Deus ex Machina
When I was in my sophomore year of college I made a classic mistake: I began reading literature put out by the anti-Psychiatrists. If you want to undermine your faith in any given field, and their narrative of success, just look into the works of the dissidents. The primary concern of the anti-Psychiatrists was that Psychiatry was being used as a tool for control of the populace, rather than helping make adjustments that would benefit the mentally ill and allow them to lead healthier lives.
Their stance exploded into view following a report in Science entitled “On Being Sane in Insane Places” that undermined the entire field of both psychology and psychiatry: the Rosenhan Experiment. What happened, in brief, was this:
Rosenhan and several participants went to several institutions (around twelve), and told those involved that they heard a voice (auditory hallucination). The voice, which was always the same gender as the participant, didn't say much except for the following words: “hollow,” “empty,” and “thud.” Everyone was diagnosed as schizaphrenic or another diagnosis along those lines, and Rosenhan himself had to spend two months institutionalized, even though once admitted all participants claimed immediate relief. The catch was this: none of them were insane, and they were all faking their symptoms.
Upon returning to the world of the “sane,” Rosenhan revealed what he'd done. Institutions immediately began challenging him to try it again, and Rosenhan seemed to agree. Within a month he began receiving details: around 193 patients were considered to be his, with at least 42 considered suspect. In reality, this time Rosenhan had sent no-one.
The effect on the Psychological and Psychiatric communities was one of melt-down. The entire premise of their diagnoses were now suspect, and a glaring error was exploding into the light. In response the DSM volumes began to be produced.
“Ahha!” Said the community, backed by new unique strands of thought (biological psychology, biopsychiatry, etc). “We've fixed the problem!”
“With the new American Psychiatric Association Diagnostic and Statistical Manual V (DSM V) slated for publication next year, leaders in American psychiatry are criticizing the volume as unreliable.The DSM is the compendium of conditions psychiatrists use to diagnose their patients and, to a great extent, determine what treatments would benefit them. The DSM also has extremely important implications for what kinds of psychiatric problems insurers will cover and even which ones schools and employers will consider disabilities.
Dr. Allen Frances, professor emeritus at Duke University, who was actually the chairman of the DSM-IV task force, asserts in a recent blog published that the clinical trials that supposedly determined whether the new DSM V is a good and accurate guide “have been a pure disaster from start to finish.” He calls the trials a “fiasco” and accuses the American Psychiatric Association of having “lost its competence and credibility.”...”
- Fox News, Leading psychiatrists question psychiatry's diagnostic manual by Dr. Keith Ablow. Accessed 11/07/12.
Oh, yes. That's right. This newest version is just as abhorrent as the DSM iterations that came before, and now it's gotten to the point that leaders in the community are challenging it. History has that tendency, remember?, to repeat itself. Here it occurs again, but it's hard to know the complete story of what you're seeing unless you know how to look for it.
“Frances is by no means the only critic of the DSM-V. I have written before that advocates for those with autism have expressed grave concerns that the new guidelines proposed to diagnose that condition could leave out 10 to 45 percent of those currently diagnosed with the condition, leading to millions of children having no insurance coverage related to it.But Frances alleges much more. He cites data that indicates that the DSM V signs and symptoms that are proposed to define Major Depression and Generalized Anxiety Disorder are unacceptably inaccurate. And he worries that the official journal of the American Psychiatric Association, the American Journal of Psychiatry, which published a positive review of the DSM V has been “forced into the role of a cheerleading house organ, not an independent scientific journal.”
Given the concerns of leading psychiatrists like Frances, with whom I happen to agree, it is time to give real consideration to fundamentally changing the way psychiatrists use the DSM and encouraging them to think much more about what caused the disorders they are diagnosing.”
The view from afar remains solid: the very pressures that created the anti-Psychiatry movement in the first place are on the prowl again. “We figured it out!” was the resounding cheer that lead to dissent in the 1970s. It has returned with a resounding blast of madness. Except that it isn't the patients that are mad in this case: the community at large has been bought out, and evidence of it is leaking all over the place.
The DSM and the way we handle patients are but one area where the focus has gone out, and the reality of the situation remains beyond the reach of current practitioners. But then again: I openly side with their antagonistic, sometimes better-halves. Laing, for example, may have been interesting and well intentioned, but he also made use of Game Theory in his work, which was rather disastrous in the long run.
Another glaring issue remains the drug companies, and how they are tampering with trials and knowledge of the risks involved using their proposed treatments. I covered this in the last round of my responses to Gordon's Apocalypse Pharmaka entries. But I've spent some time really considering the problem and decided that the only way to shed some light on these factors is to return to the old view of Materia Medica. The view was this, until around the 1940s: All Medicines Are Poisons. In small doses, with the right causes, those glorious secondary metabolites in plants can help us... Or kill us, in larger doses. The true genius of a doctor laid in his ability to accurately balance the risks of medicine against the possibility of leaving the problem untreated.
You know that medicines are poisons because we would not have side-effects without them. The side effect is a sign that what you're taking is working, but it's also a sign that too much will kill you. This is part of the reason that I become some irate about the issue of “drugs.” Our social dialogue on the matter sucks, and as a byproduct people have bought into the narrative that what we're doing with medicine is somehow good or wholesome. Let me assure you: it is not.
Quoting Dr. Healy, an expert in Psycho-Pharmacology (Pharmacology is the field that replaced Materia Medica) in So Long and Thanks for all the Fish:
“In 1860 at a meeting of the Massachusetts’ Medical Society Oliver Wendell Holmes made one of the most celebrated comments in medicine. While noting that medicines, particularly opium, could help, he nevertheless made it plain that he thought that on balance medicines risked doing more harm than good. You can’t be much plainer than this:“I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be better for mankind and all the worse for the fishes”...”
The view we should get away from is that we're discussing “drugs” at all. In fact, we're discussing chemicals which affect the body, and which are often poisons. (The other word, “toxin” is one I reserve for the more deadly of the different secondary metabolites.) All of these compounds are dangerous in some situations, but that danger lessens in others. This includes your prescription drugs, and please take that into account. Some compounds are less dangerous than others.
Yesterday, two states voted to legalize pot. Meanwhile, the DEA seems to be insisting they'll ignore these decisions. The question that remains is whether or not we will return to some semblance of sanity regarding what drugs are, where they come from, and their legality versus illegality? Can we stray from the abyss that opened up beneath us, question the narratives of past generations, and move on? If I told you that by leveling the playing field by adopting the old mentality with regards to materia medica, we could take steps to both end a century of prohibition and the corruption in the ranks of some of our most celebrated fields of science and soft science, would you believe me?
Regardless, I continue to desire something better than the messes we currently have. What about you?