Psychiatry – Label-Based Quackery or Research-Based Science?by Shaheen E Lakhan, MD, PhD, MEd, MS, FAAN | March 4, 2007
After reviewing your comments and based on the video discussed in the last article, I’ve decided to review some of the general themes often cited by opponents of psychiatry. Here is the first anti-psychiatry argument.
Psychiatry applies subjective labels to patients.
Do we do more harm than good when we define patients’ conditions based on commonly accepted labeling guidelines? How valid are the guidelines? Presumably, using established rating scales, clinicians can more objectively formulate diagnosis.
Or can they?
In the field of medicine, the patient’s account is termed “subjective” and the physician’s “objective.” The physician is charged with processing the patient’s statements under an objective lens by utilizing various medical tools. Psychiatry, as a medical discipline, functions in the same manner; however, at the moment it does not benefit extensively from the “scientific” biochemical tests and (brain) imaging studies. Nonetheless, instruments exist that measure disturbances of the mind-body relationship in clinical psychiatric practice. Clinicians interview patients to identify abnormal behaviors, ascertain risk factors, and record a personality profile. The clinician actively listens to the patient and establishes a comfortable atmosphere for revealing pertinent information.
From the last half century, the fields of psychiatry and psychology began (1) organizing their findings into books and assessment tools, including questionnaires aiming to inventory personality and behavior and (2) grouping psychiatric symptoms into distinct diagnoses. Most notable are the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Brief Psychiatric Rating Scale (BPRS).
The DSM, published by the American Psychiatric Association, serves as a provisional construct allowing the international biomedical community to employ inclusion and exclusion criteria based on potential deviations from normal psychological functioning. In fact, since the publication of DSM-III in 1980, the manual explicitly has served not to educate about a particular etiology/cause or pathology/process; rather, it reasonably classifies disorders by symptom profiles for effective universal communication. Manuals essentially offer standards for symptom definition and differential diagnosis.
The BPRS is arguably the most popular of the rating scales and is the foundation for many modified versions cited in major studies. Classically, the psychiatrist assesses 18 items, including anxiety, depression, disorganization, excitement, hostility, negativism, positivism, suspicion, symptoms, tension, and withdrawal.
Let’s take, for example, schizophrenia — a debilitating mental health disorder with a unique symptomatic and epidemiological profile. The current DSM diagnostic criteria for schizophrenia include at least one month of active symptoms (at least one symptom of bizarre delusions or auditory hallucinations or two or more positive or negative symptoms) and six months of social/occupational dysfunction or independent-care impairments. In addition to inclusion principles, the DSM establishes exclusionary guidelines for primary mood disorders with psychotic features (e.g., unipolar or bipolar depression) and psychosis induced by the physiological properties of a general medical condition (e.g., thyroid disease) or chemical substances (e.g., methamphetamines).
Now, it’s your turn to contribute: What are the realized and potential pitfalls of the DSM and BPRS? For example, does the DSM create the perception of known discrete disorders? How valid are the disorders? Given the inevitable changes required to help ensure that such a manual most accurately reflect society’s thinking (i.e., the manual’s changes on the subjects of homosexuality and women’s issues), what caveats must be given to clinicians and researchers?
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