Psychiatry and the DSM: Cracks in an epistemic empire (original) (raw)
Related papers
Psychiatry’s little other: DSM-5 and debates over psychiatric science
Social Theory & Health, 2016
In 2013, the National Institute of Mental Health (NIMH) broke rank with the American Psychiatric Association (APA) over the release of DSM-5, psychiatry's 'bible' of mental disorders. Announcing that it would use its own biological categorization system in place of DSM-5, NIMH ignited a debate about the nature of psychiatric epistemology. We analyze these DSM-5 debates as a critical moment in psychiatry's history of epistemological 'revolutions.' Psychiatric pioneers, throughout the field's history, have presumed that biological dysfunction anchored mental disorders, and yet locating biological cause has proved elusive. Each time its failure to secure biological cause is unveiled, psychiatric experts reinvent the field in the image of greater scienticity. Using psychoanalytic theory, we argue that biology operates as Lacan's objet petit a. The field of psychiatry is propelled forward by a mismatch between its imaginary identification as an objective science and its fragmented actuality as a symbolic system. Despite their attempts to repress the field's fragmentation, leaders in psychiatry continuously bump into their failure to elucidate the biological foundation of mental disorders, compelling them to reiterate psychiatry's fantasy identifications, now through imagery of the 'mysterious' brain.
1 Introduction : Psychiatry at a Crossroads
2016
Psychiatry today faces challenges on many fronts, with vigorous critiques of its theory and practice from clinicians, scholars, and people with lived experience of mental health problems. These critiques target the slow progress in understanding and treating mental illness, overreliance on medications and other biomedical treatments, and the lack of attention to patients’ lifeworlds and aspirations, but extend to much broader concerns about the medicalization of everyday life, and even wholesale condemnation of psychiatry as a source of heavy-handed social control, stigma, and harmful interventions that actually undermine recovery. In recent years, many of the concerns of the antipsychiatry movement of the 1960s have been reasserted by a new critical psychiatry literature that builds on these earlier critiques but includes attention to contemporary questions of epistemology, political economy, and globalization (Bracken et al., 2012 Cohen & Timimi, 2008; Fernando, 2014; Mills, 2014;...
Politix, 2017
Many studies of psychiatry share the same methodological and theoretical assumption:namely, to show that the reality of mental illness—both its definition and treatment—is social, always involves challenging the construction of its subject through psychiatry, and that to focus on one dimension of this reality, psychiatric or social, inevitably leads to neglect of the other. The establishment of this mutually exclusive relationship between social and psychiatric issues produces a “dualist” approach, in which the role of social sciences is to distinguish between what psychiatry claims to do—identify and treat mental health problems—and what it actually does—social control, normalizing deviance, moralizing a social class, or serving as an instrument of power over the education system. This article aims to distance itself from these dualistic approaches by challenging the mutually exclusive relationship between the social and the psychiatric, as well as the competitive relationship between the social sciences and psychiatry that it produces. This challenge is based on an approach that highlights tensionsinternal to the activity as a point of entry to the study of psychiatry. It attempts to describe a specific type of tension: ontological tension. This refers to the way in which professionals respond, in practice and under given circumstances, to the issue of the ontological indeterminacy of the problems they face. This article aims to reveal the ontological tension between psychiatric and social issues that is at work in the practices of diagnosing and treating problematic behaviors and individuals. It seeks to show that the question of the ontology of the problem, and specifically the ontological problem of the border between the psychiatric and the social, is faced by psychiatry professionals themselves and that this question, aligned with institutionalized professions, raises key issues regarding the practical division of labor and shared responsibility for a situation.
Essential Philosophy of Psychiatry
The British Journal of Psychiatry, 2008
This is an important book. The author entitles it an 'essay' , an apt term for a sharply focused but extended examination of the question. It is not a review, but an argument; but the argument analyses much that has previously been said about the subject. Bolton is ideally placed to write such a piece, being a philosopher, clinical psychologist and researcher. He also co-directs a Masters programme on the 'Philosophy of mental disorder'. Bolton notes that the question has a curious status: 'barely visible yet of widespread importance'. Clinicians may pay little regard to it in day-today practice, but the implications for social exclusion are major. Particularly troubling is the role of 'values' , as opposed to facts, in determining what mental disorder is. The essay starts by examining the assumptions underlying the diagnostic manuals, including some major recent critiques, such as that of Horwitz & Wakefield. 1 Bolton then asks what the bio-behavioural sciences now have to tell us about the phenomena. This is a valuable discussion, particularly the claim that Jaspers' celebrated dichotomy between 'understanding' and 'explanation' should be superseded by a more inclusive concept of 'intentional causality'. This encompasses biological and psychological processes construed within the context of evolutionary design, and can lead to coherent 'pluralistic' accounts of causes. Then on to the claim that mental disorders could be 'natural facts'. The strongest case is Wakefield's, who argues that mental disorders are harmful disruptions of psychological functions designed by evolution. This receives a sympathetic hearing, but is not endorsed because many proposed 'functions' are hypotheses, not facts, and are hugely pervaded by social meaning. So we cannot escape a critical role for 'values' in defining mental disorder. The social aspects of mental disorder are then examined, much influenced by Foucault. Bolton's view of the implications of 'post-modernism' is that uncertainty about 'boundaries' presents the necessity for a range of 'stakeholder' voices to be heard and to be reconciled. Bolton finally settles on a pragmatic view of mental disorder-complex, often messy agreements based on judgements of 'distress or disability' that lead to a perceived need for treatment. This does not help in relation to interventions to protect the public, which he argues should be regulated by human rights protections, not definitions of mental disorder. Sadly, this is unlikely to work in practice. The book is clearly organised and is written in an engaging style. The reader need not fear abstruse philosophical analysis. Anyone with an interest in the subject would do well to read the book-and that should include all clinicians.
