The Rise of the Secular Gurus (9-30-21)

From Decoding the Gurus:

In the below we discuss a few themes and characteristics that seem to be common among gurus. Some are more common than others, and not all will be characteristic of every guru. Nevertheless, they are often found in gurus to a heightened level, not seen in the general population of pundits, commentators, and ‘public intellectuals’.
Taken together, they help us in the task of spotting gurus in the wild. The most concise definition of a guru is “someone who spouts pseudo-profound bullshit”, with bullshit being speech that is persuasive without any regard for the truth. Thus, all these properties relate to people who produce ersatz wisdom: a corrupt epistemics that creates the appearance of useful knowledge, but has none of the substance.
Galaxy-brainness
Galaxy-brainness is an ironic descriptor of someone who presents ideas that appear to be too profound for an average mind to comprehend, but are in truth reasonably trivial if not nonsensical. Gurus often present themselves as founts of wisdom, and it is an all-encompassing kind of knowledge that tends to span multiple disciplines and topics. Their arguments often link together disparate concepts, such as quantum mechanics, logic, and the nature of consciousness. A guru will often present themselves as a polymath, who can offer novel insights with reference to many different fields. They will often allude to their own accomplishments, and exaggerate them to a shameless degree. They will confidently offer hot takes on technical topics, and with a wave of their hand, dismiss the perspectives of genuine experts. This is, of course, a confidence trick that relies on the recipient being convinced of their unique intellectual powers. Various performative flourishes can assist in this deception, such as unnecessary references to high or specialist literature, the use of jargon and technical terms. On closer inspection, these references can often be recognised to be entirely superfluous and largely tangential to the argument being presented. However, the recipient is not expected to dig too deeply or to fully understand the references being made. Indeed, they are probably most effective when the recipient does not understand them at all; they are merely allusions intended to signal a deep level of knowledge.

