From psychobabble to biobabble?
Three years ago, in the TLS, Andrew Scull reviewed David Healy’s book MANIA A short history of bipolar disorder. Here is how he introduced Healy:
Yet he has vaulted to prominence as a fierce critic of standard professional practice; of the role of Big Pharma – the collective name for large pharmaceutical companies – in reconstituting the very terms in which we as a culture understand and respond to mental illness; and of the biobabble that these days has replaced psychobabble as the verbal camouflage for our ignorance about the aetiology of mental illness. Along the way, he has exposed the extraordinary venality of many leading academic psychiatrists; the widespread ghostwriting of what purport to be cutting-edge publications in major journals (apparently produced by eminent scientists but actually concocted by public relations flacks for the pharmaceutical houses); the routine suppression or gross misinterpretation of data on the effects of psychoactive drugs along lines which maximize the profits of the huge multinationals (who thereby extract obscene sums from the sufferings of the mentally ill); the heightened risk of suicide and other untoward events that, perversely, may accompany the ingestion of antidepressants; and the fraudulent “science” on which many contemporary understandings of mental disorder rest. Small wonder that for many Healy has become a professional pariah, and that he plausibly reports being hounded, menaced and attacked by the enormously powerful corporations whose profits he threatens.
In the May 18th issue of the TLS, Scull returns to the theme with an article providing background to the controversy attending the preparation by the American Psychiatric Association of a fifth edition of its Diagnostic and Statistical Manual (DSM). Scull argues that with its third edition, the DSM had made a major departure from the emphasis the first two editions had placed on the psychodynamic genesis of mental diseases (to be treated by psychoanalysis) to one that would replace it with more biologically oriented diagnoses (to be treated now (also) by drugs). The shift was made in part because of “psychiatry’s diagnostic incompetence,” that is, the “the documented failure of psychiatrists to agree on what was wrong in any given case before them.”
DSM III’s triumph marked the advent of a classificatory system that increasingly linked diagnostic categories to specific drug treatments, and an embrace on the part of both profession and public of a conceptualization of mental illnesses as specific, identifiably different diseases, each amenable to treatment with different drugs. Most importantly, since the insurance industry began to require a DSM diagnosis before agreeing to pay for a patient’s treatment (and the preferred course and length of treatment came to be linked to individual diagnostic categories), DSM III became a document that it was impossible to ignore, and impossible not to validate.
The controversy over the new edition of the DSM concerns the likely addition of many new mental illnesses, all treatable by drugs, of course. Scull writes:
As diagnostic criteria were loosened [in DSM III], an extraordinary expansion of the numbers of mentally sick individuals ensued. This has been particular evident among, but by no means confined to, the ranks of the young. “Juvenile biopolar disorder”, for example, increased forty-fold in just a decade, between 1994 and 2004. An autism epidemic broke out, as a formerly rare condition, seen in less than one in 500 children at the outset of the same decade, was found among one in every ninety children only ten years later. The story for hyperactivity, subsequently relabelled ADHD, is similar, with 10 per cent of male American children now taking pills daily for their “disease”. Among adults, one in every seventy-six Americans qualified for welfare payments based on mental disability by 2007.
If psychiatrists’ inability to agree among themselves on a diagnosis threatened to make them a laughing stock in the 1970s, the relabelling of a host of ordinary life events as psychiatric pathology now seems to promise more of the same. Social anxiety disorder, oppositional defiant disorder, school phobia, narcissistic and borderline personality disorders are apparently now to be joined by such things as pathological gambling, binge eating disorder, hypersexuality disorder, temper dysregulation disorder, mixed anxiety depressive disorder, minor neurocognitive disorder, and attenuated psychotic symptoms syndrome.
