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Tuesday 2 December 2008

Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present

Running for shelter

Anthony Daniels looks at two books on psychiatry

They attack head-on the Diagnostic and Statistical Manual of the American Psychiatric Association, particularly its definition of depression. The DSM IV, as it is everywhere known, has been treated around the world with a superstitious veneration that makes that accorded to miracle- working virgins appear moderate and rational. It is nonetheless an intellectual house of cards.

For a doctor, or indeed anyone else, to diagnose someone as suffering from major depression, all that he need do is check that a person has suffered from five out of nine symptoms, all of them very common, for at least two weeks. The context in which he suffers them is quite irrelevant.

This means that the diagnosis can be made reliably — anyone, after all, can tick the requisite boxes and count up to five. But the question of whether the diagnosis is valid, that is to say that it refers to or picks out anything that actually exists in nature, is extremely doubtful. Indeed, common sense and reflection on the most elementary knowledge of human life suggests that it does not.

As the authors point out with great clarity, this is not a matter of merely theoretical interest. The adoption of the DSM IV definition of depression has had several baleful consequences. There is no scientific reason why depression should be diagnosed in the presence of five rather than four or three symptoms, and indeed a movement has grown up to recognise lesser degrees of supposed depression which, if treated, will avoid the development of more serious depression. Thus the number of supposedly depressed people keeps expanding like the ripples on a pond after a stone has been thrown into it. DSM IV has encouraged the development of intrusive and even sinister screening instruments to detect so-called depression in large populations (the American government wants every adolescent in the country screened for depression). It has encouraged the widespread and grotesque overprescription of anti-depressants, whose side-effects are real but whose benefits are doubtful. It encourages people to disavow responsibility for their own lives and to think of and present themselves as ill. It dehumanises medicine and psychiatry, by discouraging interest in the lives of patients other than as bearers of symptoms. It is scientistic rather than scientific, and has promoted immense quantities of junk science.

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