Psychiatry And Its Discontents: Pt.2
“They called me mad, and I called them mad, and damn them, they outvoted me.”
— Nathaniel Lee
Part 2 of my Psychiatry and its Discontents series. The focus of this post will be to highlight the most influential key texts in contemporary critical psychiatry. The history of anti-psychiatry and critical psychiatry spans five decades, and my hope is to provide a road map for those looking to navigate through this rich field while hoping to avoid the less than respectable sources of information that often compete for attention within the movement.
In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on?
Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled — and dismayed — to discover what was reported in the scientific journals.
Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?
The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5 for short) is scheduled for release in May 2013. The DSM is the bible of psychiatry; the go-to place to find out who is sick and who is not. Because it will radically stretch the boundaries of what is and what is not a psychiatric illness, DSM 5 will dramatically change how lives are lived. Under DSM 5’s new definitions, millions of people now considered normal will be diagnosed as mentally ill, causing unnecessary, costly, and sometimes dangerous treatments for misidentified ‘patients’ who don’t really need them.
Will the DSM 5 destroy what is considered normal?
Frances argues that DSM 5 offers a radical and reckless set of proposals that will overnight turn ‘normal’ people into ‘mental patients’. Everyday aches, pains, disappointments, stresses, and existential sufferings are being reframed as mental illnesses with such exuberance that it is getting hard for anyone to get through life without a psychiatric diagnosis. Is grief a useful, inevitable and poignant sign of a broken heart or is it Major Depressive Disorder? Are temper tantrums a normal part of childhood or a sign of mental illness? Are you nervous about an upcoming presentation or job interview or do you have Mixed Anxiety Depression? If you don’t remember a face or a fact once in a while, do you have Dementia?
Frances maintains we all have psychiatric symptoms from time to time, but this doesn’t mean we are all flirting with mental illness. Whenever we arbitrarily add a new ‘disease’, we subtract from what previously was ‘normal’ and lose something of ourselves in the process. Not all human suffering can or should be labeled and treated away. The grief and sorrows, the stresses, the disappointments, the aches and pains, the slings and arrows, the innate and acquired inequalities, the set-backs, the stumbles, the emotional gut-shots; this is part of life and of living in a complex and not always fair society- they should not all to be explained away as psychiatric disease.
Thirty years ago, it was estimated that less than five percent of the population had an anxiety disorder. Today, some estimates are over fifty percent, a tenfold increase. Is this dramatic rise evidence of a real medical epidemic?
In All We Have to Fear, Allan Horwitz and Jerome Wakefield argue that psychiatry itself has largely generated this “epidemic” by inflating many natural fears into psychiatric disorders, leading to the over-diagnosis of anxiety disorders and the over-prescription of anxiety-reducing drugs. American psychiatry currently identifies disordered anxiety as irrational anxiety disproportionate to a real threat. Horwitz and Wakefield argue, to the contrary, that it can be a perfectly normal part of our nature to fear things that are not at all dangerous — from heights to negative judgments by others to scenes that remind us of past threats (as in some forms of PTSD). Indeed, this book argues strongly against the tendency to call any distressing condition a “mental disorder.” To counter this trend, the authors provide an innovative and nuanced way to distinguish between anxiety conditions that are psychiatric disorders and likely require medical treatment and those that are not — the latter including anxieties that seem irrational but are the natural products of evolution. The authors show that many commonly diagnosed “irrational” fears — such as a fear of snakes, strangers, or social evaluation — have evolved over time in response to situations that posed serious risks to humans in the past, but are no longer dangerous today.
Drawing on a wide range of disciplines including psychiatry, evolutionary psychology, sociology, anthropology, and history, the book illuminates the nature of anxiety in America, making a major contribution to our understanding of mental health.
In the 1970s, a small group of leading psychiatrists met behind closed doors and literally rewrote the book on their profession. Revising and greatly expanding the Diagnostic and Statistical Manual of Mental Disorders (DSM for short), they turned what had been a thin, spiral-bound handbook into a hefty tome. Almost overnight the number of diagnoses exploded. The result was a windfall for the pharmaceutical industry and a massive conflict of interest for psychiatry at large. This spellbinding book is the first behind-the-scenes account of what really happened and why.
With unprecedented access to the American Psychiatric Association archives and previously classified memos from drug company executives, Christopher Lane unearths the disturbing truth: with little scientific justification and sometimes hilariously improbable rationales, hundreds of conditions — among them shyness — are now defined as psychiatric disorders and considered treatable with drugs. Lane shows how long-standing disagreements within the profession set the stage for these changes, and he assesses who has gained and what’s been lost in the process of medicalizing emotions. With dry wit, he demolishes the façade of objective research behind which the revolution in psychiatry has hidden. He finds a profession riddled with backbiting and jockeying, and even more troubling, a profession increasingly beholden to its corporate sponsors.
