Academic journal article Ethical Human Psychology and Psychiatry

Psychiatry as Ideology

Academic journal article Ethical Human Psychology and Psychiatry

Psychiatry as Ideology

Article excerpt

Background: The current psychiatric literature carries numerous papers arguing that the correct approach to mental disorder is to see it as a special form of brain disorder, whose precise biochemical and genetic causes will be revealed by the normal methods of laboratory science. In particular, these claims are repeated in numerous papers outlining and advocating the new Research Domain Criteria project of the U.S. National Institute of Mental Health.

Material: An extensive search of the literature shows that not one of these biologically oriented papers ever provides citations or references to authorities such that the claim "mental disorder is brain disorder" is established to the standard required of valid scientific claims.

Discussion: As it stands, the notion that mental disorder is brain disorder is unsubstantiated. In particular, no authorities in the field of biological psychiatry have ever demonstrated that they have a formal theory of mental disorder, or a model of mental disorder to guide their daily practice, their teaching or their research.

Conclusion: This means that biological psychiatry has the status of an ideology only, and the many papers arguing its case meet the definition of propaganda.

The premier funding agency in psychiatry has recently determined a new direction for psychiatric research, the goal being to establish a formal biological basis for clinical psychiatry. However, this project seems to rest on a major, unverified assumption concerning the nature of mental disorder and die proper means of investigating it.

BACKGROUND: A NEW DIRECTION FOR PSYCHIATRY

In July 2009, a meeting was held at die headquarters of the U.S. National Institute of Mental Heath (NIMH) in Bethesda, Maryland. Present were senior executives of the NIMH, the American Psychiatric Association (APA), and the Psychiatry Division of die World Health Organization. The purpose of die meeting was to coordinate a new direction for psychiatric research, the Research Domain Criteria (RDoC) project. It was acknowledged that die previous project, known as the Research Diagnostic Criteria, from which arose the current form of the APA's Diagnostic and Statistical Manual for Mental Disorders (now DSM-IV), was not expected to fulfill its original goals. RDoC represented a major change in orientation and emphasis, to what the Director of NIMH, Dr. Thomas Insel, has char- acterized as a new basis for a scientific psychiatry.

In a commentary in the American Journal of Psychiatry, he and his colleagues outlined their vision: "Diagnostic categories based on clinical consensus fail to align widi findings emerging from clinical neuroscience and genetics. The boundaries of these categories have not been predictive of treatment response . . . (they) . . . may not capture fundamental underlying mechanisms of dysfunction." Accordingly, they continued,

. . . the question now becomes one of when and how to build a long-term framework for research that can yield classification based on discoveries in genomics and neuroscience ... to create a framework for research on pathophysiology, especially for genomics and neuroscience, (to) inform future classification schemes.

Underpinning these changes were several essential notions:

First, the RDoC framework conceptualizes mental illnesses as brain disorders ... Second, (it) assumes that the dysfunction in neural circuits can be identified with the tools of clinical neuroscience. . . . Third, (it) assumes that data from genetics and clinical neuroscience will yield biosignatures that will augment clinical symptoms and signs for clinical management. (Insel et al., 2010)

Based on their outline in this and in numerous other publications (Cudibert & Insel, 2010; Insel, 2009; Insel, 2010; Insel & Freund, 2012; Kaffman & Krystal, 2012; Mor- ris & Cuthbert, 2012; Sanislow et al., 2010; Yan, 2010), it is clear that there are major problems in the entire notion of RDoC. …

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