Psychiatry struggles to cope with its inherent uncertainty

Terry Lynch, who wrote a chapter for my Critical Psychiatry edited book, has posted a video asking why doctors pay so little attention to trauma in the lives of people with psychiatric diagnosis. As Terry says, Robert Spitzer, Chair of the DSM-III taskforce (see eg. previous post), when asked in an interview whether psychiatric diagnosis shouldn't always take into account a person's life circumstances replied "If we did that then the whole system falls apart".

As I've said before (eg. see previous post), psychiatry is a cultural system. The belief that primary mental illness is brain disease clothes psychiatry with an aura of factuality, even though that belief is incorrect. As I also keep saying, biomedical psychiatry is more like a faith than a science (see eg. previous post). That includes what's often called the biopsychosocial approach to psychiatry, which can be more of an eclectic mix of biological, psychological and social in psychiatric assessment, regarding these aspects as more or less equally relevant in all cases and at all times. This understanding of biopsychosocial makes psychiatry merely a weakened, ill-defined form of the biomedical model (see eg. another previous post), rather than truly anti-reductionistic in the way originated by George Engel (see eg. yet another previous post).

Psychiatry is sustained by its professional institutions, such as the American Psychiatric Association (see eg. previous post) and the Royal College of Psychiatrists (see eg. previous post). These professional bodies can’t always be relied on for information (see eg. another previous post). In fact, they are biased and do not take a pluralistic and integrated position to psychiatry, despite claims that they do (see eg. previous post). They tend to think that primary mental illness is brain disease or at least is caused by biological factors to some extent, whereas it is not a structural brain but functional personal problem. The American Psychiatric Association is responsible for the Diagnostic and Statistical Manual (DSM) which has resulted in a dead-end in its 5th version (see eg. previous post), building on the direction started by Spitzer.

The biomedical model gives a sense of direction and purpose to psychiatry. The trouble is it induces certain dispositions and ways of understanding in psychiatrists that can lead to them treating patients more as objects than people. It provides a worldview that, if psychiatrists did not accept and believe in it, would make their practice too uncertain for most. I think that’s what Spitzer meant. He was so panicked that psychiatric diagnosis may be unreliable that he took psychiatry, particularly American psychiatry down the DSM route to its dead end in DSM-5 (see eg. previous post and my 2002 article).