Psychiatry’s Incurable Hubris by G. Greenberg
The biology of mental illness is still a mystery, but practitioners don’t want to admit it.
…But, as Earle knew, psychiatrists could not peer into a microscope to see the biological source of their patients’ suffering, which arose, they assumed, from the brain.
They were stuck in the premodern past, dependent on “the apparent mental condition [his emphasis], as judged from the outward manifestations,” to devise diagnoses and treatments.
The protracted attempt to usher psychiatry into medicine’s modern era is the subject of Anne Harrington’s Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.
As her subtitle indicates, this is not a story of steady progress. Rather, it’s a tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster.
From ice baths to Prozac, each development Harrington describes was touted by its originators and adherents as the next great thing—and not without reason.
Some people really did emerge from an insulin coma without their delusions; some people really are roused from profound and disabling depressions by a round of electroconvulsive therapy or by antidepressant drugs.
But in every case, the treatment came first, often by accident, and the explanation never came at all.
The pathological basis of almost all mental disorders remains as unknown today as it was in 1886—unsurprising, given that the brain turns out to be one of the most complex objects in the universe.
Even as psychiatrists prescribe a widening variety of treatments, none of them can say exactly why any of these biological therapies work.
It follows that psychiatrists also cannot precisely predict for whom and under what conditions their treatments will work. That is why antipsychotic drugs are routinely prescribed to depressed people, for example, and antidepressants to people with anxiety disorders.
Psychiatry remains an empirical discipline, its practitioners as dependent on their (and their colleagues’) experience to figure out what will be effective as Pliny Earle and his colleagues were.
Little wonder that the history of such a field—reliant on the authority of scientific medicine even in the absence of scientific findings—is a record not only of promise and setback, but of hubris.
That word does not appear in Mind Fixers, despite its repeated accounts of overreach by enthusiastic doctors who are often the last to recognize the failure of their theories. As Harrington tells us at the outset, she is committed to restraint.
Harrington is right to sigh over what has too often proved to be a yelling match between equally deaf opponents—members of an ambitious profession convinced that psychiatry is making strides toward understanding mental illness, and critics who believe it is at best a misguided attempt to help suffering people and at worst a pseudoscience enabling social control at the expense of human dignity. Indeed, since the sides first squared off, more than half a century ago, they seem to have learned little from each other.
….In this sense, the attempt to work out the biology of mental illness is different from the attempt to work out the biology of cancer or cardiovascular disease.
The fact that the brain is necessary to consciousness, added to the fact that the brain is a chunk of meat bathing in a chemical broth, does not yield the fact that conscious suffering is purely biological, or even that this is the best way to approach mental illness.
Those unresolved, and perhaps unanswerable, moral questions loom over the history that Harrington traces here.
….At the risk of being polemical, let me suggest that Harrington’s worddisingenuous fails to describe the cynicism of Robert Spitzer, the editor of theDSM-3, who acknowledged to me that he was responding to the fact that “psychiatry was regarded as bogus,” and who told me that the book was a success because it “looks very scientific. If you open it up, it looks like they must know something.”
Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit.
Plain bad faith is what’s on display, sometimes of outrageous proportion.
And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits.
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