Letter to the Wall Street Journal in Response to Sally Satel’s Op-Ed piece by Zvi Lothane.
Sally Satel’s caveats concerning the forthcoming DSM-V, a child of the current DSM-IV, are well taken. I would like to suggest further clarifications. Unlike medicine, a clinical discipline that deals with medical conditions, psychiatry is a hybrid discipline, not just a cultural institution but a social and political one as well, dealing with a person’s conduct in society.
Social misconduct has been variously categorized as vice by philosophers, sin by priests, crime by policemen, and disease by psychiatrists. Diagnosing social misconduct as psychosis has serious social consequences: involuntary commitment, involuntary drug treatments, and stigmatization. Psychiatric diagnoses are also powerful political and economic tools in the marketplace, serving the pharmaceutical and insurance industries. Follow the money: witness the intensity of the current political storm about the future of the entire health care system.
While reaching consensus on diagnoses may be useful in facilitating communications among scientists, the question still remains whether psychiatric diagnoses are discovered, like AIDS, or invented, like dementia praecox or schizophrenia, the names given by Kraepelin and Bleuler to what was previously called madness, both in common and scientific parlance. It is not, as Thomas Szasz famously said, that mental illness is a myth, for personal or social dysfunction is real enough, it is that the names, i.e., diagnoses, that are mythical creations that may become concretized, or reified, as essences or things in themselves.
The DSM has little to say about treatment, other than implying that the only real treatment today is drug treatment. Nor is it primarily concerned with the vast majority of people who do not need institutional therapy but office treatment. Is telling a person that according to DSM descriptor criteria he has a “pychosis risk syndrome” like telling a patient that he has or
does not have cancer? Doe it help the patient? Suspecting the presence of a psychiatric disorder today may not be far from suspecting a person of being a witch or a sorcerer in 1486, when the Witches* Hammer by two Dominican friars was published and used by the Inquisition to catch and *diagnose* women accused of being witches; it is more like the psychiatrist getting busy in a catchment area. I do not mean to cast aspersion on my profession with this comparison, merely to underscore the difference between serving institutional and societal vs. individual needs. People do
need help to get a grip on their life’s dramas, their interpersonal conflicts with themselves and with others, to reach understanding and change in a dialogue with a therapist committed to their personal welfare and well-being.
Despite its progress, psychiatrists, literally healers of the soul and through the soul, i.e. conversation, should never lose sight of their primary mission: to help people overcome pain and suffering.
Henry (Zvi) Lothane, MD, DLFAPA
Clinical Professor Department of Psychiatry
Mount Sinai School of Medicine
1435 Lexington Avenue New York, NY 10128(212) 534 5555