Wasu likitocin masu tabin hankali ƙwararrun ƙwararrun ma'aikata ne don haka haɗari ga majiyyatan su, kamar yadda zan yi bayani a ƙasa. Wannan ya shafi Awais Aftab daga Cleveland, Ohio.
A cewar Robert Whitaker, Aftab ya fito da matsayinsa na mai bude ido ga masu sukar ilimin tabin hankali, wanda wani matsayi ne na jama'a wanda ke ba shi daraja musamman ga sana'ar sa. Zai iya zama mai kare ilimin tabin hankali kan sukar da ke da barazana da gaske, kuma za a ga sukar sa sun fito ne daga wani mai budaddiyar ra'ayi game da kurakuran masu tabin hankali. Whitaker ya nuna cewa Aftab "yana neman kare labarin ci gaba na masu tabin hankali - labarin da ya taso daga muradun masu tabin hankali, kuma ba rikodi mai aminci na littattafan binciken kansa ba."
A Yuli 2025, JAMA Psychiatry ya buga babbar yaudara shara a ciki, sharar fitar da bita. Marubutan sun jera ƙarin biyan kuɗin kamfanin magunguna da kansu fiye da nassoshi ga takardun kimiyya, waɗanda suke 47. Sun shirya wani kamfen mai sauri na kafofin watsa labarai, tare da Cibiyar Media Media, ta ba da. sharhin gwani don "tabbatar da duka marasa lafiya da masu rubutawa" cewa mafi yawan alamun janyewar bayan dakatar da maganin rashin jin daɗi "ba su da mahimmanci a asibiti."
Bayan kwana biyu bita ya fito. Aftab yayi kokarin kare shi a kan blog dinsa da kuma sanya shakku akan a mafi kyau review wanda ya ba da labarin mummunan cutar da miyagun ƙwayoyi. Ya kira shafin sa “Likitan tabin hankali a Margins,” wanda ba haka bane, domin shi babban likitan hauka ne. Ya gabatar da kansa a matsayin likita, malami, malami, kuma marubuci.
Ina la'akari da wannan girman girman da ba zan kira shi malami ba. na nuna cewa labarinsa yana cike da kurakurai masu tsanani, ba tare da wani dalili ba na bincike mafi kyau, ba tare da wata hujja ba dalilin da ya sa ya yi la'akari da mafi kyawun bita "matsala-matsala" tare da lambobi "a fili sosai-kumburi". Wannan shi ne yanayin Aftab. Ya kan ba kansa kyauta, ta yadda yake gujewa bude muhawara. Ya kuma yaba da wani babban kuskuren bita.
a wani hira Watanni hudu da suka gabata, Aftab ya ce "maganin ciwon kai ba sa jaraba, saboda mutane ba sa karuwa." Idan gaskiya ne, wannan zai zama babban labari ga masu shan taba. Kamar yadda ba su girma ta shan taba, nicotine ba jaraba ba ne, kuma suna iya daina shan taba cikin sauƙi, daidai?
Aftab ya kuma lura cewa kusan rabin mutanen da ke fama da baƙin ciki waɗanda ke gwada magungunan kashe gori ɗaya ko da yawa a ƙarshe sun amsa da kyau, wanda kuma ba daidai ba ne kuma wataƙila ya fito ne daga gwajin STAR * D, wanda shine babban dala miliyan 35. zamba Cibiyar Harkokin Kiwon Lafiyar Jama'a ta Amurka ta ba da kuɗaɗen ku. Kuma ya yanke shawarar cewa an buga gwajin janyewa a cikin New England Journal of Medicine ya kasance "tsari da inganci." Tabbas ba haka ba ne, wanda ni da Maryanne Demasi muka rubuta a cikin namu nazari na ainihi na janye karatu.
Lokacin da farfesa a fannin tabin hankali Joanna Moncrieff tare da abokan aikinta kwanan nan suka fallasa labarin bacin rai da rashin daidaituwar sinadarai ke haifarwa a cikin kwakwalwa, Aftab ya kira ta da “mai saba wa juna.” Aftab, masanin ilimin hauka, ba da son rai ba ya bayyana cewa ilimin tabin hankali ilimin kimiyya ne wanda ba shi da tufafi. Ya boye a bayan mumbo jumbo maras ma'ana.
