The history of psychiatry is a history of fad diagnoses that come out of nowhere to capture much more attention than they deserve. Current fads are distinguished only by the billions of dollars spent by powerful commercial forces to create and push them.
When I started my training in psychiatry 45 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature.
Prisons are clearly not an appropriate or safe place for psychiatric patients -- but almost a million are behind bars for crimes that could have been avoided had they received proper community treatment.
I have known hundreds of patients who were not helped or were directly harmed by psychiatry. But I have also known many thousands of patients who have benefited greatly. The overall results in psychiatry are quite good and compare favorably to other medical specialties.
Yes, meds are important. For instance, those that change the chemistry of the brain through use of serotonin can help one to feel better. But turning to this drug exclusively without talk therapy does not address what in an individual life may very likely be causing the depression.
Our forty year war against the illegal drugs promoted by drug cartels has been a proven failure. If we devoted just a tenth of the effort to controlling the equally dangerous misuse of legal prescription drugs, we would most certainly succeed.
The latest in APA's fluffy public relations has come from the president of the American Psychiatric Association. He has made two astounding claims -- that criticism of DSM-5 is somehow equivalent to criticism of psychiatry and that it signifies stigma against mental illness.
May has been a dispiriting month for psychiatry and a sad and worrying time for our patients. Three of the leading mental health organizations have squabbled among themselves -- promoting silly and competing 'paradigm shifts' while ignoring the unmet needs of our patients.
My recommendation for clinicians is simple. Don't use DSM-5 -- there is nothing official about it, nothing especially helpful in it, and all the codes you need for reimbursement are already available for free on the Internet or in DSM-IV.
The flat out rejection of DSM-5 by National Institute of Mental Health is a sad moment for mental health and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country.
Psychiatric diagnosis and treatment are often life changing events -- usually for the better, sometimes for worse, sometimes a tie score. Sorting out who is who in the rule of thirds requires patience and humility -- both currently in short supply.
DSM-5 represents a wholesale, imperial medicalization of normality. So many new and untested diagnoses; so many reduced thresholds for the old ones. Pretty soon everyone will have a diagnosis and many will have a whole bunch of them.
This well-meaning program is a serious mistake for two reasons. First, it is no more than a politically correct, cosmetic solution that distracts attention from what really needs to be done. Second, it will likely wind up doing much more harm than good.
Accumulating evidence suggests that animals are a lot smarter and humans are a lot dumber than we previously thought. A recent study shows that the short term memory of chimpanzees far exceeds what we can expect from ourselves.
No bright line marks the boundary between illness and health. At the extremes it is easy to diagnose mental illness accurately and to distinguish it from normality. At the fuzzy border, it is impossible.
'It is all in your head' is no more helpful an answer to the patient's puzzling and troubling question than were 'the spirits are angry' or 'the gods are punishing you' or 'your four humors are unbalanced.'
President Obama will soon declare a second "decade of the brain." The project is a good idea, but don't hold your breath that it will lead to any quick clinical breakthroughs or deep insights into human consciousness.
In a recent piece on The Huffington Post, Allen Frances, M.D., demonstrates either an embarrassing lack of knowledge and understanding of financial reporting or an intentional misrepresentation of facts in his continuing effort to attack the forthcoming DSM-5.