert, source -- acceptable for sourcing the anti-biopsychiatry viewpoint, with attribution, but not for characterising the biopsychiatry viewpoint. Please source such statements to neutral sources. Hrafn^Talk_Stalk 13:35, 7 January 2008 (UTC)

That you consider him to be partisan is irrelevant as long as it is properly attributed. I don't see what you object to; the claims that psychiatrist are partial to the chemical balance theory is reflected in ie.

Biopsychiatry article. --Benjaminbruheim (talk

) 13:44, 7 January 2008 (UTC)

Partisanship isrelevant, when you cite a source who explicitly rejects the psychiatric mainstream for what "Psychiatrists claim..." If these statements are indeed mainstream psychiatric views, then it should be easy to find mainstream sources for them. I would note that

Monoamine Hypothesis is not much longer than your section, but cites 'five different sources for, I suspect, a less controversial topic.Hrafn^Talk_Stalk

15:06, 7 January 2008 (UTC)

I see your concern. The article cited below at least establishes that the medical industry promotes the chemical imbalance theory and cites how there is little to no evidence for this theory. However it doesn't attribute it to psychiatrists. I don't possess enough wiki-fu to work in references yet, but it might be changed to "The pharmacological industry promotes ..." and use the article as a reference. --Benjaminbruheim (talk) 14:54, 7 January 2008 (UTC)

this article claims "For many years, mental health professionals have used the term "chemical imbalance" to explain the need for medications that are used to treat mental health conditions. This simple and commonly used explanation recognizes that the condition is a medical problem and that it can be treated with medication. The "chemical imbalance" explanation also reflects the overall theme of treatment – identifying what neurotransmitters are involved in the clinical symptom picture and with medication, attempting to return that neurotransmitter level back to the "normal range".". Is this an RS? --Benjaminbruheim (talk) 15:07, 7 January 2008 (UTC)

Is this better? I removed the sentence about medicines effaciacy since the article below has references on research that goes more deeply and can explain the findings that contradict the chemical imbalance theory. --Benjaminbruheim (talk) 15:26, 7 January 2008 (UTC)

this article states "Contemporary neuroscience research has failed to confirm any serotonergic lesion in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency. Modern neuroscience has instead shown that the brain is vastly complex and poorly understood". --Benjaminbruheim (talk) 13:54, 7 January 2008 (UTC)

I'm trying to put together a coherent picture of all this, but not succeeding. I think the issue is highly complex and conflicted. According to the

It is in fact highly likely that psychiatrists say a wide range of things, depending on how well-read they are, how lazy (and thus willing to take drug company claims at face value), whether they're talking to fellow professionals or attempting to simplify so that their patients can understand, etc, etc. It may be dangerous to attempt to distil this diversity down to a single stated position. Hrafn^Talk_Stalk 15:52, 7 January 2008 (UTC)

Yes, it is an interesting problem. I have found a lot of specialists referring to the theory, and even the primary papers. But interestingly the flaw are also pointed out in the primary papers as well! It is as if this is something a text book author invented; a professional myth. I found this paper which outlines the rise of the theory, but attacks the way media, the industry and some professionals portrays it because the science says something wholly different. I will study this paper and references and perhaps we can arrive at something that will portray the criticism from a wholly different angle, and add criticism from a different source allowing us to rewrite the whole paragraph. Ie. both the setup and dismissal of the myth. Agree? --Benjaminbruheim (talk) 15:56, 7 January 2008 (UTC)

Agree with attributing the statement to Carver. The article states above says that

Nancy C. Andreasen is a proponent of the chemical imbalance theory, but I cannot find any primary sources supporting this. --Benjaminbruheim (talk

) 16:07, 7 January 2008 (UTC)

Yes, Andreasen would be an excellent source -- just be careful to amend the section to what she says rather than vice versa. Also the article on her is an excellent example of how not to write an article -- badly sourced (no sources other than herslef), badly laid out (no sections) and more than a little hagiographical. Hrafn^Talk_Stalk 16:33, 7 January 2008 (UTC)

Benjaminbruheim: stating that "psychiatrists state" things on the basis of what a single non-psychiatrist says (when he doesn't even mention half the things you are attributing to him -- specifically the personality disorder half) is exactly the sort of thing that