In this paper, I use data from 20 in-depth interviews with psychoanalytically trained psychiatrists (who prescribe medications and practice talk therapy) about their experiences navigating treatment in a profession dominated by the medical model. Psychiatrists' descriptions of their field and their patients' troubles support the central claims in sociology about the medicalization of psychiatry. Since the 1980s, the extent to which psychiatric troubles are medicalized has increased dramatically and in new ways. Pharmaceutical companies, insurance companies and consumers drive the current era in medicalization. Psychiatric training is also highly influential on practitioners' propensities to think and act medically. Qualitative data are crucial for understanding the extent to which medicalization influences practitioners and the degree to which they foster the use of medical interventions. Very few researchers have examined the medicalization of psychiatry from the perspective of psychiatrists, especially psychoanalysts, who offer insight into why medicalization is largely unchallenged within psychiatry.
Review of: Doing Psychiatry Wrong
Journal of Phenomenological Psychology, 2009
René J. Muller, a clinician with a background in emergency room evaluations and in writing accounts of these encounters for the monthly publication Psychiatric Times, has produced a book severely critiquing the current reliance of the psychiatric profession on biological psychiatry. Muller’s basic points remain important and argued with conviction. For too many of its practitioners psychiatry has lost the mind. All too often, diagnoses are not only imperfect but invalid, and no amount of DSM criteria can make up for the fact that a valid diagnosis requires, in Muller’s apt phrasing, the alignment of symptoms and meaning (pp. 89-90).
Co-opting psychiatry: the alliance between academic psychiatry and the pharmaceutical industry
Epidemiologia e psichiatria sociale
The editorial presents the arguments that an alliance between academic psychiatry and the pharmaceutical industry is harmful through a critical review of the academic literature and media coverage of activities of the pharmaceutical industry. The industry and the psychiatric profession both gain advantages from promoting biomedical models of psychiatric disturbance and pharmacological treatment. This confluence of interests has lead to the exaggeration of the efficacy of psychiatric drugs and neglect of their adverse effects and has distorted psychiatric knowledge and practice. Academic psychiatry has helped the industry to colonise more and more areas of modern life in order to expand the market for psychotropic drugs. Persuading people to understand their problems as biological deficiencies obscures the social origin and context of distress and prevents people from seeking social or political solutions. Psychiatry has the power to challenge the dominance of the pharmaceutical indu...
2016
What can philosophy offer psychiatry? What can psychiatry offer philosophy? Simply, there is nothing as harmful as a bad theory put into practice and conversely the constraints of practice and the recalcitrance of the realities of anomalous experiences offer instructive challenges to theory. We know well that the history of medicine and psychiatry have many examples of bad theory having been put into practice often with tragic consequences. Equally the extremes of armchair philosophy and far-fetched thought experiments, while keeping some philosophers busy chasing zombies or possible worlds in which minds can be uploaded into a computer harddrives, leave philosophy open to accusations of irrelevance and obfuscation. Andrew Scull, and he is not the first, calls our attention to the political, economic and social dimensions of insanity, he writes: "For the lunatic, the madman, the psychotic, the schizophrenic, call them what you will, suffer a sort of social and moral death. Their wishes and will, their very status as moral actors, as agents capable of expressing valid preferences, and exercising autonomous choice are deeply suspect in light of their presumed pathology, as the often dark history of their treatment under confinement abundantly shows." (Scull, The Insanity of Place-The Place of Insanity, 2006: 52). The stakes are thus immeasurably high and our efforts to avoid 'real mischief' demand critical appraisals of both philosophy and psychiatry, critical appraisals internal to each discipline and between these disciplines. The collection of original essays in Philosophy and Psychiatry: Problems, intersections, and new perspectives, edited by Daniel D. Moseley and Gary J. Gala brings together diverse philosophers and psychiatrists in this effort of mutual critical engagement spanning the domains of phenomenology, 2 psychoanalysis, neuroscience, neuroethics, behavioral economics,
Psychiatry interacts with contemporary Western views: theDSM‐IIIinnovation and its adverse effects
Prometheus, 2010
Economic studies of innovation are relevant to the mental health sector, not just for innovations in more conventional industries, such as telecommunications. We present an economic examination of the impact of an innovation in the mental health sector. The innovation examined here was first adopted in 1980 with the publication of a new edition of the nosology (or classification) for the diagnosis of mental illnesses and disorders, which is known familiarly as the DSM-III. In our analysis, we incorporate the impact of that innovation, and another major force relevant to psychiatric diagnosis during that time period, i.e. a trend in the West towards the medicalisation of normal sorrows. This is now a documented phenomenon. By using conventional price-quantity space and focussing attention on the quantity outcome, we are able to consider the impact of these concurrent forces on the false positive rate in the diagnosis of mental illnesses in the West and on efficacious diagnostic practice in this sector. Diagnostic efficacy is relevant to treatment, but it is relevant also to resource allocation in the mental health sector. Our analysis highlights the vital place of innovation in diagnostic practices, and the funding of this, in the mental health sector.