Yet we are almost as far removed as ever from understanding the etiological roots of major psychiatric disorders, let alone these more controversial diagnoses (which many people would argue do not belong in the medical arena in the first place). That these diagnoses provide lucrative new markets for psychopharmacology’s products raises questions in many minds about whether commercial concerns are illegitimately driving the expansion of the psychiatric universe – a concern that is scarcely allayed when one recalls that the great majority of the members of the DSM task force are recipients of drug company largesse.
All in all, not a pretty picture.
A devastating picture. We’re living Aldous Huxley’s Brave New World. Soma. But much like everything else in American culture, we take the easy way, regardless of the consequences.
Thanks for the background info. One can only hope we wake up and try to establish a more holistic approach to life rather than the advertising-defined life of success or happiness. The editorial piece here on Commonweal about Willy Loman and the revival of Death of a Salesman is very relevant to our selling our souls to the pharmaceutical industry.
Hard to respond to this except via anecdotes.
I am now taking three drugs to curb my depression. They have worked in the sense that I was deeply depressed, then I took the drugs, then the major symptoms went away (without the “triggers” going away). Of course, I (and everyone else I know who takes these things) reports side effects that don’t go away and that one has to get used to. But on the whole, I feel better with the drugs than without them.
Along with the “medical” management of the drugs by a psychiatrist, I saw a psychologist for a long time to learn to deal with the depression (as a behavior) and its triggers. This was helpful too. However, I have been unable to control my depression through behavior only (although I can alleviate things like anxiety and the blues) as I have discovered several times to my regret when I stopped taking the medication because I was feeling better.
Having said this, depression becomes a sort of “lifestyle”. The drugs are part of it; the side effects are part of it; the expectations and/or fears that one has are part of it. At this point I don’t know any more if I am locked into some kind of pattern of reasonable accommodation with myself; with the underlying disease either in remission or cured. Depression, then (or the “lifestyle” of being a depressive) then becomes a spiritual problem.
It seems to me that taking a medicinal drug is of itself not a moral issue any more than wearing shoes is. If you need them, you use them, and use of them should not be considered a spiritual weakness. On the contrary, it is reasonable to use a drug that works, however badly, if the alternative is worse.
In a world where money rules. it’s not surprising that there is lots of manipulation in all kinds of fields.
There seems to be a broad consensus that psychotropic drugs are useful in dealing with problems so ciyed -but of course the issues can be manipulated as in many edical therapies as we see today.
I don’t think the urge to disaparge the field is healthy hpwever.
A colleague told me once that melatonin “saved his life” and that he would never be able to travel so much if he did not take melatonin against jet lag.
A music teacher told me that she took anti-anxiety drugs before each concert because it was critical to her performance: she would never be able to play well during concerts otherwise.
A friend routinely takes anti-anxiety drugs when overwhelmed by life, even though the events are not exceptional but just a very busy routine.
There are worrisome articles about students taking performance-enhancing drugs to prepare for exams.
I cannot count the number of people I know who take sleeping pills, anti-depressants, or anti-anxiety drugs; in fact it would be easier to count those who do *not* take those drugs! Most of them have no particular mental health problem and are not in very unusual situations. But it seems that life puts a lot of pressure on a lot of people. Instead of changing life styles so as to better fit people’s personalities, people use drugs so as to change their personalities to better fit their life styles, and it is possible that there is less and less tolerance for those who do not fit the mold. ADHD might be an example of that.
But one friend who has a mental health problem told me that they seldom traveled and never flew because they found that it was too disruptive for their mental health: perhaps it is those who have severe limitations who are more willing to reexamine their lives and adapt it to their flaws. The others are expected to just “deal with” their minor problems, and that it is “not acceptable” when they deviate from the norm.
I work in the field of mental health and have done some research in this area.
The biological-disease model of intepreting mental illness is very much on the ascendancy and is due, largely, to the strides made in psychopharmocology.
