A version of this post was previously published on Stoffers
James Davies is the author of Cracked: Why Psychiatry is Doing More Harm Than Good. The main points of his argument, in the talk he gave at the Edinburgh International Book Festival 2013, were:
- Psychiatric drugs often do not do what they say they do, they are more ineffectual than the drug companies would have you believe
- The link between psychiatry and pharmaceutical companies has become too close, too comfortable
- Psychiatry is wrongly medicalising increasing numbers of the population
In recent years, Davies argued, psychiatry has renamed more and more of our normal functions and emotional reactions (to a range of situations) as conditions and disorders. The Diagnostic Statistical Manual of Mental Disorders, the ‘bible’ of psychiatric professionals, has expanded at a faster rate than any other medical manual in history, said Davies. We’re now up to the DSM-5 (and you may have been following much of the controversy over this much-expanded manual in the news this year) but Davies went back to focus on the DSM-III, published in 1980, the first version to introduce specific diagnostic criteria. He shared with us snippets of his interviews with Robert Spitzer, who was chair of the task force for the manual, and overall pointed out that the ‘consensus’ approach to the DSM-III was unscientific and deeply flawed.
The Wikipedia entry on the most recent DSM is quite good, you can see some of the new disorders that have been added and some of the criticisms of the manual. The novel manuscript I wrote for my doctorate actually bounces off issues around the DSM and the shrinking of the category of ‘normal’ in society. In the near future, everyone has their diagnosis and their appropriate drugs; society is essentially regulated by companies resembling the Big Pharma companies of today (that have expanded into all areas of ‘wellbeing’, including entertainment, communication and so on). But there is still resistance, so new institutions have opened up, to retrain citizens (or consumers, rather) to be ‘functional’ in society.
An issue that Davies and other authors speaking on the topic raised again and again at the festival was the re-categorisation of ‘normal’ emotional states (including extreme ones, such as prolonged grief) into disorders, for which a ‘quick fix’, commercial solution is available. And yet, many of the drugs given to patients (and given before looking into non-pharmaceutical remedies) are not always proven to be completely effective. The risk of misdiagnosis is also high, as diagnosis is based on an inevitably subjective analysis of symptoms.
Davies also mentioned the influence of neo-liberal culture in the rise of (particularly anti-depressant) prescriptions. Western neo-liberal culture measures an individual’s success and value by their productivity and performance.
‘Anything that threatens individual productivity is seen as something to get rid of,’ Davies said. ‘Decelerating mood is part of this.’ He continued: ‘As a society we’re more hostile to emotional discontent than ever before.’
One thing I therefore ask in my novel manuscript is: does low mood (and other ‘aberrant’ emotional states) then become counter-cultural? A form of societal and corporate resistance?
Covering all bases, Davies also mentioned that in the contemporary secular West we have discarded systems that may have given our ancestors solace and strategy. It’s worth mentioning (though of course there are many ‘cons’ with which we could counteract this point) because this, along with the neo-liberal element, helps us to see the bigger picture, the ‘whys’ behind these shifts.
A few solutions Davies mentioned were more and bigger conversations, an insistence that psychiatrists become more honest about the limitations of drugs (hard when the pharma dollars are being waved at them), and more funding for alternate treatments (as there used to be). He believes the process for putting together any psychiatric manual would benefit from social scientists and people from other fields besides psychiatry being involved.
In the context of all this I feel like I need to mention that I’m very close to several people who have suffered from mental illnesses and disorders and I think drugs can and often do work, definitely, but Davies’ arguments are pertinent, encompassing current flaws in psychiatry (and their overall implications). And frankly I don’t think we can ignore the frightening amount of power and influence possessed by pharmaceutical giants. I’m looking forward to reading the book.
Check out the book and James Davies’ blog for more information.
See my first post on ‘brainy stuff’ from the Edinburgh International Book Festival 2013.