- The document discusses the problems with psychiatry and how it studies mental illness. It argues that psychiatry ignores the influence of culture and views mental disorders as immutable biological facts rather than as influenced by social and cultural factors.
- It uses the example of hysteria in the late 19th century to show how psychiatric theories shape the symptoms patients experience. While hysteria is now seen as an outdated theory, the symptoms expressed by women at the time were still real.
- The influence of culture means that what constitutes a mental illness and its associated symptoms changes over time based on current theories. This calls into question the objectivity of the DSM and suggests mental illness should be viewed more as a language for communicating distress.
- The document discusses the problems with psychiatry and how it studies mental illness. It argues that psychiatry ignores the influence of culture and views mental disorders as immutable biological facts rather than as influenced by social and cultural factors.
- It uses the example of hysteria in the late 19th century to show how psychiatric theories shape the symptoms patients experience. While hysteria is now seen as an outdated theory, the symptoms expressed by women at the time were still real.
- The influence of culture means that what constitutes a mental illness and its associated symptoms changes over time based on current theories. This calls into question the objectivity of the DSM and suggests mental illness should be viewed more as a language for communicating distress.
- The document discusses the problems with psychiatry and how it studies mental illness. It argues that psychiatry ignores the influence of culture and views mental disorders as immutable biological facts rather than as influenced by social and cultural factors.
- It uses the example of hysteria in the late 19th century to show how psychiatric theories shape the symptoms patients experience. While hysteria is now seen as an outdated theory, the symptoms expressed by women at the time were still real.
- The influence of culture means that what constitutes a mental illness and its associated symptoms changes over time based on current theories. This calls into question the objectivity of the DSM and suggests mental illness should be viewed more as a language for communicating distress.
Study Mental Illness Psychiatry is under attack for not being scientific enough, but the real problem is its blindness to culture. When it comes to mental illness, we wear the disorders that come off the rack.
In the 1880s, women by the tens of thousands displayed the distinctive signs of hysteria: convulsive fits, facial tics, spinal irritation, sensitivity to touch, leg paralysis. (ILL!"#$"I%&: 'I()*LL* ")%'+!%&, Imagine for a moment that the $merican +sychiatric $ssociation was about to compile a new edition of its Diagnostic and Statistical Manual of Mental Disorders. -ut instead of .01/, imagine, 0ust for fun, that the year is 1880. 1 "ransported to the world of the late 11th century, the psychiatric body would have virtually no choice but to include hysteria in the pages of its new volume. 2omen by the tens of thousands, after all, displayed the distinctive signs: convulsive fits, facial tics, spinal irritation, sensitivity to touch, and leg paralysis. &ot a doctor in the 2estern world at the time would have failed to recogni3e the presentation. 4"he illness of our age is hysteria,5 a 6rench 0ournalist wrote. 4*verywhere one rubs elbows with it.5 )ysteria would have had to be included in our hypothetical 1880 DSM for the e7act same reasons that attention deficit hyperactivity disorder is included in the 0ust8 releasedDSM-5. "he disorder clearly e7isted in a population and could be reliably distinguished, by e7perts and clinicians, from other constellations of symptoms. "here were no reliable medical tests to distinguish hysteria from other illnesses then9 the same is true of the disorders listed in the DSM-5 today. +ractically spea:ing, the criteria by which something is declared a mental illness are virtually the same now as they were over a hundred years ago. "he DSM determines which mental disorders are worthy of insurance reimbursement, legal standing, and serious discussion in $merican life. "hat its diagnoses are not more scientific is, according to several prominent critics, a scandal. In a ma0or blow to the $+$;s dominance over mental8health diagnoses, "homas #. Insel, director of the&ational Institute of 'ental )ealth, recently declared that his organi3ation would no longer rely on the DSM as a guide to funding research. 4"he wea:ness is its lac: of validity,5 he wrote. 