Thursday, May 24, 2012

Psychiatry’s internal war over “mental illness” unhinges everything « The Teeming Brain

Psychiatry’s internal war over “mental illness” unhinges everything « The Teeming Brain

Psychiatry’s internal war over “mental illness” unhinges everything

Posted: May 23, 2012 in Society & Culture
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Have you or anybody you care about ever suffered from depression? How about bipolar disorder? Autism? Schizophrenia? Attention-deficit disorder? Obviously, given the prevalence of these mental and neurological illnesses, the answer is almost certainly affirmative.
Or then again, maybe not. Here’s the dirty little trick that’s been pulled over on all of us: each of those illnesses is a wholesale semantic/cultural invention, concocted out of thin air, that deserves to be put in scare quotes. And this, of course, imparts a whole new tone to them. Think about it: there’s an entirely different feeling when you say somebody suffers from “depression” or “ADD.” For full effect, imagine translating the scare quotes into the now-trendy “air quotes.” In fact, why not try it out. Say the words out loud and make the quotation marks with your fingers: “depression,” “autism,” “bipolar disorder,” “attention-deficit disorder,” “schizophrenia.” Feel the irony now coating these familiar psychiatric terms. Note how they no longer seem so familiar or meaningful, how they no longer seem to signify something literally real.
If you’ve successfully achieved this disorienting act of linguistic dislocation and decontextualizing, then you’ve begun to deprogram yourself and wake up from the spell of cultural hypnosis that’s been cast over us all by the American Psychiatric Association and Big Pharma. And that’s not just me talking; it’s actual members of the APA, including, most significantly, the lead editor of the DSM-IV, the fourth edition of the APA’s Diagnostic and Statistical Manual (see the linked and excerpted articles below).
The DSM is, in the words of one of the items below, “as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians.” This is because it’s the official manual that lays out the APA’s official definitions of mental illnesses and the criteria for diagnosing them. I was first introduced to it personally when I worked as a producer of video courses for Missouri State University in the 1990s. The job entailed attending and videotaping every classroom meeting of various live, lecture-based college courses, and then spending months transforming them into video versions of themselves with the help of computer graphics, music beds, and creative editing. This meant I got to know these classes better than any of the enrolled students, and one of them was a social work class about substance abuse intervention that involved regular references to the DSM-IV. Spending six or eight months making that course burned into my mind the implicit understanding that this book is truly the Holy Scripture of mental illness, because the instructor referred to it at least one or two times in every lecture.
But the thing is — and I didn’t wake up to this until some years later — psychiatry as a formal profession really has no idea what constitutes mental illness, nor does it know what constitutes mental health, for the simple reason that it doesn’t know what the soul — the “psyche” in psychiatry and psychology — really is, does, means, or ought to be. And this is the dirty little not-so-secret that lies not just at the heart of psychiatry but at the heart of every one of the so-called human sciences. How is it that we ever came to think “science” in its modern-day iteration as “the study of empirically testable and verifiable phenomena” is applicable to the realms of human society and personal reality anyway? Where exactly does psychiatry, formally defined as a medical field and thus a “hard” science, diverge from the “soft” science of psychology or any other “social science”? If there’s a controversy going on in the area of consciousness studies right now (as indeed there is) about whether consciousness really boils down to the brain or is something else, something wider, then how did the biomedical model of psychiatry ever become the supreme reigning orthodoxy in modern technological society? The answer is simple: it became so by sheer assertion, by default assumption, and by the imposition of the anti-metaphysical claim of biomedical materialism (which is of course a metaphysical position in itself) onto the study of the human self. In other words, and to widen the frame a bit, it happened as part of the ongoing takeover (hijacking) of “mainstream thought” by fundamentalist materialism wedded to economic materialism that has characterized modern society ever since the epochal transformations of the scientific revolution and Age of Enlightenment.
In the 1960s and 70s, Alan Watts, one of my most beloved authors and primary philosophical influences, wrote and lectured regularly about the fact — the fact, mind you, not the ideologically motivated assertion — that the psychiatric and psychological professions as formally practiced literally have no idea what they’re doing. (And of course he wasn’t alone in this, as the example of R.D. Laing, to name just one notable spokesperson for the anti-psychiatry movement, shows.) Watts once wrote,
