Knowledge monopoly in psychiatry
Posted by Henry Bauer on 2013/09/18
In Dogmatism in Science and Medicine, I mentioned prescription drugs as illustrating the dangerous consequences of dogmatism (pp. 238-42), but I was not aware then of the degree to which psychiatry had become an alarmingly health-threatening knowledge monopoly. I did note some time ago on my HIV/AIDS blog that this parlous situation pervaded psychiatric as well as other medical practice (The drug business, 2011/04/25 ), to the extent that pharmaceutical treatment of mental illness has actually increased instead of decreasing the number of people supposedly suffering mental disorders (BIG medical blunders, 2012/01/25).
Underlying this blundering is the manner in which mental disorders are defined and diagnosed.
Allen Frances, who wrote the item about preventing over-diagnosis mentioned in my previous post, has written in considerable detail about the dangers posed by the latest (5th) edition of the Diagnostic and Statistical Manual of Mental Disorders (Diagnosing the D.S.M.):
“At its annual meeting . . . [a year ago, May 2012], the American Psychiatric Association did two wonderful things: it rejected one reckless proposal that would have exposed nonpsychotic children to unnecessary and dangerous antipsychotic medication and another that would have turned the existential worries and sadness of everyday life into an alleged mental disorder.
But the association is still proceeding with other suggestions that could potentially expand the boundaries of psychiatry to define as mentally ill tens of millions of people now considered normal. . . .
The fourth edition of the manual, released in 1994 . . . failed to anticipate or control the faddish over-diagnosis of autism, attention deficit disorders and bipolar disorder in children that has since occurred.”
Some commentators on my Dogmatism in Science and Medicine have suggested that I exaggerate by describing the contemporary scene in terms of “knowledge monopolies”, so I was pleased to find Dr. Frances using the same description:
“I . . . have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness” [my emphasis].
Although the printed title of Frances’s piece is “Diagnosing the D.S.M.” the on-line link to that article shows as “break-up-the-psychiatric-monopoly” , as my correspondent friend had noticed.
Dr. Frances and I are also in agreement that reform cannot and will not come from within the profession itself:
“Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.”
I had written quite similarly, that “As war has long been too important to leave to the generals, so science has become far too important to be left to the scientists” (p. 167 in Dogmatism in Science and Medicine).