Home > Psychology, Science > Have the Lunatics Taken Over the Asylum? Part 1

Have the Lunatics Taken Over the Asylum? Part 1

This article was written for the superb new skeptic’s magazine site The 21st Floor, where a wealth of fascinating and humorous information can be found. Go there!

It’s nice to be able to speak in the same language. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, currently in its 4th Edition (DSM-IV), gives psychiatrists and clinical psychologists the chance to do just that, being as it is a list of every psychiatric disorder currently known, categorised into useful diagnostic criteria. Well, I say ‘useful’.

Each time a new version of the DSM is in production, a tsunami of controversy rolls across the brain sciences, as researchers into particular mental disorders battle to have their particular interpretations included in the ‘official’ text, which clinicians will then use to diagnose their patients. Now is one of those times – the 5th Edition (DSM5) is on its way, drafted here, and a movement to fill it with rigorous, evidence-based disorders which are more than merely psychiatrist’s figments. Past embarrassments, such as the inclusion in previous editions of homosexuality as a disorder (now thankfully expunged from the manual), constantly come back to haunt the DSM’s writers, and as you can see from articles such as this one decrying the new draft, you can’t please all of the psychologists, all of the time.

There is legitimate criticism of some of the DSM criteria, and there is nonsense. In this 3-part post I’ll first sort the scientific wheat from the desperate, bizarre, anti-psychiatrist chaff. In parts 2 and 3, I’ll discuss a couple of pertinent issues for the DSM5 writers – the validity of a syndrome everyone knows about (Post-Traumatic Stress Disorder), and the validity of an entirely new creation (Coercive Paraphilic Disorder).

Calm yourself. It's only the deeply exciting DSM-IV front cover.

Part 1: Those mad old anti-psychiatrists

First, we have to distance ourselves from the anti-psychiatrists. This infuriating movement was really big in the 1960’s-70’s, and doesn’t get a huge amount of press these days. One the big players is Thomas Szasz, himself a psychiatrist(?!), who wrote a book in 1961 entitled The Myth of Mental Illness. In it, he argued that our ideas of mental illnesses are simply our societal judgements on people who are, well, a bit different. Utterly ignoring the fact that maybe, just maybe, psychiatrists and clinical psychologists entered the field because they want to help people, Szasz goes on to argue that categorising someone as ‘mentally disordered’ is just a way for The Man, in this case the dark forces of psychiatry, to control deviants. They extend this control by using powerful drugs and electroshock treatment, all the while writing books and manuals which categorise certain arbitrary patterns of behaviour as disorders – disorders which have no objective physiological correlates and can’t be physically measured in the same way as, say, a cancer can.

Szasz, Szasz, Szasz. Just because we don’t understand a disorder doesn’t mean we can’t treat it. We’re actually quite good at using mysterious things in medicine. Look at anaesthetics, for instance – to this day, there’s still debate over what exactly it is that’s putting you to sleep. Equally,  it’s completely disingenuous to make an argument along the lines of ‘there is argument over this disorder, therefore it does not exist’ (it’s the sort of thing creationists say about arguments among evolutionary biologists). Indeed, the fact that psychiatrists can’t agree over some disorders – as we will see below – is surely evidence against an evil conspiracy on their part to control the masses.

It’s also true that some psychiatrists have committed abuses of power over their patients (it would be bizarre if this hadn’t happened), but to say, as the anti-psychiatrists do, that this somehow discredits the entire field makes just as much sense as the hyper-feminist argument that ‘some sex is rape, therefore all sex is rape’.

Here’s where the anti-psychiatry movement gets creepier: a certain L. Ron Hubbard gets involved. Hubbard, founder of the Cult Church of Scientology, hated psychiatrists. Apparently he had a few bad experiences with them himself, and projected his bad feeling into his writings, indoctrinating his followers into the belief that psychiatrists are part of a global conspiracy, and were in fact (I kid you not) responsible for the Holocaust. He also created the Citizen’s Commission on Human Rights, an anti-psychiatry lobbying body and front for Scientology which produces scaremongering leaflets and exhibitions. The irony of Scientology, not exactly an organisation known for the healthy mental state of its members, creating such a body hardly needs underlining. Szasz, though not a Scientologist himself, is a co-founder of the CCHR. Need I say more? Guilt by association is not a logical argument, but it’s an argument I’ve no problem using here.

You will be glad to hear that I’ve devised new diagnostic criteria for the DSM5, describing Psychiatry Denial Disorder, Lifelong Type:

A. A pervasive pattern of unreasonable criticism of a perfectly legitimate branch of medicine, often with ravings about a ‘conspiracy of control’ and a bizarre focus on ‘abuses of power’.
B. Two (or more) of the following signs:

-A ‘couldn’t care less’ attitude to those with debilitating, life-destroying mental disorders
-A desperate need to be contrarian
-Utter ignorance of the scientific method
-A belief in Lord Xenu and volcano-thetans

C. These symptoms are not due to a general medical condition, or a sharp whack upside the head.

It’s worth mentioning that, on the other – far more reasonable – end of the anti-psychiatry spectrum, we find groups such as the Hearing Voices Movement, who campaign against auditory hallucinations being viewed necessarily as a mental illness, and the Neurodiversity movement, who argue that one day our current classifications of ‘disorders’ like autism will go the same way as ‘disorders’ like homosexuality: embarrassing secrets in the DSM’s past. I don’t wish to wade into such controversy here; suffice to say that there are convincing arguments made by some proponents from these groups, but they must be tempered by an understanding of just how poor a quality of life some people with these conditions have.

There are good, scientific points to be made about psychiatric diagnosis. However, we’ve seen that there are large critical movements which are entirely unrelated to science, so one must tread carefully. In Part 2, we’ll take a look at Post-Traumatic Stress Disorder.

TO BE CONTINUED…

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