The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.
In a Cold War context, much was being made about the way the Soviets were stretching the boundaries of mental illness to label dissidents as mad in order to incarcerate and forcibly medicate them. But Western critics also began to look askance at their own shrinks and to allege that the psychiatric emperor had no clothes. A renegade psychiatrist called Thomas Szasz published a best-selling broadside called The Myth of Mental Illness, suggesting that psychiatrists were pernicious agents of social control who locked up inconvenient people on behalf of a society anxious to be rid of them, invoking an illness label that had the same ontological status as the label “witch” employed some centuries before. Illness, he truculently insisted, was a purely biological thing, a demonstrable part of the natural world. Mental illness was a misplaced metaphor, a socially constructed way of permitting an ever-wider selection of behaviors to be forcibly controlled under the guise of helping people. (...)
To address the embarrassment, one of the profession’s internal critics, Robert Spitzer of Columbia University, persuaded the American Psychiatric Association to authorize the development of a new diagnostic manual. The document he and his Task Force produced, approved and published in slightly modified form in 1980 as the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM III for short) launched a revolution in American psychiatry whose effects are still felt today. Versions III R (revised), IV, and IV TR (text revision) and DSM 5 (to be released in 2013) have been produced with numbing regularity. The advent of DSM III and its descendants constitute the backdrop to the argument presented in the new book by Allan Horwitz and Jerome Wakefield, All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders.
Horwitz and Wakefield want to argue for the harmful impact of what is often called the neo-Kraepelinian revolution in psychiatry. Emil Kraepelin was the fin-de-siècle German psychiatrist who launched the fashion for descriptive psychopathology and first made the distinction between dementia praecox and manic-depressive illness. Horwitz and Wakefield suggest that the efforts of Kraepelin’s late-twentieth century successors to make psychiatric diagnoses more rigorous and predictable have instead enabled psychiatric pathology to get out of hand. They identify two problems: the psychiatric profession’s obsession with simplistic, symptom-based diagnoses, and the looseness of its criteria for defining mental states as pathology. All sorts of anxieties that are in reality part of the normal range of human emotion and experience have been transformed by professional sleight of hand into diseases. The upshot, they contend, is that whereas thirty years ago less than five percent of Americans were thought to suffer from an anxiety disorder, nowadays some widely cited epidemiological studies have decreed that as many as 50 percent of us do so.
by Andrew Scull, LA Review of Books | Read more:
