Check your head
The late J.G. Ballard once listed Sigmund Freud’s Civilization and its Discontents alongside Jane Austen’s Pride and Prejudice and Miguel de Cervantes’ Don Quixote as his favorite books. More telling, he also includes the fairy tales of Hans Christian Andersen and The Brothers Grimm in his list. He also declared Freud to be “the great novelist of the 20th Century,” noting that while psychoanalysis itself has had “only a modest therapeutic success, and some psychiatrists see it as a complete failure,” the good doctor himself “should be seen primarily as a novelist, with a great imaginative writer’s ability to explore the human heart through the unfolding drama of a strong confrontational narrative. Freud was a born storyteller.”
In an article for Skeptic (Vol. 15, No. 3) John Sorboro, a clinical psychiatrist, notes that the writings of Freud, among others, were pivotal in the making of The Diagnostic and Statistical Manual of Mental Disorders (DSM), or the “psychiatrist’s bible,” and have continued to be an influence on its second edition. It was only after finding it insufficient in “helping define who was ‘sick’ in the collective eyes of psychiatry” — coupled with an experiment conducted and reported in Science in the piece “Being Sane in Insane Places” by psychologist David Rosenhan — that Sorboro writes a “crisis in the legitimacy of psychiatry by the 1970s” developed. (The latter involved eight people who had no history of mental illness feigning symptoms to gain admittance into psychiatric hospitals. All of them were admitted and were only released after they “agreed with the psychiatrists that they were mentally ill and took antipsychotic medications.”)
It was then that Robert Spitzer, who Sorboro claims was perhaps “the second most influential psychiatrist of all time,” took the reins in crafting the DSM’s third edition in an effort to bring “claims of scientific credibility to the field.” This was done by standardizing definitions by focusing on what disorder you had instead of trying to explain why you had them. As of this writing, the DSM is currently in its fourth edition (released in 1994) and is of great importance not only in psychiatry, “but in psychology, social work, and in the courtroom.” Even insurance companies, Sorboro reveals, have made it a “standard for determining payment.” The fifth edition is slated for release in 2013.
Why all this talk about the DSM? For one, as someone who’s been treated by a number of psychiatrists over the years (for depression and anxiety), I have a vested interest in the matter — and, as one self-help manual advised, every boy should have a hobby. Second, the recent brouhaha about faked psychological reports concerning Sen. Benigno Aquino III as well as the charges brought forth by STAR columnist Carmen Pedrosa in her column compel me to weigh in on the matter. Besides, it’s time we reviewers took up books that really do have an effect on a large number of people (besides Stephanie Meyer fans, of course).
The Psychological Association of the Philippines (PAP) has already denounced the use of so-called psychiatric or psychological reports for the current campaign, calling it “irresponsible” and having “dangerous long-term effects.” Of the three points cited, the last one reads that the PAP “denounces the insinuation that people who see a psychologist or any mental health professional is “abnormal” or “permanently debilitated… These irresponsible statements and similar acts perpetuate a profound lack of understanding of psychological concepts, of the nature of psychological problems and dysfunctions, and of the nature of psychological health and well-being.”
But there is a more serious point to consider. Being the basis for all these assessments — spurious or not — the credibility of the DSM is an important matter indeed. In Sorboro’s article, he cites the misgivings of Stuart Kirk, a professor of public policy at U.C.L.A., and Herb Kitchens, a professor emeritus of social work at California State University, who studied closely the making of the modern DSM. “If one looks intensively at what was identified as the core scientific problem of diagnosis in the 1970s — unreliability — one discovers that the scientific data used to claim success and great improvement simply do not support the claim,” they write. “In other words,” writes Sorboro, “the rhetoric of science — rather than scientific data — was used by the developers.”
Through e-mail, I corresponded with Dr. Sorboro about his article. Among the questions I asked concerned the fact that there is an ongoing debate in the psychiatric community in Asia over whether or not the DSM is readily applicable to the Asian mind. He agreed that the DSM is culturally specific. “This is what makes it a fraud,” he replied. “True disease is not specific to a cultural interpretation.”
In an earlier piece for Skeptic that he forwarded to me, he wrote: “Can psychiatry be a medical science of the mind? The answer would appear to be mostly no. Science requires us to accumulate observable empiric data in order to formulate and/or validate general laws of prediction. This works nicely when we are talking about models that have a limited number of variables that can be accounted for and held constant, such as specific sensory functions or the limited functions of specific cells or organs like the heart or kidneys. It isn’t impossible to make some predictions about the general behavior of humans, but individuals are not automatons. They have backgrounds, experiences, drives, conscious needs, and goals that are unique.”
In the same article, he points out that up until 1973 homosexuality was on the list of official diseases of the American Psychiatric Association. “Homosexuality was placed on the list for pretty much the same reasons it was removed: social mores and politics both within the field and outside of it,” he writes. “So dramatic has their shift been that the American Psychiatric Association now has a consensus statement in support of gay marriage. Going from official disease to officially approved lifestyle in less than 30 years is a cultural phenomenon, not a scientific one.”
“There is no biological test for any mental disorder,” writes Sorboro in his reply to me when I ask him about the assertion by Dr. Allen Frances — who headed the committee that created the DSM IV — that “the incredible recent advances in neuroscience, molecular biology and brain imaging that have taught us so much about normal brain functioning are still not relevant to the clinical practicalities of everyday psychiatric diagnosis. The clearest evidence supporting this disappointing fact is that not even one biological test is ready for inclusion in the criteria sets for DSM-V.”
He replies, “No such consistent finding for any mental disorder with any sensitivity or specificity has ever been found.”
That is a sobering thought, most especially for those who put too much credence in psychiatry or use it as a means of character assassination (though sobriety is not a virtue exhibited by any major political party as of late). To do so is not unlike being part of the Inquisition or of the mob at the Salem Witch Trials that persecuted and executed thousands, mostly women. In fact, Sorboro likens the DSM to the infamous Malleus Maleficarum, which was the text used to identify and try suspected witches. Remaining in use for 300 years, it included instructions like throwing those believed to be witches into a river — if they floated, then they were guilty; if they didn’t they were… dead.
Let’s hope for happier endings. Vote wisely on May 10.
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Thank you to Dr. John Sorboro, Dr. Cornelio Banaag and Oli Reyes for their help with this article. Also check out: http://thehealthyskeptic.org.
