Will psychiatry die without psychosis risk?

The sudden demise of "Psychosis Risk" as a DSM-5 diagnosis may foretell the doom of psychiatry as we know it.

History tells us that empires occasionally crumble overnight. My favorite example is the Aztecs. In 1519 the wealth and power of Tenochtitlan was literally beyond European imagining. Only two years later Hernan Cortez had not just taken Montezuma's throne, he had wiped out the Aztec religion and obliterated their whole society.

And who would doubt that things change faster today than they did in the sixteenth century?

Robert Whitacher loses hope against the wealth and power he sees lined up with the forces of the psychiatric empire. I've heard similar pessimism from no less than Thomas Szasz.

But that power is spread very thin. Subject peoples are bitter and impatient, and our modern sun god - science - is no longer easily placated.

Sometime back in 1950's America the idea arose: We've got some really bad people who do terrible things, but with modern medicine and the atomic bomb and so on, maybe instead of just punishing them we can fix their brains! Then we'll all be good people, no more bad people.

Everybody believed in modern medicine and feared the atomic bomb, so biopsychiatry was an easy sell.

But half a century later, nothing has happened. We have no improved definition of schizophrenia, let alone an objective diagnostic test or cure. The latest drugs are still no better than simple exercise, or a placebo. It requires the idiosyncratic charisma of a snake charmer like Patrick McGorry to inspire government budgets for mental health, and the twisted talent of an old adman like D.J. Jaffe to propagandize the crowds into "seeing" the emperor's new clothes.

In the last decade or two, basic genetic and biological research has made it more and more obvious that there will never be a simple cure for any "mental illness" - partly because we don't even know what we're talking about when we use that term. The disease model applies no better here than it does to poverty, or war. We are not improving human behavior medically. The naive, 50's-America optimism was evidently a delusion for psychiatry and its true believers.

But true believers must defend the faith, no matter how desperately. Enter "psychosis risk" and "prodromes" calling for "early intervention".

My friends at CCHR and elsewhere think these ideas are marketing schemes contrived by pharmaceutical companies. I rather see them as desperate, last-ditch, hail-Mary rationalizations for a doomed paradigm.

I can imagine old guys like Nate Kline and Freddy Goodwin (and let's add Bennie Rush into the mix, too) on the golf course or sitting around a coffee table with Pat McGorry, wondering what the hell's wrong. "It's too complicated, after fifty years and all the money we ever wanted, there's still no cure?!?! We can't just fail, guys. We can't let Pasteur and Salk be the last heros. Maybe if we start treating kids real early, these drugs will do something. Maybe the disease gets smart enough to hide, or fool us, unless we go after it when it's just getting started, even before anything's wrong... Let's just test 'em all and treat 'em, then we'll finally figure it out, and we'll finally create our super... uh, better... man."

But oops! Paddy (he's Irish, rght?) McGorry flat-out abandoned the plan just the other day. His renunciation of "psychosis risk" for DSM-5 purposes presents the sudden possibility that biopsychiatry is really coming to the end of its road. Not even Allen Frances, who has taken the early interventionists to task more than any other establishment figure, really seems to appreciate this.

These guys are all still dragging human sacrifices up the mountain. But the empire may be gone forever.