“There is no reality”

What would happen if the Kochs and the heads of all of the think tanks funded by fossil fuels interests publicly announced that AGW was real and serious, and candidly spoke in interviews about the history and mechanics of AGW denialism? If the reaction to public announcements and other statements from the current and former heads of the NIMH and various DSM task-force chairs and editors is any predictor, not much. When a myth has taken root in the public imagination, even the admission that it’s a myth by the mythmakers themselves seems to do little to dislodge it.

I’ve posted some of these statements in various places, but I thought I’d amass them in one spot so they can be read and appreciated together:

“His psychiatric colleagues, he said dismissively, ‘actually believe [that the diseases they diagnose using the DSM] are real. But there’s no reality. These are just constructs. There is no reality to schizophrenia or depression...we might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things[’].” – NIMH Director Thomas Insel, interviewed in 2013

“The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” – Thomas Insel in 2013 on why the NIMH would cease using DSM diagnoses

“In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.” – David Kupfer, DSM-5 Task Force Chair, statement in response to the 2013 NIMH announcement

“…‘So presumably’, I asked, ‘these disorders had been discovered in a biological sense? That’s why they were included [in the DSM-III], right?’

‘No, not at all’, Spitzer said matter-of-factly.

‘There are only a handful of mental disorders in the DSM known to have a clear biological cause. These are known as the organic disorders [like epilepsy, Alzheimer’s, and Huntington’s disease]. These are few and far between’.

‘So, let me get this clear’, I pressed, ‘there are no discovered biological causes for many of the remaining mental disorders in the DSM?’

‘Not for many, for any! No biological markers have been identified’.

…[I]f the findings of biology did not help the Taskforce to determine what disorders to include in the DSM-III, then what on earth did?

‘I guess our general principle’, answered Spitzer candidly, ‘was that if a large enough number of clinicians felt that a diagnostic concept was important in their work, then we were likely to add it as a new category. That was essentially it. It became a question of how much consensus there was to recognize and include a particular disorder’.

…What sprang to mind at Spitzer’s revelation was the point I made in the previous chapter about agreement not constituting proof. If a group of respected theologians all agree that God exists, this does not prove that God exists. All it proves is that these theologians believe it. So in what sense is psychiatric agreement different? Why, when a committee of psychiatrists agree that a collection of behaviors and feelings point to the existence of a mental disorder, should the rest of us accept they’ve got it right?” - DSM-III taskforce chair Robert Spitzer, interviewed by James Davies (Cracked, 2013)

“[T]he field has…failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder or for predicting response to psychopharmacological treatment.” – DSM-IV Editor Michael First, quoted in Brett J. Deacon, “The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research,” 2013, Clinical Psychology Review 33, 846-861

“There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” – DSM-IV Task Force Chair Allen Frances, interviewed by Gary Greenberg in 2011, quoted in Mad Science