The Problem With Contemporary Psychiatric Diagnosis
The destructive and damaging fiction of biological ‘diseases’
Posted Apr 05, 2016
“Life is pain, Princess.
Anyone who tells you different is selling you something.”
–Dread Pirate Roberts, in "The Princess Bride"
Everywhere you turn, you see “OCD, ASD, MDD, ADD, ADHD, BPD, GAD, PD, SAD, PTSD, NPD," etc. The problem is not limited to this acronym soup, but the pseudo diagnoses they represent. Patients today get stained by the specious medical diagnoses of biological psychiatry. And furthermore they are brainwashed to believe that these fictitious brain ‘diseases’ are genetic. Biological psychiatry treats people like they are mechanical objects, renaming them almost as they are re-branding products. The one I like the best is the renaming of ‘manic-depressive’ to ‘bipolar.’ Instead of a name which accurately describes the states of suffering, it was turned into something mechanical — a battery with two poles. We’ve gone from something human to something Frankensteinian.
But fear not: We have psychoactive drugs that will correct the imbalance in your genetically damaged brain. We have antidepressants for your depression; Benzodiazepines for your anxiety, amphetamines for your ADHD, anti-psychotics for schizophrenia, antidepressants for your OCD, etc.
Sadly, I have heard many stories from patients that began when they received their "diagnosis." They are told they have a disease. "It's not your fault," they are told; "it’s genetic." For the lucky few it may take only a few years to discover that their biological diagnosis is bogus, then to find their way to a good therapy, and/or continue on their journey.
We are sold a bill of goods where it is believed that taking drugs could possibly attend to the incredible complexity of human suffering. How did it happen that within a generation such a delusion captured the public imagination and currently holds sway. Young people have said to me,
“You’re a psychiatrist and you do psychotherapy? I never heard of that.”
Initially, I was shocked. Now, I get letters all the time from people who ask me if I know any psychiatrists in their town who don’t give drugs.
There have always been two competing currents in psychiatry — Psychodynamic (fundamentally psychoanalytic) psychotherapy vs. somatic psychiatry. Now there is only one. For the story of Somatic Psychiatry, see — “Do No Harm: The Destructive History of Pharmaceutical Psychiatry and its Bedfellows — Electroshock, Insulin Shock, and Lobotomies.” This gives the true story of Somatic Psychiatry. Its practice has been to act directly on our brains : shocking them, reaming them out with ice picks - and now reaming them out chemically. Somatic Psychiatry has always done great harm, but its sordid history has gotten lost in the amnesia of time. But make no mistake; pharmaceutical psychiatry is the current incarnation of somatic psychiatry. And we are doing harm all over again.
Regarding the psychoanalytic, there have been many very good therapists; illuminating writers like Fairbairn, Winnicott, and Harry Stack Sullivan, as well as important understandings about attachment. And there were many excellent teachers. Don’t get me wrong; there were plenty of problems due to faulty psychoanalytic theories which interfered with responsiveness to our patients. Nevertheless, I am suggesting a new paradigm in the psychotherapy tradition.
"The Psychotherapy of Character" is a specialized form of human engagement that repairs the damage to one’s personality by acting on the play of consciousness in the very way that it formed in the brain in the first place. It is an art and a science that bridges the old divide between psychotherapy and the brain. To put it simply, human struggle is purely a human problem. It is derived from the consequences of deprivation and abuse in our formative years, followed by additional struggles that result from our adaptations to the ongoing traumas of life. Psychotherapy promotes the recovery of a person's "Authentic Being" through genuine and trusted engagement with the therapist. Mourning the pain of this inner play heals our symptoms and our suffering.
The specious enterprise of healing ‘brain diseases’ is based on a faulty understanding of neuroscience and the brain. The biological orientation has mistaken parts of the brain for the whole. Separate elements of the brain operate mechanically, and are not the cause of psychiatric symptoms. The parts all work in concert to create the Play of Consciousness. The truth is that memories of trauma, stored via the limbic system, the amygdala, and the hippocampus, is the seat of our suffering and symptoms. The invisible replay of the scenes in the play generate our symptoms. Our genetic temperament gives form to the symptoms, - phobias in one person, or obsessions in another. And when the trauma is mourned - as when, watching a tragic play, we undergo a "catharsis" - we, sit with the pain, and the brain changes all on its own.
Psychiatry has always been a poor step-child of medicine. In doctorly circles it was demeaned and disrespected. The somatic psychiatrists wished to achieve status, and if they invented medical diseases they could put on their white coats and qualify as "real scientists." Real psychiatrists, however, never cared about this. They understood that psychiatry is different where the medical model does not apply.
When I was a psychiatric resident in the early 70’s, it was fully understood that psychiatric diagnoses are not medical and they never have been.
At best, a diagnosis was a short-hand understanding that was intended to be an aid to the therapist in highlighting pertinent issues.
All that mattered was the true story, the actual history. That is to say; ‘his story,’ or ‘her story.’ Each patient would lead the way to whatever needed attended to. Ultimately the ‘art’ of psychotherapy is about feeling, caring, and meaning-making.
A good psychotherapist does not need to be a doctor, but there are certain experiences in becoming a doctor that helped shape me in a positive way. The experience of dissecting a human body changes a young medical student forever and plunges him into the secret mysteries of life. To be in a position to make informed life-and-death decisions for patients breeds a sense of responsibility. It changes a young doctor powerfully. To learn about the mysteries of the body and the life-course of diseases, to understand about life-altering conditions such as cancer, immunological diseases, asthma, heart disease, real neurological conditions, etc., provides important experiences in grappling with the full spectrum of human experience. Eventually all people get sick with something. It was important for me, for instance, to have evaluated a "psychotic" man, and recognize that he had late-stage syphilis, not schizophrenia.
