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article imageOp-Ed: US therapist slams ‘fictional’ psychiatric standards

By Paul Wallis     Oct 10, 2013 in Health
Sydney - A US psychotherapist called Gary Greenberg has dropped a tonnage of criticism on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) the diagnostic Bible of the profession.
His book, The Book of Woe: The DSM and the Unmaking of Psychiatry, came out earlier this year, and the debate is spreading.
A lot of people might agree with Greenberg.
The National Post covered Greenberg's work for Mental Health Day:
Greenberg argues that, thanks to the DSM, “countless millions” are hooked on powerful antidepressants to cure a mythical “chemical imbalance”
Updated at regular intervals — DSM-5, the fifth edition, was published in May — it has considerable influence worldwide, including in the U.K., where it underpins several clinical guidelines on mental health. Yet Greenberg holds that by imposing a pseudoscientific model on our “hopelessly complex” inner world, it creates a “charade” of non-existent disorders.
Greenberg’s issues include childhood disorders, addictive pharmaceuticals which cause suicide (suicidal thoughts are listed as a “side effect” on some medications) and pretty much the full range of the most hotly debated areas of psychiatry. That takes guts when you’re a professional psychiatrist.
One quote in particular says a lot, and contradicts a lot of “common wisdom” by pointing out practical issues rather than spinning theories:
“It is intellectual rather than financial corruption. The idea that human suffering can be reduced to a biochemical imbalance — this is about ideology rather than money.”
Greenberg’s book tracks in painstaking detail how the DSM’s decision cookie cutters have created “false epidemics” of over-diagnosis and over-treatment.
To add some ammunition to this argument:
All of a sudden, a condition is suddenly seen as prevalent, not because of observed incidence, but because of a changed diagnostic method? Not many epidemiologists would buy that, at any price. ADHD and bipolarity are used by Greenberg as examples.
It cannot be medically, ethically or even theoretically correct to assume a mental condition is “scalable” simply to match a diagnostic method.
Greenberg offers a rather satirical comparison:
He is unimpressed with the DSM-5’s (DSM 5 is the new edition of the psych “Bible”) new Hoarding Disorder — “Is an eccentric old man living amid his junk sicker than a billionaire who is always thinking of the next way to make a buck?
On that basis, millionaire collectors would be considered psychiatrically suffering from a mental condition. Are stamp collectors with millions of stamps nuts? Most would tend to say not. How about My Little Pony collectors? There’s a point where diagnoses seem to clash with people’s favorite things.
Greenberg says in effect that psychiatry has created a self-promoting monster. He wants psychiatrists to be “more honest” and to admit that medications only help some people.
Another quote:
“…Psychiatry has little knowledge of the underlying processes governing mental health and it should not pretend otherwise.”
Some time ago I did an article called: 30 years misdiagnosed with schizophrenia- How many more?
It was a saga of total lack of interest in the patient, as far as I could tell. A previous diagnosis existed and wasn’t questioned.
I also found:
1. Epileptic diagnosed as schizophrenic for 10 years- and denied the right treatment.
2. A 1983 record of 76 bipolar patients misdiagnosed with schizophrenia
3. Asperger’s Syndrome patients misdiagnosed with schizophrenia
4. Misdiagnosis of psychotic syndrome as schizophrenia
Pretty gruesome list, isn’t it? It’s necessary to question whether a profession which never seems to quality control itself can do the job it’s supposed to do.
The medication issue was another problem I mentioned in that article:
There’s a culture of referrals followed by chronic apathy and lack of patient monitoring and management. The person referred to received a “blank check” series of repeats for multiple antidepressants, anti-psychotics and sedatives. This is appalling- Giving a person with a condition well known for suicidal behaviour the means to commit suicide by an overdose.
There’s a famous story of an LA psychiatrist who had a new patient. The patient showed him what he was taking. The psychiatrist told him to stop taking those medications and come back in a week. The patient came back and said he felt fine.
(I'm also reminded of a case when a child in the UK was given an exorcism for screaming and behaving oddly. She died. The autopsy discovered she had a broken leg.)
When did anyone suddenly get the right to provide possibly toxic medicines “on principle”, with no effective oversight? Greenberg is making a point his profession doesn’t have the guts, or possibly the sincerity or intelligence, to make. It’s notable that most self-proclaimed heroes of medical care don’t make that point, either. The current system of treatment is just another global health catastrophe, duly certified and ignored.
Where are the great defenders of human rights when systematic abuse of people’s medical right to proper treatment is happening to millions of people every day?
Perhaps more to the point:
How many cowards does it take to change a prescription?
How about a culture?
Don’t hold your breath waiting to find out. Like all the “smug” professions, psychiatry has sold its shriveled soul for a few bucks to real nuts. The rest is just another chapter in human misery.
This video is about Greenberg’s book, The Book of Woe, referring to DSM-5. The YouTube “about” section says “embedding disabled by request”, so I hope I’m not doing him any disservice by putting it in this article, but I do think his message needs to spread far and wide. You have to like a guy who “has to question his self-loathing”, though, and the video adds quite a bit to the information made publicly available, although it's short and cuts out in the middle of the talk before he reads to his audience.
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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