Psychiatry – Label-Based Quackery or Research-Based Science?




Psychiatry_Psychology2.jpgAfter 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?

  • http://psychcentral.com/ John Grohol

    Actually, if you delve into medicine further, you’ll find that many of the things you assume or take as “objective” are no more objective than patient self-report or interpreting complex test results. There is a *lot* of subjectivity in *all* of medicine, so I’m not certain why people feel psychiatry (or mental health in general) is a better, easy target.

    The DSM is an imperfect instrument in an imperfect world. It is a huge step forward (starting with the DSM-III) in terms of scientific validity and reliability than many other diagnostic systems. Is it perfect? No. Would any system be perfect in dealing with human maladies? No. Could it be better. Certainly. And the next edition will have even more research backing up every diagnosis.

    And that’s the crux of the matter — research. The social sciences have a huge wealth of scientific research — literally thousands of new studies every year — that add to our understanding of human behavior and what happens when that behavior goes awry. We’ve come a long way, even in the past 2 decades, and we’ve still got a long ways to go. But it’s important to make the effort, because no matter what you use to describe the problems, at the end of the day people still have these things we call depression or anxiety and want help for them.

  • http://www.cchr.org/ Jon von Gunten

    Fact-Based, Not Faith-Based

    Most “critics of psychiatrics critics” miss the central point: Critics of psychiatry decry psychiatry *not* because of some faith-based concept, but based on documented deaths and criminality in the field.

    It is easy to mentally equate anti-psychiatry stands with many Christians’ anti-abortion stands, which are based their faith and bolstered by true stories of abortions gone bad. Every Christian has every right to hold those faith-based beliefs.

    But those who criticize critics of psychiatry are confusing two very different sets of objectors: Those who object to psychiatry do so based on 50 years of documenting psychiatry’s horrible results.

    Critics of the critics of abortion automatically negate theological ideas, so they try to marginalize the critics of psychiatry as theologically based. In their minds, “If it’s theological, it’s wrong. Case closed.”

    But critics of psychiatry base their criticisms on tens of thousands of documented cases of psychiatric patients who either (a) got progressively worse; (b) died, committed suicide or mutilated themselves; (c) attacked family or went on shooting sprees; (d) were raped or financially coerced by the psychiatrists themselves. And that number of cases doesn’t include less-serious but still-numerous crimes of financial fraud the profession perpetrated daily on insurance companies and patients’ families.

    To see documented examples, go to: http://www.cchr.org/

    There anyone can see factual examples of why the critics of psychiatry will continue to grow in number. As long as psychiatry ignores and winks at the crimes of its members, it forces watchdog groups to expose the profession’s cruelty and disregard for human life.

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  • http://VisionAndPsychosis.Net L K Tucker

    You are on the right track. The first thing to recognize about the DSM is that none of the “disorders” actually exist. They are names given to observed then sorted behaviors.

    The APA, authors of the DSM, freely admit they do not know what causes them.

    Without that basic knowledge it is impossible to know where one disorder begins and another ends.

    They are voted into existence. No science is involved.

    VisionAndPsychosis.Net began an investigation in 2002. There is a trail through history to support the thesis that Subliminal Distraction causes most mental distress.

    The method was to look at activities that cause mental events and examine that activity for Subliminal Distraction exposure.

    Qi Gong and Kundalini Yoga have centuries of experience with known mental problems associated with the attempt to reach enlightenment. Although they ignorantly claim that Chee or Prana causes these problems their exercises, when done in groups, replicates the design problem of 1960’s too-close office workstations. That may be hard to envision at first reading.

    Sudden intense exposure creates the harmless temporary episode, but low-level long-term exposure creates a fixed altered mental state that resembles schizophrenia.

    When schizophrenia is viewed as an altered mental state caused by random SD exposure much of the mystery of mental illness disappears. It allows you to understand why schizophrenia onsets in adolescence.

    The problem is that this is so different from the current beliefs and treatment modalities that interested parties don’t want to investigate it.

    There is no financial incentive. Once this is explained to a patient little else is required.

    http://VisionAndPsychosis.Net

  • http://encefalus.com/ Encefalus

    I do believe that the DSM has been used as a replacement for causes and effects. What psychiatry really does is to give drugs and make money out of it. If you want I express some of my opinions on the subject at http://encefalus.com/sociopolitical/psychiatry-antipsychiatry-history-mental-disease/ and http://encefalus.com/general/metaphor-mental-illness/

Shaheen E Lakhan, MD, PhD, MEd, MS

Shaheen E Lakhan, MD, PhD, MEd, MS, is executive director of the Global Neuroscience Initiative Foundation (GNIF). He is a published scholar in protein biomarkers, bioethics, biotechnology, education technology, and neurology. He serves on the editorial board of several scholarly publications and has been honored by the U.S. President and Congress.
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