However, with respect to the DSM and interpreting mental illness, psychiatric researchers Kendell and Jablensky wrote:
Consequently, the assumption among the majority of researchers today is that most currently recognized psychiatric disorders are not disease entities (Kendell and Jablensky). Kendell cites Jaspers who adds that while the idea of disease entities has become a fruitful orientation for the investigations of psychiatry no actual disease entities exist. They conclude, therefore, that it is important to distinguish between the validity and the utility of all diagnostic concepts and of their formal definitions. Otherwise, the term ‘valid’ will continue to mislead. At present there is little evidence that, strictly speaking, most contemporary psychiatric diagnoses are valid, because they are still defined by syndromes that have not been demonstrated to have natural boundaries.
This view represents the consensus of the scientific psychiatric community at present. The editors of the Diagnostic and Statistical Manual of Medical Disorders (DSM IV) state in the preface:
It really is an issue of language and what kind of language we will use to describe experiences of depression, anxiety (once referred to as melancholia). It is clear that there have been throughout history all manner of psychiatric disorders and the issue of treatment has always been difficult and complex.
One psychologist who has lived experience of mental illness and has a great story (diagnosed with shizophrenia at 19 and later went on to get a phD in psychology) expressed it this way:
I work with psychiatrists and I think that it is a bit of a caricature to suggest that anybody seriously believes that medication alone will help but in many instances, it will at least contribute to part of a solution. I lean more towards the naturopathic route myself but for many of the clients we see encouraging good diet, exercise, regular sleep, meditation is very difficult given the challenging nature of their lives as many live in poverty or chaotic situations.
I will add that I have met very few women involved in the mental health system or men for that matter who have not experienced some form of childhood trauma.
“It really is an issue of language and what kind of language we will use to describe experiences of depression, anxiety (once referred to as melancholia). ”
George D. –
Yes, as you describe the problems language is a problem. But whenever you’re talking biological entities there are problems of classification — even distinguising one-celled organisms can be difficult. Small wonder then, that the most complex being in the universe (a person), should present taxinomic problems. Given, especially, our dependence on our brains, that most complex part of us all, and given that the brain works as a system of areas which both cooperate and compete, and given that the brain can all too easily break down in unpredictable ways and cause unexpected phenomena, it’s no wonder that the psychiatrists have trouble classifying mental illnesses.
Not to mention the fact that humans occasionally make free choices, which can ruin any attempt at scientific generalizations about human behavior.
Indeed Ann:
Regarding the brain and its connection to the mind and body, I like this poem from one of my favourite poets, Emily Dickinson.
George D. –
What does that last stanza mean? Really?
(Emily drives me up the wall.)
Hi Ann:
The first two stanzas refers to the fact that it is the mind or brain that interprets all of our sense experience. The brain therefore, is wider than the sky, because it is only in and through that relatively small organ that the whole of nature and external experience is interpreted and understood. It is very powerful and can in fact trick us into seeing or hearing things that are not in reality present (on the topic at hand such things as delusions and hallucinations).
I interpret that last stanza in light of a particular interpretation that Emily had with respect to her faith and God (at least as far as i can discern). I think that she was influenced by a strain of immanent theology that might have been current in the US at that time. Or even if she was not directly influenced by it, she was a very interior person.
At the same time there is a distinction but the distinction is between “syllable” and “sound”. Very inter-related. And maybe they do not differ at all. Meister Eckhart referred to the “grunt” or ground. By that he meant that the ground of the soul and the ground of God are the same ground!!
PS:
Emily Dickonson, may have suffered, from what we would refer to today as a mood disorder.
Check you this article from the American Journal of Psychiatry:
http://ajp.psychiatryonline.org/article.aspx?Volume=158&page=686&journalID=13
Thanks, George. I didn’t know her physician thought her mental states were so seriously off.
I still don’t think that “weight of God’ metaphor works. Yes, she had a great talent, but her work, I think, is very uneven. To many of her admirers all her work is the ultimate in poetry, even the jingly-jangly trivia. I guess it’s those admirers who really irritate me.