“Even at its best psychiatric diagnosis is fiction sold to the public as fact”
Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence
In the early 1970s, psychologist David Rosenhan set out to answer a simple question: Can psychiatrists tell the sane from the insane?
Rosenhan and seven other perfectly rational “pseudopatients” went to a dozen U.S. hospitals complaining that they were hearing voices. All but one were diagnosed with schizophrenia and sent to a psychiatric ward. Each had been warned by Rosenhan that, to get out, they would have to convince the psychiatric staff they weren’t insane. So, immediately after they were admitted, they stopped mimicking symptoms of “abnormality” and behaved as they normally would.
Still, they were kept in the hospital for periods ranging from seven to 52 days, each finally discharged with a diagnosis of schizophrenia, “in remission.”
The Rosenhan experiment sparked a crisis of confidence in psychiatric diagnosis — a crisis that appears to be playing out again today.
This time the catalyst is the newest and fifth edition of the official guidebook of psychiatry: the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. The encyclopedic tome has undergone its first major revision in nearly two decades and makes its official debut May 18 at the annual meeting of its publisher, the American Psychiatric Association.
The rewrite has been rocked by boycotts and the resignations of some of the very experts tapped to give advice — including the former head of the department of psychiatry at the University of British Columbia, John Livesley, who says he quit the DSM-5’s personality disorders work group over a “disregard for evidence.”
The public clash is making psychiatry look like “nonsense,” says Allen Frances, the man who led the task force that created the fourth edition of the DSM in 1994. “It’s bad for patients. This will discourage people who desperately need help from getting it.”
Frances has been the DSM-5’s most dogged and unapologetic critic. He says the book contains untested diagnoses on the “fuzzy boundary of normality” and that it recklessly lowers the thresholds for existing ones.
Psychotherapist Gary Greenberg is more blunt. “Even at its best … psychiatric diagnosis is fiction sold to the public as fact,” Greenberg writes in his new book, The Book of Woe: The DSM and the Unmaking of Psychiatry.
“There is a huge disconnect between what psychiatry claims for itself, and what it can actually do,” he says.
Canadian psychiatrist Joel Paris says that “no one really knows what a mental disorder is,” or how to clearly separate normal from abnormal. “It’s all very fuzzy.”
In other words, 200 years after psychiatry was recognized as a medical discipline, a stark question persists: Is psychiatry credible?