4nli:e our definitions of ischemic heart disease, lymphoma, or $I<!, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any ob0ective laboratory measure. In the rest of medicine, this would be e=uivalent to creating diagnostic systems based on the nature of chest pain or the =uality of fever.5 $s an alternative, Insel called for the creation of a new, rival classification system based on genetics, brain imaging, and cognitive science. "his idea>that we might be able to strip away all sub0ectivity from the diagnosis of mental illness and render psychiatry truly scientific>is intuitively appealing. -ut there are a couple of problems with it. "he first is that the science simply isn;t there yet. $ functional neuroscientific understanding of mental suffering is years, perhaps generations, away from our grasp. 2hat are clinicians and patients to do until then? -ut the second, more telling problem with Insel;s approach lies in its assumption that it is even possible to strip culture from the study of mental illness. Indeed, from 2 where I sit, the trouble with the DSM> both this one and previous editions>is not so much that it is insufficiently grounded in biology, but that it ignores the inescapable relationship between social cues and the shifting manifestations of mental illness. It is true that the DSM has a great deal of influence in modern America, but it may be more of a scapegoat than a illain! PS"#$IAT%" T&'DS '(T T( learn from its past. 2ith each new generation, psychiatric healers dismiss the enthusiasms of their predecessors by pointing out the unscientific biases and cultural trends on which their theories were based. Loo:ing bac: at hysteria, we can see now that 11th8century doctors were operating amidst fanciful beliefs about female anatomy, an assumption of feminine wea:ness, and the @ictorian8era weirdness surrounding female se7uality. $nd good riddance to bad old ideas. -ut the more important point to ta:e away is this: "here is little doubt that the symptoms e7pressed by those thousands of women were real. "he resounding lesson of the history of mental illness is that psychiatric theories and diagnostic categories shape the symptoms of patients. 4$s doctors; own ideas about what constitutes Areal; dis8ease change from time to time,5 writes the medical historian *dward !horter, 4the symptoms that patients present will change as well.5 "his is not to say that psychiatry wantonly creates sic: people where there are none, as many critics fear the new DSM-5 will do. $llen 6rances>a psychiatrist who, as it happens, was in charge of compiling the previous DSM, the DSM-IV>predicts in his new boo:, Saving Normal, that the DSM-5 will 4mislabel normal people, promote diagnostic inflation, and encourage inappropriate medication use.5 -ig +harma, he says, is intent on ironing out all psychological diversity to create a 4human monoculture,5 and theDSM-5 will facilitate that mission. In 6rances; dystopian post8 DSM-5 future, there will be a psychoactive pill for every occasion, a diagnosis for every inconvenient feeling: 4<isruptive mood dysregulation disorder5 will turn temper tantrums into a mental illness and encourage a broadened use of antipsychotic drugs9 new language describing attention deficit disorder that e7pands the diagnostic focus to adults will prompt a dramatic rise in the prescription of stimulants li:e $dderall and #italin9 the removal of the bereavement e7clusion from the diagnosis of ma0or depressive disorder will stigmati3e the human process of grieving. "he list goes on. 3 In .00B, a large study suggested that CD percent of $mericans will receive a mental8 health diagnosis at some point in their lifetimes. (ritics li:e 6rances suggest that, with the new categories and loosened criteria in the DSM-5, the percentage of $mericans thin:ing of themselves as mentally ill will rise far above that mar:. -ut recent history doesn;t support these fears. In 111C the DSM-IV>the edition 6rances oversaw>launched several new diagnostic categories that became hugely popular among clinicians and the public (bipolar II, attention deficit hyperactivity disorder, and social phobia, to name a few,, but the number of people receiving a mental8health diagnosis did not go up between 111C and .00B. In fact, as psychologist Eary Ereenberg, author of The Book of Woe, recently pointed out to me, the prevalence of mental health diagnoses actually went down slightly. "his suggests that the declarations of the $+$ don;t have the power to create legions of mentally ill people by fiat, but rather that the number of people who struggle with their own minds stays somewhat constant. 