BACKGROUND
On May 15, Peter Kinderman, PhD, of the University of Liverpool, posted an article on DxSummit.org. It was called So…What Happens Next?
The gist of the article was that psychiatric “diagnoses” are conceptually spurious, unhelpful, and even hindersome in practice, and discourage practitioners from pursuing genuine explanations for the problems clients bring to their attention.
It was an excellent piece, and I did a short post in which I recommended it strongly.
ENTER DR. PIES
On May 29, Ronald Pies, MD, posted a response to Dr. Kinderman, also on DxSummit.org. It was titled When Language Goes on Holiday.
It was standard biopsychiatric spin.
For instance:
“On what basis does Prof. Kinderman come to believe that psychiatric diagnoses imply that people’s difficulties can be understood, or ought to be understood, ‘in the same way as bodily diseases’? Where, in any of the DSMs, is such a claim made? In what psychiatric textbook is this claim made? How does the claim square with the ‘biopsychosocial model’, which has been the predominant paradigm in American academic psychiatry since George Engel introduced the term?”
In this quote Dr. Pies is apparently pleading ignorance of the fact that the great majority of psychiatrists – at least here in America – tell their clients that their problems are real illnesses, just like diabetes, and that the drugs will correct the biological deficiency in the same way that insulin will help a diabetic!
Which, as often happens with spin doctors, forces one to conclude that Dr. Pies is either very deceptive or very much out of touch.
DR. KINDERMAN RESPONDS
Yesterday, June 4, Dr. Kinderman responded. His article, also on DxSummit.org, is a superb critique of the conceptual and practical failings of biopsychiatry. Here are some quotes:
“… DSM-IV, DSM-5 and ICD criteria sets actively hinder caring and skilled clinicians as they try to understand and help their clients.”
“They [psychiatric diagnoses] aren’t useful over and above simply focusing on the problems people experience. Two people with the same diagnosis may have two largely (sometimes completely) non-overlapping sets of problems, with no established underlying pathology. Proponents of psychiatric diagnosis argue that a diagnosis is useful for communication, but since the information doesn’t tell you what problems a person is actually experiencing, doesn’t specify what treatment will be effective and doesn’t point towards a specific set of causal agents, I find this claim hard to understand.”
“Dr. Pies is absolutely correct – when I refer to ‘humanity’, I’m making a moral judgment. I fear that the ‘diagnosis-treat’ model leads to inhumane treatment.”
“To my mind, the reduction of this [client’s] narrative from the understandable consequences of rape to the symptoms of schizophrenia is inhumane.”
“And as a result of all these failings, the diagnostic tools that we are currently living with mean a person’s social and interpersonal difficulties are often ignored in the hope that the right medication regimen will achieve the desired return to normal functioning.”
” That is, when we expose psychiatric diagnoses to factor analysis or cluster analysis or other statistical techniques, the wise and careful judgments of committees of experts turn out to be … wrong.”
“We can, we should, work with self-generated problem-lists. The difficulties arise when, completely unnecessarily, scientifically unwisely, we insist upon adding meaningless and misleading committee-generated labels to this useful and valid description of a person’s problems. The labels necessarily obscure the real nature of the person’s difficulties. My question to Dr. Pies would be: since clearly describing a person’s problems seems so helpful, what additional benefit is offered by a diagnosis?”
As I said earlier, Dr. Kinderman’s critique is superb. It is cogent, scholarly, and meticulous. In the few quotes given above I cannot begin to do the article justice.
Please read it, and pass it on.