Depression has become the single most commonly treated mental disorder, amid claims that one out of ten Americans suffer from this disorder every year and 25% succumb at some point in their lives. Warnings that depressive disorder is a leading cause of worldwide disability have been accompanied by a massive upsurge in the consumption of antidepressant medication, widespread screening for depression in clinics and schools, and a push to diagnose depression early, on the basis of just a few symptoms, in order to prevent more severe conditions from developing.
In The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that, while depressive disorder certainly exists and can be a devastating condition warranting medical attention, the apparent epidemic in fact reflects the way the psychiatric profession has understood and reclassified normal human sadness as largely an abnormal experience. With the 1980 publication of the landmark third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mental health professionals began diagnosing depression based on symptoms — such as depressed mood, loss of appetite, and fatigue — that lasted for at least two weeks. This system is fundamentally flawed, the authors maintain, because it fails to take into account the context in which the symptoms occur. They stress the importance of distinguishing between abnormal reactions due to internal dysfunction and normal sadness brought on by external circumstances. Under the current DSM classification system, however, this distinction is impossible to make, so the expected emotional distress caused by upsetting events-for example, the loss of a job or the end of a relationship- could lead to a mistaken diagnosis of depressive disorder. Indeed, it is this very mistake that lies at the root of the presumed epidemic of major depression in our midst.
Psychotherapist Gary Greenberg’s musings on the intersection of science, politics, and ethics have graced the pages of The New Yorker , Wired , and Mother Jones. A longtime sufferer of depression, in 2007 he enrolled himself in a clinical trial for major depression (after his initial application for a minor depression trial was rejected). He wrote about his experience in a Harper’s magazine piece, which received a tremendous response from readers..• “Am I happy enough?”: This has been a pivotal question since America’s inception. Am I not happy enough because I am depressed? is a more recent version. Greenberg shows how depression has been manufactured — not as an illness, but as an idea about our suffering, its source, and its relief. He challenges us to look at depression in a new way..
• A nation of depressives: In the twenty years since their introduction, antidepressants have become staples of our medicine chests — upwards of 30 million Americans are taking them at an annual cost of more than $10 billion. Even more important, Greenberg argues, it has become common, if not mandatory, to think of our unhappiness as a disease that can, and should, be treated by medication. Manufacturing Depression tells the story of how we got to this peculiar point in our history.
Schizophrenia: A Scientific Delusion?, first published in 1990, made a very significant contribution to the debates on the concepts of schizophrenia and mental illness. These concepts remain both influential and controversial and this new updated second edition provides an incisive critical analysis of the debates over the last decade. As well as providing updated versions of the historical and scientific arguments against the concept of schizophrenia which formed the basis of the first edition, Boyle covers significant new material relevant to today’s debates, including: The development of DSM-IV’s version of ‘schizophrenia’ Analysis of social, psychological and linguistic processes which construct ‘schizophrenia’ as a reasonable version of reality A detailed critical evaluation of recent alternatives to the concept of schizophrenia Schizophrenia: A Scientific Delusion? demonstrates that the need for analysis and debate on these issues is as great as ever and that we need to question how we think about and manage what we call “madness”.
The practice of psychiatry has undergone great changes in recent years. In this book, Joel Paris, MD, a veteran psychiatrist, provides a fluently written and accessible “state-of-the-field” assessment. Himself a clinician, researcher, and teacher, Paris focuses on the most striking change within the field — the diverging roles of psychopharmacology and psychotherapy in contemporary practice. Where once psychiatrists were trained in Freudian psychoanalysis — which involved, more than anything else, talking — current pressures in mental health practice, including those imposed by managed care, are leading psychiatrists to treat more and more of their patients exclusively with medication, which is cheaper and faster. At the same time, psychotherapy is increasingly not being taught to new psychiatrists-in-training, even though, as Paris reveals, there is scientific evidence that both talk therapies and medication can play an important role in the treatment of mental illness. These developments are occuring against a backdrop of exploding research in the genetics and neurobiology of mental illness that will continue to drive the field. Paris ends by contemplating how going forward psychiatry can best respond to all these forces and proposes a team-based approach to mental health care. The book will appeal both to specialists and nonspecialists, particularly psychiatric residents and fellows, medical students considering specialization in psychiatry, clinical psychologists, social workers, and general readers, especially consumers of mental health services.
