This is a brutal interview on the fraud and failure of psychiatry. The only question remaining is whether the field can reform or whether it will die (gradually or with a bang). Highlights from the article:
One, the low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable. It is too easy for critics and the public to point to the scientific findings that contradict it.
Second, a number of pharmaceutical companies have shut down their research into psychiatric drugs [see Science, 2010], and they are doing so because, as they note, there is a lack of science providing good molecular targets for drug development. Even the drug companies are moving away from the chemical-imbalance story, and thus, what we are seeing now is the public collapse of a fabrication, which can no longer be maintained.
I think this challenging of the validity of DSM is, in many ways, potentially much more of a paradigm-changer than are the scientific reports that detail how the medications may be causing long-term harm. Our current drug-based paradigm of care, which presents drugs as treatments for the symptoms of a “disease,” stems from DSM III. The APA [American Psychiatric Association] and its leaders boasted that when DSM III was published in 1980, that the field had now adopted a “medical model,” and thus its manual was now “scientific” in kind.
In fact, the APA had adopted a “disease model,” and if you carefully read the DSM III manual, you saw that the authors acknowledged that very few of the diagnoses had been “validated.” The APA’s hope and expectation was that future research would validate the disorders, but that hasn’t happened. Researchers haven’t identified a characteristic pathology for the major mental disorders; no specific genes for the disorders have been found; and there isn’t evidence that neatly separates one disorder from the next. The “disease model,” as a basis for making psychiatric diagnoses, has failed.
We are now witnessing, in Insel’s statements and those by Allen Frances, an acknowledgment of this failure. And here is why this is potentially such a paradigm-changer: The foundation of any medical specialty begins with its diagnostic manual, which should be both reliable and valid. If the disorders listed in a manual haven’t been validated, then you can’t conclude they are “real,” in the sense of the disorders being unique illnesses, and the diagnoses being useful for prescribing an appropriate treatment.
Thus, when Insel states that the disorders haven’t been validated, he is stating that the entire edifice that modern psychiatry is built upon is flawed, and unsupported by science. This is like the King of Psychiatry saying that the discipline has no clothes. If the public loses faith in the DSM and comes to see it as unscientific, then psychiatry has a real credibility problem on its hands, and that could prove to be fertile ground for real change.
Even as the intellectual foundation for our drug-based paradigm of care is collapsing, starting with the diagnostics, our society’s use of these medications is increasing; the percentage of children and youth being medicated is increasing; and states are expanding their authority to forcibly treat people in outpatient settings with antipsychotics drugs. Disability numbers due to mental illness go up and up, and we don’t see that as reason to change either. History does show that paradigms of psychiatric care can change, but, in a big-picture sense, I don’t know how much is really changing here in the United States.
I think we have to appreciate this fact: any medical specialty has guild interests, meaning that it needs to protect the market value of its treatments. If it is going to abandon one form of treatment, it needs to be able to replace it with another. It can’t change if there is no replacement in the offing.
When the APA published DSM III, it basically ceded talk therapy to psychologists, counselors, social workers and so forth. Psychiatry’s three domains, in the marketplace, were diagnostics, research and the prescribing of drugs. Now, 34 years later, we see that its diagnostics are being dismissed as invalid; its research has failed to identify the biology of mental disorders to validate its diagnostics; and its drug treatments are increasingly being seen as not very effective or even harmful. That is the story of a profession that has reason to feel insecure about its place in the marketplace.
Yet…this is why it is going to be so hard for psychiatry to reform. Diagnosis and the prescribing of drugs constitute the main function of psychiatrists today in our society. From a guild perspective, the profession needs to maintain the public’s belief in the value of that function. So I don’t believe it will be possible for psychiatry to change unless it identifies a new function that would be marketable, so to speak. Psychiatry needs to identify a change that would be consistent with its interests as a guild.