The core paradigm of the Psychotherapy of Character is a unified field theory of human consciousness and how the brain actually operates that is consonant with neuroscience, myths, dreams, religion, art, and Darwin. The medicalization of the human condition did not begin with psychiatry; humans have been looking to nature — herbs, tree barks, trepanation (drilling holes in the head) —for cures of psychic distress since civilization began. However the cause of much of the psychic distress we sought to relieve is really to be found when we look inward, to our selves, and to civilization itself. "Psychiatry" refers, after all, literally, to the "medical treatment of the soul." Which begs the essential question of what a "soul" is; where it resides, and by what means it can be addressed. In my understanding, as the patient mourns the pain of his inner play, he writes a new script infused with his own authenticity and his own capacity to love. This is his soul, or in my terms his ‘Authentic Being’.
When I was a resident, a senior psychiatrist who was influential in the alcohol world announced that alcoholism should be referred to as a ‘real’ disease. He explained, that since people make moral judgments about alcoholism, shifting the metaphor to ‘real’ will help them not blame themselves or be blamed by others. He said that this was just an innocent shading of the truth and will help people. I objected, because it wasn’t a disease. Truth matters. Words matter. About a decade later medical insurance came into play; it wouldn’t cover alcoholism because it was an addiction (which it is), not a disease. In 1987, to deal with the insurance issue, the AMA redefined alcoholism into a disease. Do I smell money here?
But the 12 steps of Alcoholics Anonymous have always been a spiritual practice. “When the spiritual malady is overcome, we straighten out mentally and physically.” When alcoholism was referred to as a physical disease, it was understood as a metaphor. Then people actually started to believe the ‘disease’ concept. When brain scans showed differences in the brains of people who were chronic alcoholics, this was taken as proof that it really is a disease. (It didn’t matter that when people stopped drinking, their brains returned to normal.) The brain reflects behaviors, it doesn’t cause behaviors. Once the disease model was accepted as an established fact, researchers found pseudo-evidence that alcoholism is also genetic. Though not true, but has become accepted as fact.
Psychiatric diagnosis has followed the same trajectory as alcoholism. Each diagnosis in turn has been constructed by somatic psychiatrists as a disease, in each case building a similar house of cards. It doesn’t seem to matter that the multi-billion dollar pharmaceutical industry and its influence-peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives.
Take, for example, the antidepressants: the chemical imbalance theory has been discredited, but this didn’t alter the fact that the theory is still believed. Never mind that antidepressants don’t actually do anything constructive, (which has also been proved), apart from the fact that people believe they do. And in their wake a lot of harm has been done. (see — “No, It’s not the Neurotransmitters, Depression is not a biological disease caused by an imbalance of serotonin” ).
The brain reflects. It doesn’t cause. Time and space don't permit me to go through the entire DSM-5, but each ‘disease’ is a work of fiction. Brain scans showing thinned areas of the cortex in "affected" regions of brain which correlated to a "symptom" are taken as proof of genetic disease. This cannot be so, or therapy would not magically reverse the thinning, as we know it to do.
A so-called landmark study, all over the press, is that a gene related to eliminating connections between neurons in adolescence is the "cause" of schizophrenia. Since neurons are eliminated in adolescence, the new theory is that an overactive gene variant is responsible. This theory is believed, then taken as a major breakthrough. But it doesn’t prove anything. Conclusions, in the absence of real mechanisms, or solid and comprehensive explanations that fit every instance, end up creating a false and speculative fantasy that is then taken as "knowledge." Once these conclusions are established, they become reified and operate as beliefs. This one is already (falsely) established, as if it has been actually been proven that schizophrenia is biological. (See- “‘Evidence-based’ Psychiatry is ‘Evidence’ in Name Only, A call for the science of psychotherapy has taken a wrong turn”.)
Here are two random — yet typical — examples that popped up on Google: “Genetic Discovery Could Lead to Development of New Bipolar Meds.” The research indicates that abnormal variations in PDE10A19 might (my italics) impact signaling of cAMP by engaging with another protein, restricting that protein’s activity and its signaling… … “Once we understand how this protein helps neurons remain healthy, we might (my italics) be able to develop medications to treat neurons when they function abnormally, such as in patients with bipolar disorder and schizophrenia.” These leaps are delusional. In addition, one study then uses a previous study as a fact and extends them. There is nothing here but a house of cards.
And how about this one, “Biomarker Could Lead to Earlier Detection in Women of Mental Disorders”: “A newly identified biomarker linked to mental illness in female psychiatric patients could lead the way for a simple blood test for improved interventions and treatment, (My Italics) according to a study in EBioMedicine. … overproduction of XIST has been found in female patients with mental illnesses such as bipolar disorder, major depressive disorder, and schizophrenia. About half of the female patients had abnormally higher levels of XIST and other genes related to the X chromosomes, which could (my italics) indicate that overproduction of XIST and genes from the inactive X chromosome are common denominators in the development of psychiatric disorders in patients … in the general population of female psychiatric patients.” This study has already taken as fact that these three conditions are diseases in the first place. There has never been a study where these assumptions ever turn out to lead anywhere.
We have to stem the tide of somatic psychiatry and bring sanity back to psychiatry.
A recent article by Peter Kinderman, “Mental illness mostly caused by life events not genetics, argue psychologists” challenges the waste of research money in England which has been based on the assumption that the cause of human struggle is biological. We need to do this in America, and worldwide. Our understanding of human suffering needs to return to a legacy of caring and wisdom. Our children's futures — all our futures — depend on it.
Robert A. Berezin, MD is the Author of “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”