Attitudes In Psychiatry By Scott Alexander
- 2 attitudini dello psichiatra
- Attitude 1 says that patients know what they want but not necessarily how to get it, and psychiatrists are there to advise them. So a patient might say “I want to stop being depressed”, and their psychiatrist might recommend them an antidepressant drug, or a therapy that works against depression.
- Attitude 2 says that people are complicated. Sometimes this complexity makes them mentally ill, and sometimes it makes them come to psychiatrists and ask for help, but there’s no guarantee that the thing that they’re asking about is actually the problem.
- Tipico errore di 1. A woman goes to a plastic surgeon asking him to fix her nose, which she insists is hideously deformed. The plastic surgeon thinks the nose looks perfectly normal and asks her to be cleared by a psychiatrist before surgery. The psychiatrist diagnoses the woman with body dysmorphic disorder, a delusional belief that one of their body parts is unbearably ugly. The psychiatrist advises the woman and her surgeon that plastic surgery does not work for this disease; if the woman gets her operation, she’ll inevitably either think that the new nose is just as ugly as the old one, or she’ll switch to focusing on something else like her ears or her mouth. He suggests she get psychotherapy instead. After several years of psychotherapy, the woman learns not to worry so much about her nose.
- Tipico errore di 2. I remember a textbook talking about a case study by a famous psychiatrist. The patient had come in talking about how her husband was being borderline-emotionally-abusive to her. The psychiatrist interrupted her and said that she was perpetuating this dynamic to feed her own narcissism. The patient said this was absolutely not true and she wasn’t narcissistic. The psychiatrist said she would never be able to get over her provoking-her-husband problem until she admitted the depth of her narcissism. The patient refused to keep seeing the psychiatrist after that, and the psychiatrist commented that it had been a hopeless case
- I tend to lean way toward Attitude 1. I’m not sure I can justify it. Part of it is my personality: conflict scares me and I want to be liked.
- Part of it is that Attitude 2 has a lot of its philosophical grounding in Freud, and I really don’t trust Freud.