Monday, July 8, 2013

The Kingdom of Psychiatry Is at Hand

I've begun reading an interesting new book, Mad Science: Psychiatric Coercion, Diagnosis and Drugs, by Stuart A. Kirk, Tomi Gomory, and David Cohen, published this year by Transaction Publishers.  All three authors are academic, professors of social work, with backgrounds as mental health clinicians.  A major thesis of the book is that medical psychiatry has grossly inflated its achievements: that there is no evidence of biological causes for most mental illnesses, that drugs have not been effective as treatment, and that the concept of mental illness itself is incoherent. This is interesting, because I've recently been told the opposite by boosters of psychiatry and the medical model of mental illness, though I remained skeptical of these claims, so I'm looking forward to reading the rest of the book and seeing the authors' arguments and evidence for their position.

I'm sure I'll have more to say about Mad Science as I read the rest of it, but for now let me quote this passage, in which the authors discuss the assumptions and claims made by Edward Shorter, a distinguished historian of mental illness and psychiatry.  (Again, I've silently removed citations from the quotation.)
His uncritical commitment to the reality of biological causes of psychiatric diseases is illustrated by his discussion in A History of Psychiatry concerning the increases in the frequency of certain psychiatric illnesses during the nineteenth century. He names “in particular neurosyphilis, alcohol psychosis and … schizophrenia.” But the facts are that neither of the first two is a psychiatric disease. Neurosyphilis is a neurological disease with behavioral correlates, a brain infection caused by the bacteria Treponema pallidium, if untreated leading to death. Alcohol psychosis is caused by chemical poisoning: either too much alcohol consumption or sudden withdrawal from it. The historical record is clear that both these physiological disease processes, along with a few others, were analogically applied by nineteenth-century mad-doctors to explain the phenomena they came to call schizophrenia.  About the latter, some anonymous wit famously said that “unlike neurosyphilis it is a disease where the treating psychiatrists perish before the patients do.” Shorter’s silence concerning the hard empirical evidence for the reality of the first two entities and the absence of such evidence for schizophrenia (although he lumps all three together as “mental diseases,” having been demonstrated as biological diseases) can only be attributed to political calculation, not scientific judgment. What would be needed from him as an honest historical broker are the scientific facts of the matter both pro and contra, from the historical record, regarding schizophrenia. The current  [2000] DSM states explicitly that “no laboratory findings have been identified that are diagnostic of Schizophrenia.”  Of course Shorter knows this, as he explains in a later work when he concedes that “so little is understood about the underlying causes of psychiatric illness. Not having a solid ‘pathophysiolology’ or understanding of the mechanisms of disease, psychiatry cannot rigorously delineate disease entities on the basis of anatomical physiology, as other medical fields do” [69].
That quotation from the Diagnostic and Statistical Manual IV is especially telling, when I consider how many people have told me confidently that schizophrenia has been identified as a physiological entity.  I was as skeptical of that, from what I already knew on the subject, as I am of confident claims that homosexuality has been established as a biological, probably genetic condition.

One more brief quotation:
Thomas Insel, the [National Institute of Mental Health]'s director, speculates that "abnormal activity in specific brain circuits" are the causes of mental illnesses.  Unfortunately, after a hundred years of these hypotheses, not a single biological marker for a single psychiatric disorder has been identified to validate distress and misbehavior as a medical disease.

Insel and other psychiatric authorities reassure the public, despite their continual inability to provide the evidence, that if the public is just patient for a little while longer and holds on to the descriptive DSM sydromes, diagnostic lesions underlying these syndromes will definitely be identified in the not too distant future, initiating a psychiatric utopia -- one in which psychiatric science will deliver specific cures for our behavior problems [69].
I've written before that confident claims for the medical model of homosexuality were made in advance of any real evidence for them; it appears that the same happened with psychiatry in general.  And the imminence of the kingdom of psychiatry on earth recalls themes from religious teaching about the End Times: though there be heretics and scoffers, True Science is not slow in keeping its promise, as some understand slowness.  But those that endure until the fullness of true Gnosis will be saved.  Meanwhile, just keep taking your Thorazine, Adderol, and Abilify; and have faith, the substance of things hoped for, the evidence of things unseen.