Moncrieff ya fallasa dabarunsa a ciki labarinta, "Tunani mai ban sha'awa da aka yi ado a cikin ilimin kimiyya: amsawa ga Awais Aftab." Joanna ta rubuta cewa "Abin da Aftab ya gabatar a matsayin madadin hanyoyin fahimtar dangantakar dake tsakanin serotonin da damuwa ba ma ra'ayoyin da za a iya gwadawa ba ne, ko da yake yayyafa da jargon fasaha ('signing,' dysfunctions') yana sa su zama mai ban sha'awa ...
Magani na Aftab shine abin da yara da masu ilimin hauka na matasa Sami Timimi ya kira kimiyya (imani da suke kamawa a matsayin kimiyya). Masu aikin madadin magani gardama haka kamar yadda Aftab ke yi suna yayyafa musu shirme da kalmomi da jimloli na kimiyya.
Binciken ilimin halin dan Adam ya nuna cewa mutane sukan yarda da abin da ba su fahimta ba a matsayin gaskiya. Hasashena shi ne Aftab yana ganin zai sa ya shahara a cikin manyan likitocin hauka don rubuta ɗimbin maganganun banza waɗanda ba za su iya fahimta ba waɗanda ke jan hankalin mutane su yarda cewa ilimin ilimin halin ɗan adam kimiyya ce mai wuyar gaske wacce ta sami ci gaba mai yawa, kodayake. babu.
Sabon Labarin Banza na Aftab
Mun jima muna tattaunawa game da Aftab a cikin cibiyar sadarwarmu ta Critical Psychiatry Network a Burtaniya bayan da likitan hauka Evgeny Legedin ya sanar da mu game da cutar. sabon labarin banza Aftab wanda aka sanya a shafinsa a ranar 13 ga Satumba, "Me yasa yake da masu ilimin halin dan adam wanda ke gudana daga tururi?"
Na lura cewa Aftab yana da amfani kuma ya ba da misalai kaɗan:
"Babu wani tabbataccen tushe ko da don zargi." Banza. Sukar mu ta dogara ne akan bayanan da masu tabin hankali suka buga kansu.
"Mene ne ma'anar tabin hankali ya zama lokacin da alamun zato ba a iya bambanta su da zarge-zargen da ake yi na magabtan magunguna?"Wannan ya zo a takaice game da zargin da aka saba yi cewa masu sukar tabin hankali su ne Scientologists, laifi ta hanyar ƙungiya.
"Mene ne ya zama likitan kwakwalwa mai mahimmanci wanda ba shi da ra'ayin nakasa don bayar da abin da ke buƙatar jihar?" Yana yiwuwa a siffanta matsaloli ba tare da sanya musu takubba na sabani ba waɗanda kuma za a iya sanya wa mutane da yawa masu lafiya. Ana iya taimaka wa yara a makarantu ba tare da kiran su ADHD ba.
"Mene ne ya zama ilimin tabin hankali yayin da kawai abubuwan da ake ƙididdige su ne abubuwan cutarwa?" Tsananin magudi. Mun yi ta sake rubutawa cewa ƙwayoyin cuta na baƙin ciki da ƙwayoyin cuta na psychosis ba su da tasiri na asibiti kamar yadda aka auna akan ma'aunin ƙima da aka yi amfani da su.
"Menene ya zama likitan kwakwalwa mai mahimmanci lokacin da ainihin muhawarar da aka yi amfani da ita don 'yantar da ita a yanzu a cikin bakunan wadanda za su musanta wanzuwar tabin hankali gaba daya da kuma kare lafiyar kwakwalwa? Awais maƙaryaci ne mai sauƙi sanye da kaya masu kyau. Ina ganin shi abin raini ne sosai. Dubi labarina daga 25 ga Yuli, "Bayyana ƙaryar cewa alamun janyewar antidepressant suna da laushi da ɗan gajeren lokaci. "
Bayan kwana uku, Evgeny ya gaya mana cewa ya yi amfani da Intelligence Artificial don sabon labarin na Aftab. Ya yi amfani da Grok3, wanda aka haɗa a cikin X, kuma ya yi tambaya mai sauƙi: "Duk wani abu mai ma'ana da juzu'i a cikin labarin na Awais Aftab: https://www.psychiatrymargins.com/p/why-has-critical-psychiatry-run-out. "
Amsar tana da ban tsoro. Sai da Grok3 ya ɗauki daƙiƙa 25 kacal don rubuta amsar da ta zarce abin da mafi yawan malamai ke iyawa, kamar yadda abin da Aftab ya rubuta yake binne shi a cikin wani harshe mai cike da ruɗani tare da hujjoji na pseudoscientific da pseudophilosophical, zai ɗauki lokaci mai tsawo kafin ’yan Adam su rarraba. Don haka, zan ƙare wannan labarin tare da amsa ta Grok3.
