Diagnosing in the Dark: The continuing relevance of Thomas Szasz’s assault on psychiatric...

Reason ^ | October 2011 | Jacob Sullum

[neverdem]

The continuing relevance of Thomas Szasz’s assault on psychiatric pretensions

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, 50th anniversary edition, by Thomas Szasz, Harper Perennial, 329 pages, $14.99

Manufacturing Depression: The Secret History of a Modern Disease, by Gary Greenberg, Simon & Schuster, 432 pages, $27

The Protest Psychosis: How Schizophrenia Became a Black Disease, by Jonathan M. Metzl, Beacon Press, 246 pages, $24.95

Half a century after Thomas Szasz first declared “there is no such thing as ‘mental illness,” his radical critique of psychiatry is widely viewed as outmoded and simplistic at best, cruelly dogmatic at worst. “The opinion of official American psychiatry,” Szasz writes in the preface to the 50th anniversary edition of The Myth of Mental Illness, “contains the imprimatur of the federal and state governments. There is no legally valid nonmedical approach to ‘mental illness,’ just as there is no such approach to measles or melanoma.…Debate about what counts as mental illness has been replaced by legislation about the medicalization and demedicalization of behavior.”

Yet psychiatry’s lack of scientific rigor is so obvious today that the profession’s leading lights openly complain about it. In a January Wired article about the ongoing revision of the American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders (DSM), Gary Greenberg, a psychotherapist and journalist, recounts an interview with Allen Frances, lead editor of the manual’s current (fourth) edition. “There is no definition of a mental disorder,” Frances tells him. “It’s bullshit. I mean, you just can’t define it.”

Since mental disorders officially exist in the United States only if they are listed in the DSM, which is the bible for mental health professionals and the key to insurance coverage, this is a pretty significant concession. It reinforces Szasz’s point that psychiatrists invent mental illnesses by...

[mountn man]

Obamas narcissism is a mental illness.

[tired&retired]

In a time when everyone appears insane, only the sane people will appear to deviate from the norm.

[newheart]

Pfl

[tired&retired]

I know Allan Frances, and I am sure the quote was out of context. Allen has been very careful to make sure the committees have accurate descriptions and criteria in describing a disorder in the DSM IV. I’ve heard him lecture at psychiatry grand rounds about how the mere slip of using “or” instead of “and” in one DSM IV description caused an over application and mis-interpretation in the courts.

He also has been an outspoken critic of the authors of the DSM V who are now revising the text to combine areas such as “drug addiction” and “drug abuse”, Asperger’s Syndrome into “Autism Spectrum Disorders; as the combinations create vagueness and potentially mis-label a one time drug abuser in college as an addict for life. These labels are hard to remove in the medical records once they have been attached to a person!

[acapesket]

Tell me about it!!!
As my GP Dad always said...”it’s only the “nuts” who go into psychiatry”!

[Vince Ferrer]

Does this mean I can go back to doing the same thing over and over, and expect a different outcome?

[Skepolitic]

Thud.

[tired&retired]

“Does this mean I can go back to doing the same thing over and over, and expect a different outcome?”

Only if you are an elected politician in a high office applying economic policies!

[HiTech RedNeck]

Political problems with the DSM doesn’t prove that there are no sick brains.

[1010RD]

And although he bemoans “the medical industry’s invention of a disease out of our daily troubles and aspirations,” he concedes that pills might be the best choice for some people in some situations. But he emphasizes the crucial role that the placebo effect seems to play in the impact of SSRIs. In clinical trials, drugs like Prozac perform only slightly better than placebos, so slightly that the difference is “not clinically significant,” according to a 2002 review of the evidence by Irving Kirsch, a professor of psychology at the University of Hull, who elaborates on his findings in The Emperor’s New Drugs (Basic Books). The difference is so small that it may be partly or entirely due to expectations primed by the drug’s side effects. These results (along with Greenberg’s own experience as an experimental subject, which he describes) suggest the power of hope, kindled by the rituals of self-improvement, as an antidote to depression.

That sounds like Christianity.

[editor-surveyor]

Invent a problem, become wealthy solving it.

That is the basis of our entire allopathic “health” industry.