In an effort to enlighten a new generation about its growing reliance on psychiatry, this illuminating volume investigates why psychiatry has become the fastest-growing medical field in history; why psychiatric drugs are now more widely prescribed than ever before; and why psychiatry, without solid scientific justification, keeps expanding the number of mental disorders it believes to exist.This revealing volume shows that these issues can be explained by one startling fact: in recent decades psychiatry has become so motivated by power that it has put the pursuit of pharmaceutical riches above its patients’ well being. Readers will be shocked and dismayed to discover that psychiatry, in the name of helping others, has actually been helping itself.In a style reminiscent of Ben Goldacre’s Bad Science and investigative in tone, James Davies reveals psychiatry’s hidden failings and how the field of study must change if it is to ever win back its patients’ trust.
For more than two years, author and psychotherapist Gary Greenberg has embedded himself in the war that broke out over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — the DSM — the American Psychiatric Association’s compendium of mental illnesses and what Greenberg calls “the book of woe.”
Since its debut in 1952, the book has been frequently revised, and with each revision, the “official” view on which psychological problems constitute mental illness. Homosexuality, for instance, was a mental illness until 1973, and Asperger’s gained recognition in 1994 only to see its status challenged nearly twenty years later. Each revision has created controversy, but the DSM-5, the newest iteration, has shaken psychiatry to its foundations. The APA has taken fire from patients, mental health practitioners, and former members for extending the reach of psychiatry into daily life by encouraging doctors to diagnose more illnesses and prescribe more therapies — often medications whose efficacy is unknown and whose side effects are severe. Critics — including Greenberg — argue that the APA should not have the naming rights to psychological pain or to the hundreds of millions of dollars the organization earns, especially when even the DSM’s staunchest defenders acknowledge that the disorders listed in the book are not real illnesses.
Greenberg’s account of the history behind the DSM, which has grown from pamphlet-sized to encyclopedic since it was first published, and his behind-the-scenes reporting of the deeply flawed process by which the DSM-5 has been revised, is both riveting and disturbing. Anyone who has received a diagnosis of mental disorder, filed a claim with an insurer, or just wondered whether daily troubles qualify as true illness should know how the DSM turns suffering into a commodity, and the APA into its own biggest beneficiary. Invaluable and informative, The Book of Woe is bound to spark intense debate among expert and casual readers alike.
IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine article “Dr. Drug Rep,” and as he continues to do in his popular watchdog newsletter, The Carlat Psychiatry Report, he writes with bracing honesty about how psychiatry has so largely forsaken the practice of talk therapy for the seductive — and more lucrative — practice of simply prescribing drugs, with a host of deeply troubling consequences.
Psychiatrists have settled for treating symptoms rather than causes, embracing the apparent medical rigor of DSM diagnoses and prescription in place of learning the more challenging craft of therapeutic counseling, gaining only limited understanding of their patients’ lives. Talk therapy takes time, whereas the fifteen-minute “med check” allows for more patients and more insurance company reimbursement. Yet DSM diagnoses, he shows, are premised on a good deal less science than we would think.
Writing from an insider’s perspective, with refreshing forthrightness about his own daily struggles as a practitioner, Dr. Carlat shares a wealth of stories from his own practice and those of others that demonstrate the glaring shortcomings of the standard fifteen-minute patient visit. He also reveals the dangers of rampant diagnoses of bipolar disorder, ADHD, and other “popular” psychiatric disorders, and exposes the risks of the cocktails of medications so many patients are put on. Especially disturbing are the terrible consequences of overprescription of drugs to children of ever younger ages. Taking us on a tour of the world of pharmaceutical marketing, he also reveals the inner workings of collusion between psychiatrists and drug companies.
Concluding with a road map for exactly how the profession should be reformed, Unhinged is vital reading for all those in treatment or considering it, as well as a stirring call to action for the large community of psychiatrists themselves. As physicians and drug companies continue to work together in disquieting and harmful ways, and as diagnoses — and misdiagnoses — of mental disorders skyrocket, it’s essential that Dr. Carlat’s bold call for reform is heeded.
During her two decades at The New England Journal of Medicine, Dr. Marcia Angell had a front-row seat on the appalling spectacle of the pharmaceutical industry. She watched drug companies stray from their original mission of discovering and manufacturing useful drugs and instead become vast marketing machines with unprecedented control over their own fortunes. She saw them gain nearly limitless influence over medical research, education, and how doctors do their jobs. She sympathized as the American public, particularly the elderly, struggled and increasingly failed to meet spiraling prescription drug prices. Now, in this bold, hard-hitting new book, Dr. Angell exposes the shocking truth of what the pharmaceutical industry has become–and argues for essential, long-overdue change.
