Leading American Psychiatrist Calls DSM IV Diagnostic Method Dehumanizing.

As reported here Contemporary American psychiatry has been dealt a shattering blow by no other than one of the most influential psychiatrists in academia.

Dr. Nancy Andreasen, Director of mental health clinical research at the University of Iowa, the editor of the American Journal of Psychiatry, and author of 500 publications, including the influential book, "The Broken Brain" (1984, recently released) in which she describes the "biological revolution" in psychiatry, has delivered a devastating blow to American psychiatry.

In her critical article in the Schizophrenia Bulletin, Dr. Andreasen makes some astounding acknowledgements--including the fact that American psychiatry is a veritable wasteland in need of "a reverse Marshall plan so that the Europeans can save American science by helping us figure out who really has schizophrenia or what schizophrenia really is..."

Dr. Andreasen points an accusing finger at psychiatry's reliance on an invalidated diagnostic guideline:

"The DSM has had a dehumanizing impact on the practice of psychiatry. History taking — the central evaluation tool in psychiatry — has frequently been reduced to the use of DSM checklists. DSM discourages clinicians from getting to know the patient as an individual person because of its dryly empirical approach. Third, validity has been sacrificed to achieve reliability. DSM diagnoses have given researchers a common nomenclature — but probably the wrong one. Although creating standardized diagnoses that would facilitate research was a major goal, DSM diagnoses are not useful for research because of their lack of validity."

Yet, she notes, the DSM-III and its successors, DSM III-R and DSM-IV were universally and uncritically accepted as if they were the ultimate authority on psychopathology and diagnosis. DSM forms the basis for psychiatric teaching to both residents and undergraduates throughout most of the United States.

Equally astounding--especially to those who didn't pay heed to critics who pointed out 20th century psychiatry's failings and decades of abusive "treatments"--is that Dr. Andreasen has to go back to the 19th century to find a period during which psychiatry resembled something close to a healing profession:

"the early psychiatrists attempted to develop therapies that might help to relieve mental pain in as humane and effective a manner as possible.

The picture of Pinel freeing the mentally ill from their chains is perhaps the most famous icon of their therapeutic approach. ‘‘Moral therapy’’ was developed in many countries in Europe, in Britain, and in the United States. In an era when no pharmacological treatments were available, it emphasized a variety of psychotherapeutic techniques that included personalizing the care to the individual’s needs, using nonintrusive and compassionate approaches, appealing to reason when possible, and giving the patient some responsibility for improving symptoms and behavior."

This firm conceptual and moral grounding, she acknowledges, is what psychiatry should strive to maintain--not the invalid, dehumanizing current practices.

She also acknowledges that the evidence has shown since the 1970s that "American psychiatrists were over diagnosing mental illnesses in comparison with the rest of the world and not doing systematic clinical assessments and that their diagnoses and clinical assessments were not reliable."

"Someday, in the 21st century, after the human genome and the human brain have been mapped, someone may need to organize a reverse Marshall plan so that the Europeans can save American science by helping us figure out who really has schizophrenia or what schizophrenia really is..."

In the meantime, psychiatry continues to expand its domain, devaluing those it labels as mental patients, subjecting them to harmful chemical interventions that undermine both their mental and physical health.

Dr. Andreasen is strangely silent about the all-pervasive influence the pharmaceutical industry has wielded on psychiatry during the second half of the 20th century. Conflicts of interest have been a dominant factor in the task force responsible for the formulation of DSM-III R and DSM-IV. Those conflicts of interest have been documented by Dr. Lisa Cosgrove and Dr. Sheldon Krimsky. [Link] and [Link]