@ mungbean:
[quote]mungbean wrote...
Also, mental illness unlike perhaps in the US is not an industry over here, it is a medical condition.[/quote]
So you are suggesting that if it is an industry (or part of the corporate for-profit industrial process), it cannot be medicine? Or something else?
As a note, I'm a Canuck, and our healthcare here is a very different model from that of the US. However, I don't hold any illusions as to whether publicly funded healthcare means that we have somehow transcended medicine as an industry. However, the fact that healthcare is indeed, a big-dollar business does not necessarily mean that medicine is not coherently practiced within it.
[quote]If it isn't a medical condition, it's not a mental illness, it's a disciplinary issue. That simple. If you can't measure it with *hard* scientific evidence, it aint there. That means no behavioural observation, no opinions, it means a CT/MRI with physical anomolies. And that follows world leading Swiss nomenclature on the subject. But you're right, it varies with cultural perspectives.[/quote]
Hm, but that is interesting. If that is the case, is depression (DSM designation: major depressive disorder) not considered a disorder there? As far as I know there are no neurological tests available for the diagnosis of depression in a clinical setting, though there is research being done on a biological basis for diagnosis. Currently it is considered a disorder under both the DSM as well as the ICT diagnostic manuals for mental health and is diagnosed by a practicing psychiatrist or psychologist via a checklist that uses both behavioural cues and self-report. Basically it's a list of things such as anhedonia, too little or too much sleep, fatigue, etc, and a certain number of checks out of the checklist is sufficient for a diagnosis by the clinician.
So. Depression: does it exist in your neck of the woods, or not? If not, then how do psychiatrists deal with patients who display the above symptoms?
[quote]And the formal prerequisite is only patient distress. Nothing else. Patient distress. It's the first thing written on the CAT form. The team can only progress the evaluation if the patient is distressed, otherwise mental incompetency is simply off the table. This is the international standard. [/quote]
I have already previously cited the WHO (World Health Organization) as a source for my counter-argument for this. If you can give me a credible source as to that being an international standard, I will at the very least
consider that I am flat out incorrect and go digging through my box of crap for my cites (because memory, it is utterly falliable). As for your CAT form, that is a local requirement. Does the CAT form explicitly state that it is an international standard, and if so, by which governing or authoritative organization?
I also notice that you now state that mental distress is the criteria for "mental incompetency", not as a prerequisite for a medical disorder (as I believe was your previous assertion). Those two are not equivalent things (here, anyway). Mental incompency has more to do with legal procedures than actual diagnoses of a mental disorder; it is largely a legal definition used in courts to determine whether someone is 1) fit to stand trial, or 2) able to understand their crime, or it is used if someone is diagnosed with say, progressive dementia, in which case, there must be someone who signs things for him or her.
For example, someone with a mental disorder such as paranoid schizophrenia might be deemed mentally incompetent by the court, but a person with say, a personality disorder like antisocial personality disorder or histronic personality disorder may not necessarily be considered incompetent in the legal sense. Granted this would vary with the professional medical counsel given in this case, and I will admit that legal processes are not my forte.
[quote]It will be until physical descriptors of criminal psychopathy can be identified, thus far they have not (researchers whom promote the ideal however are hopeful).[/quote]
Once more, you insinuate that I have somewhere stated that psychopathy is a medical term and a medical diagnosis. I have not. Furthermore, I have clarified this point in a previous post and asked you how you are coming to this incorrect conclusion regarding any of my statements. I am still waiting for your rationale.
Furthermore, you assert that physical descriptors of "criminal psychopathy" have not yet been identified, but I have given examples of neurological differences found in clinically psychopathic prison populations vs. non-psychopathic prison populations, including the unusual activity in the outer limbic region, the under-active amygdala, and the consistently low SCT scores across the board. You have yet to counter this biological data in any of your statements.
I would further like to remark,
once more, that a lack of medical designation as a disorder (or a clinically available neurological test) does not negate a well-documented cluster of behaviours and biologically consistent traits. The latter two things exist seperately from the former. Furthermore, I assert (again) that this fact means that it is perfectly valid to use the term "psychopathic" as a descriptor for a fictional character (Bishop, in this case) which you seem to be objecting for the reason that it is not "medical." My argument is that it needs not be medical to be useful or valid. Once more, you have not contended with this, which I believe was the whole reason for this long debate on psychology vs. psychiatry.
[quote]Feller, in other words if someone acts crazy and is perfectly happy doing so, that's an issue for disciplinary authorities, medical authorities only work with physical, real illness that can be proven to exist with physical evidence, not just people disagreeing with someone's point of view no matter how criminal or odd.[/quote]
This is simply a reiteration from your previous post. I believe my previous response will still suffice.