Cultishness
Being a guru is a social role: a guru is only a guru if there are people who regard them as such! How gurus interact with their followers and critics, their in-group and out-group, is often quite revealing. Gurus are not usually bonafide cult-leaders. However, the social groups they cultivate — often with themselves positioned as intellectual leaders — can have some elements reminiscent of cultish dynamics. A key characteristic of cults is the establishment of clear in-group and out-group identities, primarily between the cult-members/admirers and outsiders. However, there will often be internal discriminations made within the cult, such as between an inner-circle of favoured members, the broader normal members, and problematic or troublesome members (who may need to be reprimanded, temporarily excluded, or exorcised). In general, cultish behaviour is characterized by emotional manipulation and control.
We’ve noticed that gurus tend to act in a manipulative fashion with their followers and potential allies. This often takes the form of excessive flattery, such as intimations that their followers are more perceptive, more morally worthy, and more interested in the pursuit of truth than outsiders. A guru will often put some effort into signalling a close and personal relationship with their followers — essentially encouraging the development of parasocial ideation. Praise and regard for the guru is usually reciprocated, whilst disagreement or criticism is usually dismissed as coming from an unworthy person who does not truly understand the significance of the guru’s ideas.
A guru may often wish to avoid the appearance of being a controlling leader. It is, after all, inconsistent with the flattery of their followers and the oft-spoken idea of cultivating a community of like-minded and clear-sighted individuals. However, they also do not want their privileged position challenged. Thus, they may often wistfully talk of a desire to engage with ‘good faith’ critics who truly understand their ideas, and lament that they have been unable to receive the robust criticism they desire. Of course, this is a sham, as anything other than fawning praise, or at best the most superficial or minor disagreement, will typically be designated as being low-quality or badly-motivated.
An interesting example of a manipulative technique to prevent criticism and ensure agreement is what we have dubbed the ‘emperor’s new clothes manuevor’. The guru will prime a particularly special, highly elaborate, or controversial idea with various cautions such as ‘I know many of you won’t be able to understand this, but I think the more perceptive among you might’, or ‘I don’t think many of you are in a place where you are ready to accept this kind of idea, but here goes’. Naturally, few among their followers will want to admit that they lack the necessary qualities to appreciate the brilliance of the guru’s insight, and those that do, reveal themselves to be potentially among the set of ‘troublemakers’.
Anti-establishment(arianism)
It is necessary that the orthodoxy, the establishment, the mainstream media, and the expert-consensus are always wrong, or at least blinkered and limited, and are generally incapable of grappling with the real issues. In the rare occasions when they are right, they are described by the gurus as being right for reasons other than they think. Kavanagh has coined the term ‘science-hipsterism’ which captures this tendency quite nicely. A guru can seldom agree with the establishment, because it is crucial to their appeal that they are offering unique insight – a fresh hot take that is not available elsewhere, and may be repressed or taboo. The guru’s popularity will obviously benefit, if this iconoclastic view happens to coincide with their prejudices or intuitions of their lay-followers. Thus, gurus are naturally drawn to topics where there is a split between the expert consensus and public opinion (e.g. climate change, GMOs, vaccinations, lockdowns). After all, if a guru is merely agreeing with an expert consensus on a topic such as COVID, then there is less reason to listen to the guru rather than the relevant experts. Thus, the guru is highly motivated to undertake epistemic sabotage; to disparage authoritative and institutional sources of knowledge. There is a tradeoff where the more the guru’s followers distrust standard sources of knowledge, such as that emanating from universities, the greater the perceived value that the guru provides. This tendency is at odds with the guru’s natural tendency towards self-aggrandisement, which may involve emphasising or inflating their (even limited) academic intellectual recognition, which results in some amusing contradictions. Gurus will also strategically utilise ambiguity and uncertainty within their criticisms, providing themselves with the means to walk back claims that prove wrong or attract criticism or to enable them to highlight disclaimers. This dynamic of sabotaging other sources of wisdom is also evident in their fractious relationships with other gurus, with whom they may often have alliances of convenience, but are also strongly incentivised to compete with.
Grievance-mongering
A cult will generally have more than a few bones to pick with supposedly nefarious forces in the outside world. Likewise, fascist organisations will derive much energy from narratives of grievance focused on specific out-groups. Feelings of frustration and oppression, being excluded and disregarded, and deprived of one’s manifest rights and recognitions, represent a potent set of negative emotions. Gurus too, will sometimes rely on narratives of grievance pertaining to themselves and their potential followers in order to drive engagement. After all, a worldview in which all is essentially fair and just is not one that will encourage people to search for alternative ways in which to view the world.
Gurus sometimes also engage in personal grievance narratives. These are especially convenient, in that they not only encourage emotional connection and sympathy for the guru, but they provide a convenient explanation for why someone of their unique talents has not been well-supported or given the recognition they deserve by the outside world. They also relate to conspiratorial ideation (discussed more below), in explaining why the special ideas and perspectives shared with followers have not been recognised and accepted by the outside world. It is because their ideas have been suppressed by malevolent and powerful actors for selfish reasons.

