Saturday, May 25, 2013

Psychiatric Inanity Disorder

I’ve become increasingly angered as NIMH’s reaffirmation of its commitment to biopsychiatry has sunk in, and reading The Body Economic only stoked that anger.

The book’s calls for evidence-based public health policy make the unscientific and ideological nature of the NIMH’s RdoC project all the more painfully evident. The decision to (continue to) pursue this course, shifting millions of dollars away from productive research and interventions, simply ignores the decades of evidence showing that the biopsychiatric model is invalid and leads not to helpful treatments but to ineffective and harmful interventions; it ignores decades of evidence pointing to the social-experiential roots of psychological distress and “madness.” Like austerity plans, it’s being imposed from above without even an attempt to justify it scientifically and against the vocal opposition of many of the people most directly affected.

And the fact that the government agency responsible for investigating and responding to psychological problems is declaring that the roots of these problems lie in individual people’s brains amounts to a political statement and a political project. As Stuckler and Basu discuss, there’s strong evidence – not that this should be a surprising or controversial claim – of the devastating impact of homelessness, poverty, economic insecurity, and the fear and stress caused by joblessness in regimes of austerity on people’s mental well-being (in addition, of course, to their physical well-being). More generally, the evidence for social-political factors, and especially victimization, in psychological problems is overwhelming.* Stuckler and Basu provide the data showing that austerity plans cause substantial increases in suicides, for example, while well-designed social protection programs prevent and even reduce them. Insel’s denial of this reality and his determination to try to locate the source of distress in people’s brains amounts to an apology for systemic problems and failures. It’s a project about propaganda – not science or public health.

Which brings me to my third point. This approach is just so…inane. I had to shake my head reading this (useless and trope-ridden) piece in Forbes. It describes:
…[Bruce] Cuthbert [director of the division of adult translational research at NIMH] says that the NIMH is already working on ways to build “crosswalks” between the DSM-V and its new RdoC diagnosis system, which is still barely sketched out.

Why change at all? Cuthbert gives the example of one symptom of depression called anhedonia, the scientific name for inability to find pleasure in normally enjoyable activities. On the one hand, this condition occurs in lots of psychiatric illnesses, including anxiety and eating disorders. We don’t know if it is neurologically similar in all of them or not. On the other hand, there are different types of anhedonia, Cuthbert says. Some people might go out to dinner with friends and not enjoy it. Others might be so down as to lack the energy to get to the restaurant in the first place, even though they would enjoy it once they arrived.

The NIMH’s strategy with the RDoC approach is to dis-entangle a diagnosis like this. If there were a protein or blood test or brain scan that fit with one type of anhedonia (people with eating disorders who are too tired to go out for instance), but not with the others, it doesn’t want to miss it. But this means taking the DSM-5 apart and re-assembling it through arduous experimental work. “It’s going to take a decade or more for results to bear fruit,” Cuthbert says.
Of course, it’s never going to bear fruit, and it takes a high level of willful ignorance to believe that it would. But aside from this, it’s just so inane. Reading the human stories in the news and in The Body Economic - especially the tragic and iconic story of Dimitris Christoulas - we can start to understand the political and existential meaning of suffering. Or we can do decades of silly research to find the proteins responsible for different types of not-wanting-to-go-out-to-dinner. Inane.

*And that’s not even touching on Erich Fromm!

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