Sorry, I was going to attribute that more precisely since I was concerned for that myself but forgot. --Benjaminbruheim (talk) 17:20, 7 January 2008 (UTC)

Incidentally, I suspect that the Valenstein statement needs more in the way of specifics (substantiation, clarification and/or qualification of what he's talking about) in order for him not to come across as some sort of out-of-touch voice-from-the-wilderness. 16:56, 7 January 2008 (UTC) Hrafn^Talk_Stalk 17:12, 7 January 2008 (UTC)

I agree. Too bad Cesar Tort is no longer watching this article, he could probably help with that. I will look into it, or find other sources that raise the same issues. --Benjaminbruheim (talk) 17:20, 7 January 2008 (UTC)

Added some more. I am not too happy with the attributions, but it is getting more and more clear that the hypothesis has little concrete evidence. However, all references to this hypothesis having support in, or at least affecting, psychiatry is often mentioned but never cited. Frustrating. I'm also unhappy with the formatting. --Benjaminbruheim (talk) 21:15, 7 January 2008 (UTC)

I am likewise unhappy with the attribution -- it is to an "essay", an explicit "opinion piece", with no real authority beyond what the individual authors might command. Further, it provides no citation to the research literature for the first and most important point you attribute to it, "science has not established an ideal chemical balance of serotonin, nor a pathological imbalance" -- possibly because the authors would have difficulty finding one. This sort of statement should be cited to a good review article -- one that thoroughly surveys the current state of research. It is generally better to find good sources first, then write, as this helps avoid accidentally misrepresenting them through preconceptions and a natural tendency to think that the source "sort of says what I said, so will be okay as a source for it", while overlooking discrepancies between your and their position. I'll give you a chance to repair it (and may do some copyediting myself to alleviate some of the worst problems with using such a source), but really it's not the sort of thing that gives either wikipedia, or your own viewpoint, a good name. Hrafn^Talk_Stalk 03:51, 8 January 2008 (UTC)

Further on what authority "the individual authors might command", Jonathan Leo appears to be a partisan and a scientific lightweight. He is editor of Ethical Human Sciences and Services, the journal of Breggin's International Center for the Study of Psychiatry and Psychology, and his "selected publications" lists only an article in this journal, a chapter in a book explicitly presenting "current controversial issues in a debate-style format" and a journal "dedicated to the interdisciplinary approach within psychology and related fields". What I could find on him on Google Scholar isn't much more substantial. Jeffrey Lacasse's highest qualification is a master's in social work. If you are going to cite an entire paragraph to a single (or single pair of) author(s), please check out their qualifications, background and publication record first. Hrafn^Talk_Stalk 04:54, 8 January 2008 (UTC)

That is no proof that this source is unserious. The papers are cited 37 times and 27 times which is much higher than most papers. Now you're just getting tendentious and letting your subjectivity interfere. Try better than that. I might even reword your apologectic wording. --Benjaminbruheim (talk) 11:06, 8 January 2008 (UTC)

Check this seconday source: http://www.medicalnewstoday.com/articles/33290.php --Benjaminbruheim (talk) 11:11, 8 January 2008 (UTC)

I'm sorry you feel that way Benjaminbruheim. I scratched around further in L&L and found the references underlying their claims. One was to just the sort of thorough review article I had been demanding above. So I've put it in the first sentence, with some briefer, punchier wording, and a lengthy quotation from the abstract in the citation to back it up (in case of controversy). Incidentally, Google Scholar lists 152 citations of it -- slightly higher than L&L's 27. Hrafn^Talk_Stalk 13:29, 8 January 2008 (UTC) (Strictly speaking it's a "reanalysis" not a "review article", but lets not quibble. Hrafn^Talk_Stalk 13:58, 8 January 2008 (UTC) )

Excellent. I will try to find the original sourcing for the statement that efficacy of the medicine is by no means a proof of the chemical balance hypothesis, and thus establishing the reasoning L&L used. Then we will probably have sourced that section well enough. From a cursory review it seems that the L&L papers did have a profound impact around the world, even if they are indeed very critical against the psychiatric orthodoxy. But this is after all the spirit of science. :) I am not able to find any heavy criticism of their science so the unreliable tag is unwarranted though. --Benjaminbruheim (talk) 00:36, 9 January 2008 (UTC)

