Skepticism about science and medicine

In search of disinterested science

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).

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7 Responses to “Knowledge monopoly in psychiatry”

  1. mo79uk said

    I know little about psychiatry, but in ordinary conversation a lot of people seem to agree that there’s a pill for every ‘ailment’; things that really would benefit from counselling or are really just some deviation from a textbook norm.

    Over-diagnosis of autism seems to be due to ever-expanding criteria of what it is, and – like something else we know! – that not only harms the misdiagnosed but people who fall under a more conservative definition of it.

  2. Vortex said

    Dr. Bauer, I’m glad you are writing about the problems of psychiatry – it does has an abundance of them indeed! If you start looking at them in detail, I can guarantee that even you will be shocked: the sad situation in modern science and medicine in general is relatively “soft” if compared with psychiatry… If there is a medical/scientific field that is not just in a need of reform, but in a need of really rapid and radical reform, this is psychiatry.

    I think I can recommend you “Mad in America”, a website containing news, blogs and forum concerning problems with psychiatry. It was founded by Robert Whitaker, whose books you have read already. The range of topics is vast, from the most recent scientific and medical research to alternative theoretical models of mental health and treatment to personal stories of former patients harmed by their “therapies”:

    http://www.madinamerica.com/

    I would be glad to read your further posts about this topic.

    • Henry Bauer said

      Vortex:

      I fully agree with your recommendation of Robert Whitaker’s work. I mentioned his work some time ago on my other (earlier) blog:

      BIG medical blunders (2012/01/25)

      • Vortex said

        The fact which is promising: Robert Whitaker is strongly supported by a quickly growing number of academicians and practitioners. He was the one who made the issue of malfunctioning psychiatry really public; now results can be achived by a strong movement of professionals who refused to be silent and are now openly critical of the current dogma.

        They have already achieved some results… For example, look at this article:

        http://www.madinamerica.com/2013/09/behind-amazing-victory-mental-health-activists-robert-whitaker/

        Dr. Bauer, if you look at the general picture of what’s happening at the mental health system now, you’ll see that, despite its desperate state, some glimpses of hope is visible.

        And, I think, the change in the mental health system may become a starting point for a change of modern science and medicine in general. If psychiatry will be reformed, it will be much more easier to reform other fields. We would have a living example of the fall of dogmaticism and the victory of the open-minded inquiry.

      • Henry Bauer said

        Vortex:

        I fervently hope you turn out to be right!

  3. Vortex said

    Dr. Bauer, Drs. Johnatan Leo and Jeffery Lacasse – whom you had mentioned already in “BIG medical blunders” – published a critique of modern academic publication policies in medicine and psychiatry on the “Mad in America”:

    http://www.madinamerica.com/2013/10/bogus-journal-articles-distract-real-problem-academic-medicine/

    What they tell there echoes the message of your SciMedSkeptic blog – mainstream academia does have a lot of severe problems…

    Dr. Bauer, what is your opinion on these Leo-Lacasse materials? I think that would be useful for the purpose of your blog.

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