[derefr]

> You don't need psychology to recognise symptoms. Unless you're saying psychology has it's own set of symptoms and it's own terminology - which is just a truism.

Psychology precisely defines syndromes (clusters of symptoms), and then, in terms of syndromes, provides both:

• tests qualifying patients into those syndromes (usually in the form of various rating scales)

• specific flowcharts for known-effective treatments for patients qualified into a given syndrome

It's not the rigor of physics, but rather the rigor of engineering or civic planning: making rules for doctors to follow that have been found in clinical practice to optimize for population-wide outcomes.

> How could you claim that the 'underlying pathology is benign' without even knowing what it is?

Because we have figured out what the underlying pathology is in many (not the majority, but many) cases, and almost every underlying pathology we've discovered is something benign: e.g. a genetic mutation that causes your synapses to produce less of some messenger-chemical. Such mutations have no long-term effect on your health, other than affecting your psychology. (And most of the cases we don’t understand present the same, are treated the same, and have the same long-term health outcomes if treated or ignored, and so are very likely to be similar in etiology to known diseases, despite not having yet been specifically researched.)

Also, as I said, psychiatrists pre-screen for non-benign pathologies first, often too widely. You can't get diagnosed with clinical depression (by a psychiatrist who's doing their job) until you've been checked for vitamin deficiencies, hypothyroidism, anemia, diabetes, etc. Even in cases where you have 100% of the symptoms of clinical depression, including ones that have no organic basis. They'll still do the pre-screen, just to be sure you don’t have clinical depression and one of those things.

But once you're known to not have any of the known-malignant pathologies, then they can and will treat the symptoms, because at that point the only problem they have left to treat is the symptoms. (What else would you expect them to do? Drill a hole in your skull to biopsy your brain tissue, to figure out what step in amine metabolism is failing—just to end up with the same treatment they’d get to from looking at the symptoms?)

> Except you really have no idea how many 'psychological diseases' could be progressing and/or affecting you

There is the simple observation that these syndromes aren't degenerative. People can have e.g. untreated ADHD all their lives, and they won't live less long or end up in the hospital more often than people without ADHD. That’s despite ADHD being a syndrome with potentially dozens of etiologies. Everything that causes that cluster of symptoms, and only that cluster of symptoms, is equally non-degenerative, because it’s all equally being expressed solely as the same kind of non-long-term-harmful down-line effect.

A degenerative neurological disease makes itself pretty obvious. Neurosyphilis is easy to recognize the symptoms of, to the point that even doctors in the 1700s could make the correlation that patients with that set of symptoms at age 60, were the same people having a lot of casual sex at age 20.

> while you mask the symptoms

When we treat a syndrome, what we're treating for usually is our best understanding of the etiology. Sometimes we're "sawing off one leg to make it even with the other" (e.g. you have too few dopamine receptors, so instead of telling your brain to make more — which we don't know how to do — we tell your brain to make less dopamine), but the treatment chosen is still putting the upstream system into a new (and beneficial!) equilibrium state, rather than “masking” down-line symptoms in the way that e.g. painkillers do.

(Though I would note that even painkillers are therapeutic in some cases — as often pain itself can have negative short- or long-term consequences, e.g. acute inflammation or acute increase in blood pressure in response to the pain. A non-negligible part of the reason that people are given opioids when they’re in severe pain, is to decrease the risk of them having a heart attack or going into shock.)

[pseudalopex]

> People can have e.g. untreated ADHD all their lives, and they won't live less long or end up in the hospital more often than people without ADHD.

They will.[1]

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

[mioasndo]

> It's not the rigor of physics, but rather the rigor of engineering or civic planning:

I would say engineering has more rigour because almost everything that really matters is based on rigorous science. Engineering also includes a certain amount of artistry, but that's generally within a rigorous framework that allows this. But, yeah, as I said, psychology is pseudo-science.

> Because we've figured out what the underlying pathology is many (not the majority, but many) cases

Again, how many cases? If you've figured out the underlying pathology for 1% of cases (which is still many), how can you claim that underlying pathology is 'almost always benign'?

> and almost every underlying pathology we've discovered is something benign: e.g. a genetic mutation that causes your synapses to produce less of some messenger-chemical. Such mutations have no long-term effect on your health, other than affecting your psychology.

First of all I would question the accuracy of these diagnoses. Second, I would question the classification of these pathologies as benign - a more accurate statement is probably 'we don't know'. Third, you say 'other than affecting your psychology' - so they often do actually have long term effects on the person?

> Like I said, psychiatrists pre-screen for non-benign pathologies first, often too widely. You can't get diagnosed with clinical depression (by a psychiatrist who's doing their job) until you've been checked for vitamin deficiencies, hypothyroidism, anemia, diabetes, etc. Even in cases where you have 100% of the symptoms of clinical depression, including ones that have no organic basis. They'll still do the pre-screen, just to be sure.

This is the only reason why psychology is even able to exist - because all of the heavy lifting is done in the realm of real science, and once real, understood pathologies are excluded the psychologists/psychiatrists can do their thing. That is, until yet another real pathology is discovered and the guidelines have to be updated such that psychologists don't end up mistreating people with the condition as they were up until then.

> But once you're known to not have any of the known-malignant pathologies, then they can and will treat the symptoms, because at that point the only problem they have left to treat is the symptoms.

So, basically, once the real medicine and science find they cannot solve the problem, the patient is left with the psychologist, who drugs the patient to mask the symptoms?

> (What else would you expect them to do? Biopsy your brain?)