Currently Americans spend a staggering $200 billion each year on prescription drugs. As Dr. Angell powerfully demonstrates, claims that high drug prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into the marketing of products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.
Zeroing in on hugely successful drugs like AZT (the first drug to treat HIV/AIDS), Taxol (the best-selling cancer drug in history), and the blockbuster allergy drug Claritin, Dr. Angell demonstrates exactly how new products are brought to market. Drug companies, she shows, routinely rely on publicly funded institutions for their basic research; they rig clinical trials to make their products look better than they are; and they use their legions of lawyers to stretch out government-granted exclusive marketing rights for years. They also flood the market with copycat drugs that cost a lot more than the drugs they mimic but are no more effective.
The American pharmaceutical industry needs to be saved, mainly from itself, and Dr. Angell proposes a program of vital reforms, which includes restoring impartiality to clinical research and severing the ties between drug companies and medical education. Written with fierce passion and substantiated with in-depth research, The Truth About the Drug Companies is a searing indictment of an industry that has spun out of control.
How are decisions made about who is normal? As a former consultant to those who construct the “bible of the mental-health professions,” the DSM (Diagnostic and Statistical Manual of Mental Disorders), Paula Caplan offers and insider’s look at the process by which decisions about abnormality are made. Cutting through the professional psycho-babble, Caplan clearly assesses the astonishing extent to which scientific methods and evidence are disregarded as the handbook is developed. A must read for consumers and practitioners of the mental-health establishment, which through its creation of potentially damaging interpretations and labels, has the power to alter our lives in devastating ways.
In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.
“Thought-provoking and important. . .Drawing on and consolidating the ideas of a range of authors, Horwitz challenges the existing use of the term mental illness and the psychiatric ideas and practices on which this usage is based. . . . Horwitz enters this controversial territory with confidence, conviction, and clarity.” — Joan Busfield, American Journal of Sociology
“Horwitz properly identifies the financial incentives that urge therapists and drug companies to proliferate psychiatric diagnostic categories. He correctly identifies the stranglehold that psychiatric diagnosis has on research funding in mental health. Above all, he provides a sorely needed counterpoint to the most strident advocates of disease-model psychiatry.” — Mark Sullivan, Journal of the American Medical Association
“Horwitz makes at least two major contributions to our understanding of mental disorders. First, he eloquently draws on evidence from the biological and social sciences to create a balanced, integrative approach to the study of mental disorders. Second, in accomplishing the first contribution, he provides a fascinating history of the study and treatment of mental disorders. . . from early asylum work to the rise of modern biological psychiatry.” — Debra Umberson, Quarterly Review of Biology
Toward the end of the twentieth century, the solution to mental illness seemed to be found. It lay in biological solutions, focusing on mental illness as a problem of the brain, to be managed or improved through drugs. We entered the “Prozac Age” and believed we had moved far beyond the time of frontal lobotomies to an age of good and successful mental healthcare. Biological psychiatry had triumphed.
Except maybe it hadn t. Starting with surprising evidence from the World Health Organization that suggests that people recover better from mental illness in a developing country than in the first world, Doctoring the Mind asks the question: how good are our mental healthcare services, really? Richard P. Bentall picks apart the science that underlies our current psychiatric practice. He puts the patient back at the heart of treatment for mental illness, making the case that a good relationship between patients and their doctors is the most important indicator of whether someone will recover.
Arguing passionately for a future of mental health treatment that focuses as much on patients as individuals as on the brain itself, this is a book set to redefine our understanding of the treatment of madness in the twenty-first century.
Thomas Szasz (1960) suggested that the myth of ‘mental illness’ functions to ‘render more palatable the bitter pill of moral conflict in human relations’. The medicalization of distress enables the mental health professions to manage the human suffering that they are confronted with, and also the suspicion that there is little that they can do to help. But the medicalization of misery and madness renders people unable to comprehend their experiences in ordinary, meaningful terms. In this collection we restore to everyday discourse a way of understanding distress that, unlike contemporary psychiatry and psychology, recognises and respects the essential humanness of the human condition. De-medicalizing Misery is a shorthand term for this project. The book resists the psychiatrization and psychologization of human experience, and seeks to place what are essentially moral and political — not medical — matters back at the centre of our understanding of human suffering.
This book expands upon the previous volume of De-Medicalizing Misery. It seeks to extend the critical scope of that original project into a wider social and political context, with a view to developing the critique of the psychiatrization of Western society in particular. It draws from the work of a number of international critical scholars to explore the contemporary mental health landscape and to pose possible alternative solutions to the continuing problem of emotional distress and disturbance.
