Andrew Scull on All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders
Psychiatry’s Legitimacy Crisis
August 8th, 2012"Why is psychiatry forced to rely on a grab bag of symptoms to make its diagnoses? Because, fundamentally, it has nothing else to offer. The cause of the overwhelming majority of psychiatric disorders remains as obscure as ever. Periodic weightless claims, endorsed by credulous science journalists, that schizophrenia is triggered by a newly discovered gene or by a dopamine deficiency in the brain, or that people suffering from depression have a shortage of serotonin, which can be reversed by taking a Selective Seratonin Reuptake Inhibitor (SSRI) such as Prozac to immerse their synapses in a serotonin bath, are so much biobabble — scientific nonsense that has proved good marketing copy for Big Pharma but is otherwise worthless.
This reliance on symptoms, and on the simplistic approach of counting symptoms to make a diagnosis, creates a bogus confidence in psychiatric science. Such categories have an element of the arbitrary about them. When Robert Spitzer and his associates created DSM III, they liked to call themselves DOPs (data-oriented persons). In fact, DSM’s categories were assembled through political horse-trading and internal votes and compromise. The document they produced paid little heed to the question of validity, or to whether the new system of categorizing mental disorders corresponded to real diseases out there. And subsequent revisions have hewed to the same approach. With the single exception of Post Traumatic Stress Disorder (PTSD), which, as its name implies, is a diagnosis having its origins in trauma of an extreme sort, the various categories in the DSM, including the anxiety disorders that preoccupy Horwitz and Wakefield, are purely symptom-based. (The construction of the PTSD diagnosis, incidentally, as the authors show, was every bit as political as the creation of the other DSM categories.)"
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