Psychiatry knows very little about the processes that determine our mental health, says a well-known American psychotherapist. The specialist draws attention to the fact how much we still have to learn about the human mind.
In his fascinating book about the medical treatment of human suffering by psychiatrists, Gary Greenberg describes how physician Samuel Cartwright reported in 1850 in the respected New Orleans Medical and Surgical Journal about the discovery of a new disease. He called it “drapetomania”, from the word “drapetes” meaning in ancient Greek a runaway slave. This disease was to “cause Negroes to run away”. Cartwright listed one primary diagnostic – “dismissal” – and several secondary ones, including “pouting and discontent just before fleeing”.
Drapetomania, of course, ended up in the dumpster of medical history. It has never been listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), a compendium of widely respected guidelines for the testing and diagnosis of mental health disorders. However, Greenberg, a staunch critic of the DSM, suggests that if the manual had been published in the mid-nineteenth century, it would likely have included drape mania as well.
The author recalls that homosexuality was listed in the first edition of the DSM in 1952 as a “sociopathic personality disorder” and that this version was in force until 1973. “Doctors got money to treat him and scientists got money to research his causes and treatments,” writes Greenberg in “The Book of Woe: The DSM and the Unmaking by Psychiatry.” “And homosexuals themselves have been treated for years by a variety of methods, including electroconvulsive therapy, psychoanalysis, behavioral therapy, and sessions with sex assistants.”
Greenberg, 56, an American psychotherapist with 30 years of experience, is the author of numerous publications on mental health problems (including his own depression after the breakdown of his first marriage). In his latest book, however, Greenberg takes a different perspective, dealing with the DSM, the so-called “Psychiatrist’s Bible”, which contains a comprehensive list of all mental health disorders with diagnostic criteria.
This regularly updated publication – the most recent issue, DSM-5, came out in May this year – is regarded as an oracle almost everywhere in the world, including the UK, where it forms the basis of much of the clinical mental health recommendations. Nevertheless, Greenberg argues that the DSM reduces our “infinitely complex” inner life to a pseudoscientific model, fabricating “a whole host of” non-existent diseases.
The author claims that thanks to the DSM, millions of people are prescribed powerful antidepressants to heal the mythical “chemical imbalance”. Greenberg emphasizes that the frequency of diagnosing mental disorders such as autism, bipolar disorder and ADHD in children has jumped sharply. According to the American, DSM is a “fiction” that medicalises human experience and gives psychiatrists “power over the world of our mental suffering”.
This style may seem lofty at times, but Greenberg is not alone in his opinions. The creators of the DSM-14, prepared for 5 years, have been criticized for succumbing to pressure from the pharmaceutical industry and striving to medicalize behaviors and moods that, in the opinion of many experts, do not exceed the norm.
“Most specialists don’t like the new DSM,” says Greenberg, who lives in Connecticut with his wife, teenage son, cat, dog, and a dozen hens over the phone. – We are forced to diagnose disorders that we do not even notice in our patients. And it’s about the most trivial thing about it: money. (In the US, the diagnosis must comply with the DSM for the patient to receive funding from health insurance.) – I am talking not only about therapists. Even psychiatrists admit that this publication is full of errors.
According to Greenberg, everything started to deteriorate as early as the XNUMXth century, when, after the discovery of microorganisms, expectations about medicine changed dramatically. – There was a postulate to treat all mental disorders in the same way as physical diseases such as smallpox or cholera. It has become extremely fashionable to see madness as a treatable biological ailment.
On top of that, there is another factor, and that is the influence of the pharmaceutical industry. While the American Psychiatric Association has tried to cut itself off from the industry in recent years, it is said that as many as 67 percent of DSM-5’s “working group” members have ties to pharmaceutical companies.
But Greenberg believes that many psychiatrists – and even in the pharmaceutical industry – are acting in good faith. – Here we are dealing with intellectual rather than financial corruption. The belief that human suffering can be reduced to a biochemical imbalance stems from ideology, not material motives.
