Psychiatric Diagnosis A Parody Of Medicine And Science

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http://www.cchr.org/doctors/eng/page10.htm

 

PSYCHIATRIC DIAGNOSIS

A PARODY OF MEDICINE AND SCIENCE

 

 

" There are indeed many illusions about DSM and very strong needs among

its developers to believe that their dreams of scientific excellence

and utility have come true, that is, that its diagnostic criteria have

bolstered the validity, reliability, and accuracy of diagnoses used by

mental health clinicians. " The " bitter medicine " is that DSM has

" unsuccessfully attempted to medicalize too many human troubles. " 57

 

— Professors Herb Kutchins & Stuart A. Kirk

Making Us Crazy, 1997

 

 

While the appearance of Virchow's Cellular Pathology as Based upon

Physiological and Pathological Histology in 1858 firmly established

medicine's scientific credentials, psychiatry was still fumbling

around with brutal treatments and the lack of any systematic approach

to mental health until the 1950s. The absence of an equivalent system

of diagnosis for mental problems contributed greatly to psychiatry's

poor reputation, both among professions and the population as a whole.

 

 

Psychiatrists Emil Kraepelin (above) and William Menninger are

credited as the pioneers of mental disorder classification and

diagnosis. However, there is no test to validate any psychiatric

disease or disorder. Many are literally voted into existence without

scientific proof.

 

 

The development of the sixth edition of WHO's International

Classification of Diseases (ICD) in 1948, which incorporated

psychiatric disorders (as diseases) for the first time, and the

publication of Diagnostic and Statistical Manual of Mental Disorders

(DSM) in the United States in 1952, were the first steps toward

systematic diagnosis.

 

Later, with criticism of the day running high due to inherent

ambiguities and inaccuracies in DSM-II, psychiatry sought to create an

improved diagnostic system, one that would provide an international

foundation of agreement for the entire profession.

 

David Healy, psychiatrist, director of the North Wales Department of

Psychological Medicine and author of The Anti-Depressant Era, says

that psychiatrists sought more alignment with medicine, believing that

" discrete and identifiable mental illnesses " existed and that

" psychiatry should treat these and not problems of living and

unhappiness. " 58 Following the introduction of neuroleptic drugs in the

1950s, the number of mental disorders exploded from 163 in DSM-II

(1968), to 224 in DSM-III (1980), and 374 in DSM-IV (1994).

 

Science by Skirmish

 

According to Healy, " There must inevitably be a struggle, or a

dialectical process, to determine the meaning of physical symptoms and

where the boundaries of health and disease lie. " 59 In psychiatry's

diagnostic battle, the line was drawn between psychopharmacology and

psychotherapy.

 

" There followed a set of political skirmishes. These were political in

that the pitches made by both sides were based on what would secure

votes rather than by appeals to the evidence... " 60 Healy writes. The

final result, DSM-III, was what he calls a " revolution by committee. " 61

 

What was politically voted in was a system of classification that was

drastically different from, and foreign to, anything medicine had seen

before. Among numerous other distinctions, the most notable was that

the new DSM was devoted to the diagnosis or categorization of symptoms

only, not disease. Another was that none of the diagnoses were

supported by objective evidence of physical disease or mental illness.

 

Psychiatrist David Kaiser states, " Symptoms by definition are the

surface presentation of a deeper process. This is self-evident.

However, there has been a vast and largely unacknowledged effort on

the part of modern (i.e., biologic) psychiatry to equate symptoms with

mental illness. " He says he would be a " poor psychiatrist " if the only

tool he had for treatment was a prescription pad for medications which

may " lessen symptoms " , but which " do not treat mental illness per se. "

He is left, he said, " still sitting across from a suffering patient

who wants to talk about his unhappiness. " 62

 

Science Fiction

 

In their 1997 book Making Us Crazy, Professors Herb Kutchins and

Stuart A. Kirk say that the transformation of psychiatry's diagnostic

manual is a " story of the struggles of the American Psychiatric

Association to gain respectability within medicine and maintain

dominance among the many mental health professionals. " 63

 

