Misdirections in Psychiatry

Dr. Steven Hyman, a former director of the NIMH, starts an article in Scientific American by giving us a history lesson. The title of this article is, oddly enough, Slipping the ‘Cognitive Straitjacket’ of Psychiatric Diagnosis. I guess he must be blaming straitjackets on Sigmund Freud, but only non-chemical straitjackets. It is subtitled, also oddly enough, Psychiatry’s diagnostic bible meets the awkward facts of genetics. I imagine he is thinking that graceful facts would be less subject to genetics, and more a matter of practice.

It can fairly be said that modern psychiatric diagnosis was “born” in a 1970 paper on schizophrenia.

Psychoanalysis was derailed and drug pushing biological medical model psychiatry started taking off.

The authors, Washington University psychiatry professors Eli Robins and Samuel B. Guze, rejected the murky psychoanalytic diagnostic formulations of their time. Instead, they embraced a medical model inspired by the careful 19th-century observational work of Emil Kraepelin, long overlooked during the mid-20th-century dominance of Freudian theory. Mental disorders were now to be seen as distinct categories, much as different bacterial and viral infections produce characteristic diseases that can be seen as distinct “natural kinds.”

As I’ve said before, the “mental illness” label is a physical disease when I can find it on a microscope slide. Despite attempts, such as E. Fuller Torrey’s harebrained cat flu theory, to make personal dilemmas biological in nature, as of yet, it’s a no show.

Four decades after their seminal paper, there are still no widely validated laboratory tests for any common mental illness. Worse, an enormous number of family and genetic studies have not only failed to validate the major DSM disorders as natural kinds, but instead have suggested that they are more akin to chimaeras. Unfortunately for the multitudes stricken with mental illness, the brain has not given up its secrets easily.

I will bet you that if we were to call what we now call “mental illnesses” chimaera, the name change alone would make them a lot more “cureable”.

Before turning to the scientific evidence of fundamental problems with the DSM, let’s first take note of an important problem that the classification has produced for clinicians and patients alike: An individual who receives a single DSM diagnosis very often meets criteria for multiple additional diagnoses (so-called co-occurrence or “comorbidity”), and the pattern of diagnoses often changes over the lifespan. Thus, for example, children and adolescents with a diagnosis of an anxiety disorder often manifest major depression in their later teens or twenties. Individuals with autism spectrum disorders often receive additional diagnoses of attention deficit hyperactivity disorder, obsessive-compulsive disorder, and tic disorders.

Now if you buy this explanation, you are awfully gullible. If truth be known, so called co-occurring disorders are an excuse to resort to polypharmacy. Polypharmacy is known to be good at producing very poor outcomes, but poor outcomes may be ignored if we blame them on the seriousness of the condition and, of course, two (or more) conditions must be more serious than one. Actually, this is merely a ploy to sell psychiatric drugs. Rather than put the patient on one drug, for one condition, we have an excuse to put the patient on more than one drug. When outcomes are poor, business is booming for drug companies and psychiatrists. Investors are pleased, market values rise, and the “patient” is a regular customer.

Once you’ve read the first four paragraphs of the article you’ve read the only important part of it. Either you’re on board with the author and other drug pushing shrinks, and you continue, or you have a different take on matters. If you have such a different take, as I do, then you have no reason to read the rest of the article. In the rest of the article, after a short ride abreast the wild mad gene chase, Dr. Hyman offers his two cent contribution to revising the DSM. I would strongly advise storing such revisions, together with previous and future editions of the DSM, safely in a trash can.