INTERDISCIPLINARY COURSE-

INTRODUCTION TO PHILOSOPHY OF SCIENCE

(DEPARTMENT OF COMMUNICATION STUDIES)

ASSIGNMENT
Science Test- The Real Problems with Psychology

SHUBHA GOVINDARAJAN
4TH SEM BSc BtCZ
REGISTER NUMBER: MS173080
 The Real Problems with Psychiatry

1. Gary Greenberg criticizes the Diagnostics and Statistics Manual of Mental Disorders, stating
that none of these mental disorders are real and that they are invented.

The DSM started with a goal to produce a ‘paradigm shift’ in psychiatry. It started off as a
‘statistical manual’ to ‘count people’. But then, diagnosis had to come into the picture, as that
was what would define any medical field. However, the diagnosis of ‘mental disorders’ is not
like the diagnosis of, say, a sore throat or a cold. Mental illness cannot fit into one single
definition. The DSM uses the term ‘disorders’. Diseases are caused due to a physiological
response (due to a pathogen) to external and internal factors. It is possible to use medication,
that is, a chemical or a combination of chemicals that try to lower this pathophysiological
response. However, a disorder results from the disruption of a normal bodily function. Mental
illnesses fall into the second category because they are not generally caused by some pathogen
evoking a physiological response. However, such psychiatric disorders are treated as any other
normal disease. Since people do not know much about mental illness, our reaction to mental
illness is sort of like ‘evil’ or ‘sick’. Diagnosing a mental illness can change people’s lives for
the better, and can also have bad effects as well. It gives people an identity formed around a
disease that doesn’t even exist. There is every possibility of overdiagnosis in fields like
psychiatry. False positives are dangerous as they can affect peoples’ identities and can result in
the use of drugs whose side-effects are unknown, and which may not be able to rectify the root
or underlying cause.

Social and historical context also affects our understanding of mental illness, like in the case of
Dr Samuel Cartwright and his invention of the term ‘drapetomania’ in slaves, an aspiration for
freedom that is not their nature. Even homosexuality was regarded as a disease, but once people
started opening up to the idea of same-sex love, it doesn’t become something ‘out of place’ and
hence it is not termed as a ‘disease’ anymore. While psychologists use the DSM, psychiatrists
wield all the power and money. At the end, it just boils down to business.

There are a lot of aspects which Greenberg mentions that are agreeable. Although the DSM
calls ‘mental illness’ as a ‘disorder’, people are trying to find out the physiological basis of
mental disorders such as depression, mania and anxiety. Research is going on to investigate the
cellular and molecular basis of mental health, in the hope that one day, drugs that can set back
the normalcy in the physiology could be developed. Many months back, an elder in my family
was suffering from severe anxiety and depression and nothing seemed to help. She finally
consulted a psychiatrist who prescribed corrective medication, and after a few months, regained
her cheerful and enthusiastic self. I have heard celebrities and well-known personalities who
have gone through times of mental disorders, and most of them second with the opinion that
medical intervention and medication makes a difference. However, we are not sure if the
positive effect is due to the efficacy of the drug, or whether it is just like a placebo.

The DSM has scientific reliability but lacks scientific validity. The categories are only
constructs, there is no evidence that, say, a major depressive disorder exists in the same way as
cancer and diabetes exist. The public reifies these categories and believes them to be ‘real’. The
DSM-III adopted a scientific rhetoric, but no actual scientific basis for its rendering of mental
illness. In other words, it isn’t backed up by scientific research, like the kind of scientific
research, say, cancer is backed up by.

One can see Greenberg’s view that the categories laid out by the DSM are not very clear. The
criteria for some of the disorders are so loosely written. The DSM is not backed by much
scientific evidence and is more based on internal experiences, and cognitive behavior.
Psychologists like Allen J Frances strongly feel that the DSM is just a guide to psychiatrists and
should not be treated as a Bible.

Greenberg mentions that psychiatrists, today, wield all the money and power, and convert
psychiatry into a business. Some psychiatrists have drug company ties and the changes in the
DSM will enhance pharmaceutical profits. But this only adds to the existing careless over-
dosage of medicines.

This is an example of the conflict between practical knowledge and experiential knowledge. In
a psychology or psychiatry course, one is taught that such mental disorders arise from
‘chemical imbalances’ or ‘disruption in physiology’. However, a different kind of knowledge is
gained when we really interact with a person with such conditions. The DSM is based on the
 latter. And since practical knowledge is emphasized more that theoretical knowledge, people
like Greenberg tend to disregard the DSM.

One can agree with Greenberg’s opinion that the above ideas are a result of not just scientific
discovery, but the convergence of a number of political, social and economic forces. Greenberg
has made a case for how the DSM could prove dangerous to psychiatry if continued with, and
how it needs to be backed by more evidence.

2. Greenberg points out that the therapists use DSM as a ‘means to treat illnesses’ , and, use it as a
means of getting paid.
The main drawback is that psychologists convert this into a business and have a
money-oriented mindset. This is a general problem not only concerning psychiatric
sciences, but all fields. One cannot completely cut off from this basic human tendency,
but there can be a limit on how much hospitals or therapists levy for a consultation or
treatment, which prevents levying amounts over a limit.
One of the major issues concerning psychiatric sciences is that neither people, nor their
family, are willing to accept, in the first place, that they have some sort of mental illness
or disorder. Especially in a country like India, people think that one who has a mental
illness is ‘possessed’ by some ‘evil spirit’ and one has to perform things like exorcism
to bring the person back to normal. Presence of a social stigma about mental illness is
also a problem. When a person has a mental illness, they are shunned by the society as
they appear ‘abnormal’. In this regard, mental health awareness among the general
public is important in changing people’s outlook towards mental health. Mental health
awareness is as equally required, say, as cancer or AIDS awareness is.

The public, at large, should be made aware of the DSM or its equivalent in other
countries. The DSM’s scientific review process is highly confidential and secretive.
This reduces the scope of it being falsified, as false knowledge is dangerous. Hence,
genuine validation and transparent review processes will make the DSM more
acceptable to the public. Once they are aware that such a set of criteria exist, they will
be assured that the inferences and diagnosis by the therapist or doctor is not vague, but
has some basis.
Also, the DSM should not be followed blindly, which will lead to massive over-
diagnosis and harmful over-medication.

A large fraction of the public is of the opinion that the text writing is sloppy and that the
text editors lacked the experience to ensure that a level of consistency, clarity and
accuracy is maintained. Moreover, a scientific review must be open, independent,
systematic and rigorous. There is a lot of controversy and opposition stating that the
DSM strikes out badly on these four requirements. Hence, the DSM requires a complete
revamp in its process of making and reviewing. The American Psychological
Association (or APA) should commission independent literature reviews to determine
whether the existing evidence really supports them.
None of the radical and highly controversial DSM 5 suggestions should be accepted
unless and until first subjected to a completely independent review of scientific merit
and a risk/benefit analysis of its likely impact on actual clinical practice.
The criteria for some of the disorders are loosely written. DSM-5 should have included
clearer requirements that the patient's distress and dysfunction be far beyond the
expectable given the medical problem and that all possible medical and psychiatric
causes of distress had been definitively ruled out. Without these restrictions, it is far too
easy for doctors to carelessly assume "it is all in the patient's head"; leading to an
incomplete workup; and missing the underlying cause of the symptom.

(This response has been written with references to the articles related to DSM-5 by Dr
Allen J Frances, in Psychology Today.)