By turning a critical lens to ongoing processes of recovery, resilience and the expansionist project of psychiatric classification, this book seeks to undermine these processes through the development of realizable alternatives to this psychiatrization of misery and distress.
Antipsychotic (neuroleptic) drugs have become some of the biggest blockbusters of the early 21st century, increasingly prescribed not just to people with ‘schizophrenia’ or other severe forms of mental disturbance but for a range of more common psychological complaints. This book challenges the accepted account that portrays antipsychotics as specific treatments that target an underlying brain disease and explores early views that suggested, in contrast, that antipsychotics achieve their effects by inducing a state of neurological suppression. Professional enthusiasm for antipsychotics eclipsed this understanding, exaggerated the benefits of antipsychotics and minimized or ignored evidence of their toxic effects. The pharmaceutical industry has been involved in expanding the use of antipsychotics into territory where it is likely that their dangers far outweigh their advantages.
It is well known that American culture is a dominant force at home and abroad; our exportation of everything from movies to junk food is a well-documented phenomenon. But is it possible America’s most troubling impact on the globalizing world has yet to be accounted for? In “Crazy Like Us,” Ethan Watters reveals that the most devastating consequence of the spread of American culture has not been our golden arches or our bomb craters but our bulldozing of the human psyche itself: We are in the process of homogenizing the way the world goes mad. America has been the world leader in generating new mental health treatments and modern theories of the human psyche. We export our psychopharmaceuticals packaged with the certainty that our biomedical knowledge will relieve the suffering and stigma of mental illness. We categorize disorders, thereby defining mental illness and health, and then parade these seemingly scientific certainties in front of the world. The blowback from these efforts is just now coming to light: It turns out that we have not only been changing the way the world talks about and treats mental illness — we have been changing the mental illnesses themselves.
For millennia, local beliefs in different cultures have shaped the experience of mental illness into endless varieties.” Crazy Like Us” documents how American interventions have discounted and worked to change those indigenous beliefs, often at a dizzying rate. Over the last decades, mental illnesses popularized in America have been spreading across the globe with the speed of contagious diseases. Watters travels from China to Tanzania to bring home the unsettling conclusion that the virus is us: As we introduce Americanized ways of treating mental illnesses, we are in fact spreading the diseases.
In post-tsunami Sri Lanka, Watters reports on the Western trauma counselors who, in their rush to help, inadvertently trampled local expressions of grief, suffering, and healing. In Hong Kong, he retraces the last steps of the teenager whose death sparked an epidemic of the American version of anorexia nervosa. Watters reveals the truth about a multi-million-dollar campaign by one of the world’s biggest drug companies to change the Japanese experience of depression — literally marketing the disease along with the drug.
But this book is not just about the damage we’ve caused in faraway places. Looking at our impact on the psyches of people in other cultures is a gut check, a way of forcing ourselves to take a fresh look at our own beliefs about mental health and healing. When we examine our assumptions from a farther shore, we begin to understand how our own culture constantly shapes and sometimes creates the mental illnesses of our time. By setting aside our role as the world’s therapist, we may come to accept that we have as much to learn from other cultures’ beliefs about the mind as we have to teach.
Hacking tells the fascinating tale of Albert Dadas, a native of France’s Bordeaux region and the first diagnosed mad traveler. Dadas suffered from a strange compulsion that led him to travel obsessively, often without identification, not knowing who he was or why he traveled. Using the records of Philippe Tissié, Dadas’s physician, Hacking attempts to make sense of this strange epidemic.
In telling this tale, Hacking raises probing questions about the nature of mental disorders, the cultural repercussions of their diagnosis, and the relevance of this century-old case study for today’s overanalyzed society.
Hippocrates Cried offers an eye-witness account of the decline of American psychiatry by an experienced psychiatrist and researcher. Arguing that patients with mental disorders are no longer receiving the care they need, Dr. Taylor suggest that modern psychiatrists in the U.S. rely too heavily on the DSM, a diagnostic tool that fails to properly diagnose many cases of mental disorder and often neglects important conditions or symptoms. American psychiatry has come to reflect simplistic algorithms forged by pharmaceutical companies, rather than true scientific methodology. Few professionals have a working knowledge of psychopathology outside of what is outlined in the DSM, and more mental health patients are being treated by primary care physicians than ever before.
