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June 21, 2005
Mental Disorder Of The Day
Jacob Sullum writing over at Townhall.com wonders about the proliferation of named mental disorders:
According to a new government-sponsored survey, most Americans qualify for a psychiatric diagnosis at some point in their lives.[...]
As the psychiatric iconoclast Thomas Szasz has been arguing for many years, mental illness is a literalized metaphor that conceals more than it reveals. Although their training and billing practices suggest that psychiatrists deal with medical problems, it seems unlikely that many of them truly believe all the myriad sins and foibles listed in their Diagnostic and Statistical Manual of Mental Disorders (DSM) are in fact brain diseases.
If they did, why would they cling to the deliberately ambiguous term "mental disorder"? Why would the diagnostic criteria for so many psychiatric conditions include ruling out, as opposed to confirming, an organic cause? And how could psychiatry be justified as a discipline distinct from neurology?
Sullum goes on to note that at least a few psychiatrists are admitting that their profession is not exactly shot through with scientific rigor:
"The problem is that the diagnostic manual we are using in psychiatry is like a field guide, and it just keeps expanding and expanding," Johns Hopkins psychiatrist Paul McHugh told the Times. "Pretty soon, we'll have a syndrome for short, fat Irish guys with a Boston accent, and I'll be mentally ill."
I think in general the research and categorization of mental disorders does represent progress; but the problems arise from how the new knowledge is used and abused by both the medical profession and the general public. As usual, the pendulum has swung too hard to the other side--we've gone from ignoring severely depressed individuals ("Just work through it...") to handing out Ritalin like candy.
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Comments
Next we've just got to get economics to admit that it isn't a rigorous science, and then we're going somewhere.
I was a teacher for a year, at a sort of low-key LD school, and a lot of these conditions, for all their overdiagnosis, are real. ADD is a real thing, caused by some stuff in the brain (I'm a mathematician, not a doctor, but I went to a talk on it at the time). So I think it falls somewhere between the two extremes of "Medicate medicate medicate" and "Walk it off, you'll be fine."
Posted by: Fargus at June 21, 2005 10:58 AM
Yep. It's kind of like lawyers--I'm not one of those people who despise lawyers as a class. We are a nation of laws, after all. ;-) And I appreciate the precise thinking required by the study of law.
My beef is with the fraction of lawyers who exhibit questionable ethics or common greed, combined with like-minded clients.
There's always the possibility of abuse of any system.
Posted by: Jeff at June 21, 2005 11:25 AM
A few thoughts:
Think of the barbaric things we used to do to people in the name of medical science in the past. We've come a long way. Let's hope we can simply describe the current state of psychiatry as a stepping stone to something more precise in the future. At the same time, though, we should avoid the tendency to over-medicate problems before firguring out what is really going on. Yes, ADD is real. And yes, it's often used to "treat" a child whose parents just need to instill some discipline and guidance. To Fargus: I hope you've checked out Freakonomics.com. I think it proves your point that you can prove anything with economic analysis, which brings the true science of economics into question. To Jeff: I'll be a lawyer in a year. The fraction you talk about is not so much a fraction. It's a pretty big chunk of the pie, sorry to say. I work at a firm that adheres fiercely to ethics. We struggle to pay the bills, but we sleep well at night.
Posted by: Jim Voigt at June 21, 2005 11:37 AM
