Saturday, August 18, 2012

Psychiatry's Illegitimacy

A very good review of All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders. From the article: 

A renegade psychiatrist called Thomas Szasz published a best-selling broadside called The Myth of Mental Illness, suggesting that psychiatrists were pernicious agents of social control who locked up inconvenient people on behalf of a society anxious to be rid of them, invoking an illness label that had the same ontological status as the label “witch” employed some centuries before. Illness, he truculently insisted, was a purely biological thing, a demonstrable part of the natural world. Mental illness was a misplaced metaphor, a socially constructed way of permitting an ever-wider selection of behaviors to be forcibly controlled under the guise of helping people.

The problem was exacerbated when some psychiatrists sought to examine the diagnostic process. Their findings dramatically reinforced the growing suspicion that their profession’s claims to expertise were spurious. Prominent figures like Aaron Beck, Robert Spitzer, MG. Sandifer and Benjamin Pasamanick published systematic data that dramatized just how tenuous agreement was among psychiatrists, even the most prominent ones, regarding the nature of psychiatric pathology; consensus barely exceeded 50 percent whether the subjects were patients in state hospitals or out-patient settings. And in 1972, a systematic study of diagnostic practices in Britain and the United States found massive differences: New York psychiatrists diagnosed nearly 62 percent of their patients as schizophrenic, while in London only 34 percent received this diagnosis. And, while less than five percent of the New York patients were diagnosed with depressive psychoses, the comparable figure in London was 24 percent. Further examination of the patients suggested that these differences were byproducts of the preferences and prejudices of each group of psychiatrists, and yet they resulted in consequential differences in treatment.

Shortly thereafter, a cleverly designed study by a Stanford social psychologist, David Rosenhan, appearing in the august pages of Science, poured gasoline on the flames. Rosenhan had eight pseudo-patients (including himself) show up at a dozen psychiatric hospitals complaining they were hearing voices and uttering the words “empty,” “hollow,” or “thud.” The so-called patients otherwise presented their normal selves. Seven received the diagnosis of schizophrenia, the eighth was labeled manic-depressive, and all were hospitalized for terms as long as 52 days.

To address the embarrassment, one of the profession’s internal critics, Robert Spitzer of Columbia University, persuaded the American Psychiatric Association to authorize the development of a new diagnostic manual. The document he and his Task Force produced, approved and published in slightly modified form in 1980 as the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM III for short) launched a revolution in American psychiatry whose effects are still felt today. Versions III R (revised), IV, and IV TR (text revision) and DSM 5 (to be released in 2013) have been produced with numbing regularity.

All sorts of anxieties that are in reality part of the normal range of human emotion and experience have been transformed by professional sleight of hand into diseases. The upshot, they contend, is that whereas thirty years ago less than five percent of Americans were thought to suffer from an anxiety disorder, nowadays some widely cited epidemiological studies have decreed that as many as 50 percent of us do so.

Horwitz and Wakefield are scarcely the first scholars to suggest that rising rates of mental illness are a reflection of the widening and loosening of diagnostic schema. Three decades ago, the British psychiatrist Edward Hare and I engaged in a vigorous debate on this issue in the pages of the British Journal of Psychiatry. He argued that the growing number of lunatics in Victorian museums of madness were victims of a new viral disease, schizophrenia, and I countered that it was more probable that other factors were at work — namely, the amorphousness of nineteenth century definitions of madness, the decreasing willingness and ability of families to cope with difficult or impossible relations, and the eagerness of psychiatrists to enlarge their sphere of operations. Of more contemporary relevance, a range of commentators have noticed the explosive growth of depression as a diagnosis, to the point where it is now frequently termed ‘the common cold’ of psychiatry; the equally dramatic expansion in the number of children being diagnosed with ADHD; the appearance out of nowhere of juvenile bipolar disorder, which apparently became forty times as common between 1994 and 2004; the epidemic of autism, a formerly rare condition afflicting less than one in five hundred children in 1990, which has now mushroomed into a disease found in one in every ninety children. More than a few scholars have been tempted to attribute these seismic shifts not to any real alteration in the numbers of sufferers from these disorders, but to disease-mongering by the psychiatric profession and by Big Pharma, the multi-national pharmaceutical industry that obtains a huge fraction of its profits from the sale of drugs aimed at mental disorders of all sorts.

Among the most zealous critics of the expanding psychiatric empire have been two unlikely souls: Robert Spitzer, the principal architect of DSM III, and Allen Frances, who played a similarly large role in the construction of DSM IV. As the latest edition of that tome, the largest thus far and the most delayed, struggles to be born, those assembling it have been assaulted by Spitzer and Frances for creating a version built on hasty and unscientific foundations; they claim it pathologizes everyday features of normal human existence, and that, like its predecessors, it will create new epidemics of spurious psychiatric illness. Allen Frances, in particular, has taken to uttering frequent mea culpas, taking the blame for loosening the criteria for diagnosing autism in DSM IV, and thus, so he claims, sowing fear and mislabeling thousands and thousands of children.

