« Psychiatric Problems | Main | What is a Potdoc? »

March 05, 2007

Psychiatry and Science; Evidence and Disbelief

I posted a quite different entry with the same title last Thursday (March 1), but then quickly deleted it because it just wasn’t the lucid critique of Doctor Minot’s psychiatric evaluation of George Bush I’d intended. The main reason was that I'd been rushing to get ready for a quick trip to LA to attend a one day course on the current chemotherapy of advanced lung cancer, a subect more closely related to my former life as a Thoracic Surgeon, but one I’d been away from for several years.

As it turned out, that meeting not only brought me up to date on a rapidly evolving field of Medicine, it also dramatically illustrated how the yawning abyss that’s been developing between scientific and religious thinking has been overlooked in the areas of both Psychiatry and Drug Policy (more on the meeting and its lessons later). Briefly, neither Psychiatry nor US drug policy is as ‘scientific’ as claimed; and the same generic reason applies to both: they’ve been following erroneous roadmaps based on controlling assumptions that were both false beyond testing far long intercals.

Because both public policies and scientific nosologies are based on theories, and because theories are primarily intended to organize facts into coherent explanations, they are never ‘true’ or ‘false;’ but, rather coherent and valid or incoherent and invalid. When a theory is demonstrated, usually by new observations, to require some adjustment, it can be modified, a common phenomenon that occurs gradually by consensus in most disciplines without a much public fuss. When, as in the case of Phrenology, an entire field is ultimately shown to be based on a major false assumption, it’s scrapped.

Psychiatry has operated under two separate, but equally unscientific schema for the classification of the clinical entities it deals with for its entire history and should either radically modify or scrap (my preference) the DSM. US Drug policy, on the other hand, been based on simplistic false assumptions about ‘addiction’ for nearly a century. Because those implementing it have never allowed those assumptions to be tested at all, the policy itslef  has long been out of synch with medical reality and is based on such inappropriate religious thinking that it should be scrapped forthwith.

I realize how sweeping and improbable these statements may seem to many, especially those without the requisite background in science. That’s why I’m only introducing them in preliminary fashion. However, because they are so critical to any understanding of how an extensive  false paradigm could have evolved (and still be evolving) around a protected drug policy,  I’ll be returning to them frequently.

To begin with Psychiatry, its modern clinical history begins with two European pioneers, Sigmund Freud and Emil Kraepelin, both born in 1856, and each quickly gaining professional recognition.  However, only Freud went on to capture public and literary imagination and thus cause Psychoanalysis to dominate popular notions of Psychiatry throughout the first half of the Twentieth Century while Kraepelin was being almost completely forgotten.

However, because Kraepelin’s memory is now being (mistakenly) credited with inspiring the modern DSM, some accurate knowledge of each man becomes important to any critique of modern psychiatric nosology, and — because these things are never simple— it’s also necessary to consider the contributions of yet another Ninetenth Century European physican, Rudolph Virchow,  born  three and a half decades before Freud and Kraepelin and, during their lifetimes, was transforming Pathology into the specialty that plays an essential role by serving as modern Medicine’s gold standard for diagnosis. Because the conditions treated by Psychiatry do not produce characteristic anatomic changes, they simply cannot be usefully classified like those that do.

To focus this entry back on the key points I hope to establish: Psychiatry’s error has been in embracing two misleading schema for classifying the clinical entities it deals with on a daily basis. My objection is that while those conditions certainly exist, they do not qualify as ‘diseases.’ Freudian psychoanalysis captured the public imagination, but was never even remotely scientific; however, it effectively displaced the more clinically oriented, empirical approach of Kraepelin until after World War Two, when the nascent reform effort to Freudian influence represented by the DSM first emerged in 1952 . It’s now necessary to introduce another historically important physician: Doctor Robert Spitzer, whose enthusiastic, but ( I believe) completely misguided efforts have transformed the DSM from a minor project into a giant mistake that slavishly reinforces the mistaken assumptions about drugs and addiction our drug policy so oobviously takes for granted.

In the meantime, a number of potent drugs and delivery systems were being introduced throughout the Nineteenth and Twentieth Centuries. Their use eventually inspired a punitive public policy in 1914, but any role that psychiatric conditions might have been playing was lumped under the generic term of ‘addiction.’ The same severely limited Nineteenth Century assumptions about addiction and its only permissible treatment (obligatory abstinence) have remained at the heart of the policy ever since. That policy should be scrapped urgently; not simply because it doesn’t work, as most reformers currently insist (and the public already knows),  but because its false assumptions mean it will NEVER work and there is no gradual way to ‘reform’ such gross error; especially while the policy’s doctrinaire adherents control both its enforcement and the national budget.

I realize this still leaves me with the task of addressing Dr. Minot’s evaluation of Dubya, but at least, this sets the stage.

Doctor Tom

Posted by tjeffo at March 5, 2007 05:11 PM