Greenberg carefully shows in his book how the decisions of the DSM creators contributed to the plague of false epidemics, unnecessary diagnoses and unnecessary treatments. For example, in 1994 the diagnostic threshold for bipolar disorder was lowered to include also patients who do not have the typical mania (but only euphoric moods called hypomania by doctors and spontaneity by Greenberg). As a result, bipolar disorder was diagnosed much more frequently, and antipsychotic and mood stabilizing medications were prescribed for the first time in the mass media. “Suddenly, one in two of us has bipolar disorder,” recalls Greenberg. Currently, there are about six million people in the United States who have been diagnosed with this condition, while in the United Kingdom, the disease is diagnosed in one in XNUMX people.
Greenberg also describes how a gap in the DSM criteria was exploited “by one of the most despicable psychiatrists” who, despite the lack of a solid scientific basis, promoted the trend of childhood bipolar disorder. It happened just as powerful antipsychotics began to be called mood stabilizers. As a result, the number of diagnosed cases of bipolar disorder in children increased forty-fold over the decade. “In 2007 alone, half a million children, 20 of whom were under six, were given drugs that had been prescribed only in the most serious cases ten years earlier,” says Greenberg.
Side effects of these pharmacological cocktails for children were obesity, diabetes and suicidal thoughts, among others.
To reduce the diagnosis of bipolar disorder in minors, a new entity was introduced in the DSM-5, called destructive mood lability disorder (DMDD) and manifested by violent tantrums or hysteria. This decision is also controversial, as many people fear that these criteria may also include healthy children with impulsive temperaments. – Clinical trials of DMDD therapy are probably already underway. It could end up with another physician-induced epidemic, warns Greenberg.
When it comes to Asperger’s syndrome, the American therapist believes that the inclusion of this disorder in the DSM in 1994 brought some positive results. – It may not be a disease, but thanks to this classification, a previously neglected group of children has gained access to educational support and services, as well as a sense of identity and community. On the other hand, the frequency of diagnosing autistic disorders (including Asperger’s syndrome) all over the world has increased almost thirty-fold – in 1988 it was found in four out of 10 patients, and twenty years later in one in every 88 children examined. Concerned that the situation was “out of hand,” the authors of DSM-5 removed Asperger’s Syndrome from the list, replacing it with the more general term for autism spectrum disorder. According to Greenberg, this means “a higher diagnostic threshold” and, as a consequence, possibly worse access to educational services for future generations.
The author of the book also has doubts about the so-called gathering unit, another new unit in the DSM-5. – Is an eccentric old man who accumulates various lumber in his apartment more sick than a billionaire who is constantly figuring out how to earn more money? – he asks. Greenberg also believes that another “new” disease – mild cognitive impairment – could be diagnosed in anyone over the age of 50, including himself.
Greenberg is particularly critical of the change in the criteria for diagnosing depression. So far, such a diagnosis has been ruled out in cases where the patient has recently lost a loved one, as grief was considered to be a normal feeling. This exception was deleted from the DSM-5, which is why critics believe that mourning has been medicalized.
“This clause was troublesome because it undermined the dogma about the biological basis of depression, and provided arguments for people who demanded the exclusion of other external factors, such as divorce or termination,” explains Greenberg. – That’s why it got rid of. This means that if someone is depressed because of mourning, they may be labeled as mentally ill. I’m not saying that people who suffer the loss of loved ones don’t need help. But is it really a medical problem?
So what should be done? Greenberg argues that psychiatrists need to narrow down their field – and make “reasonable arguments” for the existence of specific diseases within that domain. – At the time of publication of the first DSM, 14 mental disorders were distinguished, but now there are as many as 250. This number should be limited.
According to Greenberg, pharmacological therapies can be used, although “you only need to look at clinical trials to see that they only help some patients.”
Greenberg believes that psychiatrists, above all, should be honest with their patients. “Don’t let them tell people that their disease is caused by a chemical imbalance when there is no evidence of it.” Psychiatry knows very little about the processes that determine our mental health and should not pretend otherwise.