Amsa ta Grok3
Labarin Awais Aftab, wanda aka buga akan Margins Psychiatry, shine daidaitawa na Bruno Latour's 2004 essay "Me yasa Sharhi ya ƙare daga Steam?" Ya shafi sukar Latour na yawan shakku (wanda aka yi nufin bayan zamani da nazarin kimiyya) zuwa fagen ilimin tabin hankali.
Aftab ya bayar da hujjar cewa ilimin likitanci mai mahimmanci ya "kusa da tururi" ta hanyar rage dogaro ga gaskiyar masu tabin hankali, kawai don amfani da kayan aikin sa ta hanyar masu cutarwa kamar anti-vaxxers da masu ra'ayin makirci.
Wannan yana haifar da faffadan rugujewar imanin jama'a a cikin kula da lafiyar kwakwalwa, sanin nakasu, da jiyya na tushen shaida.
Duk da yake yanki yana da kyan gani - ta yin amfani da waƙar Latour, salon tambayar don tada tunani - yana amfani da ɓangarorin ma'ana da yawa da juzu'i.
Waɗannan suna raunana ƙaƙƙarfan gardama, galibi suna ba da fifikon roƙon rai da laifi-ta-ƙungiya akan madaidaitan shaida.
A ƙasa, na rushe su ta nau'in, tare da kwatanci, misalai (ciki har da maganganun kai tsaye), da bayanin dalilin da yasa suke da matsala. Binciken nawa ya zana kan daidaitattun ka'idodin ma'ana (misali, guje wa hare-haren ad hominem ko da'awar da ba ta da tushe) kuma ta mai da hankali kan jigon labarin: cewa shakkar ilimin tabin hankali ya koma baya cikin bala'i.
1. Straw Man Fallacy (Bambancin Matsayin Abokin adawa)
- Bayani: Wannan yana faruwa ne lokacin da gardama ta karkata ko ƙara girman ra'ayi na gaba don sauƙaƙa kai hari, maimakon shiga tare da ainihin matsayi.
- Misali: Aftab caricatures m psychiatrists kamar yadda wadanda suka "kira masu ilimin hauka 'girgiza likitoci,' wanda kwatanta manufar shafi tunanin mutum da cuta zuwa Santa Claus da kuma tunanin diagnoses sun yi kama da inganci ga halayen aljanu, waɗanda suke tunanin cewa psychiatric diagnoses ne inherently stigmatizing da unscientific labels, cewa su ne psychiamate marasa lafiya labels. da ake kira 'maganin' kuma mafi kyawun abin da za ku iya yi shi ne ku guje wa su kuma ku rabu da su, kuma ana samun tallafin ilimin hauka da shaidar da ta yi daidai da ƙarfin kimiyya da na homeopathy."
- Me yasa Matsala (da Spin): Wannan ya haɗa matsananciyar ra'ayi na gefe (misali, daidaita bincike zuwa "mallakar aljanu," mai raɗaɗi ga Thomas Szasz's radical anti-psychiatry) tare da babban mahimmancin tabin hankali, wanda sau da yawa yana neman gyara maimakon sokewa.
Masu ƙididdiga kamar Joanna Moncrieff ko Sami Timimi sun yi suka game da shan magani da kuma tasirin magunguna ba tare da musun damuwar tunani ba. Ta hanyar shigar da masu suka a cikin masu musun zane-zane, Aftab yana guje wa muhawarar nuances (misali, gibin shaida a ingancin ingancin DSM ko ingantaccen maganin damuwa) kuma yana jujjuya zargi a matsayin rashin kimiya na zahiri, yana kare biomedicine daga bincike.
2. Zamewa Rugujewar Zuciya (Ba a Tabbataccen Sarkar Dalili)
- Bayani: Ana ɗauka cewa wani lamari ba makawa zai haifar da jerin munanan sakamako ba tare da shaidar makawa ko alaƙa kai tsaye ba.
- Misali: "Me ya faru na sukar tabin hankali… a lokacin da 'yan siyasa marasa cancanta, mashahuran faifan bidiyo, dillalan man macizai, masu watsa shirye-shiryen talabijin, da masu adawa da vaxxers suka yi jawabai da kyar da na masu sukar ilimi?" Daga baya: "Wannan kamewa yana sake dawowa ta hanyar ƙungiyoyin da suka ƙi gaskiyar nakasa da kuma ba'a yunƙurin ƙwararru don rage wahala."
