Creating
Mental Illness
by
Allan V.
Horwitz
2002
Reviewed by
Mira de Vries
Horwitz is
one of those tantalizing authors (see also: Blok, Blom,
Boyle, Caplan, Thomas, Walker)
in the field who exposes the folly and fraudulence
of psychiatric diagnoses, yet fails to follow his own views to their
logical conclusion.
Below are some of his own persuasive arguments questioning the validity
of the foundation of psychiatry and psychotherapy:
- “Contrary
to its definition of mental disorder, a basic principle in the DSM definitions
of particular disorders is to avoid inferences about the causes of
symptoms.”
- “The
reasons for the proliferation of mental illnesses lie in the historical
development of the psychiatric profession over the course of the
twentieth century.”
- “[T]he
grounds for inclusion of the conditions found in the DSM-III, and
perpetuated
in the DSM-II-R and DSM-IV, did not stem from either theory or research
but
from the need to maintain the existing clientele of mental health
professionals.”
- “Through
discarding etiology as a means of classification, the DSM could
encompass the
conditions treated by all competing schools of psychotherapy.”
- “If a
professional wants to argue, for example, that there is an entity
called ‘compulsive
television watching’ she can easily come up with specific criteria …
and train
observers to measure the disorder in a consistent way.”
- “Insurance
forms, not the nature of symptoms, demand precise diagnoses.”
- “[O]nce a
drug was developed, a specific illness would have to be found that the
drug
would treat.”
- “Once a
diagnosis has been created, it enters professional curricula,
specialists
emerge to treat it, conferences are organized about it, research and
publications deal with it, careers are built around it, and patients
formulate
their symptoms to correspond to it.”
- “Diagnostic
categories emerged in order to raise the prestige of psychiatry, to
guarantee
reimbursement from third parties, to allow medications to be marketed,
and to
protect the interests of mental health researchers and professionals.”
- “'Frightening mental illnesses'
...
help justify large research budgets for the NIMH.”
- “[T]he most
direct benefits of high prevalence estimates of depression accrue to
pharmaceutical companies.”
- “Their
dependence on professionals can lead [people] to produce the kinds of
symptoms
their therapists expect them to have… [the symptoms] vary as
professional fashions in
diagnosis change.”
- “Diagnostic
psychiatry recognizes the presence of ‘culture-bound’ disorders only in
other cultures.”
- “[T]he best
predictor of MPD is having a therapist who believes in the diagnoses.”
- “[L]inkage
analysis [linking psychotic disorders to particular locations on
chromosomes]
has to date been the source of more embarrassment than accomplishment
in
biological psychiatry.”
- “[M]ethods
of assessing brain structure and function… [and] the discovery of
neurotransmitters …despite rhetoric to the contrary…have not led to
significant
advances in knowledge about the causes of mental disorders.”
- “It does
not follow from the fact that drugs produce changes in the brain that
the
original brain state that is changed constitutes a mental disorder.”
- “[P]rofessionals
are not more effective clinicians than nonprofessionals… No amount of
coursework, training, or experience can create the qualities that lead
to
successful psychotherapy.”
But now
comes the big surprise. In spite of all of the above, Horwitz fully
believes in “the three major disorders that Kraepelin
distinguished one hundred years ago: schizophrenia, bipolar disorder,
and
endogenous depression.” How these “real” disorders can be reliably
identified,
or how Kraepelin identified them, he doesn't say. On the contrary, he
admits that "the distinction between people who can't function
appropriately and those who won't function appropriately is far more a
moral value judgment than a judgment based on psychiatric
knowledge.” Nor does he postulate as to the causes of these supposedly
real diseases.
He only mumbles that there is a “strong possibility that these are
brain-based
disorders.”
The drug
companies that conspire with NIMH and the
APA to convince us all
that we need their poiso- I mean medications, suddenly turn into heroes
when it comes to what he considers Kraepelinian diagnoses. “[T]he
greatest accomplishment of modern psychiatry [is] the development of
efficacious
psychotropic medications,” and “Schizophrenia … responds to the
phenothiazines
and clozapine. Overall, there is little doubt that these medications
are ‘antischizophrenic’
agents, not general tranquilizers.” Likewise, he goes on to claim that
lithium is
an effective treatment for “bipolar patients.” Yet when someone with a
diagnosis that Horwitz pooh-poohs feels helped by a drug, this "could
stem from cultural expectations for success, rather than from the
biological impact of the drug itself." He doesn't say whether he means
the patient's expectations or the physician's. Though Horwitz
acknowledges a study
which indicated that “patients [on a] placebo pill had the lowest rates
of
relapse,” he never entertains the idea that the drugs he lauds may be
precisely the
cause of a great deal of what he considers real mental illness.
Just as Horwitz
fails to present evidence for the presence of somatic lesion in his
three pet mental illnesses, so he fails to point out that somatic
lesion can never be conclusively ruled out. He ascribes the "sensations
of pain, fatigue, or distress" of "fibromyalgia in the contemporary
United states" to “sociocultural processes” and "the nature of
hysteria... [that] represent culturally produced symbolic entities
rather than direct indicators of underlying diseases." The unsustainability of this
position is given away by the fact that he makes the same claim about Lyme disease
(spread by ticks and curable
by antibiotics).
Why not just
admit that all of
psychiatry and psychotherapy is bunkum, and mental health workers don't
know what they are doing?