Self-aggrandisement and narcissism
It is almost impossible to be a guru without having a sense of grandiosity and inflated idea of one’s self-importance. The role of being a guru involves cultivating praise and attention, and demands a certain level of charisma and charm. Another trait of narcissists is a belief in one’s uniqueness, and that only special people can appreciate them. It is therefore not surprising that one tends to see other narcissistic traits in gurus, such as having a very thin skin when it comes to criticism, or expecting that the world should be recognising one’s talents far more than it does. Our tentative hypothesis is that narcissism is the key personality trait of gurus. People without at least some degree of over-confidence and attention-seeking will find the role of guru very uncomfortable and eschew it, even if it is thrust upon them. People who are not narcissistic, but with genuine expertise and insight in a given domain, may find the spotlight an unwelcome distraction. People ‘on the spectrum’ of narcissism, however, will find any attention and regard highly satisfying, and this is the motivating factor for engaging in going beyond whatever talents they may have, to engage in the pseudo-profound bullshitting techniques described here. The lack of self-awareness common among narcissists also seems to explain why gurus seem to ‘believe their own bullshit’. Just as a narcissist loves themselves, they are in love with their own ideas, and may be incapable of seeing the degree to which they are bullshit.
Cassandra complex
Gurus like to claim prescience among their many talents. Their heightened insight gives them a superior ability to predict the future, and they will enjoy dwelling on those instances in which they made a purportedly correct prediction (obviously not mentioning or acknowledging the times when they got it wrong). We’ve already described how a narrative of grievance plays a role in being a guru. A heightened sense of how the world is not right, and ought to be fixed, and that they are the persons to do it, is a common feature. Unfortunately, the broader public fails to recognise their genius and heed their advice, and thus the world lurches from calamity to calamity. Combining these features, we will often see that a guru positions themselves as something of a Cassandra – seeing the future and warning of possible calamities, that could be avoided if only they were heeded. The followers also gain a positive role for themselves, in supporting, defending, and promoting the guru, they can help make the world a better place.
Revolutionary theories
If galaxy-brainedness refers to a breadth of knowledge, an ability to forge connections between disparate topics, then their professed development of revolutionary theories displays the depth of their knowledge. Connected with their narcissism and worthiness of being a guru, they are greatly attracted to claiming that they have developed game-changing and paradigm-shifting intellectual products. This is, in a sense, the credentials and the resume of a guru. Just as the public were keen to seek out Albert Einstein’s opinions on all matter of topics unconnected with physics, they also find it quite natural that one who has accomplished something great in one area, should be qualified to offer advice on all matter of topics. Of course, genuinely revolutionary theories such as general relativity are few and far between, and therefore the guru is compelled to manufacture their revolutionary theories. The problem of why they are not already famous is dealt with via reference to the personal grievance narratives discussed above.
Pseudo-profound bullshit
At the outset we described a guru who engages in pseudo-profound bullshit (PPB). This is their core business, their stock-in-trade. They are most comfortable in the role of armchair opinionator, the wise man (or woman, but usually man) graciously offering their advice to eager seekers of wisdom. Most of the other techniques and maneuvers discussed here function primarily to support and justify this most-favoured activity. Whilst the ‘revolutionary theories’ and ‘galaxy brainness’ describe the content of their discourse, PPB describes the form of their discourse. It is typified by language that is cognitively easy to process, superficially appears to be something profound, but upon analysis turns out to be trite, meaningless, contradictory, or tautological.
The ‘classic’ examples of PPB are best exemplified by Deepak Chopra, who said things such as
“There are no extra pieces in the universe. Everyone is here because he or she has a place to fill, and every piece must fit itself into the big jigsaw puzzle.”
And
“To think is to practice brain chemistry.”
Or
“It is the nature of babies to be in bliss.”
All of which are easily detected by most people to be cases of PPB, partly due to their strong resemblance to ‘inspirational quote’ memes, in being blandly positive messages of saccharine self-affirmation. However, it is the logical and semantic structure, not the content, that is the core property of PPB. Modern secular gurus do not necessarily provide self-help (although some, like Jordan Peterson certainly do), and their PPB, liberally peppered with abstract and abstruse references (see galaxy-brainedness above) can be on any literally any secular (scientific, health, political, social, etc) topic.
Conspiracy mongering
To gain real insights, real special knowledge that nobody else can see – that’s hard work. For normal people, even a lifetime of study and research only provides scant few original intellectual contributions. That is not nearly enough for a guru, who needs a steady supply of fresh, original content to supply to their followers and justify their status. To be a guru, they must set themselves up, not only as uniquely insightful, but above and apart from orthodoxies, including established political or ideological groups. Thus, they are encouraged to go beyond standard heterodoxy, contrarianism and scepticism, into the realm of conspiratorial ideation. This is because the expert consensus – though naturally not infallible – but definition, tends to supply the most reasonable and evidence-based view, based on current information. The guru is in the position of needing to provide a strongly contrasting perspective, and then to supply the argumentation that backs up their bold claims in a compelling way. This leads them inexorably down the path of bespoke conspiracy mongering, with an alternative view of events that authoritative sources either can’t or won’t tell you about. Conspiracy theories require a ‘suppressive network’ to explain away the lack of evidential support, and why almost nobody else is willing or able to accept their theories. Gurus are subject to the same dilemma, and will often need recourse to some conspiracy-like As with conspiracy theories, their reasoning will be intricate but subject to massive reaches, and they will disregard simpler or more conventional alternative explanations.
Grifting
Gurus perhaps desire respect and admiration above all else, but they also tend to feel that more worldly and tangible recognition of their talents is appropriate. Accordingly, gurus may be surprisingly willing to undertake activities such as shilling health supplements, that would otherwise be a little surprising in an intellectual of their calibre. Note that it is natural and reasonable for any intellectual worker or content creator to be compensated for their effort. Thus, book royalties, YouTube advertising royalties, or the insertion of standard advertising in a podcast does not usually or necessarily indicate grifting. However, gurus tend to go somewhat further in an effort to monetise their following, while avoiding the appearance of such – which would detract from their guru status. A recent example was the actions of London Real, a venue for gurus such as JP Sears or David Icke, who constructed an elaborate censorship justification for gathering over 1 million dollars from followers, to move their content from YouTube to a dedicated platform, from which they could then further monetize their content at a much higher rate.

