Psychiatrists bemoan the deficiencies of their diagnostic labels while ignoring the cause, they use the wrong method, descriptive diagnosis (see Psychiatry). It identifies the symptoms that occur together as implying that they have a common cause. The reasoning survives because most people hold to this basic error. They defy the logic that effects do not descry the cause (see Humes law). Only the treatments that combat the cause will work. The elephantanopia series document the blindness of psychiatrists to the elephant in the room. I begin with the September 2011 issue of the British Journal of Psychiatry (BJP). Why that one? Firstly, because I value the BJP as the best of all psychiatric journals. Secondly, in July 2012 I am that far behind in my reading.
Descriptive diagnosis provides no more than a shorthand label for an effect, not a cause of the illness. It has such an obvious nature that the layperson can readily understand what is intended by “generalised anxiety disorder”, the subject of the first paper I select. The authors discover that anxious people think inefficiently, hardly a surprise. The anxious spend so much effort on their worries that they have difficulty thinking about anything else. Their thinking improves as their anxiety diminishes.
I suspect that the authors tried to dredge some benefit from a profitless study of a new antidepressant, an SSRI. They found that very different medication obtained the same alleged benefit. As they had no other measure of benefit, and time has shown that many drugs fail to live up to the early expectations, more likely the SSRI had the same ineffectiveness. Turning to study of the depression they had set out to treat, they rediscover birds that flock together; the symptoms of anxiety and mental inefficiency remain or dissipate together. What else could anyone expect? A descriptive diagnosis labels the state brought about by symptoms that flock together.
Nor does understanding the next study in this issue of the journal require profound thought. An Australian group found that people who have anxiety and depression, or either, are at increased risk of using alcohol to excess. They argue that they have established cause and effect: anxiety leads to alcohol abuse. They continue a century of pointless data gathering. Seventy years ago most Australians had come from the United Kingdom, with a large proportion of Irish. Wherever the potato famines had driven the Irish they took their predilection for the bottle and there the earnest data gatherers found an association of alcoholism with a fervent adherence to Roman Catholicism, large broods of children and the like.
In the same issue a very brief paper compares cases of anxiety disorder with a supposed cardiac disease called “mitral valve prolapse”. Patients in both groups had the same disturbance of cardiac function. The authors fail to discuss the dubious nature of the supposed heart disorder. If they had gone far enough they could identify its mental nature. They had rediscovered the concurrence of related effects. And all this in the best journal. In comparison, The Psychiatrist, its companion minor journal, happens to have the best paper for the month. Together with a colleague Joanna Moncrieff explains why a proposed new descriptive diagnosis, adult attention-deficit hyperactivity disorder, has even less claim to reliability than the childhood form.