Also adding: you imply rather disingenuously that I am somehow in confusion as to how medical practice actually works. As can be evidenced from my previous posts, that is not the case; I am merely responding on a philosophical level, not an applied level, as the philosophical level is what applies in this argument about the "proper" descriptors for Bishop. It's all there. Feel free to LOOK AGAIN.
[quote]Psychologists may differ individually as it is a commercial industry, not a medical facility. Big fricken difference pal.[/quote]
For the context of this statement, I need you to define the term "commercial industry." When you say that psychology is a commercial industry, do you mean that is is all private practice, while psychiatry, being a medical facility, is in fact practiced entirely within the public sphere? If this is so, how is it that the latter creates better healthcare or higher validity than the former?
On that note: In Canada, we have public healthcare. Most things medical illnesses that require prescription drugs are covered (the official rationale is: absolutely required healthcare services are covered); psychological services, such as counselling, is not one of them. So I suppose you could say that psychologists here have it really hard, and have to work at bringing in customers, since patients are mostly paying either out of their pockets or with insurance from work.
On the other hand, the fact that medicine is largely government funded does not mean that big businesses don't ever touch medicine; the opposite is true: in nearly every step of the medical process, Big Pharma's influence is there. Research dollars and grants? Government and Big Pharma. Clinical testing of new drugs? One common complaint would be that researchers working for pharmaceutical companies sometimes use high dosages of their new drug in comparison to a control group with regular dosages for an old, standard treatment (this is during the animal testing stage), so naturally when they publish, they show a higher overall efficacy of their new drug in comparison. But when it goes into clinical testing, how responsible is this? Now we're talking human patients, using a drug at smaller, human-approved dosages. In this case, do we even know how much efficacy we can expect?
Healthcare is an industry. To say that psychology is somehow less responsible or less valid solely on the basis that it is a commerical industry is a flawed premise drawn from an artifical line.
There are better arguments. And now, to be more specific: Around here, psychiatry, rather than psychology, is often criticized and accused of being interested in the almighty dollar. The DSM-4 drew heavy criticism when it was published as many professionals in the field saw it as a push to pathologize relatively normal and innocuous behaviour (drinking coffee an x number of times a day was listed as a disorder in the DSM-4, I believe) in an effort to maximize the patient pool. Now the cynical part of me is well aware that psychologists and psychiatrists are often in direct competition for their patient pool (though certain disorders have been shown to have the highest level of treatment efficacy when drugs and therapy are combined, as in the case with MDD), and thus perhaps this criticism isn't entirely with the interests of the patients at heart. However, it is also true that there are psychiatrists who agree with the criticism, and levy critiques of the APA of their own; the more likely explanation then, is that the situation is far more nuanced than a simplistic "psychology bad, psychiatry good", or its flipside, "psychiatry bad, psychology good."
[quote]And furthermore as it stands today the very premise that any such medical condition called psychopathy or sociopathy even exists is under extreme contention throughout the medical research community, it has been thus far consistently falsified wherever physical evidence has been brought into the equation.[/quote]
I am unaware of any studies that have negated the textbook results of lower amygdala function, lower SCT results, and unusual outer-limbic area activity during emotion-inducing stimuli. If I've missed something, feel free to share it.
[quote]Criminal Psychopathy is the correct term for clinical psychopathy, it is a criminologists term.[/quote]
The term "criminal psychopathy" is not used with any degree of frequency in Canada at the present time. The term used is "clinical psychopathy", which is used to differentiate it from the common usage of the term. Furthermore, clinical psychopathy can only be determined by a qualified clinician (usually a clinical forensic psychologist) and is a long, arduous process requiring a complete "patient history" (re: the inmate undergoing psychological evaluation).
[quote]Whether or not clinical psychopathy even exists is under contention (Craig et al, tender entitled "altered connections on the road to psychopathy", pub. Kings College London 2009).[/quote]
If you listed that Craig et. al article to strengthen your argument, you've made a mistake. Though I have not yet had the time to read the entire article, I have read the abstract (which is basically a summary) and nowhere does it say that psychopathy does not exist. In fact, the authors conclusions are in favour of the existence of psychopathy, even if only by implication.
According to the abstract, the researchers: 1) claim that the "biological basis of psychopathy are poorly understood"; 2) decided to try a novel approach and studied the microstructural integrity of the uncinate fasciculus (UF)
in vivo using DT-MRI tractography; 3) reported a statistically significant fractional anisotrophy, which is according to them an indirect measure of microstructural integrity; 4) did some other tests to eliminate confounds; 5) and finally conclude that the specific region that appears to have a significant role in the behaviours displayed in psychopathy is a specific region of the OFC-amygdala limbic region. And then to be extra-sure that was the conclusion, I skipped down to the conclusions section and made sure the conclusions matched (they did).
