Tuesday, March 2, 2010

Shorter Maleficarum

Dr. Vaughan Bell of King's College London comments on the Edward Shorter WSJ article, praising it but for the title, which he believes is mysterious and stupid. Bell can't understand why Shorter would headline his no-holds-barred criticisms, "Why Psychiatry Needs Therapy: A manual's draft reflects how diagnoses have grown foggier, drugs more ineffective."

Well, first of all, Shorter only criticizes expanding definitions of mental illness and huge increases in powerful drug prescriptions because these phenomena could ultimately be bad for psychiatry's image. It's an over-reach or a PR blunder. It could undermine public confidence and the authority of the essential dogma, that insanity is brain disease and individuals are just complex bio-mechanical things.

Shorter says the evidence is very strong that major depression and the depression in bipolar disorder are the same disease. But the evidence is beyond very strong - it's actually quite conclusive - that neither kind of depression is any disease at all. It's a matter of the definition of disease.

The proper medical-scientific concept includes a proven, demonstrable gross, microscopic or chemical abnormality which necessarily accompanies and presumably causes symptoms. There is no such proof for any mental illness in any edition of the DSM, including DSM-V. In fact, as historian Shorter certainly knows, whenever any mental illness was proven to be an actual brain disease (e.g., syphillis), it lost its status as a mental illness and became the province of neurology or some other medical specialty, not psychiatry.

Shorter pretends these are technical issues in the classification of disease. He knows better. They're technical issues in the politics of mental health.

Contrary to Shorter's pretenses, an absense of "careful attention to what patients actually have" does not distinguish American psychiatry from a European scientific tradition. No psychiatrist ever noticed or cared what a patient actually had. At best, their attention goes to specific behavior which somebody in power says must change. There's no connection to anything a patient has, it's what he does or says, and sometimes what he believes.

Psychiatry might need therapy because it's basically an ongoing social project, conducted by people who occasionally lose interest, forget, and become confused, contrary, or overzealous about goals, ethics, etc. - all things which therapy might be designed to resolve. Dr. Bell only thinks the title of the WSJ article is stupid because he mistakes psychiatry for a legitimate medical specialty.

The D in DSM stands for diagnostic, but there's no medical science, it's all politics. Read it, it's obvious.

And read the Hammer of Witches for comparison. I'm sure Edward Shorter could tell you that's a real eye-opener....

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