No matter what words are used to describe it, at some point your decision algorithm needs to categorize by cause in order to compute the correct treatment: for example, to give antibiotics to the patients with bacterial diseases and antivirals to the patients with viral diseases. If the authoritative body of professional psychiatrists has a āphilosophical commitmentā against this, that means we donāt have a science of psychiatry.
This is overstating your evidence. Categorizing by cause in order to compute the correct treatment is only helpful (in treatment) if treatments differ by cause. To some extent, thatās definitely true. If someone experiences sadness, you want to treat a short term sadness caused by an event (eg. a loved one dying) separately from a long term sadness caused by a hormone imbalance (eg. generic long term depression). The APA does distinguish theseāaccording to the DMV, you donāt diagnose sadness as depression if it is short term and caused by a significant event. However, Iām not convinced that it applies for all issues.
Imagine Sisyphus whose job is to keep a boulder balanced at the top of a flat-topped hill. If a wind came and pushed the ball off the peak, he must push the boulder back up. If a god comes and knocks the boulder off, he must push the boulder back up. The treatment is the same no matter the cause. Even in medicine, a broken bone is treated the same whether it is caused by falling out of a tree or getting hit by a rock. If Iām a doctor and I know that you broke your bone, knowing the cause isnāt helpful for me to resolve it. Categorizing by cause is only useful to the degree that cause informs treatment more than symptoms do.
The key is to be able to distinguish illnesses by the relevant factors. When the APA decided to not recognize developmental trauma disorder, it was because they thought that knowing that a disorder was caused specifically by childhood trauma is not the primary piece of knowledge needed to help a patient. Iām admittedly not a psychiatrist, but that sounds very plausible to me.
One factor it also depends on is what kind of treatment one is attempting to doācuring vs palliative care. If someone has a serious mental health problem, then presumably there is some persistent difference(s) between them and other people, generating that problem.
(Even if the generation only happens in a liability sense, e.g. someone might have a temprary psychotic episode. The episode itself is not a persistent difference, but most people never have psychotic episodes at all. So the fact that someone does sometimes and that those who do sometimes can get then repeatedly suggests that they have some underlying thought disorder that makes them vulnerable to it.)
If you want to cure the problems, then your best bet is to treat the underlying difference, or at least have a treatment specialized to it so youāre sure you get rid of all of the effects. But if you just want to perform palliative care, reducing the harm of symptoms while being unable to fully get rid of them, then focusing on what the symptoms are is a good bet.
It seems to me that a lot of psychiatry is essentially palliative.
(FWIW your comment seems helpful to me, and in general LW voting seems noisy in general as a signal of value, like often helpful things are ignored or downvoted and low-value things are heavily upvoted.)
This is overstating your evidence. Categorizing by cause in order to compute the correct treatment is only helpful (in treatment) if treatments differ by cause. To some extent, thatās definitely true. If someone experiences sadness, you want to treat a short term sadness caused by an event (eg. a loved one dying) separately from a long term sadness caused by a hormone imbalance (eg. generic long term depression). The APA does distinguish theseāaccording to the DMV, you donāt diagnose sadness as depression if it is short term and caused by a significant event. However, Iām not convinced that it applies for all issues.
Imagine Sisyphus whose job is to keep a boulder balanced at the top of a flat-topped hill. If a wind came and pushed the ball off the peak, he must push the boulder back up. If a god comes and knocks the boulder off, he must push the boulder back up. The treatment is the same no matter the cause. Even in medicine, a broken bone is treated the same whether it is caused by falling out of a tree or getting hit by a rock. If Iām a doctor and I know that you broke your bone, knowing the cause isnāt helpful for me to resolve it. Categorizing by cause is only useful to the degree that cause informs treatment more than symptoms do.
The key is to be able to distinguish illnesses by the relevant factors. When the APA decided to not recognize developmental trauma disorder, it was because they thought that knowing that a disorder was caused specifically by childhood trauma is not the primary piece of knowledge needed to help a patient. Iām admittedly not a psychiatrist, but that sounds very plausible to me.
One factor it also depends on is what kind of treatment one is attempting to doācuring vs palliative care. If someone has a serious mental health problem, then presumably there is some persistent difference(s) between them and other people, generating that problem.
(Even if the generation only happens in a liability sense, e.g. someone might have a temprary psychotic episode. The episode itself is not a persistent difference, but most people never have psychotic episodes at all. So the fact that someone does sometimes and that those who do sometimes can get then repeatedly suggests that they have some underlying thought disorder that makes them vulnerable to it.)
If you want to cure the problems, then your best bet is to treat the underlying difference, or at least have a treatment specialized to it so youāre sure you get rid of all of the effects. But if you just want to perform palliative care, reducing the harm of symptoms while being unable to fully get rid of them, then focusing on what the symptoms are is a good bet.
It seems to me that a lot of psychiatry is essentially palliative.
Not sure why I got downvoted? :(
(FWIW your comment seems helpful to me, and in general LW voting seems noisy in general as a signal of value, like often helpful things are ignored or downvoted and low-value things are heavily upvoted.)
Oh it seems to be back up, when I posted it I was at ā5, I thought I had done something very wrong.