No other branch of medicine generates so many critics from within its ranks. The devotion of psychiatrists to their craft impels them. They wrestle daily with its failings or wince as they cope with those of their colleagues. They address our most complex organ with our weakest tools of reason. Diagnosis has no practical value unless it pinpoints the cause of an illness (see “The Magic of Names” in Chap.9 of “Welcome to the Loony Bin“). Only addressing the cause can remedy disorder. All medicine once depended on descriptive diagnosis, which labels illness in terms of its effects. It amounts to tautology. The patient developed a fever. The doctor diagnosed”fever”. Knowing nothing of cause such as germs, doctors speculated miasmas and practised bleeding. They hastened death. Similarly ignorant, psychiatrists talk of depression and push pills while its rate climbs meteorically parallel to their prescription (see pill pushing).
Effects do not give a reliable guide to cause. Rather, they provide a means to those who mislead (see “Fostering victim mentality”). To reason backwards from the consequent breaks Hume’s law. To take a plain medical example, during the coma caused by a head injury infection produces fever indistinguishable from the brain damage that disorders heat regulation. Compared to fever, depression has an equally inscrutable range of diverse causes extending from genetic predisposition to chance fate. Effects or the descriptive diagnosis cannot tell one from the other. The irrationality invites speculation. In the consulting room it justifies talk of chemical imbalance involving serotonin, delivered as dogma even though science has yet to prove its relevance. Marketing propaganda created the serotonin hypothesis. Similar unreason misleads justice. In the court room reasoning backwards from an effect justifies blaming imagined complaint on the work, or a spouse, or best of all, the boss. In serving these purposes psychiatry turns diagnosis to harm rather than benefit.
In its preamble the authors of DSM-III clearly spelled out the reason why the descriptive approach does not identify cause. But they did not practice what they preached. They invented post-traumatic stress disorder (PTSD), a set of complaints, which they claimed identifies stress-caused illness. Much later the chief designer of DSM-III, Robert Spitzer, condemned the results. The chief designer of DSM-IV, Allen Frances, similarly regretted his own creation. Few recognise that descriptive diagnosis must continue to fail. The textbooks give its flaws little or no mention. Few of the papers that bemoan the weaknesses of psychiatric diagnoses indict it. It has become the ignored elephant in the room (see “Elephantanopia” series). The gaps in the knowledge of cause does not excuse psychiatry. Research has accumulated a great fund that psychiatry ignores, mostly because it does not fit with common prejudice or vanity. Failure demands a radical rethinking of psychiatric theory and practice.
Indeed “the inability of science to pin down cause does not excuse psychiatry…” Psychiatry appears to have become the conduit for “pill pushing” through the highly financed marketing strategies of Big Pharma… It’s no longer the psychiatrist/ physician but the marketing representative’s skills which negates the science. Through demand and supply the patient as “consumer” reinforces the market dynamics of a commodity. Therefore, would it be in the interests of Big Pharma to effect a cure?
I should think not! It would be contrary to any marketing strategy. The increased influence of the biomedical model appears to have coincided with the increase in mental disorders. Perhaps the emphasis of Big Pharma is no longer on the science but the marketing to attract those shareholders, whose invested return is based on the harm caused because there is not a science base.
Psychiatry has indeed become a conduit for pill pushing, submitting uncritically to the sophisticated marketing methods of Big Pharma. But neither conspire to avoid a cure. Given the choice of conspiracy or incompetence at achieving that success, the latter wins hands down. Psychiatrists can do no better with its methods. Big Pharma can do no better than the tools of psychiatry permit. Where both have real illnesses to deal with such as schizophrenia or bipolar affective disorder, they produce real benefits, sadly not cures as yet. Like all humans neither do so perfectly and have a long way to go yet. With infections Big Pharma provides antibiotics that cure. When Big Pharma goes beyond valid knowledge and pushes drugs for off-label purposes it could be seen as engaging in conspiracy and has been called to order, not yet perfectly or enough, by regulatory authorities. Greed has as real an existence as incompetence.