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Pompous Luke (9-27-21)

05:00 Moral Acrobatics: How We Avoid Ethical Ambiguity by Thinking in Black and White, https://lukeford.net/blog/?p=142074
07:00 Lives on the Edge: Profiles in Sex, Love and Death, https://www.lulu.com/en/us/shop/luke-ford/lives-on-the-edge-profiles-in-sex-love-and-death/paperback/product-19qmzrv.html?page=1&pageSize=4
10:00 Holly Randall: Jasmin St. Claire: America’s Most Controversial Sex Symbol, https://youtu.be/DRgxPfT4vdo?t=1446
29:00 The psychology of internet fame, https://www.outsidethebeltway.com/the-psychology-of-internet-fame/
30:00 We’re all famous on the internet, https://www.newyorker.com/news/essay/on-the-internet-were-always-famous
40:00 Richard Spencer on his parting from Keith Woods, https://youtu.be/Uqhx2bDhcJo?t=5187

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Trump 2024

00:00 WP: Our constitutional crisis is already here, https://www.washingtonpost.com/opinions/2021/09/23/robert-kagan-constitutional-crisis/
06:00 LEAKED GRANT PROPOSAL DETAILS HIGH-RISK CORONAVIRUS RESEARCH,

Leaked Grant Proposal Details High-Risk Coronavirus Research


10:00 Why you feel tired all the time, https://time.com/6099133/why-you-feel-tired-all-the-time/
12:00 12 Mindless Habits That Are Secretly Exhausting You, https://www.huffpost.com/entry/habits-exhausting-you_l_61489344e4b0175a18347a6f
16:00 Religion in Secular Society: Fifty Years On, https://lukeford.net/blog/?p=141986
19:00 Why there is no way back for religion in the West, https://www.youtube.com/watch?v=YtAR_OGzlcg
1:05:00 DSM: A History of Psychiatry’s Bible, https://lukeford.net/blog/?p=142015
1:10:00 Moral Acrobatics: How We Avoid Ethical Ambiguity by Thinking in Black and White, https://lukeford.net/blog/?p=142074

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Moral Acrobatics: How We Avoid Ethical Ambiguity by Thinking in Black and White

Here are some highlights from this 2021 book by psychologist Philippe Rochat:

* Rare are the ultrastrict law abiders. The fact is that in all countries giving as little as possible to the taxman is a national sport. We tend to preserve and defend our privileges with little to no restrains and hold on to our inherited wealth and privileges as if we were naturally entitled to them. In our head, we are all monarchs chosen from above.

* Unlike most characters in Shakespeare’s plays or Dostoevsky’s novels, we are not inclined to acknowledge the unsettling fact that we are all made of a bundle of conflicting values. Monsters only exist in our simplifying head.

* We talk about Chinese, Russians, or Arabs with no nuances or any obvious awareness of the multiplicity of cultures and languages represented by such grouping.

* Criminals are never just criminals; good people are never just good people. This state of things is deeply incompatible with the either/ or, black or white, good or bad contrasts driving our moral intuitions and righteous
mind.