As Dr. Thomas Dorman, an internist and member of the Royal College of

Physicians of the United Kingdom and Fellow of the Royal College of

Physicians of Canada, wrote, " In short, the whole business of creating

psychiatric categories of `disease,' formalizing them with consensus,

and subsequently ascribing diagnostic codes to them, which in turn

leads to their use for insurance billing, is nothing but an extended

racket furnishing psychiatry a pseudo-scientific aura. The

perpetrators are, of course, feeding at the public trough. " 64

 

Dr. Thomas Szasz writes, " Psychiatrists spend many years learning

their specialized language whose authoritative use distinguishes them

from other physicians and lay persons. Under the heavy weight of habit

and self-interest, they are likely to be taken in by their own jargon

and believe that persons called `mental patients' have brain diseases,

that cause them to have mental diseases. The possibility that mental

diseases are merely names no longer occurs to them.... " 65

 

Shorter puts it this way: " ...in psychiatry, where genetics apart, the

causes of few conditions are known. What is the cause of something

like erotomania, the delusional belief that someone else is in love

with you? Nobody knows.... These considerations suggest that in

classification it is very easy for psychiatry to lose its way. " 66

 

The Myths of Biopsychiatry

 

Seeking to attract government research funds in testimony before a

United States House of Representatives Committee in 2000, Steven

Miran, Medical Director of the APA, stated that " scientific research

over the last two decades has shown that severe mental illness and

addictive disorders are... diseases of the brain with a strong genetic

and biological basis. " 67

 

In contrast, Healy reports, " There are increasing concerns among the

clinical community that not only do neuroscientific developments not

reveal anything about the nature of psychiatric disorders but in fact

they distract from clinical research.... There has been astonishing

progress in the neurosciences but little or no progress in

understanding depression. " 68

 

Glenmullen reports that with the " absence of any verifiable diseases " ,

psychopharmacology " has not hesitated to construct `disease models'

for psychiatric diagnoses. These models are hypothetical suggestions

of what might be the underlying physiology—for example, a serotonin

imbalance. " 69

 

Pushing the Psychiatric Envelope

 

A June 2000 article in Toronto, Canada's Globe and Mail headlined,

" The Gap Is Closing Between Psychiatry And Family Medicine " , reported

that " Psychiatrists are wary of the unfamiliarity family doctors often

show with mental health problems. " The article quoted Glenn Thompson,

the executive director of the Ontario division of the Canadian Mental

Health Association, saying that there's nothing wrong with the primary

care physician being " the likely first port of call " , provided the

physician is connected, above all, to a psychiatrist.

 

 

 

" There is no test for depression. Our understanding of the brain is

simply not sophisticated enough. You diagnose from behavior... We are

more likely to treat depression because there are drugs available to

treat it. "

 

— Dr. Jim Bolton Lecturer in Psychiatry St. George's Hospital, London,

2001

 

 

 

The " mental health problems " to which the article refers are, of

course, those outlined in the DSM. The reliability of that contrived

system of diagnosis and the inevitable assignment of a psychoactive

drug prescription is the singular " expertise " that psychiatry has to

offer.

 

Non-psychiatric medical acceptance of psychiatric thinking and

practice may come at a steep price. Says J. Allan Hobson and Jonathan

A. Leonard, authors of Out of Its Mind, Psychiatry in Crisis, A Call

For Reform, " ...DSM-IV's authoritative status and detailed nature

tends to promote the idea that rote diagnosis and pill-pushing are

acceptable. " 70

 

" In scientific terms, there are underlying serious issues of

reliability and validity. You cough. Does that mean you are suffering

from `Cough Disorder'? That is the nature of psychiatric diagnoses, "

says Kutchins.

 

If psychiatrists are indeed mental physicians, let them restrict

themselves to mental doctoring and leave physical doctoring to

non-psychiatric physicians. That is the gap that should not be bridged.