By David Gutierrez
June 27, 2010
Modern psychiatry went wrong when it embraced the idea that the mind should be treated with drugs, says Edward Shorter of the University of Toronto, writing in the Wall Street Journal.
Shorter studies the history of psychiatry and medicine.
Modern U.S. psychiatry has adopted a philosophy that psychological diseases arise from chemical imbalances and therefore have a very specific cluster of symptoms, he says, in spite of evidence that the difference between many so-called disorders is minimal or nonexistent. These “disorders” are then treated with expensive drugs that are no more effective than a placebo.
“Psychiatry seems to have lost its way in a forest of poorly verified diagnoses and ineffectual medications,” he writes.
Shorter calls for U.S. psychiatry to abandon its emphasis on “psychopathology” and instead adopt the European approach, which focuses on the symptoms and needs of people as individuals. Yet the draft of the latest edition of psychiatric diagnostic “Bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM), shows that U.S. psychiatry has no intention of changing course.
“With DSM-V, American psychiatry is headed in exactly the opposite direction: defining ever-widening circles of the population as mentally ill with vague and undifferentiated diagnoses and treating them with powerful drugs,” Shorter writes.
U.S. psychiatry was not always obsessed with psychopharmacology, he notes. Its early years were marked by a psychoanalytic approach that categorized mental disorders in broad, fluid categories such as “nerves,” “melancholia” or “manic-depressive illness.” These categories sufficed because similar treatments would work for people suffering from any version thereof: lithium treated both mania and severe depression, for example, while the specific symptoms experienced by an anxious person had little influence on the therapies needed.
“Our psychopathological lingo today offers little improvement on these sturdy terms,” Shorter said. “A patient with the same symptoms today might be told he has ‘social anxiety disorder’ or ‘seasonal affective disorder.’ … The new disorders all respond to the same drugs, so in terms of treatment, the differentiation is meaningless and of benefit mainly to pharmaceutical companies that market drugs for these niches.”
In the 1950s and ’60s, a new wave of psychiatrists sought to turn away from psychoanalysis — perceiving it as focusing excessively on “unconscious psychic conflicts” — and toward a more “scientific” model instead. As a result, the DSM-III introduced the vague new categories of “major depression” and “bipolar disorder,” even though evidence suggests that there is no substantial difference between the two conditions. At the same time, “major depression” absorbed what Shorter calls two very different conditions, “neurotic depression” and “melancholia.”
“This would be like incorporating tuberculosis and mumps into the same diagnosis, simply because they are both infectious diseases,” he writes.
DSM-V only continues the trend of extending the disordered label to more and more normal people, Shorter warns: “To flip through the latest draft of the American Psychiatric Association’s Diagnostic and Statistical Manual, in the works for seven years now, is to see the discipline’s floundering writ large.”
For example, the new disorder of “psychosis risk syndrome” associates a whole new class of people with full-blown schizophrenia, under the logic, Shorter says, that “even if you aren’t floridly psychotic with hallucinations and delusions, eccentric behavior can nonetheless awaken the suspicion that you might someday become psychotic.” The implication, of course, is that such people should be treated with antipsychotics.
Symptoms of “psychosis risk syndrome” include such vague descriptors as “disorganized speech.”
Other new “disorders” include hoarding, mixed anxiety-depression and binge eating. “Minor neurocognitive disorder” describes a reduction in cognitive function over time, such as that normally experienced by people over the age of 50, while “temper dysregulation disorder with dysphoria” refers to children who suffer from outbursts of temper.
“DSM-V accelerates the trend of making variants on the spectrum of everyday behavior into diseases,” Shorter says, “turning grief into depression, apprehension into anxiety, and boyishness into hyperactivity.”
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