* So, how do we cope with such a self- reflective curse? We do so mainly by faking reality and tricking ourselves. We simplify, create order in our head where there is none, give ourselves illusions of control, reduce unmanageable complexities by building shortcuts, staging and challenging ourselves, dramatizing, and representing situations to enhance our embodied experience of being. We are ceaselessly creating comfort values for ourselves and for those we identify as extension of ourselves, namely in- group “family” allies.

* There is the awareness of our own mortality and that everything we experience is transient and essentially doomed to disappear from the surface of this earth. This existential truth is the natural source of human deep, unsettling existential angst and despair, the inescapable sense of absurdity. It is also the human universal struggle to find meanings allowing us to transcend the realization of our doom on earth. This struggle is the main existential framing of our morals.

* Last but not least, self-reflective rumination makes us realize how dependent we are on others, how elusive our own freedom is because most of what we do is to please others to get their validation and how much we depend on how others perceive and evaluate us on our own reputation. This self- reflective rumination leads us toward the constant preoccupation with our own social place and situation, how we compare with others. Social emotions like guilt and shame, but also hubris, pride, and contempt, shape human morals. These emotions are presumably unique to human selfconscious psychology. All arise from our self- reflective propensity, framing and motivating our moral decisions. These emotions are linked to the deepseated existential realization that without others, we are nothing. The curse of such realization is the deepest fear of being rejected and, as a consequence, a fear that makes all of us desperate for social recognition and validation, obsessed with how we are perceived and evaluated by others. Above all, we care about our own reputation. We literally exist through our good relations and cares from others, without which we deteriorate and die, both physically and psychologically. At a deep motivational level, what drives human selfconscious psychology and shapes human morals is our basic affiliation need (BAN), with the necessary association of the deep, universal fear of being rejected by others. This is the basic foundation of our insatiable need and struggle for social recognition, the human care for reputation, and our universal quest for positive evaluation from others.

* The main moral rule, psychologically speaking, is the fact that our moral compass is instantly recalibrated depending on people and situations. We hold different standards in our moral decisions whether people are in- group (same family, same social class, same language, same party, etc.) or out-group (legal or illegal
immigrants, foreigners, stranger to the family, different skin color or body weight, etc.).

* …terrorists and serial killers love their parents and children. They worship their God and, in most instances, show extreme devotion to others that can lead to horrendous self- sacrifices like suicide bombings. As much as they kill, they also reciprocate affections and dedication from family members, neighbors, or close ideological allies. Pure monsters do not exist, and this is difficult, if not impossible for us to either fathom or digest.
High- ranking Nazis were often cultured. They had a coherent romantic cult of Nature and narrative regarding the cult of their own mythical origins as part of a “pure” Aryan species, a narrative powerful enough to rationalize
the eradication of millions of “impure” individuals following strict and wellarticulated fetishist blood lineage law. They also loved Mozart, had strong views on aesthetics, and many of them were accomplished musicians. Whether we like it or not, Nazis had “morals” and hence were not pure irrational monsters. They were also parents, children, and friends. If not pure monsters proper, they expressed a most extreme moral ambiguity and hypocrisy,
a hideous exaggeration of what we actually all are. We have to own up to this if we want to grow wiser.

* We are the only species that tortures; exploits; ostracizes; and engages in ethnic purification, ideological crusades, and other imperialist conquests, in addition to being carnivores like many other creatures, eating meat and killing other animals. We are unique in our cultivation of war as “art,” a perennial human source of affiliation and pleasure, elevating intraspecific conflicts as symbolic sources of honors, heroism, and enhanced individual as well as group reputation.

* “I’d like to thank my family for loving me and taking care of me, and the rest of the world can kiss my ass.”1 These are the last words of Johnny Garrett before being executed by lethal injection in Texas for the 1981 rape and murder of a 76- year- old nun. He was only 18 at the time of the crime, 28 when he died in 1992. These last words epitomize the cleavage between proximal in-group and distal out- group value systems and moral codes for which radically different moral standards apply. Extreme as it might be in this particular case, what Garrett’s last words exemplify is what is universally experienced: the well- separated moral spheres we live in, specifically delimited by context and people. These spheres call for different moral biases and codes. They are typically well compartmentalized and we develop a remarkable ability to switch moral codes depending on people and circumstances…

* How can a guy like Castro be affectionate with his mother after raping one of his victims, take his child to
church after treating the mother as a sex slave, looking at her in the eyes, showing love and tenderness, switching modes with not much blinking. How does one manage to keep self- unity as moral agent while enacting blatant moral disconnects across alliances, something we all do to some degree, not just psychopaths?