Horwitz and Wakefield rightly place the DSM in its various post-1980 incarnations at the center of their explanation of how we are to account for the massive growth in the numbers of people diagnosed with pathological anxiety. DSM III “solved” the legitimacy crisis that psychiatry faced in the late 1970s. As long as one employed its methods and categories, high levels of agreement among psychiatrists confronting the same case were all but assured. In that sense, psychiatric diagnosis became, as statisticians would put it, more reliable. How was that feat accomplished? By rendering the diagnostic process mechanical, employing a tick-the-boxes approach to deciding whether or not someone had a mental disorder, and if so, what disorder it was. Display any six out of ten symptoms, and voil√†, a schizophrenic. Tick another set of boxes and you had General Anxiety Disorder (GAD), and so forth. A given patient might potentially have several “illnesses” at once, a problem alleviated by setting up a hierarchy of psychiatric diseases and awarding patients the most serious of them, or by creating a category called “co-morbidity” and thereby accepting the presence of multiple illnesses. The overlap in symptomatology between two schizophrenics with the “same” disease might be as few as two out of ten symptoms.

Why is psychiatry forced to rely on a grab bag of symptoms to make its diagnoses? Because, fundamentally, it has nothing else to offer. The cause of the overwhelming majority of psychiatric disorders remains as obscure as ever. Periodic weightless claims, endorsed by credulous science journalists, that schizophrenia is triggered by a newly discovered gene or by a dopamine deficiency in the brain, or that people suffering from depression have a shortage of serotonin, which can be reversed by taking a Selective Seratonin Reuptake Inhibitor (SSRI) such as Prozac to immerse their synapses in a serotonin bath, are so much biobabble ­­­— scientific nonsense that has proved good marketing copy for Big Pharma but is otherwise worthless.

As the manual went through successive editions, however, and as its categories were simplified to make the job of epidemiologists easier and cheaper, the effect, as Horwitz and Wakefield argue, was steadily to enlarge the numbers of ordinary people drawn into the ranks of the mentally unstable, often to a spectacular degree. And because of the seemingly scientific basis of the labels, the consistency with which cases were diagnosed, and the translation of human judgment by means of this verbal alchemy into statistics, the multiplication of the anxious and nervous (as with other psychiatric categories) has proceeded in relentless fashion.

Read the article in full, then filter transsexualism through Horwitz and Wakefield's findings, particularly the current rush to transsexualize young rebellious/lesbian females and children who do not conform to the ever tightening Gender Straight Jacket. As out dated as Freudianism is today, at least Freud would have applied psychoanalysis to first diagnose and then utilize to treat the trans patient, whether that analysis took months or years. Head doctors today are much more concerned with quick expediency coupled with a quick buck while what is REALLY best for the patient lingers nowhere in the distance.

On a good note, we are seeing more and more similar books and articles taking psychiatry to task. The trans politic would have you believe it is merely a handful of radfems and bloggers like myself viewing psychiatry's motives and methods with a critical eye, clearly the article proves they couldnt be more wrong. While we bloggers and radfems are also filtering the Male Medical Machine through a feminist lens, there obviously are others in the medical community using serious critical analysis/ethics to do the same. This is a real beginning of the dismantling of the DSM as it is known, putting the brutalizing end to the trans disorder finally in our sights.

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  1. Many people have been fighting the farce and assault that is psychiatry since its inception.

    The thing is, it's all a game that people must play for access. Trans people don't need to buy into the myth of mental disorders, they just need to pretend to in order to gain access to the treatments.

  2. Psychiatry/Wikiepdia

    Psychiatry/mental illness....from lobotomies to Drapetomania (the mental illness slaves got when they tried to run away) to the "Martha Mitchell effect"

    Political abuse of psychiatry is the purported misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society.[1][2]:491In other words, abuse of psychiatry including one for political purposes is deliberate action of getting citizens certified, who, because of their mental condition, need neither psychiatric restraint nor psychiatric treatment.[3] Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.[4]:6 As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.[5]:14 Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions.[6]:3 Psychiatric confinement of sane people is uniformly considered[by whom?] a particularly pernicious form of repression.[7]

    Psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine.[8]:

    Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the Nazi era and the Soviet rule when political dissenters were labeled as “mentally ill” and subjected to inhumane “treatments.”[11] In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.[8]:66 The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.[12] Political abuse of psychiatry also takes place in the People's Republic of China.[1] Psychiatric diagnoses such as the diagnosis of ‘sluggish schizophrenia’ in political dissidents in the USSR were used for political purposes.[13]:77

    Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity.[28]:41 In addition to identifying drapetomania, Cartwright prescribed a remedy. His feeling was that with "proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented."[29] In the case of slaves "sulky and dissatisfied without cause" — a warning sign of imminent flight — Cartwright prescribed "whipping the devil out of them" as a "preventative measure".[30][31][32] As a remedy for this disease, doctors also made running a physical impossibility by prescribing the removal of both big toes.[28]:42



    In the United States, political dissenters have been involuntarily committed. For example, in 1927 a demonstrator named Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of Sacco and Vanzetti.[33]

    In the 1970s, Martha Beall Mitchell, wife of U.S. Attorney General John Mitchell, was diagnosed with a paranoid mental disorder for claiming that the administration of President Richard M. Nixon was engaged in illegal activities. Many of her claims were later proved correct, and the term "Martha Mitchell effect" was coined to describe mental health misdiagnoses when accurate claims are dismissed as delusional.