So, unless it is the case that 1) the actual content of the paper itself is RADICALLY DIFFERENT from the abstract (in which case, I must contact the authors to figure out how the hell they managed to publish in Nature: Molecular Psychiatry, because I definitely need to know that trick), or 2) the actual content of the paper is hopelessly uncritical and lackluster in its design, methodology, and statistical power, and you are hoping that this single example of extremely poor research is enough to argue that the field is hopeless (unlikely, since it's a psychiatry journal and you appear to love psychiatry, and also because that would be a ******-poor argument), you've actually undercut your own argument. Please,
illuminate this mystery for me. [quote]Many researchers would like it to exist, plenty of western industry has evolved under the premise such conditions exist and that they are not part of irresponsible government and social memetics but a genetic failure of random individuals.[/quote]
Many researchers? I'd love to hear from them because that would certainly be a new (or perhaps simply archaiac) perspective. No, the current discourse on psychopathy is not merely that of a biological determinent; the biology I have described is
descriptive, as I have said,
over and over. The current discourse regarding causes involves an interaction between the envionment and the genetics. That's why risk factors are called "risk factors", and protective factors are called "protective factors." And I'm fairly sure that I've covered this point as well - you know, the whole paragraph where I ranted about how in these here parts, it's not called discipline, but rehabilitation? Also: "genetic failure of random individuals"? Really? Where did that come from? The *genetic* failure of *random* individuals? Evolution isn't a completely random process overall, you know. And genes have to come from somewhere.
[quote]New forms of MRI scans are being investigated to try to find physical evidence thus far lacking.[/quote]
Examples,
s'il vous plait. [quote]So it is up in the air, but not by much. [/quote]
This is certainly true, though I don't quite mean it the way you do.
[quote]Sort of like where you're trying to convince a racist to get a clue and they just plain refuse to, you come up with physical examples of racial equality and so they say it's intellectual, you come up with intellectual examples and they say it's genetic, you falsify that and they find the next goalpost, a cultural aberration, and so on. It just never ends, eugenics on skull measurement gets falsified so becomes reinvented as neo-eugenics on genetic reasoning instead but the same agenda when the premise is faulty, the premise is inferiority and superiority.[/quote]
Er...no, it isn't. It isn't like that at all, and you would know that had you actually understood and contended with *everything I wrote* in my previous posts. And no, it's not eugenics, and as a note,
you have managed to falsify nothing. Also? A race != a small percentage of people displaying very specific sociopathic behaviors that are *so consistent* that someone managed to create the PCL-R. The former is based upon a percieved physical phenotype, which says nothing about individuals' intellectual capacity, and the latter is based upon, once more, VERY SPECIFIC BEHAVIOURS. If you can't understand the difference between discrimination based on race/gender/class vs. a study of abnormal
behaviour that extends
past races/gender/class, I really don't know how else I can explain this to you; if researchers were advocating that psychopaths should all be put on death row or locked up, there would be serious ethical objections, but the majority of researchers are pushing for the medical definition BECAUSE THEY WANT THE LARGER SCIENTIFIC COMMUNITY TO PUT THEIR HEADS TOGETHER for a treatment, because traditional treatments DO NOT WORK.
Also, thanks for implicitly comparing me to a racist. I suppose it's better than actually being accused of
being a racist, or being a Pastafarian Ritual Baby-Eater or some such rot.
[quote]Disassociation is the game that never ends, it's the one where you just plain refuse to say, well maybe industrialism as a cultural basis of developed nations is a little too 19th century and causes 19th century fictional social issues which ergo cannot be resolved using more advanced sciences.[/quote]
Disassociation: does not mean what you think it means. Not in the sciences, at least.
And your grammar in that last bit confuses me. It sounds like you are saying that disassociation is where you think that the idea, "industrialism as a cultural basis of developed nations" is too 19th century in thought and discourse, and because it is a 19th century thought and discourse, it causes *fictitious* 19th century social issues, and because it is a 19th century social issue, it cannot be resolved using sciences that are not era-specific. This is actually a false equivalence on your part (and yes, disassociation STILL doesn't mean what you think it means), pretty much due to the fact that:
1) you have, time and time again, misconstrued my argument, and is once more doing so in this post; as it is a premise built upon a misrepresentation, it does not actually have to do with my actual post;
2) are arguing that psychopathy *does not exist at all* without providing sufficient evidence to falsify (and provided an article*** that supports my argument, and weakens yours); and
3) even if we were to run with your premise that psychopathy is a fictional pathology cooked up by those money-grubbing psychologists, no one has actually stated that the "problem of psychopathy" cannot be solved using advanced techniques. It's actually the opposite: people are using new techniques all the time to study and characterize it. Thus: false equivalence.
