Psychiatric "diagnosis"

It has been almost five years since Allen Frances started criticizing the DSM, several years since Ron Pies admitted that no psychiatrist who knows anything should ever talk about "chemical imbalances in the brain", and almost exactly three years since Thomas Insel disavowed the whole system of mental health "diagnosis" as lacking scientific validity.

This week another stellar authority came out as -- exaggerating just a bit, I suppose -- an effective antipsychiatrist.  Stephen M. Stahl made a presentation at the APA's annual conference in Atlanta, in which he stated categorically, "Our psychiatric diagnoses are not diseases." He also informed his audience, "There is no known gene for any major psychiatric disorder, nor is one ever likely to be found. Genes do not code for psychiatric disorders. Genes do not code for psychiatric symptoms."

Dr. Stahl is, of course, the author of Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. In its third or fourth edition by now, the book is absolutely the authoritative text on why it makes sense to "treat" human problems in thinking, feeling and behavior with medicine. We may wonder whether when he points out that there are actually no diseases being "treated", Stahl triggers all kinds of cognitive dissonance and problematic consequences for most of the people who buy his book.

I recently cross examined a psychologist who works for the Criminal Division of the Circuit Court of Cook County, Illinois, who insisted under oath that mental illnesses are in fact brain diseases. State-employed clinicians routinely tell my clients that they need more "insight into their illnesses" (by which is meant, the patient must accept and profess true faith in the "diagnosis" of "schizophrenia"/"bipolar"/whatever, as a lifelong genetically-caused brain disease that he or she "has"), or else they will never be eligible for release from Elgin Mental Health Center.

It is very difficult to understand how state psychiatrists get away with lying and misrepresenting their own field and their own activities as a matter of course, to the extent that they do. It seems to me they will have to start talking about things differently, especially when under oath. There is no rational scientific or ethical excuse for deceiving the public into a false belief that state psychiatric "hospitals" successfully medicate anyone to be better behaved or less dangerous. They restrain people and disable them, but they don't help.

On the other hand, I had an amazing conversation with a state psychiatrist about "diagnosis" just the other day, prompted by my discussion of Stahl's presentation in Atlanta. According to this doctor, who is not originally from a Western culture, there are only two or three valid psychiatric "diagnoses". The first is "disconnected from reality". The second is "too connected to reality". A possible third might be something like, "eccentric manufactured reality", as with a person who is hallucinating on street drugs, or perhaps a truly strange or antisocial personality.

The category of "too connected to reality" is brilliant, and it probably needed a non-Western mind to describe. In Anglo-American culture, we figure "reality" is our benevolent anchor, which we can reasonably hope to shape according to our own purposes. In India however, "reality" is draconian, crushing, absolutely merciless. Of course, depression, anxiety, etc., are a matter of being too connected! One has to separate somewhat from oppressive circumstances to find peace.

My friend also specified -- and by the way, I almost find myself looking over my shoulder, wondering who might have me in a pillory for calling a psychiatrist my friend! -- a critical principle: no matter what diagnosis is assigned to a patient, it becomes appropriate or necessary to treat somebody if and only if they are socially or occupationally disabled by their mental illness. That means that when they get along well enough in their own community with other people, just leave them alone. It doesn't matter how bad their "mental illness" might seem to some professional.

This view is that psychiatrists actually treat conditions existing in the relationships between people and society, not illnesses confined to individual bodies (or brains). That seems honest enough to me.

I just think, still... they do a terrible job and ought to be fired.