    In 2006, Canadian psychiatrist Colin A. Ross's book was published, titled The C.I.A. Doctors: Human Rights Violations by American Psychiatrists. The book presents evidence based on 15,000 pages of documents received from the CIA via the Freedom of Information Act that there have been systematic, pervasive violations of human rights by American psychiatrists during the recent 65 years.

  4. "The thing is, it's all a game that people must play for access. Trans people don't need to buy into the myth of mental disorders, they just need to pretend to in order to gain access to the treatments."

    In all honesty, I have respect for psychiatrists in general, and I don't imagine this medical speciality is any worse or better than other field of medicine. The reason I bring up psychiatry's chekcered and troubled past is to illustrate my point. Good old fashioned common sense, humanity, and clear thinking skills are far more important than whatever the current trend or fad is.

    One of the main problems that I have with trans activists is that they are so darned myopic in their thinking. They can't stand back and take a long look at what has occurred in the past, and to put things into historical context. History and medicine are littered with some rather bazaar and disturbing trends that seemed to be one's salvation at the time, but turned into an Orwellian nightmare. For some reason, trans activists think that history began in the 1990s when the words transgender, "T" (testosterone) and "transitioning" slowly crept into our vocabularies. Twenty years ago, these little "gender incongruent" kids were just tomboys or tomgirls. How did we go from being tomboy to a psychiatric label followed by drugs and surgery? Now, kids are drug from therapist to therapist, diagnosed with "gender dysphoria", and given puberty suppressing drugs at twelve or thirteen years of age to halt normal adolescence. At Trans Kids Purple Rainbow, seven year old kids are already talking about sex change. We are supposed to just go along with it and bury any concerns we might have.

  5. "I don't imagine this medical speciality is any worse or better than other field of medicine."

    Psychiatry is worse than the field of medicine because it tries (very hard) to make psychology into a biological science, which it is not. Psychiatry doesn't just have a checkered past, its very foundation is, as dirt pointed out, built on faulty science, junk studies (largely funded by drug companies), and pathologizing very normal human distress. Its "treatments" just change with the times, as technology changes. For example, they've replaced lobotomies with electro-shock "therapy" in treating things like depression and eating disorders. This horrific practice continues today, and is growing.

    And the idea of "chemical imbalances"? False -- it is actually the brain damaging drugs that psychiatry doles out that *create* chemical imbalances -- specifically, SSRI's (anti-depressants) and anti-psychotics.

    I completely agree with you that "Good old fashioned common sense, humanity, and clear thinking skills are far more important than whatever the current trend or fad is" -- though I would add that common sense doesn't appear to be so common!

    Re. myopic trans people -- sure some are, but the ones I've seen post here sound anything but.

  6. My parents have that book by Szasz, The Myth of Mental Illness, and told me it was mandatory reading in their university psychology study in the 80s.

    It was actually encouraged back then, and in the 70s, to take society into account (granted some alternative approaches went too far to the other side, like schizophrenics smoking weed naked all day in the woods, and critics being called nazis).

    But now they're going really too far to the other side, all they do in psychology now is spit out totally random (semi-)neurological facts, like confetti in a vacuum.
    And psychiatry is as always ignoring literally any form of causility or explanatory variables. There is no framework.
    (The connection to Big Pharma I find a bit overestimated - there is no medicine for autism or any of the personality disorders (schizoid/histrionic/etc) for example - it's likelier that the massive amount of psychologists and therapists have a need for jobs).

    tl;dr:pomo ruined everything from the 70s/80s, but be positive, history proceeds in waves.

  7. Dear Dirt,

    The review from which you quoted is very instructive, and I couldn't agree more with the author. The only objection I have concerns the sentence, "The cause of the overwhelming majority of psychiatric disorders remains as obscure as ever." This is not the case.

    The seminal work of psychiatrist and author Ronald David Laing has demystified schizophrenia – exemplary of "mental illness" – showing it to be not "obscure" but an intelligible response to the sufferer's social life within his or her family nexus. The trouble is that Dr. Laing's brilliant insights, along with the work of like-minded experts, has largely been ignored or marginalized by mainstream psychiatry.

    See: R. D. Laing, The Divided Self and Sanity, Madness, and the Family

    Best wishes,

    P.S. Being German, I came across this blog when I was roaming the Internet searching for a critical take on the trans issue. I hope to see more of such criticism in the future. I appreciate your having the courage to unequivocally and firmly declare, "I reject the concept of transition" – for good reasons. I believe you're right that "female transition is not simply about becoming a man so much as it is about unbecoming a woman." The same would apply, I think, to male transitioners. Not born not in the wrong body so much as "born in the wrong society," as you put it.