Dr. Taylor creates a passionate yet scholarly account of this issue. For psychiatrists and researchers, this book is a plea for help. Combining personal vignettes and informative data, it creates a powerful illustration of a medical field in turmoil. For the general reader, Hippocrates Cried will provide a fresh perspective on an issue that rarely receives the attention it requires. This book strips American psychiatry of its modern misconceptions and seeks to save a form of medicine no longer rooted in science.
This book exposes the traditional view that psychiatric drugs correct chemical imbalances as a dangerous fraud. It traces the emergence of this view and the way it supported the vested interests of the psychiatric profession, the pharmaceutical industry and the modern state. Instead it is proposed that psychiatric drugs ‘work’ by creating abnormal brain states, which are often unpleasant and impair normal intellectual and emotional functions along with other harmful consequences. Research on antipsychotics, antidepressants and mood stabilisers is examined to demonstrate this thesis and it is suggested that acknowledging the real nature of psychiatric drugs would lead to a more democratic practice of psychiatry.
Relative to some other medical specialties, psychiatry is a new and still scientifically underdeveloped field — as a result practitioners can be influenced by attractive but unproven ideas. Since mental illness is still a mystery and answers to the most important questions about mental illness will require another century of research, it is important to criticise contemporary practice — especially as fads in psychiatry have occurred not only on the fringe, but in the very mainstream of theory and practice. Some of the trendiest theoretical paradigms may turn out to be unsupported by data. In diagnosis, the many faddish approaches to classification are unlikely to last. In treatment, both psychopharmacology and psychotherapy sometimes embrace interventions with a weak base in evidence that run the risk of doing harm to patients. This book examines the fads and fallacies that have and continue to plague psychiatry, in both diagnosis and in treatment. These include over-diagnosis (especially of depression, bipolar disorder, ADHD, PTSD and autism), over- treatment with pharmaceuticals and the assumption that neuroscience has all the answers for psychiatry. The reasons why psychotherapy has long been prone to faddishness are explored; as are the reasons for more recent faddishness in psychopharmacology, which can lead to irrational methods of over-treatment, and a failure to consider alternatives. There is discussion of the problematic areas of diagnostic systems (ICD and DSM) and an over-reliance on drugs. Many examples from the author’s own personal clinical experience are included. The author’s strong opinions and critical tone may seem to conflict with the dispassionate approach of evidence-based medicine, however, the book presents balanced arguments and includes positive suggestions and recommendations for change.
Psychiatry and the Business of Madness deconstructs psychiatric discourse and practice, exposes the self-interest at the core of the psychiatric/psychopharmacological enterprise, and demonstrates that psychiatry is epistemologically and ethically irredeemable. Burstow’s medical and historical research and in-depth interviews demonstrate that the paradigm is untenable, that psychiatry is pseudo-medicine, that the “treatments” do not “correct” disorders but cause them. Burstow fundamentally challenges our right to incarcerate or otherwise subdue those we find distressing. She invites the reader to rethink how society addresses these problems, and gives concrete suggestions for societal transformation, with “services” grounded in the community. A compelling piece of scholarship, impeccable in its logic, unwavering in its moral commitment, and revolutionary in its implications.
There is growing international resistance to the oppressiveness of psychiatry. While previous studies have critiqued psychiatry, Psychiatry Disrupted goes beyond theorizing what is wrong with it to theorizing how we might stop it. Introducing readers to the arguments and rationale for opposing psychiatry, the book combines perspectives from anti-psychiatry and critical psychiatry activism, mad activism, antiracist, critical, and radical disability studies, as well as feminist, Marxist, and anarchist thought. The editors and contributors are activists and academics — adult education and social work professors, psychologists, prominent leaders in the psychiatric survivor movement, and artists — from across Canada, England, and the United States. From chapters discussing feminist opposition to the medicalization of human experience, to the links between psychiatry and neo-liberalism, to internal tensions within the various movements and different identities from which people organize, the collection theorizes psychiatry while contributing to a range of scholarship and presenting a comprehensive overview of resistance to psychiatry in the academy and in the community.
A courageous anthology, Psychiatry Disrupted is a timely work that asks compelling activist questions that no other book in the field touches.
The recent publication of a new edition of the American Diagnostic and Statistical manual (DSM-5) highlighted the two contrary viewpoints that exist within the field of mental health. There are those who value such classification systems, seeing each revision of the DSM as a fine-tuning exercise, and there are those who are strongly opposed, seeing such exercises as fundamentally flawed. ‘Madness Cracked’ provides a fascinating introduction to the history of psychiatry and clinical psychology, looking at how these areas have attempted to classify the various problems and disorders that their practitioners have faced in everyday use. Within the book, Power argues that — like in other areas of science — progress can only be made if the classification systems that are used have a sound theoretical basis. In addition, he outlines a model derived from work on cognition and emotion showing how, with appropriate modifications, it could provide a theoretical basis for classification and diagnosis. Using extraordinary examples from the history of psychiatry and clinical psychology, along with fascinating case material, he shows how our current knowledge in psychology can be developed to provide the theoretical basis that the field needs. For anyone in the field of mental health, Madness Cracked is a thought-provoking and controversial new book.
