Alan F. Schatzber, M.D., President of the American Psychiatric Association, and Henry J. Friedman, M.D. of Harvard Medical School offer an odd assortment of points, ostensibly to oppose Edward Shorter's views on why psychiatry is in trouble. (The Wall Street Journal, March 6-7, 2010.)
Schatzenberg wants readers to believe that the new diseases created by DSM-V are all perfectly circumscribed as problems of emotional regulation. They are not normal-range human emotions and reactions just being called disorders, because "minimum levels of pathology" are so clearly defined. Pathology...? This guy would love to sell you some swampland in Florida and a couple of Brooklyn Bridges, too.
"Emotional regulation" sounds biological, or at least technical. It's not. It's an arbitrary evaluation about whether somebody is justified to feel the way they feel. There's no objective test of whether emotional regulatory machinery in any human being -- whatever that is in any context -- is functioning properly, or has functioned properly, or will function properly. It's absolutely no more scientific than a couple guys sitting around saying, "Well, he seems pretty crazy to me, what do you think?" -- "Oh, I don't know, maybe the boss is just nagging him this week, give him a break."
I've seen how subjective the criteria are for mental disorders when nuthouse psychiatrists ask courts to order involuntary medication (forced drugging). If the patient is truly violent or unable to even feed or dress himself, then no "mental illness" excuse is necessary to pre-empt his rights because "self defense" and "emergency life -saving" are more to the point. But almost anyone can defeat an involuntary medication petition, especially if he or she is defended by a competent, zealous attorney who doesn't believe a priori that all psych patients, just by definition, need their medication.
Often, if forced to really litigate involuntary treatment, state psychiatrists will change the patient's diagnosis instead. Delusional, bipolar or schizo-affective disorders, even schizophrenia, can just as well be called substance induced psychosis, for which non-medical treatment is perfectly logical. I've had several cases over the years which went exactly this way. The point is they can call it whatever they want. Treatment comes first, diagnosis is mere justification after the fact.
Dr. Schatzberg actually verifies this when he points out the impetus for inclusion of "prodromal schizophrenic disorder" in DSM-V: people who don't meet the criteria for schizophrenia need to be treated.
Harvard's Dr. Friedman seems like an old-timer, not as slick as the APA President. He's a bit unfocused with his arguments, mostly just appalled over the brutality of Edward Shorter's attacks on such good, honest organizations as Big Pharma, who would never consider inventing diseases just for a larger market and profits....
All in all, I think these two guys fail more miserably in their attempts to refute Shorter, than the heads of NAMI and CHADD did when they went up against George Will the other day. Which is amazing, considering Shorter is ultimately an apologist for psychiatry.
The bad guys all fighting each other and all losing. This is good.