* Why does our infatuations with others always tend to be associated with the systematic rejection of others and, hence, always to the detriment of others? Why are exclusion and compartmentalization the necessary corollaries of social bonding? In other words, why is love typically exclusive?

* Inscribed into our psychic system are affective imprinting processes. These processes are the original source of differential investment and quick binding toward certain things over others. It always takes place in favor of a selected few.

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DSM: A History of Psychiatry’s Bible

Here are some highlights from this 2021 book by sociologist Allan V. Horwitz:

* The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association pervades our culture. Since publication of the manual’s third edition in 1980, its diagnoses define what mental disorders are considered legitimate, how patients conceive of their problems, who receives government benefits, and which conditions psychotropic drugs target and insurance companies will pay to treat. They also delineate the curriculum that is taught to psychiatrists and other mental health professionals, the diagnoses that researchers and epidemiologists explore, and the psychic problems that public policies attempt to remedy.

* Diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM) have become part of our culture. Environmental activist Greta Thunberg is widely known to have Asperger syndrome; one of her adversaries, Donald Trump, is commonly seen as displaying a narcissistic personality disorder. The singer Mariah Carey has discussed her struggles with bipolar disorder, the same condition dramatized in the main character in Homeland, Carrie Mathison. Lady Gaga has spoken about her struggles with posttraumatic stress disorder (PTSD). TV mobster Tony Soprano seeks treatment for panic attacks, while his son is suspected of having attention deficit / hyperactivity disorder (ADHD). Susanna Kaysen, the author of the best-selling memoir Girl Interrupted, discovered she had borderline personality disorder while reading the DSM-III in her local bookstore. Many patients enter therapy already knowing what diagnosis they expect to receive.
The centrality of DSM diagnoses is a new phenomenon, arising only after the third edition of the manual was published in 1980.

* The importance of the DSM for psychiatry is unique among medical specialties. Other areas of medicine commonly rely on biological markers that confirm or refute a diagnosis of some disease: cardiologists use PET scans to see whether a heart has tissue damage, nephrologists take x-rays to search for a kidney stone, oncologists perform biopsies to detect cancerous cells, and general practitioners employ blood tests to establish levels of cholesterol or blood pressure. Psychiatrists, however, have none of these tools. The lack of confirming markers for any common mental disorder means that diagnosis in itself has an outsize role in psychiatry compared to other branches of medicine. Although most of the DSM diagnoses lay out detailed symptom criteria and specific inclusion and exclusion rules, in actuality, patient self-reports and, sometimes, clinical observations constitute
psychiatry’s diagnostic resources. No independent criteria can verify the accuracy of a clinician’s assessment of a mental disorder.

The American Psychiatric Association owns the DSM, which allows the organization to monopolize the diagnoses of mental disorder for all mental health professions.

* Aside from using the DSM for rhetorical and institutional purposes, few psychiatrists consider its diagnoses accurate portrayals of underlying natural phenomena. They do, however, religiously use them for educational training, obtaining reimbursement for treatment, submitting grant applications, providing measures for epidemiological studies, and all other activities where some diagnosis is necessary.

* Clinical psychologists, psychiatric social workers, psychiatric nurses, mental health counselors, and
other therapists must use the DSM categories to receive third-party payment for their services. In addition, the manual serves as the benchmark for determining mental disorder in the judicial system. As of 2011, more than 5,500 court opinions cited the DSM. Its diagnoses are invoked in widely disparate legal areas including providing
defense from criminal responsibility, exemptions from the death penalty, eligibility for disability benefits, and determinations in child custody cases.

* The use of DSM diagnoses thus makes it seem as if mental disorders are rampant in the population. Far from being a specialty that treats a small group of seriously disturbed people, psychiatry (and other mental health professions) is charged with a mission to confront a large and growing “public health epidemic” that threatens virtually everyone.

