The Failures of Psychiatry and Psychology

Monday, May 03, 2010

In 1973, Psychiatrist Dr. David Rosenhan assembled 8 very normal people, including himself, to show up at random hospitals in the U.S. and announce to the psychiatrist on duty that they heard a voice in their head that said the word "thud." That should be the only lie they tell. They were admitted as schizophrenics and bipolars, given strong psychotropic drugs, and could not get out sometimes for months. Ultimately, the only way they could get out was to pretend that they were insane and then slowly show they were getting better.

When Dr. Rosenhan published his research in the journal Science, it rocked the professions of psychiatry and psychology. One major hospital challenged Dr. Rosenhan to do it again. He agreed and a month later, the hospital announced and released 41 "fakes." Dr. Rosenhan then announced that he had not sent any people.

After this failure, the fields then moved into more "mathematical" models based on checklists, looking at symptoms rather than asking "why?" At the end of the 1970s, hundreds of thousands of normal people in America were interviewed at random and the results of the questionnaires fed into computers. The results: more than 50% of Americans suffered from some type of mental disorder. As recently as 2005, similar studies show 46.4% of Americans have one or more mental disorders [].

This shift coincided with the discovery of serotonin reuptake inhibitors (SRI) drugs. In 2009, over 300 million prescriptions of psychiatric drugs were dispensed in the U.S. [].

The co-creator of the checklist system, Dr. Robert Spitzer now says that this system is flawed.

At its heart, the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) is a simple matter: Do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments and contexts in which observers find them? From Bleuler, through Kretchmer, through the formulators of the recently revised Diagnostic and Statistical Manual of the American Psychiatric Association, the belief has been strong that patients present symptoms, that those symptoms can be categorized, and, implicitly, that the sane are distinguishable from the insane. More recently, however, this belief has been questioned. Based in part on theoretical and anthropological considerations, but also on philosophical, legal, and therapeutic ones, the view has grown that psychological categorization of mental illness is useless at best and downright harmful, misleading, and pejorative at worst. Psychiatric diagnoses, in this view, are in the minds of observers and are not valid summaries of characteristics displayed by the observed...

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment – the powerlessness, depersonalization, segregation, mortification, and self-labeling – seem undoubtedly counter-therapeutic.

Dr. David L. Rosenhan, On Being Sane in Insane Places, Science, Vol. 179 (Jan. 1973), 250-258,

What happened is that we made estimates of prevalance of mental disorders totally discriptively without considering that many of these conditions might be normal reactions which are not really disorders. That's the problem, because we were not looking at the context in which those conditions developed.

Dr. Robert Spitzer, BBC Interview, 34:15, 2007,

These are among dozens of proposals being unveiled Wednesday by the American Psychiatric Association in the first complete revision since 1994 of the Diagnostic and Statistical Manual of Mental Disorders, or "DSM" -- the massive tome that has served as the bible for modern psychiatry for more than half a century...

"There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic," said Robert Spitzer, a professor of psychiatry at Columbia University, who has been one of the most vocal critics of the DSM revision process.

Revision to the bible of psychiatry, DSM, could introduce new mental disorders, The Washington Post, Rob Stein, February 10, 2010,

About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence.

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication, Kessler et al, 2005,