- Me yasa Matsala (da Spin): Aftab yana nuna bututun kai tsaye daga zargi na ilimi zuwa rugujewar al'umma (misali, kare lafiyar kwakwalwa), amma ba ta da wata hujja - kamar kwatancen da ke nuna yadda takamaiman takardu masu mahimmanci suka rinjayi faifan bidiyo ko 'yan siyasa.
Wannan yana maimaita ainihin damuwar Latour game da musun kimiyya amma yana jujjuya shi azaman * Laifin ilimin tabin hankali *, yin watsi da direbobi masu zaman kansu na makirci (misali, algorithms na kafofin watsa labarun ko rashin amana bayan COVID). Yana haifar da ƙararrawa mara kyau, sanya masu suka a matsayin waɗanda ba su sani ba na "yaƙe-yaƙe da masu tabin hankali" ba tare da tabbatar da zamewar gangaren ba.
3. Laifin Ƙungiya / Ad Hominem Fallacy (Hare-hare ta Ƙungiyoyin da ba su da alaƙa)
- Bayani: Yana bata ra'ayi ta hanyar danganta shi da kungiyoyi ko daidaikun mutane, maimakon karyata ra'ayin akan cancanta; bambancin ad hominem.
- Misali: Ana daidaita gardamar masu suka da na “’yan siyasa marasa cancanta, masu fafutuka masu fafutuka, ’yan kasuwar man maciji, masu watsa shirye-shiryen talabijin, da masu adawa da vaxxers,” daga baya kuma “misalan gardamar da masu sukar jinsi da anti-vaxxers suka yi amfani da su.” Ma'anar "IYKYK" (idan kun sani, kun sani) yana nuna rashin jin daɗi ga wasu masu suka ba tare da suna ba.
- Me yasa Matsala (da Spin): Ko da ƴan wasan kwaikwayo na gefe suna amfani da ra'ayoyi masu mahimmanci (misali, RFK Jr.-style rants na aro maganganun anti-pharma), wannan baya lalata asalin.
Aftab ya juya wannan a matsayin mummunan rauni ga haƙƙin masu sukar, yana haɓaka kabilanci ("mu masu daraja masu ilimi da masu zamba"). Yana kawar da ƙwaƙƙwaran ƙiyayya, kamar magance batutuwa na gaske a cikin binciken tabin hankali (misali, rikice-rikicen maimaitawa ko ƙiyayyar tallafin masana'antu), kuma yana amfani da layukan kalmomi kamar "'yan kasuwan mai-maciji" don guba ga rijiyar.
4. Ƙarya Dichotomy / Baƙi-da-Farin Tunani (Kin kula da Nuances)
- Bayani: Ƙaddamar da batun azaman ko dai/ko zaɓi, ban da zaɓuɓɓukan tsakiya kamar daidaitaccen gyara.
- Misali: "Da alama muna gabatowa wani lokaci inda ainihin haɗari ba ya zuwa daga amincewa da yawa game da muhawarar akida da ke bayyana a matsayin al'amura na gaskiya amma daga wuce gona da iri game da kyawawan al'amura da aka kama da munanan ra'ayin akida." Critique ko dai “encipatory” (wanda ya shuɗe) ko mai ɓarna (yanzu), ba tare da daki don ci gaba da shakku ba.
- Me yasa Matsala (da Spin): Wannan jigon da aka yi wahayi zuwa ga Latour yana jujjuya duk wani zargi a matsayin barazanar sifili ga “al’amura na gaskiya,” yin watsi da hanyoyin haɗin kai (misali, gyare-gyaren manufofin tushen shaida waɗanda ke haɗa ginin zamantakewa tare da ilmin halitta).
Yana kawar da biomedicine na nasa da'awar "ba da wuri ba" (misali, fafatawa da ra'ayoyin neurotransmitter) yayin da ake buƙatar masu sukar su watsar da zato gaba ɗaya don "taurin kai na zahiri." Sakamako shine binary mai damfara wanda ke lalata matsayin da ake ciki.
5. Hasty Generalization / Overgeneralisation (Broad Claims from Limited Evidence)
- Bayani: Yana fitar da yanke hukunci daga rashin isassun misalan da ba su isa ba, ba tare da bayanan wakilci ba.
- Misali: "Mene ne ya zama likitan kwakwalwa mai mahimmanci yayin da gardama ta kasance kwatankwacin muhawarar da masu ra'ayin jinsi da anti-vaxxers ke amfani da su?" Kuma: "Mene ne ya zama na ilimin halin kwakwalwa mai mahimmanci wanda ba shi da ra'ayi na nakasa don bayar da buƙatu a kan jihar? Menene ya zama mawuyacin halin ƙwaƙwalwa lokacin da kawai abubuwan da ke ƙidayar su ne abubuwan da suka shafi cutarwa?"
