Factions in Psychiatry
Greegor
psychiatry be used in court to prove diddly squat?
THE WALL STREET JOURNAL
June 28, 2008; Page W8
Five Best
Paul McHugh on books about the factions and follies of psychiatry
June 28, 2008; Page W8
1. Great and Desperate Cures
By Elliot S. Valenstein
Basic Books, 1986
Alone among medical disciplines, psychiatry is riven by factions, each
presuming pre-eminence and each capable of generating disasters. The
"brain faction" encompasses psychiatrists who would tackle all mental
disorders in the way one tackles urinary disorders: mess with the
machinery. In "Great and Desperate Cures," experimental psychologist
and sagacious scientist Elliot S. Valenstein describes the craze for
frontal lobotomy that sprang up in the mid-20th century. The practice
began when a self-promoting Portuguese neurosurgeon, Egas Moniz,
misunderstanding an experiment with chimpanzees, cut into the frontal
lobes of several seriously mentally-ill patients in his local
hospital, and claimed that they had improved. Lobotomies later went
into mass production when an American psychiatrist, Walter Freeman,
began to travel across the country to treat patients using nothing
more than a glorified ice pick that he pushed through the soft bones
in the roof of their eye sockets to sever their frontal brain regions.
Valenstein describes how this treatment flourished despite the absence
of evidence, how the media promoted it (especially after Moniz
received the Nobel Prize in 1949), and how thousands of patients with
chronic anxiety, depression and schizophrenia were made easier to
manage by being transformed into quiet mental invalids. Above all, the
book shows how a treatment that essentially killed mental life could
masquerade as a cure.
2. In the Name of Eugenics
By Daniel J. Kevles
Knopf, 1985
The "genetics faction" is made up of psychiatrists who presume that
mental infirmities rest on genetic endowments that can be eliminated
by selective reproduction. Daniel J. Kevles, a professor of the
history of science, documents how 20th-century enthusiasts for
"eugenics" encouraged governments to improve the human population by
interfering with the procreation of patients with mental retardation
and other mental disorders. This eventually took the form of the
forced sterilization of thousands in the U.S. (supported by the
Supreme Court in 1927 in Buck v. Bell, where Oliver Wendell Holmes Jr.
decreed: "Three generations of imbeciles are enough") and of the
slaughter of hundreds of thousands in Nazi Germany in a warm-up to the
Holocaust. The author brings the issue up to date by addressing the
"New Eugenics" of today, when the genetic control of offspring is
achieved through prenatal screening and selective abortion. "The more
masterful the genetic sciences have become," Kevles writes, "the more
they have corroded the authority of moral custom in medical and
reproductive behavior."
3. Remembering Trauma
By Richard J. McNally
Belknap/Harvard, 2003
Psychiatrists who follow Sigmund Freud make up the "psychodynamic
faction" of psychiatry, and they explain mental disorders as the
result of unconscious conflicts stemming from infantile sexuality. In
the 1980s a splinter group within this faction claimed that the
conflicts were driven by the actual sexual abuse of the child --
memories of which had been "repressed." These ideas about memory and
trauma were mistaken, but they nonetheless spurred a witch hunt, led
by psychotherapists, against parents and other guardians of children.
In the remarkably dispassionate and thorough "Remembering Trauma,"
Harvard scientist and clinical psychologist Richard J. McNally looks
closely at the issue of traumatic memory -- its history and its
application in psychiatric explanations and therapy. The book
systematically lays out all the claims about repressed memories and
their role in mental disorders. And then McNally just as
systematically demolishes every one of the claims. "The notion that
the mind protects itself by repressing or dissociating memories of
trauma, rendering them inaccessible to awareness," he concludes, "is a
piece of psychiatric folklore devoid of convincing empirical support."
This book effectively ended a disgraceful therapeutic craze.
4. Stolen Valor
By B.G. Burkett and Glenna Whitley
Verity Press, 1998
Psychiatrists who tend to work on social agendas that are remote from
patient care constitute the discipline's "political faction." Almost
unfailingly, its politics support left-leaning government policy and
can have a pernicious, blame-America-
first effect at times of international crisis. In "Stolen Valor," B.G.
Burkett and Glenna Whitley produced a classic indictment of this
faction's overreaching. The authors describe how Post-Traumatic Stress
Disorder (PTSD) emerged as a new diagnosis from the Vietnam War, the
result of an alliance of antiwar psychiatrists, VA hospital
administrators, and patients who never saw combat or even Vietnam
service but found that reciting the PTSD symptoms would result in the
awarding of disability payments. These allies combined to cultivate
the idea that hundreds of thousands of Vietnam veterans were rendered
incapable of normal civilian life because they had suffered an
"incurable wound" of the mind. "Stolen Valor" dissects just how vested
interests distorted our understanding of the normal emotional
reactions to battle that psychiatrists had long recognized. Similar
vested interests are nowadays again in play, making PTSD the diagnosis
du jour for our soldiers -- with the intention of building a case
against vigorous military action in our current war on terror.
5. Abducted
By Susan A. Clancy
Harvard, 2005
For decades, psychiatry has included a "far-out" faction that reliably
turns to unusual sources in the pursuit of insight. The far-out crowd
has embraced, among other things, mysticism, yoga and maharajahs and
is usually headquartered in California. But in the mid-1990s the
Harvard psychiatrist John Mack registered the ultimate far-out claim:
Many patients, he said, were in need of treatment because space aliens
had abducted and abused them. Susan Clancy, a psychologist -- also at
Harvard -- was moved to study these patients for several reasons, but
in part because they were plentiful in Boston. In "Abducted," she
describes how patients with a variety of vague and confusing symptoms,
such as recurrent nightmares and sleep paralysis, found reports of
alien abduction an interesting possible explanation for their troubles
and were brought to believe in it through treatments that included
hypnosis. Many of these patients, it turned out, were pleased by what
they came to believe. Being abducted by aliens, they thought, meant
that they were "chosen" or "privileged" as human representatives.
Alas, Clancy draws an analogy to Judeo-Christian beliefs. I would have
preferred to see her give a nod to the observation, usually attributed
to G.K. Chesterton, that people who don't believe in God are liable to
believe in anything.
Dr. McHugh is a University Distinguished Service Professor of
Psychiatry at Johns Hopkins University. His book "Try to Remember:
Psychiatry's Clash Over Meaning, Memory, and Mind" will be published
in October.