Dr. Dalrymple has a post: Why Psychiatric Disorders Are Not the Same as Physical Diseases.
They sure aren't. That's why we don't term them "diseases." But it's more complicated than that. Psychiatrists address most complaints which concern the mind.
Some are caused by wiring abnormalities in the brain (eg autism, PDD, probably schizophrenia), some by brain damage (eg strokes, Alzheimers, hydrocephalus, trauma). Many complaints seem to combine brain vulnerabilities of some sort with the mind and personality of the person (eg OCD, Bipolar spectrum problems, severe depressions, etc etc). However, most often in outpatient settings we deal with complaints which appear to be "all in the mind" or mostly so (eg neuroses, personality problems, relationship problems, character flaws and weaknesses, fears and phobias, addictions - first in the mind, then engraved in the brain -, emotional immaturity, major life dilemmas, milder and reactive forms of depression, etc etc).
Dalrymple's post is about Dr. Oliver Sachs' determination not to label his symptom as a neurotic one. There is much comfort in believing that one's complaint is "physical" or, as we often term it, "organic."
In fact, many Psychiatrists today seek to over-medicalize Psychiatric complaints. Did your beloved spouse of 60 years just die? Oh, you have Depression, a chemical imbalance requiring 40 mg of Paxil daily.
Our trademark term "Psycho-utopianism" refers to the idea that we would all be thoroughly happy and fulfilled in life were we only given the right drugs or psychotherapy. Reality would be undone, and Eden restored.
Thus there can be a sort of conspiracy between patients and Psychiatrists (perhaps aided and abetted by the structure of the DSM and the drug companies) to view all or most complaints and symptoms as external or alien to the mind, so to speak, instead of, often, embedded in it or part of it. Part of oneself, that is.
During one of my residency inpatient rotations, we were to sit with hospitalized schizophrenics, addicts, and Borderlines for 4 hours/week. We were instructed not to attempt any "therapy" or to try to fix anything, but just to use the time to try to comprehend where they were coming from, what was going on in them, and how they were interacting with us. This was a remarkable experience in more ways than I have time or space to write.
The neuroscience craze of the 1990s grossly overpromised future clinical usefulness. My advice to the neuroscientists is to be as humble as Eric Kandel because Oliver Sach's hysterical paralysis will never be located in brain matter just as my love for tennis never will.
Related: Was it really me? - Neuroscience is changing the meaning of criminal guilt. That might make us more, not less, responsible for our actions
Also related: Googlizing Neuroscience
I touched on some of these topics recently in Psychiatry’s Legitimacy Crisis