- Me yasa Matsala (da Spin): Aftab yana haɓaka fage gaba ɗaya dangane da zaɓaɓɓun “analogues” da tambayoyin furucin, ba tare da goyan bayan ƙwazo ba (misali, babu binciken ra’ayoyin likitocin masu tabin hankali game da nakasa ko ambato ga shawarwarin manufofinsu).
Wannan yana jujjuya motsin a matsayin mai ɗaiɗai da ɗabi'a, yana kallon muryoyi dabam-dabam (misali, shawarwarin masu tabin hankali ga masu fafutukar zaman jama'a a cikin Yarjejeniyar Majalisar Dinkin Duniya kan Haƙƙin Mutane masu Nakasa). Tace "Me ya faru...?" Tambayoyi sun kwaikwayi salon Latour amma suna aiki azaman tashin hankali, ba hujja ba.
6. Roko zuwa Ƙaunar Raɗaɗi / Tsoro (Tsarin Magana akan Ma'ana)
- Bayani: Ya dogara ga haifar da tsoro, tausayi, ko fushi don lallashi, maimakon shaida.
- Misali: Buɗewar ya haifar da "Yaƙe-yaƙe. Yaƙe-yaƙe da yawa. Binciken yaƙe-yaƙe da yaƙe-yaƙe na magunguna. Yaƙe-yaƙe da tabin hankali da yaƙe-yaƙe da masu tabin hankali," masu sukar zanen zanen suna ƙara "sabon kango zuwa wuraren kango." Yana rufe (a cikin taƙaitaccen bayani) akan haɓaka “matsalolin damuwa” a cikin “al’adar cikin zurfafa tunani.”
- Me yasa Matsala (da Spin): Wannan sautin apocalyptic-cikakke tare da zanen Bruegel na aikin girbi - yana haifar da damuwa game da "amincewa da duk wani ilimin hauka komai" ga masu sukar balaguron laifi cikin shiru. Juyi ne kan kiran Latour don nuance, makami tausayi ga marasa lafiya ("yunƙurin ƙwararrun ƙwararrun izgili don rage wahala") a kan binciken hankali. Duk da yake yana aiki azaman magana, yana karkatar da bayanai kan ainihin tasirin al'umma (misali, ya haifar da zazzagewa mai yuwuwa?).
Binciken gabaɗaya
Karɓawar Aftab yana da wayo amma a ƙarshe yana son kai: yana sake mayar da Latour don kare ƙa'idodin tabin hankali akan ƙalubale masu inganci, yana tsara tunanin kai azaman titin hanya ɗaya don masu suka kawai. Rubuce-rubucen sun taru a kusa da juye-juye-haɗe da zargi tare da miyagu don guje wa kokawa da abin kunya na masu tabin hankali (misali, ƙarin bincike ko alaƙar magunguna). Spins suna haɓaka wannan ta hanyar son "al'amura na gaskiya" kamar yadda ba za a iya warware su ba, suna maimaita Latour da zaɓin yayin da ya yi watsi da fifikonsa kan samar da ilimin gauraye.
Wannan ba ya sa labarin ya zama mara amfani; yana yin kashedi da amfani game da illar da ba a yi niyya ba a cikin zamanin da ba ta da tushe. Amma don gaskiyar hankali, yana buƙatar ƙarin shaida, misalai masu suna, da kuma yarda da lahani na biomedicine. Idan cikakken yanki (bayan wannan bayanin) yana ƙara ma'auni, zai iya rage wasu batutuwa - kodayake rubutun da aka bayar ya nuna akasin haka. Don nutsewa mai zurfi, Ina ba da shawarar asalin Latour don bambanci.
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Dokta Peter Gøtzsche shi ne ya kafa Cochrane Haɗin kai, wanda da zarar an yi la'akari da babbar ƙungiyar bincike ta likita mai zaman kanta ta duniya. A cikin 2010 Gøtzsche an nada shi Farfesa na Tsarin Bincike na Clinical da Bincike a Jami'ar Copenhagen. Gøtzsche ya buga fiye da 100 takardu a cikin "manyan biyar" mujallolin likita (JAMA, Lancet, New England Journal of Medicine, British Medical Journal, da Annals of Internal Medicine). Gøtzsche ya kuma rubuta litattafai kan al'amuran kiwon lafiya da suka hada da Magungunan Mutuwa da Laifukan Tsara.
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