I'd suggest putting anything more into a new paragraph. The starkness of the disparity of what the medical facts show, versus what the drug companies say, works best without theoretical considerations confusing the reader: 'Fact: it doesn't, drug companies say it does.' <new paragraph> 'Further, [theoretical shakiness...]'. Don't let a desire to cover everything at once get in the way of making a clear, concise and easily understood point for the reader. On a side matter, could you explain why you inserted "alone" into the article? It adds the impression that antidepressants, when used in combination with other treatments, have a greater than "minimal" effect. This may be true, but I would prefer not to give this impression unless and until we can

verify and cite it. Hrafn^Talk_Stalk

02:42, 9 January 2008 (UTC)

I understand. I think the change will make it clearer however. :) I inserted "alone" for two reasons, but I see your objection. I will revert it. I can however find sources that do show that medicines in combination with other treatment is notably better than treatment alone (or medicines alone), however it is unclear wether this is considered in the source. --Benjaminbruheim (talk) 02:52, 9 January 2008 (UTC)

Given that

POV-forks are against wikipedia policy, so it is hardly a compelling argument for removal of a quote that its presence is inconsistent with such a fork. In any case, a (rather heavily cherry-picked) version of this quotation has long been in the article. Hrafn^Talk_Stalk 17:04, 8 January 2008 (UTC)

The APA quote does admit that there are limitations to the biological model. I do agree, however Hrafn felt that was NPOV to selectively quote that. Perhaps the more recent APA statement is more relevant. Also, this is not a POV-Fork, it is about a tangible topic that is not relevant to the mother biopsychiatry article. --Benjaminbruheim (talk) 22:08, 8 January 2008 (UTC)

I agree on the preferability of a more recent one, and had thoughts in that direction when I tracked down a less 'highlighted' version of the original. However, it may be difficult to find as the APA does not appear to have them on their site. It is also possible that there isn't a more recent one. The APA probably releases them 'as and when needed' (e.g. when a major development has occured or when the issue gets major media attention) rather than on a regular basis. If anybody can put their hands on a more recent one it would be very welcome. Hrafn^Talk_Stalk 03:16, 9 January 2008 (UTC)

Not exactly an replacement, but this editorial states for example:

"One of the charges against psychiatry that was discussed in the resultant media coverage is that many patients are being prescribed the wrong drugs or drugs they don't need. These charges are true, but it is not psychiatry's fault—it is the fault of the broken health care system that the United States appears to be willing to endure. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the biopsychosocial model to become the bio-bio-bio model. In a time of economic constraint, a "pill and an appointment" has dominated treatment. We must work hard to end this situation and get involved in advocacy to reform our health care system from the bottom up."

This might help making the article reflect the mainstream view. To the original remark, the criticism against bio-psychiatry is fairly widespread and recognized, and the above quote might reflect this. I suspect that we soon will be able to document that this has lead to changes in practice in mental health care (and in lesser degree in psychiatry) in a manner that it will probably be relevant to the parent article(s). This is after all a moving target and a lot has happened the last few years. --Benjaminbruheim (talk) 03:34, 9 January 2008 (UTC)

• This editorial is good, but really belongs in the 'Pharmaceutical industry influence' section.
  • I particularly like the sentence "In a time of economic constraint, a 'pill and an appointment' has dominated treatment." -- its a very concise summation that needs to be prominently quoted, but I don't know that we have a section for it to go into as yet. Perhaps the 'Pharmaceutical industry influence' section, perhaps an umbrella section over it on economic issues more generally.
• We should also consider Thoughts on Pharmaceutical Companies and Gifts to Physicians that the editorial links to.
• I have a suspicion that the 'Fact: it doesn't, drug companies say it does' sentence may end up fitting in better in the 'Pharmaceutical industry influence' section as well (but the article's structure is still insufficiently solidified to say for sure).

Hrafn^Talk_Stalk 04:43, 9 January 2008 (UTC)

Okay, I rewrote the lead to be more "up to date". I need stuff to fudge the claims, whilst some might be fixed by summarizing it in a different way. But any help is appreciated. --Benjaminbruheim (talk) 14:21, 12 January 2008 (UTC)