The publication of my Psychotherapy East and West and Joyous Cosmology early in the sixties brought me into public and private discussion with many leading members of the psychiatric profession, and I was astonished at what seemed to be their actual terror of unusual states of consciousness. I had thought that psychiatrists should have been as familiar with these wildernesses and unexplored territories of the mind as Indian guides, but as I perused something like the two huge volumes of The American Handbook of Psychiatry, I found only maps of the soul as primitive as ancient maps of the world. There were vaguely outlined emptinesses called Schizophrenia, Hysteria, and Catatonia, accompanied with little more solid information than “Here be dragons and cameleopards.”
– Alan Watts, “The Soul-Searchers,” excerpted from his In My Own Way: An Autobiography, 1915-1965 (1972)
This isn’t just a problem from the past. The “emperor has no clothes” situation that Watts identified in the psychiatric profession half a century ago is still with us today, only more so, because today we are, if possible, even more overtaken and programmed and hypnotized by the false idea that psychiatry and psychology actually proceed on a basis of assured and verified knowledge. And this means we live even more fully under the sway of falsely conceived ideas about our very souls and subjectivities that are forced upon us from without like mental-spiritual straitjackets. Hence the almost universal, casual, workaday acceptance of the ideas of “depression” and all the rest. All of them, to repeat, are invented concepts, not discovered realities. Entrenched and sometimes debilitating sadness and lethargy, and the draining of happiness or even the ability to experience it — what used to be called “melancholia” — is a reality. But the label “major depression” and all that goes with it is a made-up concept that falsely implies psychiatrists really know what they’re dealing with. A high amount of jumpiness and nervous energy accompanied by a rapidly shifting focus of attention are experienced by a lot of people, but to call them “ADD” or “ADHD” is a sleight-of-hand maneuver that falsely reifies them and binds them together into a supposed illness. Hearing voices and experiencing a kind of volcanic uprush of sensory and mental-emotional activity from an apparently internal source in the psyche that feels separate and autonomous from one’s conscious self is as old as the human race itself, but to medicalize the experience by labeling it “schizophrenia” and then proceed on the idea that it requires drug-based treatment (which does, yes, prove helpful to some people) is to flat-out lie by saying the condition’s basic nature is scientifically understood even if its exact causes aren’t. (Who can confidently claim — as in truly, authoritatively, reasonably — that the psychiatric profession’s medicalized clampdown on this perennial human experience is any more valid than, say, Philip K. Dick’s assertion that “The schizophrenic is a leap ahead that failed”?)
For people who have never begun the journey down this path of mental deprogramming, it can be very difficult to get a handle on it and really feel the true depth of its earth-shattering implications, which center around the fact that the very view of human life — yours, mine, everybody’s, up-close and personal — and the nature of reality that we collectively share in our post-industrial techno-dystopia is shot through with arbitrary scientistic bullshit. The “official” (note the scare quotes) line about who and what we are, and who and what life is, is a scam, a snow job, a line we’ve been fed along with a spoonful of sugar about its supposedly solid status to help the medicine go down. There is no more intimate and comprehensive locus from which to arbitrate these kinds of all-encompassing, axiom-level notions than the psyche itself, the center-point of our individual perspectives. Blast the reigning assumptions and dogmas there, and the entire world radiating outward from them begins to crack apart.
As a starting point, I advise reading the following extended excerpts from various recent writings about the psychiatric profession’s internal war over the imminent new revision — the first in nearly 20 years — of the DSM. I’ve also included a couple of excellent pieces from The New York Review of Books about the deep history of how we arrived at the current biomedical model of mental illness, and why this development was very conscious, very illogical, and very driven, in part, by an unholy alliance between the psychiatric profession and what, with their help, became today’s Big Pharma.
James Howard Kunstler recently published a couple of blog posts (“Juked by Medicine” and “Matrix of Rackets“) about an unpleasant and thoroughly disillusioning experience he had with his doctor. In one of them he said, “I wonder if doctors are losing their legitimacy now in a way similar to the other authority figures in our culture: the political leaders, the bankers economists, the business executives.” The answer, of course, is yes, and this is something I assert based not only on hearsay but on recent and ongoing experiences that my family and friends have had with doctors and medical institutions. And the same point extends, clearly and incontrovertibly, to the psychiatric and psychological professions as well. All bets, as they say, are now off.