Now, if there is some ground-breaking, paradigm-shift inducing scientific breakthrough that renders Hare's work and everything else completely NULL, and it is actually a solid scientific breakthrough (and not woowoo pseudoscience), then I will happily be true to my 7 years of science training and *incorporate it into my knowledge pool* because that's what science is about.
But you have not provided anything except reiterations of your old arguments with little or no variance, no solid evidence or examples (in comparison to what I have provided), and continuously misrepresented my argument and stance in the worst way possible. Seriously, what's up with that?
[quote]The one thing governments won't say is maybe it's us.[/quote]
Hm, which government? And lets not forget, it's not just the government, it's the citizens as well. The general population appears to *want* your average criminal to be psychopathic, when forensic psychologists actually estimated that in the normal population, psychopaths are ~1%, and the majority of criminals (~75%) are NOT PSYCHOPATHIC.
Psychopathy is not a prerequisite for criminal behaviour. But the relative rarity of psychopathy doesn't make it an invalid area of study, or descriptor, or observation. You want to falsify? Give me actual arguments.
[quote]And you see, that's what most medical doctors say should be on the table in diagnoses of any and all mental disorders.[/quote]
Yes, because as I have stated in my previous post, the actual model used in psychiatry and psychology both is the bio-social-psychological model, though emphasis differs by area. So yes, we are actually in agreement with this point. Well, *sort of*.
[quote]So you see because this is indeed a political subject, as it does become political then the only recourse is to stick with celebrated,
current international standards for medical diagnoses of mental incompetency such as criminal psychopathy, which in short terms begins with this questionairré, written like this:[/quote]
My point: you missed it. Again: redundant. I have already EXPLAINED MY CONTEXT. Your insistence in annihilating all alternative discourses for a complex subject is immensely puzzling. Why does current real-world politics restrict discourse on the bioboards regarding Bishop? In fact, why does politics mean that we have to restrict our standards? Political agitation has also been a tool for social change in the past. Why insist on using this to simply...sit?
Also:
1. mental incompetency: is, once more, a legal term for whether a person is capable of standing trial, or understanding their crime/what they are on trial for.
2. Criminal psychopathy is not ever a sufficient reason for #1; it doesn't meet the requirements and psychopaths are completely lucid. Mostly. Unless they have some other disorder on top of being psychopathic.
3. I'm going to ask you AGAIN: Why is it not valid to use the term "psychopathy", a term used and accepted by forensic researchers, to describe the behaviours of a ficticious individual (Bishop) in a non-medical setting? Do you merely not understand what a non-medical descriptor is? You harp continually as to whether *psychiatrists* consider the term valid, but as you've said, the term is used by "criminal" psychologists. So why can we not use the term to describe someone who is indeed showing at the very least anti-social behaviours (re: Bishop) in a non-medical way? Furthermore, even if we were to accept your premise that "psychopathy does not exist", and thus use it in the common way as to describe a sociopath or someone with anti-social tendencies, why is it unacceptable to use the term in such a way provided that the use of the descriptor is explained? I put forth that
characterized nouns can be used personally on a free forum (i.e. the bioboards) in whatever way, provided the communication is clear. Why this insistance on tyranny of discourse?
This is, I believe, the 3rd time I am asking you about #3 in its various permutations. I suggest you answer me clearly this time, because this is getting ridiculous - you never actually manage to actually contend with what I *actually wrote*!
Also, I'm not going to bother with rebutting the last two paragraphs, as they were completely redundant.
***At some point, I will read the entirety of the article. If it turns out I am wrong, I will likely come back and apologize. Or, if you manage to illuminate why the article is a point to your favor, I will also have acknowledge your point. But before then, I'm going to go with the abstract and conclusion, which runs counter to your argument.
Modifié par bokhi, 07 octobre 2011 - 11:34 .
Retour en haut
I've been away just few days and now there are SO MANY replies! Ok, calm down, I can handle this problem!
However, I would like to "provoke" an alignment shift from CE to CN. I don't think Bishop's personality could be MUCH better, but just a sort of improvement due to "he understands his faults, he forgives himself, he can now start a new life". Something like that...
I've been away from the forum since months! (and still I haven't started playing again). My point is exactly this: I want to "forget" game-constraints. I always suppose the characters ARE real people, so if I consider them in this way, I can imagine the outcome of numerous options and I can also make them behaving realistically. So, please, forget about game, and start think about human (elf, dwarf, etc) beings 
This is the reason why I still disagree with the vision "evil alignment = no-love feelings". Thank you very much for your Bishop-psycologichal-situation opinion. It is extremely interesting. I am curious on this point. You said: "if he were psychopathic, killing his village wouldn't bother him so 
he needs to realize that he can control his own evil, and that it is not necessary; he must begin to see evil as an aberration, not the status quo. 