* After the 1960s, however, intense pressures developed from, among other sources, federal regulators, insurance companies, and medical schools to portray psychiatrists as doctors practicing medicine. In recent decades, their legitimacy stems from how they name, define, and distinguish their central concepts from each other: “Diagnosis is the first step in the technological process of transforming a person with an ambiguous complaint into a client with a defined mental disorder.” The credibility of the DSM now depends on its depiction as the evidence-based
result of scientific research. This means that diagnoses must be believed to stem from empirically derived data, despite the evidence justifying many diverse interpretations of symptoms.

* after 1980 [the public] increasingly considered mental disorders something independent of individuals (e.g.,
“have depression”) as opposed to something that is an individual attribute (e.g., “am depressed”).

* Xanax showed the drug industry how valuable the DSM diagnoses could be for marketing their products. It was the first of many successful attempts to commercialize the manual’s conditions. The idea of a tranquilizer that worked across a spectrum of nervous states was dead. “Henceforth,” Edward Shorter observes, “magic bullets would match disease labels: There would be only anxiolytics for anxiety, antidepressants for depression, and antipsychotics
for what everybody was calling ‘schizophrenia.’”

* Ironically, the SSRIs are probably least effective for the condition—depression—that they are marketed for. They are less successful in treating melancholic depression than older medications and have marginal impacts on reactive depression, but they are more effective with anxious conditions.96 Despite this evidence, the need to use the DSM straitjacket led to their initial promotion as “antidepressants.” Whatever the SSRIs do has little
relationship to any specific DSM diagnosis but cuts across many diverse syndromes.

* The diagnostic changes in the DSM-IV allowed drug companies to propel a formerly rare condition to prominence as a widely celebrated cultural phenomenon. Bipolar II exemplifies, as historian Andrea Tone observes, a diagnosis that captures “the relentless expansion of illnesses to accommodate new medications that purport to treat them.”

* Perhaps the most important conclusion emerging from genetic studies was that, contrary to the DSM assumption of disorder specificity, genes for virtually all psychiatric disorders are nonspecific. No disorder corresponds to a distinct gene or group of genes; instead, all share large amounts of genetic vulnerability with other conditions: any genetic variant that is tied to one diagnosis is also associated with multiple others. In addition, the most characteristic symptoms of mental disorders were widely distributed across diagnoses and not localized within any
particular one.

* While medical diagnoses are often uncertain and ambiguous, most diseases are distinct from—not continuous with—health. Even such dimensional conditions as blood pressure or cholesterol levels are divided at cut points that indicate likely pathology. Regardless of whether any illness is dichotomous or continuous in nature, clinicians must make decisions to treat or not to treat it. Therefore, the constraints of medical practice lead physicians, including psychiatrists, to think in black and white. Perhaps most important, diagnostic categories make mental
disorders seem more real to the public, to physicians in other medical specialties, to insurance companies,
and to federal regulators.

* No attempt to develop etiologically informed diagnoses has yet to succeed. “Psychiatry is in the position—that
most of medicine was in 200 years ago—of still having to define most of its disorders by their syndromes,” eminent diagnosticians Robert Kendell and Assen Jablensky observe.

* In psychiatry, however, divorcing symptoms from context has the opposite impact of hopelessly blurring situationally appropriate psychological phenomena from mental disorders. This is because all mental
functions are highly sensitive to environmental circumstances. Virtually every symptom of various mental disorders can sometimes be biologically and psychologically suitable adaptations to given contexts, culturally explicable expressions, or both. For example, symptoms resembling depression that arise after the death of a loved one indicate that grief mechanisms are working appropriately, not inappropriately. Likewise, a panic attack is an understandable response when facing an impending fall off a cliff but a sign of disorder in the absence of danger.
Or hearing voices, which can be a hallmark of schizophrenia, is sometimes explicable in particular cultural and religious settings. In contrast, a heart attack always signals a failure of natural functioning regardless of the context or culture in which it emerges. Unlike other medical specialties, context is an intrinsic aspect of deciding what a mental disorder is or is not.

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