Irwin Savodnik is a psychiatrist and philosopher who has an apparent gripe against the medical establishment (“Psychiatry’s sick compulsion: turning weaknesses into diseases,” January 1, 2006).
Unfortunately, his argument seems predicated on his understanding of science from a purely medical perspective. But science isn’t limited to the world of medicine, genetics or biology. Psychologists and other social scientists have a long, rich history of empirical research that support mental disorder diagnoses. Railing against psychiatric diagnoses because they don’t parallel medical diagnostic procedures is a little like railing against cognitive-behavioral psychotherapists for not spending enough time analyzing a patient’s dreams. It’s comparing apples to oranges.
Medical tests are for medical conditions. Mental health diagnoses, on the other hand, are thought to be largely caused by a complex combination of biological, psychological and social factors that come together to create a testable, reliable symptom cluster. How do I know this? Because social scientists, such as psychologists, have amassed over four decades worth of research validating those symptom clusters.
One of Savodnik’s points to support his argument is to say, “Well, look at how large the diagnostic manual has grown in four decades.” He states there is no comparison to the explosion of diagnostic categories in medicine, politely ignoring earlier medicine at the turn of the century. In medicine, they have a similar book of diagnoses called the ICD. The ICD-10, the current version of this book, has some 12,420 diagnostic codes and 8,000 categories. Compare this with the previous version which had only 6,969 diagnostic codes and 4,000 categories. The original ICD-1, released in 1900, had less than 200 such categories. As you can see, the multiplication of diagnoses is not limited to mental disorders.
Scientists are taught to ask questions and not assume they know the sometimes not-so-obvious answers. This is called “hypothesis testing.” An alternative hypothesis to Savodnik’s arguments on diagnostic quantity is simple – in the past four decades, neuroscientists and behavioral researchers have learned a lot more about how brains and human behavior actually works. Much as the science of medicine exploded in the early 20th century, the science of human behavior is now experiencing a similar knowledge explosion.
So while it may be fun to turn to statistics to support an argument, it isn’t scientific or helpful for individuals who, rather than being “self-indulgent,” are diligently working to try and understand and help themselves via established, empirical treatments such as psychotherapy and psychiatric medications. Savodnik believe it’s simply a matter of “personal responsibility” for people with serious mental disorders such as schizophrenia or depression. This sounds an awful lot like the argument that one should just be able to “pull oneself up by one’s bootstraps” and carry on no matter what adversity one faces.
I naively thought we had left such stigmatizing views behind in the 1990’s. The new year sadly illustrates how such stigma is still alive and thriving, even amongst fellow professionals.
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