A Scientific Delusion?(second edition)
Reviewed by Mira de Vries
Among the professionals who raise their voices against psychiatry, the general consensus is that psychiatric disorders by their various names do not exist. The most prolific author on this subject is Dr. Thomas Szasz. His best known book, published in 1961, is called The Myth of Mental Illness. Szasz asserts that mental illness by definition cannot exist, as disease means demonstrable physical lesion. Only the body can be ill, not the mind. Dr. Fred Baughman agrees. On his website, named ADHD fraud he states: “Twenty five years of research ... has failed to validate ADD/ADHD as a disease.” Dr. Peter Breggin asserts in his classic book Toxic Psychiatry that any lesion found is not the cause of purported mental illness, but rather the result of (mis)treatment for it.
Supporters of biopsychiatry, on the other hand, insist that psychiatric disorders do involve physical lesions which are yet to be discovered. They support their claim by pointing out that broken bones were real enough before x-ray photographs were invented, syphilis was a real disease before the spirochete was discovered, and Creutzfeldt-Jakob Disease was killing people before anyone had heard of prions. This is true, of course. The presence of physical lesion cannot be ruled out just because it hasn't been demonstrated to exist. So to deny that "psychiatric disorders" are diseases, disease will have to be defined some other way than dependent on physical lesion.
This is precisely what Mary Boyle, Professor of Clinical Psychology, does. She begins by explaining that illness and disease are not scientific terms at all. They are lay terms. Illness is identified by the person himself (or if he is incompetent, by the person responsible for him) before the services of a physician are sought. He does this because he has complaints, which in medicine are called symptoms. Symptoms are the subjective complaints reported by the patient to the physician.
The physician’s job is to identify which symptoms are relevant and which aren’t, and to look for a pattern in them. Identifying patterns is what science is all about.
Once a pattern in the patient’s complaints has been found to match a familiar pattern, the physician looks for signs that fit in with the symptoms. A sign in medicine is something related to symptoms that the physician can observe and measure, possibly using special tools.
When the symptoms and signs together form a pattern which matches patterns familiar to the physician from his training, professional literature, or clinical experience, this is called a syndrome. The syndrome itself, however, is not a fact, but an idea, a construct. To be valid, it has to refer to symptoms and signs that are unlikely to be clustered together by chance. It also has to be usable to predict what is going to happen next to the patient.
Syndromes are given names which may or may not include the word syndrome. Down’s Syndrome includes it. Diabetes doesn’t but is nonetheless a syndrome. Confusingly, some syndromes are given names which have the word disease in it such as Creutzfeldt-Jakob Disease (my example, not Boyle’s.)
So let’s say a patient goes to his doctor and complains of thirst, weight loss, and fatigue. Individually, each of these complaints are frequent, and can have a variety of causes. Clustered together, these complaints form a pattern of complaints that occur when people have high levels of sugar (glucose) in their blood. However, the doctor will not decide that this is the case until he has tested for high glucose levels in the patient’s urine (before modern laboratory tests, done by tasting!) or blood. Only when the tests indeed verify high glucose levels, does the doctor “diagnose” diabetes. The doctor can then, on the basis of previous experience with this syndrome, reliably predict what will happen next, and possibly propose a course of treatment which will change the prediction. If, however, no unusual level of glucose was detected by the tests, the doctor will probably tell the patient that his complaints are unrelated, and that he (the doctor) doesn’t know what, if anything, is wrong with him.
The DSM claims that schizophrenia (and other "disorders") is a syndrome. But this cannot be, because there is no pattern in the symptoms. It is perfectly possible, and in fact constantly happens, that various people are labeled “schizophrenic” according to the DSM even though they don’t have a single “symptom” in common.
The supposed symptoms themselves are often not complaints by the patient at all, but complaints by others, or accusations, or attributes assigned by the psychiatrist. None are supported by signs, which, it must be remembered, are observable and measurable by the physician. Take, for example, the classic “symptom” of hearing voices. These voices cannot be heard by anyone else. There is no way to verify that the person is actually hearing voices. And of course, as has been demonstrated over and over again by research, the label of “schizophrenia” (or others in the DSM) has no predictive power whatsoever.
No amount of revisions and claims for scientific basis will ever be able to correct the underlying flaw in the DSM, namely, that it assumes the existence of syndromes, patterns of symptoms and signs with reliable predictive value, which don’t exist.
Boyle is not saying that none of the people brought to the attention of psychiatrists have anything wrong with their brain. She is saying that nobody can know what if anything is wrong with the person, because the symptoms and signs (of which there usually are none) don’t match any pattern. Kraepelin himself, considered the discoverer of “schizophrenia,” was not able to establish such a pattern, even though in retrospect, it is likely that most of his patients were victims of the epidemic of encephalitis lethargica which swept through Europe in his day. That disease was caused by a virus, and like so many epidemics, has since died out. Kraepelin’s belief that the disease was hereditary was undoubtedly influenced by the popularity of eugenics among psychiatrists of his day, which led to unspeakable crimes and genocide. Tellingly, psychiatrists still insist today that “schizophrenia,” the non-existent syndrome, is hereditary, or as they call it now, genetic.
No doubt Boyle was repeatedly asked, "If schizophrenia doesn’t exist, then what is wrong with these people?" That may be why in the final chapter she makes a stab at answering this question. Focusing on the two classic features of “schizophrenia,” namely hearing voices and delusions, she suggests seeing them not as part of a pattern or syndrome, but, for instance, as coping mechanisms. Although her suggestions are interesting and compelling, they obviously suffer from the same flaws she so brilliantly exposes regarding the concept of schizophrenia: no pattern, no proof, no predictive value, no usefulness. She seems to be proposing dealing with these phenomena outside of the medical profession, but inside the psychological profession. Like so many other professionals in the field, she fails to take that last little step, and recognize that no profession is equipped to deal with these phenomena, and that what people affected by them need is non-professional, practical assistance.
Boyle’s explanation why “schizophrenia” (and by extension, all other psychiatric disorders) doesn't exist, is the clearest and most thorough I have ever read. Yet I hesitate to recommend this book to you. The sophisticated language and challenging argumentation are not for everybody. If you can borrow it from the library (make sure you get the second edition), do it. If you have to buy it, and you are uncomfortable with complicated texts or you are not a native English speaker, I recommend Mad in America instead. However, do keep Boyle's message in mind. Nobody else has explained it as well as she has.