I’m quite sceptical myself about DSM classifications; there are clearly a lot of disorders being brought into being – seemingly from nowhere – and the issue here appears to be the need to create a greater fusion with pharmacological research. For all the new conditions found in the DSM -V (and rest assured there are plenty of those) each will have to have a corresponding drug tailored to the “client’s” requirements. This is, in short, more of a market led exercise aimed at generating revenue for the APA and “Big Pharma”.
There is always a way back from “psychosis” for instance other than through the compulsory drug regimen. I put the term in inverted commas because (a) the experience concerned differs so widely from one individual to the next and (b) psychiatry has a very narrow definition and understanding of what that experience entails; and is likewise limited as a consequence in the methods it uses to “treat” it.
I think it was Adler who first remarked that ‘we should stop classifying people as we do plants’ and that treatment regimes should be based on a a more concrete specification of the individual’s difficulties. The use of labels within the medical fraternity is a hot button topic for patient advocacy groups. In my country for instance, Schizophrenia Ireland have renamed themselves “Shine” thus drawing attention away from the negative stereotypes that have accumulated over the years in film and the popular media. Altering a central “signifier” can do wonders for the concepts that become associated with a particular condition and in patient advocacy it is not only a battle over (mis)representation but about how those people – who after all, have, in many cases, severe ‘difficulties in living’ – themselves view the nature of their condition. To be told one is a “schizophrenic” is not a pleasant experience and this “diagnosis” is often arrived at with a very questionable paucity of information; particularly within public sector psychiatry where the individual cannot financially afford lengthier consultations.
It’s my experience that labelling has a very counter-productive effect. In a post-graduate course I once took in psychotherapy there was a ‘field trip’ arranged to visit one of the large mental hospitals in Dublin; it would supplement our textwork if we had a look at “them”. After all the hours of lectures and grappling with Freud’s texts it finally dawned on me that many health care professionals are utterly divorced from the fact that the people who are languishing in mental hospitals are flesh and blood individuals born into the same society as the rest of us – not representatives of “a type” who because of their ‘learning’ they imagine themselves to be far better informed. The so-called “neuroleptic revolution” of the 70’s – advances in MRI and PET technology – opened the door for the DSM diagnostic category expansion and attempted to place on a secure scientific footing the various psychiatric “disorders”. The difficulty however is in ascertaining the precise connection between alterations in brain chemistry and behavioural traits. Whilst we no doubt know a lot more about what is going on physically between our ears the magician’s sleight of hand of the psycho-pharmaceutical complex has been to dumbfound the populace into believing that this new ‘hard’ science leads to a corresponding understanding of the intricacies of people’s interpersonal relations.
There is a DSM inspired bank of questions issued to all psychiatrists which they are encouraged to use when assessing the potential diagnostic category in which their client should fall. They are too subjectively slippery to merit the credence attached to them yet they often become the basis of an initial/trial drug regimen which are then afterwards perhaps tailored depending on the client’s responses but the suggestion that the problematic behavioural trait is being addressed specifically by these neuroleptics is a laughable fiction. The anti-psychotics – Serenase, Olanzapine, Largactol etc are all sledgehammers designed principally to douse out your fires.
There are also sweeteners given to psychiatrists from the moment they enter their medical postgrad courses – books and fees are often paid for, chairs and research departments in universities are sponsored and by the time they get practising inducements are offered by drugs companies to include their product in off-label prescriptions – symposia to discuss the latest research are often just sponsored junkets, the very clinics and offices in which they practise; their walls drip with posters advertising the latest blockbuster, cups, notepads, calendars – are all festooned with the latest neuroleptic “miracle”.
As a former psychotherapy student, a former involuntary patient and a former advocate for patient rights I can tell you that the vast majority of people now taking psychiatric drugs have no need of them whatsoever – their absorption into the medical model and it’s compulsory drug-taking regime is facilitated by pie charts and market spread sheets in the boardrooms of the drug majors. Along with this of course is the human tragedy – people classified as ‘depressive’ ‘bipolar’ or ‘schizophrenic’ are told by their psychiatrist that their “condition” is “genetically determined” and therefore ineluctably written in the stars – they can no more do anything about it than a sheep can suddenly start bleeting Latin. This is a pernicious lie. There are many alternate therapies along with a host of alternate solutions yet none are attempted or even entertained as they would upset the lucrative drugs band wagon.
A woman I once knew while I was in one of these “hospitals” slit her wrists one fine morning and was pronounced dead later that afternoon. I had gotten to know her quite well as had many others on the ward and I can say if there was even a sliver of humanity; and by that I mean a humane response to her difficulties, she would be alive today. She had taken into her heart the crucial ‘killer’ message of psychiatry; your condition is “permanent” and there is no road back except through maintaining your course of drug treatment. The majority of suicides which take place in psychiatric wards occur in the first few weeks of “treatment”; it is here, when a patient is at their most vulnerable that they first learn that they are a ‘type’ with a corresponding lifetime’s drug regime ahead of them and all the stigma that comes associated with it.
Society refuses to deal with the problems found in psychiatric wards; many are homeless, from abusive relationships or at their wits ends living in heroin soaked neighbourhoods. One 18yr old I knew was made involuntary ostensibly because he had recurring ‘psychotic episodes’ – in actual fact when I got talking to him it was clear he never had experienced a “clinical psychosis” but was instead engaged in an ongoing feud with a neighbouring drug gang and on the night he was arrested and referred to a psychiatrist had fired several shots through the window of one his tormentors. With the system in place he could be detained indefinitely without ever seeing the inside of a courtroom.
Society yet again gets to wipe its hands clean – and the DSM is its principle rag.