* * *
Trouble at the Heart of Psychiatry’s Revised Rule Book
Edward Shorter (historian of psychiatry, University of Toronto), Streams of Consciousness, Scientific American, May 9, 2012
One might liken the latest draft of psychiatry’s new diagnostic manual, the DSM-5, to a bowl of spaghetti. Hanging over the side are the marginal diagnoses of psychiatry, such as attention deficit hyperactivity disorder and autism, important for certain subpopulations but not central to the discipline. At the center of the spaghetti bowl are the diagnoses at the heart of psychiatry: major depression, schizophrenia, bipolar disorder… The main difficulty is that the principal diagnoses of psychiatry are artifacts…[Major depression was created by] lumping…two forms of depressive illness together. In fact, they are so disparate that the depression term itself should be abandoned. It is now shopworn with use and has approximately the same scientific value as other discarded psychiatric diagnoses such as hysteria and madness…There is no natural disease entity called schizophrenia: it has no typical, or pathognomonic, symptom, no predictable response to treatment, no reliable prognosis. Chronic psychosis is really a common final pathway for several disparate forms of psychotic illness that should not be lumped together…[L]umping] all [forms of chronic psychosis] together commits the same error as lumping together melancholia and nonmelancholia…The third fatal flaw at the center of the bowl of spaghetti is bipolar disorder, a diagnosis that assumes that the depression of unipolar disorder (otherwise known as major depression) is different from bipolar depression. But they’re really the same…And the entire concept of bipolar disorder has been a gift to the pharmaceutical industry, which has been able to re-position anticonvulsant drugs to counter the terrible bipolar menace.
* * *
Inside the Battle to Define Mental Illness
Gary Greenberg, Wired, December 27, 2010
“We made mistakes that had terrible consequences [in the DSM-IV]” [says Allen Frances, the edition's lead editor]. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics — and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs…The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it….At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians…What the battle over DSM-5 should make clear to all of us — professional and layman alike — is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench.
* * *
The Epidemic of Mental Illness: Why?
Marcia Angell, The New York Review of Books, June 23, 2011
The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain…What is going on here? Is the prevalence of mental illness really that high and still climbing?…On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one?…In the space of three short years…drugs had become available to treat what at that time were regarded as the three major categories of mental illness — psychosis, anxiety, and depression — and the face of psychiatry was totally transformed…[I]nstead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug. That was a great leap in logic…“By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin…[B]ecause the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants…[E]ven as drug treatment for mental illness has skyrocketed, so has the prevalence of the conditions treated…”Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?”…[T]he natural history of mental illness has changed. Whereas conditions such as schizophrenia and depression were once mainly self-limited or episodic, with each episode usually lasting no more than six months and interspersed with long periods of normalcy, the conditions are now chronic and lifelong. Whitaker believes that this might be because drugs, even those that relieve symptoms in the short term, cause long-term mental harms that continue after the underlying illness would have naturally resolved.
* * *
The Illusions of Psychiatry
Marcia Angell, The New York Review of Books, July 14, 2011
[T]he medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible…Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies…”A powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority”…[The psychiatric profession is currently beset by a] “frenzy” of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest.
* * *
‘Label jars, not people’: Lobbying against the shrinks
James Davies, New Scientist, May 17, 2012
“Label jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters — including former patients, academics and doctors — gathered to lobby the American Psychiatric Association’s (APA) annual meeting. The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification. At the heart of the issue is the Diagnostic and Statistical Manual of Mental Disorders (DSM) — psychiatry’s diagnostic “bible.” Allen Frances, who headed the last major rewrite of the manual — DSM-IV — fears that the revised version will undermine the profession’s credibility. “What concerns me most,” he says, “is that its publication will dramatically expand the realm of psychiatry and narrow the realm of normality.”

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