Psychiatry suffers a lot of criticism, not least from within its own scientifically founded medical world. Much of this can be understood as a consequence of trying to force the round pegs of unhappiness, fear, confusion and distress into the square hole of medical science. This book provides an account of mental health difficulties and how they are generally addressed in conventional medical circles, alongside critical reviews of the assumptions underpinning them. The lack of scientific justification for medical treatments is explained and psychotherapies, although often helpful, are shown to be largely so because they offer a healing relationship, rather than because they convey expertise in one or another of the many psychotherapeutic techniques. These inescapable conclusions have profound implications for how mental health difficulties might be better considered and provided for. They encourage approaches that focus much more upon social and humanitarian perspectives, than scientific ones.
The message of this book is that psychiatrists have some very good drugs, but can expect bad results when they are over-used, prescribed outside of evidence-based indications, or given to the wrong patients. While acknowledging that many current agents are highly effective and have revolutionized the treatment of certain disorders, Joel Paris criticizes their use outside of an evidence base. Too many patients are either over-medicated or are misdiagnosed to justify aggressive treatment. Dr. Paris calls for more government funding of clinical trials to establish, without bias, the effectiveness of these agents. He has written this book for practitioners and trainees to show that scientific evidence supports a more cautious and conservative approach to drug therapy.
After describing the history of psychopharmacology, including its early successes, Dr. Paris reviews the relationship between psychiatry and the pharmaceutical industry. This problem has received considerable popular attention in recent years and Dr. Paris documents initiatives to increase transparency and decrease the influence of pharmaceutical marketing on diagnosis and prescribing habits.
Dr Paris then examines some major controversies. One is the fact that newer drugs have not been shown to be superior to older agents. Another is that while the number of prescriptions for antidepressants has increased dramatically, meta-analyses show that their value is more limited than previously believed. Still another is the widespread prescription of mood stabilizers and antipsychotic drugs for patients, including children and adolescents, who do not have bipolar illness. Polypharmacy is an especially contentious area: very few drug combinations have been tested in clinical trials, yet many patients end up on a cocktail of powerful drugs, each with its own side effects.
Dr Paris briefly considers alternatives to pharmacology and again calls for more clinical trials of these approaches. He also discusses the current trend to medicalizing what many would describe as normal distress and states succinctly: Some things in life are worth being upset about.
Decolonizing Global Mental Health is a book that maps a strange irony. The World Health Organization (WHO) and the Movement for Global Mental Health are calling to ‘scale up’ access to psychological and psychiatric treatments globally, particularly within the global South. Simultaneously, in the global North, psychiatry and its often chemical treatments are coming under increased criticism (from both those who take the medication and those in the position to prescribe it).
The book argues that it is imperative to explore what counts as evidence within Global Mental Health, and seeks to de-familiarize current ‘Western’ conceptions of psychology and psychiatry using postcolonial theory. It leads us to wonder whether we should call for equality in global access to psychiatry, whether everyone should have the right to a psychotropic citizenship and whether mental health can, or should, be global. As such, it is ideal reading for undergraduate and postgraduate students, as well as researchers in the fields of critical psychology and psychiatry, social and health psychology, cultural studies, public health and social work.
As one of the few books to thoroughly examine the critical problem of over-diagnosis in psychiatry today, Dr. Joel Paris — author of The Intelligent Clinician’s Guide to the DSM-5r — shows how over- diagnosis leads to over-treatment in Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life’s Misfortune. Leaving no stone unturned, Dr. Paris considers the complications of the DSM-5 system with particular reference to major depression, bipolar disorder, PTSD and attention-deficit hyperactivity disorder. While each of these conditions have given rise to diagnostic fads and epidemics, the classification of mental disorders remains provisional without any biomarkers for mental disorders. Because of this, Dr. Paris makes the case for the importance of conservative diagnoses, recognizing that normal variants are not necessarily disorders.
