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March 01, 2007

Psychiatric Problems

I posted Dr. Minot’s devastating  ‘psychiatric evaluation’ of  President Bush for two reasons. The first was because I emphatically agree with it as political opinion; the second was to point it out as an arresting example of the degree to  which Psychiatry has, once again, been seduced into adopting a completely conjectural and misleading nomenclature for the conditions it aspires to treat.

Psychiatry is a clinical specialty that was dominated during the first half of the Twentieth Century by the thinking of Sigmund Freud (1856-1939) the man considered by most as its founder. Almost from its beginning, it was odd man out among medical specialties precisely because it deals almost exclusively with conditions that cannot be placed within the same objective and marvelously adaptive intellectual framework that was created by Pathology, the non-clinical and largely descriptive specialty founded by Rudolph Virchow, an equally brilliant, but less famous Freudian near-contemporary. The reason is simple: psychiatric conditions are not associated with the anatomic and chemical anomalies which provide pathologists with the objective standards they use to diagnose ‘somatic’ diseases.

One way to think of it is that Virchow’s intuition was to Medicine what Darwin’s was to Natural History: both simultaneously created supple intellectual frameworks able to accommodate new discoveries, indeed, whole new disciplines, without any need for radical revision of the underlying theory.

Amazingly (to me, at least), is the general failure of both Medicine and Psychiatry to appreciate those critical differences as they  apply to the concept of ‘diagnosis.’ That failure has allowed an absurdity as grotesque as the one enabling our drug policy to become prevalent within Medicine. But it gets worse: because our drug policy and psychiatric absurdities have now been mutually supporting each other for decades, ‘reform’ of either has become more daunting.

Both absurdities were enabled by the same cognitive mechanism: an uncritical extrapolation from an untested ‘theory’ based on a single false assumption. In the case of drug policy, the false assumption has gradually evolved into a (usually unstated) dogma: the ‘disease’ of ‘addiction’ represents the consequence most to be feared from any use of certain drugs and the only way to prevent it is a total ban on all  possession for any purpose. The equivalent psychiatric absurdity is that invention a purely conjectural diagnostic framework, also beyond testing, will facilitate the management of conditions that aren’t diseases at all, but merely collections of signs and symptoms. The trap, of course, is that those conditions, even though carefully labeled ‘disorders,’ are assigned equivalent code numbers and used to pigeon-hole patients with the same finality as a biopsy proven case of cancer.

That's all I have time for now, but I plan to add to it soon, because debunking DSM is an essential step in repudiating American drug policy; if for no other reason than that an absurdity like ‘Cannabis Use Disorder’ can be taken so seriously.

Doctor Tom

Posted by tjeffo at March 1, 2007 01:23 AM