Psychiatry's Hammer
By Joel F. Wade - May 30, 2012

You know the adage: When the only tool you have is a hammer, everything looks like a nail.

Psychiatry has one big hammer, psychiatric medications, with which to address a nail: psychological disorders.

Without a public that believes in and accepts the use of these medications, and the diagnoses that they presume to treat, there would be no profession of psychiatry. Many (not all; this is a critique of a system, not everybody involved) psychiatrists' entire life's work would become meaningless and their livelihood would disappear.

That's quite an incentive for confirmation bias. And now there is a push by the writers of the upcoming 5th edition of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, to define more and more of normal human functioning as just so many nails to be struck by psychiatry's pharmaceutical hammer.

The DSM-5 is the diagnostic manual for psychology. It lists all of the psychological disorders that can be suffered by people, all in one handy little book. I've got a copy of an earlier version, from the days when I accepted medical insurance from my counseling clients and was obliged to find for them a label with which to burden them.

I say burden because there are two purposes for identifying a diagnosis. One is very good: to identify the problem so that you can treat it. If you have a bacterial infection and you can identify that this is the problem, then a course of antibiotics will usually solve that problem.

The other reason for identifying a diagnosis is very bad: to label a person, to decide who a person is and what they should accept as their fate forevermore. Once this is accomplished, you don't have to explore the problem, or get to know that person, any further.

When you label a person as "severely depressed" or "bi-polar" it has an air of certainty, a sense of having solved the mystery of that person. Then that person gets to incorporate that diagnosis into their self-concept: "I am a person who is severely depressed" or "I am a person who is bi-polar." Then what?

Then that person is supposed to accept that this is their fate. It's no different than being labeled "stupid" or "ugly." What do you do with it? Where is the solution to the problem that you've now been cleverly identified as having?

A problem without a possible solution is not a problem, it is just life. It may be very troubling, and you may wish it better; you may want to spend your life searching for a solution and you may find one. But that is different than focusing on labeling and dwelling on the problem.

If somebody finds an actual solution to a problem, then we can reassess what normal life expectations are. We do that all the time, which is why our life expectancy in the US is decades longer than it was a hundred years ago. Medical and nutritional problems have been actually solved.

At a local elementary school, there is a woman who works as a special education instructor. Her job is to diagnose kids who have learning problems. She works as a contractor, so the more kids are diagnosed, the more work she gets and the more money she makes. Guess how many kids have "learning problems" at that school? 80%!

Of course, if 80% of kids have learning problems, those aren't problems. They are by definition the normal range of human functioning. This instructor is not comparing these kids to the normal range of human functioning; she is comparing them to an idea in her mind of how they should be.

This is just like thinking that a certain person should be smarter or more attractive.

People get depressed, and they have mood swings. Some have very severe bouts of these. We desperately need to find solutions to these problems. The common knowledge nowadays is that you simply find the right psychiatric medication, or combinations of psychiatric medications, and then you take those for the rest of your life. Problem solved!

But the problem is not solved. Psychiatry depends on the theory that psychological problems are a matter of chemical imbalances in the brain. The medications, according to this theory, serve to "re-balance" that chemical imbalance.

But that is not what happens. These medications don't "balance" anything. They shift the feedback mechanism in a certain direction, changing the structure of the brain (See Robert Whitaker's important book, Anatomy of an Epidemic).

They have also, for the most part, only been tested for short-term use among adults but they are commonly prescribed for long-term use and, increasingly, for children.

What's more disturbing is that if these medications did what they were supposed to do we should see a decrease in these problems − just like we see a decrease in people dying of bacterial infections since antibiotics have been used.

But the truth is, these problems haven't just increased, they have multiplied!

These medications may be useful for some people, particularly for short-term use, but they are now widely prescribed and often for long-term use, as though they are the solution to the problem.

But the problem is much more complicated than this. Severe depression and anxiety, bi-polar, psychosis; these are all seriously debilitating conditions and they deserve the best that professionals in the field can bring in order to bring genuine relief to those suffering from them. Medication may have some benefit for some people but it is so ridiculously overprescribed that it's hard to sort out what's useful from what's not.

Another big problem is that, like that special education instructor, some people in the fields of psychiatry and psychology have been looking for problems. They have found that the normal range of human functioning is not to their liking so they just decide to label it as a problem anyway.

This brings me back to the proposed new edition of the diagnostic manual, the DSM-5.

Here are a few of the "new" diagnoses that have been proposed:

  • "Attenuated Psychosis Syndrome" This would have been applied to people who were at risk of developing mental illness sometime in the future. They would be given this label and "treated" with medications to manage this problem − presumably diagnosed with the help of a crystal ball and a Ouija board.
  • "Mixed Anxiety Depressive Disorder" This would have lowered the threshold for diagnosing people who have a mild depression and anxiety, which could include most of us at one time or another.
  • Perhaps most ridiculous of all is that depression immediately after a loss would be diagnosed as depressive disorder. In the past this was only diagnosed if somebody remained depressed for a prolonged period of time. But with the proposed DSM-5, you have to be up and at 'em, feeling just great right away after losing a loved one, or suffering a severe life changing event.

All of this smacks of creating problems to diagnose so that people can be appropriately labeled and medicated; but these medications do not usually solve the problem and, used long-term, can cause grave problems of their own.

There are, I understand from this article, deep ties between the pharmaceutical industry and the DSM panel members. Like my example with the special education instructor, the more problems can be labeled, the more money they can make and the more prestige they can enjoy.

But there is good news. There has been a strong backlash against this new version of the DSM, with over 13,000 professionals (including yours truly) signing an open letter objecting to these ridiculous revisions. You can sign it, too, here.

"Stupid," "ugly," "mentally disordered"… these labels do not help people to get better. They do not search for strength and resilience with which to overcome hardship or trouble. All they do is stick people with a sentence of a dysfunctional self-concept, they hobble the natural capacity for people to overcome adversity and they pound people down further with the hammer of professional arrogance.