Well, I don't expect a psychologist to have enough expertise for a biopsy, but could I expect to at least have a couple holes drilled in my skull, or maybe some electroshock therapy?

> There's also just by the simple observation that these syndromes aren't degenerative. People can have e.g. untreated ADHD all their lives, and they won't live less long or end up in the hospital more often than people without ADHD.

ADHD isn't a pathology, and 'live less long & end up in the hospital more' are not the only criteria I would consider required to label a disease as benign - they must have ongoing issues affecting their qualify of life in order to be diagnosed with ADHD in the first place. That being said, your statement is a pretty good argument for why psychology is irrelevant.

> When we treat a syndrome, what we're treating for usually is our best understanding of the etiology.

When you say 'our best understanding' you mean a psychologists best understanding? The question is how good is this 'best understanding' really?

There are many different fields involved in modern medicine - biology, chemistry, neuroscience, physics, statistics, etc. What does psychology add? From where I'm sitting it adds absolutely nothing, and is far less rigorous.

[derefr]

> But, yeah, as I said, psychology is pseudo-science.

Science is about doing experiments to get data that allow you to create+refine models of reality that make predictions on what further data will look like.

Psychology is a science. People may argue whether it is a hard science, but it’s doing all the science things.

What is the difference between an RCT on how a drug affects cancer (given some formal rating scale for cancer), vs. an RCT on how a drug affects ability to concentrate (given some formal rating scale for ability-to-concentrate)? The former is considered medical research. The latter is considered psychological research.

> Well, I don't expect a psychologist to have enough expertise for a biopsy, but could I expect to at least have a couple holes drilled in my skull, or maybe some electroshock therapy?

Keep in mind that psychologists — i.e. people who do academic research in psychology — are drilling holes in skulls all the time. Y’know, on rats. (And not just on dead rats. They’re often implanting wires and such.)

Still, though: why? A brain biopsy is almost-always worse/higher-risk than just putting up with whatever was wrong with you before.

Also, I don’t want people to drill holes in my skull. Most people don’t. It is, in fact, considered unethical by most medical boards to drill holes in a patient’s skull, if what you’re treating for would not be worse than a hole in the skull. (And a hole in the skull is very risky, in terms of liability to infection, stroke, etc.)

This is my point: psychiatrists are people who, like IT help desk techs, try to diagnose a thing by hearing it described over the phone, with no ability to touch or interact with it. Psychology is the model, the best set of predictions we’re been able to attain, for how the mind works, given that we can only interact with it this way.

Psychologists try very hard, using a lot of rigor and very powerful statistical methods, in an attempt to extract signal from the super-noisy clinical input of the practice of clinical psychiatry and of human psychiatric research. (Plus animal psychological studies, where we have the alternate problem of trying to model a mind we can probe directly but can’t communicate with.)

“Unethical psychology” would be a hard science indeed.

> When you say 'our best understanding' you mean a psychologists best understanding?

I mean humanity’s best understanding. The academic-scientific ‘us’ — everyone working together to advance the frontier of knowledge.

—————

Addressing your comments as a whole, you seem to have conflated the practice of clinical psychiatry, with the medical science of psychology.

“Psychology” is just what neuroscientists call their neurological behaviour studies, when the study doesn’t involve or rely on a white-box model for what’s happening, only a black-box behavioural model.

In modern practice, there are no psychologists who aren’t neurologists; no psychology paper is being written by someone who isn’t a neuroscientist. “Psychology” is to “neuroscience” as “ML” is to “Computer Science” — i.e. a specific sub-discipline that some researchers might focus on, but not because they lack the skills outside of that discipline; rather only because they enjoy the process of doing that particular type of research more.

Psychiatry is the practice of using psychological findings in a clinical, medical context. Psychiatrists are doctors, who have then further specialized by learning deeply+broadly about the various models-of-understanding that psychologists have developed. They know as much about medicine as any other doctor; they just have the additional understanding that e.g. “depressed people aren’t just sad.” (Which is, y’know, something we had to prove, and all the papers that do that are psychology papers.) Or “being gay is not a disease.” (Which, again, something psychologists had to prove.) Sadly, you can’t rely on a non-psychiatrist doctor to be aware of these sorts of things.

As such, psychiatrists are probably the doctors it’d be most beneficial to talk to, if you have a problem that is potentially psychologically rooted. A regular GP, who never touched any of that specialty while getting their degree, will be able to recognize organic diseases, but won’t necessarily recognize psychiatric syndromes, and so will be very likely to mis-diagnose a purely-psychiatric syndrome as an organic disease.

[mioasndo]

> Psychology is a science. People may argue whether it is a hard science, but it’s doing all the science things.

True, when I say 'science' I mean 'hard science'. Every theory is basically an arbitrary statistical model trained on extremely noisy signals. Generally, it can't carry out controlled experiments or predict new phenomena.

> What is the difference between an RCT on how a drug affects cancer (given some formal rating scale for cancer), vs. an RCT on how a drug affects ability to concentrate (given some formal rating scale for ability-to-concentrate)? The former is considered medical research. The latter is considered psychological research.

You can measure the size of the cancer in a fairly direct and objective way. To measure ability to concentrate you need to have a statistical model that interprets a very noisy signal.

> Also, I don’t want people to drill holes in my skull. Most people don’t. It is, in fact, considered unethical by most medical boards to drill holes in a patient’s skull, if what you’re treating for would not be worse than a hole in the skull.

It was a joke about lobotomies...

> “Psychology” is to “neuroscience” as “ML” is to “Computer Science”

It's more like what 'astrology' is to 'astronomy'.