On May 27, David Brooks, a New York Times columnist, wrote a piece on psychiatry called Heroes of Uncertainty.
It’s an interesting and somewhat contradictory article. Here are some quotes:
“As the handbook’s [DSM-5] many critics have noted, psychiatrists use terms like ‘mental disorder’ and ‘normal behavior,’ but there is no agreement on what these concepts mean.”
“What psychiatrists call a disease is usually just a label for a group of symptoms.”
This is beginning to look like an anti-psychiatry article. But then:
“Psychiatrists are not heroes of science. They are heroes of uncertainty, using improvisation, knowledge and artistry to improve people’s lives.”
“They certainly are not inventing new diseases in order to medicalize the moderate ailments of the worried well.”
So what we’ve got is a kind of middle of the road article. Psychiatrists are basically good guys (heroes, actually), but their subject isn’t as scientific as they claim.
If I were a psychiatrist, I think I would have just left it alone. But the not-scientific jab had to be addressed, and psychiatrists Jeffrey Lieberman and Jack Drescher weighed in with comments.
Dr. Lieberman is president of the APA and a professor of psychiatry at Columbia University.
He opens his rebuttal with this paragraph:
“While I share David Brooks’s frustration over the slow progress in finding the biological causes of mental disorders, I am concerned about his opinions on the scientific basis of psychiatry and the clinical care that it provides to millions of people. The brain has proved to be infinitely more complex than any other organ in the human body, and the functions that mediate behavior are the most highly evolved in the animal kingdom.”
There’s a lot of spin in here. Firstly, David Brooks, in his article, never expressed any “frustration over the slow progress in finding the biological causes of mental disorders.” What he said was:
“Furthermore, psychiatric phenomena are notoriously protean in nature. Medicines seem to work but then stop. Because the mind is an irregular cosmos, psychiatry hasn’t been able to make the rapid progress that has become normal in physics and biology.”
What he’s saying here is that mental phenomena are inherently too complicated, irregular, and changing to ever yield the kind of scientific certainty that one finds in physics and biology. And that’s what Dr. Lieberman can’t let go of, because that is their Holy Grail – that “one day” we’ll know the underlying biological causes of “mental illnesses,” and psychiatrists will finally be real doctors.
Back to Dr. Lieberman’s quote:
“I am concerned about his opinions on the scientific basis of psychiatry and the clinical care that it provides to millions of people.”
This is the spin mechanism known as juxtaposition. The “scientific basis of psychiatry” is juxtaposed (irrelevantly) with “clinical care…to millions of people”. We’re good guys toiling in the trenches of human suffering; therefore our work must be scientifically based! It’s not real logic. It’s Madison Avenue logic, and psychiatrists are getting better at it every day. It’s the equivalent of politicians arranging to have themselves photographed kissing babies or shaking hands with soldiers in wartime.
“The brain has proved to be infinitely more complex than any other organ in the human body…”
Note the phrase “has proved to be” – like this is something that psychiatrists have just discovered. They went looking for their neurochemical causes of complex human behavior, and guess what – the brain is more complex than they had thought! For decades they and their psycho-pharma allies have been telling us that they had it all figured out. But now the beans are spilled. So will they come clean and say: “Guys, we’re a bunch of shysters who have been deceiving you for decades?” No. The brain was just more complex than they had thought. The scale of complexity of the brain has been known for at least 100 years. But perhaps they didn’t teach that in psychiatry school!
Here’s more spin from Dr. Lieberman:
DSM- 5 “… reflects the current state of our knowledge, limited as it may be. This does not negate its value in helping clinicians evaluate and treat patients, as well as the fact that it can and will continue to be improved as subsequent research enables us to better understand the biology of the brain and mental illness.”
There it is again: the “biology of the brain and mental illness.” Still the Holy Grail.
Jack Drescher, MD, is a psychiatrist, and served on one of the DSM-5 work groups. Here are two quotes:
“Like the rest of humanistic medicine, a science of the mind should never lose its heart.”
This sounds good, but says nothing.
“In comparing psychiatry with astronomy, however, Mr. Brooks should remember that in 2006, the International Astronomical Union voted on whether Pluto is a planet. Even astronomy, the hardest of sciences dealing with the most irrefutable of facts, is dependent on its human practitioners’ subjectivity and interpretation of data.”
This is very high order spin. The message that a casual reader would take from this paragraph is that psychiatry is just as scientific as astronomy – “the hardest of sciences.”
The International Astronomical Union voted to designate Pluto a dwarf planet instead of a planet, but no astronomer ever imagined that this had any significance other than administrative. NASA called the shuttle a “vehicle.” They could have called it a “spaceship.” It wouldn’t have made the slightest difference. A botanist can call a plant by its Latin name or its English name. It doesn’t affect anything in the world of botany. But when psychiatrists vote, for instance, to expand their “diagnosis” of depression to routinely include bereavement, this is an entirely different matter, and highlights that the entire taxonomic system is arbitrary and subjective.
A biological analogy of the DSM voting system would be if biologists voted that henceforth geese would be swans. They could vote all they liked, but that will not make geese swans. Biological classification is based on reality, whereas psychiatric classification is based on the subjective perceptions and votes of psychiatrists.
An analogy from astronomy would be if the astronomers had voted to make Pluto a star.
As we often find when we analyze the psychiatric spin, Dr. Drescher is either not too bright or very deceptive.
Psychiatry is under attack for its spurious concepts and its destructive, disempowering practices. It presents no defense based on logic or facts, because it has none. It’s a sandcastle, and the tide has turned.