In 2013, the American Psychiatric Association published the 5thedition of itsDiagnostic and Statistical Manual of Mental Disorders(DSM-5). Often referred to as the bible of psychiatry, the manual only classifies mental disorders and does not explain them or guide their treatment. While science should be the basis of any diagnostic system, to date, there is no knowledge on whether most conditions listed in the manual are true diseases. Moreover, in DSM-5 the overall definition of mental disorder is weak, failing to distinguish psychopathology from normality. In spite of all the progress that has been made in neuroscience over the last few decades, the psychiatric community is no closer to understanding the etiology and pathogenesis of mental disorders than it was fifty years ago.
This book provides a critical evaluation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Starting from a historical overview of the evolution in psychiatric diagnosis, Vanheule asserts that the diagnostic reliability of the DSM-5 is overrated: important factors that undermine its diagnostic reliability have never been sufficiently addressed and the common idea that the handbook is reliable rests on a biased interpretation of statistical data. The book argues that the DSM-5 builds on a narrow biomedical approach to mental disorders that neglects context, and proposes its replacement with a contextualizing model of mental health symptoms. Drawing from phenomenological psychiatry and Lacanian psychoanalysis, the author concludes that a reflexive account of psychopathology is urgently needed.
Everyone knows that antidepressant drugs are miracles of modern medicine. Professor Irving Kirsch knew this as well as anyone. But, as he discovered during his research, there is a problem with what everyone knows about antidepressant drugs. It isn’t true.
How did antidepressant drugs gain their reputation as a magic bullet for depression? And why has it taken so long for the story to become public? Answering these questions takes us to the point where the lines between clinical research and marketing disappear altogether.
Using the Freedom of Information Act, Kirsch accessed clinical trials that were withheld, by drug companies, from the public and from the doctors who prescribe antidepressants. What he found, and what he documents here, promises to bring revolutionary change to the way our society perceives, and consumes, antidepressants.
The Emperor’s New Drugs exposes what we have failed to see before: depression is not caused by a chemical imbalance in the brain; antidepressants are significantly more dangerous than other forms of treatment and are only marginally more effective than placebos; and, there are other ways to combat depression, treatments that don’t only include the empty promise of the antidepressant prescription.
This is not a book about alternative medicine and its outlandish claims. This is a book about fantasy and wishful thinking in the heart of clinical medicine, about the seductions of myth, and the final stubbornness of facts.
In Mad in America, medical journalist Robert Whitaker reveals an astounding truth: Schizophrenics in the United States currently fare worse than patients in the world’s poorest countries, and quite possibly worse than asylum patients did in the early nineteenth century. With a muckraker’s passion, Whitaker argues that modern treatments for the severely mentally ill are just old medicine in new bottles, and that we as a society are deeply deluded about their efficacy. Tracing over three centuries of “cures” for madness, Whitaker shows how medical therapies have been used to silence patients and dull their minds. He tells of the eighteenth- and nineteenth-century practices of “spinning” the insane, extracting their teeth, ovaries, and intestines, and submerging patients in freezing water. The “cures” in the 1920s and 1930s were no less barbaric as eugenic attitudes toward the mentally ill led to brain-damaging lobotomies and electroshock therapy. Perhaps Whitaker’s most damning revelation, however, is his report of how drug companies in the 1980s and 1990s skewed their studies in an effort to prove the effectiveness of their products. Based on exhaustive research culled from old patient medical records, historical accounts, numerous interviews, and hundreds of government documents, Mad in America raises important questions about our obligations to the mad, what it means to be “insane,” and what we value most about the human mind.
A classic work that has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. “Bold and often brilliant.” — “Science” “Bold and often brilliant.” “ — Science” “It is no exaggeration to state that Szasz’s work raises major social issues which deserve the attention of policy makers and indeed of all informed and socially conscious Americans…Quite probably he has done more than any other man to alert the American public to the potential dangers of an excessively psychiatrized society.
Since its third edition in 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has acquired a hegemonic role in the health care professions and has had a broad impact on the lay public. The publication in May 2013 of its fifth edition, the DSM-5, marked the latest milestone in the history of the DSM and of American psychiatry. In The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel, experts in the philosophy of psychiatry propose original essays that explore the main issues related to the DSM-5, such as the still weak validity and reliability of the classification, the scientific status of its revision process, the several cultural, gender and sexist biases that are apparent in the criteria, the comorbidity issue and the categorical vs. dimensional debate.
For several decades the DSM has been nicknamed “The Psychiatric Bible.” This volume would like to suggest another biblical metaphor: the Tower of Babel. Altogether, the essays in this volume describe the DSM as an imperfect and unachievable monument — a monument that was originally built to celebrate the new unity of clinical psychiatric discourse, but that ended up creating, as a result of its hubris, ever more profound practical divisions and theoretical difficulties.
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