2hat changes, it seems, is that they get categorized differently depending on the cultural landscape of the moment. "hose wal:ing worried who would have accepted the ubi=uitous label of 4an7iety5 in the 11F0s would accept the label of depression that rose to prominence in the late 1180s and the 1110s, and many in the same group might today thin: of themselves as having social an7iety disorder or $<)<. @iewed over history, mental health symptoms begin to loo: less li:e immutable biological facts and more li:e a :ind of language. !omeone in need of communicating his or her inchoate psychological pain has a limited vocabulary of symptoms to choose from. 6rom a distance, we can see how the flawed certainties of @ictorian8era healers created a sense of inevitability around the symptoms of hysteria. "here is no reason to believe that the same isn;t happening today. )ealers have theories about how the mind functions and then discover the symptoms that conform to those theories. -ecause patients usually see: help when they are in need of guidance about the wor:ings of their minds, they are uni=uely susceptible to being influenced by the psychiatric certainties of the moment. "here is really no getting around this dynamic. *ven Insel;s supposedly ob0ective laboratory scientists would, no doubt, inadvertently define which symptoms our troubled minds gravitate toward. "he human unconscious is adept at spea:ing the language of distress that will be understood. 4 W$" D( PS"#$IAT%I# DIA)'(S&S fade away only to be replaced by something new? "he demise of hysteria may hold a clue. In the early part of the .0th century, the distinctive presentation of the disorder began to blur and then disappear. "he symptoms began to lose their punch. In 6rance this was called la etite h!sterie. %ne doctor described patients who would 4content themselves with a few gesticulatory movements, with a few spasms.5 )ysteria had begun to suffer from a :ind of diagnostic overload. -y 11/0s or so, the dramatic and unmista:able symptoms of hysteria were vanishing from the cultural landscape because they were no longer recogni3ed as a clear communication of psychological suffering by a new generation of women and their healers. It is true that the DSM has a great deal of influence in modern $merica, but it may be more of a scapegoat than a villain. It is certainly not the only force at play in determining which symptoms become culturally salient. $s 6rances suggests, the mar:eting efforts of -ig +harma on "@ and elsewhere have a huge influence over which diagnoses become fashionable. !ome commentators have noted that shifts in diagnostic trends seem uncannily timed to coincide with the term lengths of the patents that pharmaceutical companies hold on drugs. Is it a coincidence that the 5 diagnosis of an7iety diminished as the patents on tran=uili3ers ran out? %r that the diagnosis of depression rose as drug companies landed new e7clusive rights to sell various antidepressants? (onsider for a moment that the diagnosis of depression didn;t become popular in Gapan until Ela7o8!mithHlein got approval to mar:et +a7il in the country. Gournalists play a role as well: 2e love to broadcast new mental8health epidemics. "he dramatic rise of bulimia in the nited Hingdom neatly coincided with the media fren3y surrounding the rumors and subse=uent revelation that +rincess <i suffered from the condition. !imilarly, an $merican form of anore7ia hit )ong Hong in the mid8 1110s 0ust after a wave of local media coverage brought attention to the disorder. "he tric: is not to scrub culture from the study of mental illness but to understand how the unconscious ta:es cues from its social settings. "his :nowledge won;t ma:e mental illnesses vanish ($mericans, for some reason, find it particularly difficult to grasp that mental illnesses are absolutely real and culturally shaped at the same time,. -ut it might discourage healers from leaping from one trendy diagnosis to the ne7t. $s things stand, we have little defense against such enthusiasms. 42e are always 0ust one bloc:buster movie and some wee:end therapist;s wor:shops away from a new fad,5 6rances writes. 4Loo: for another epidemic beginning in a decade or two as a new generation of therapists forgets the lessons of the past.5 Eiven all the players stirring these cultural currents, I;d ma:e a si3able bet that we won;t have to wait nearly that long. http://www.psmag.com/health/real-problem-with-dsm-study-mental-illness- 58843/ 6
Biochemical and Pharmacological Roles of Adenosylmethionine and the Central Nervous System: Proceedings of an International Round Table on Adenosylmethionine and the Central Nervous System, Naples, Italy, May 1978