The Cognitive Biases of Psychiatrists

More than anything else, the greatest issue in my mental health history has been agnotology. That is people not knowing what is happening. Having studied a great deal of psychology, it is frustrating to find out conditions I had years later and to discover that these conditions were known about at the time but not by the people who were treating me. Some of that is not mental health things about me but also social psychological things that were happening around me. A child psychiatrist is typically very bad at understanding the etiology of social rejection or bullying or how to handle it beyond the most stereotypical means. Psychologists are, indeed, much worse at diagnosing conditions and knowing problems than people, generally think.

If an autistic child is lonely and lacking a social life, a typical child psychologist will analyze their symptoms and typically assign those symptoms to their autism. They’re looking for weirdness, not the banal tragedy that is usually true. This is not to say the psychological effects of loneliness are not known, they are and, mostly, have been for decades. It’s in Maslow’s hierarchy of needs. Having spent a lot of time in Special Ed, the typical child psychologist does not think to Maslow’s Hierarchy of Needs or the effects of social isolation. They will then treat the symptoms of anxiety borne of isolation with things like ABA.

This has a lot to do with another part of psychology: cognitive biases. Namely, System One and System Two. Basically, the brain has RAM and storage for memories. The RAM is in the prefrontal cortex and the storage is in the hippocampus. Since it is time-consuming to go through one’s library of memories, the brain recieves stimuli from the outside world and sends memories related to that stimuli to the prefrontal cortex for quick retrival. This is how someone can respond swiftly in a conversation without diving into their terrabytes of life memories. I cover this in my blog “A Story of Obviousness” The problem is that a child psychologist is thinking of the DSM-5 and stereotypes associated with developmental psychology. This very subconscious approach to psychiatry is pretty inexact and often woefully inaccurate. Eight-year-olds are not stereotypically associated with Maslow Hierarchy of Needs. Of course, the way to fix loneliness is to give them a social life at which point we run into the philosophical problem of friend-raping. It is contrary to the principles of consent to force a social group to accept someone they don’t wish to accept.

However, it usually never gets to that point. The psychiatrists are just as much subject to cognitive biases as anyone else. And once a system has labelled someone, the psychiatrist will see them through that filter and will also have other biases, especially WYSIATI and Dunning-Krugger. The former is What You See Is All There Is. At that point, they aren’t treating their patient but the avatar of their patient constructed from the phenomena of social psychology. This becomes a major issue if the psychologist is, themselves, narcissistic, because then they want to be a hero and that is bad because they’ll over-diagnose to imagine themselves as having a tougher case than they actually do. Given the media climate, a socially awkward loner is the stereotypical cause of many a tragic headline and for a narcissistic psychiatrist, they want to see themselves as stopping the next headline like that. That type of narcissism is more common than people think and leads to the overreaction to a relatively mild case and then stigamtizing the patient in counterproductive ways.

Psychiatrists handling cases of disability seldom perform miracles and often do clusterfucks. They work on limited information without accounting for their lack of information and without usually trying to dig for it. They don’t think across the subfields of their field and miss what should be obvious things. And they don’t check their own cognitive biases for how they may be subconsciously miscalculating their patient. This is much less of a problem in the normal world since neurotypicals can function well enough that when they are mis-diagnosed, it doesn’t matter too much. They’ll be fine whether or not their therapist is good at what they do. When it comes to disability, this is a massive problem and the portportion of cases that are mis-diagnosed for the aforementioned reasons is very high. The science tends to be good because researches can control for variables and zero in on what they’re looking for. Clinicians can’t often handle the intersectional and messy world of reality.

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