{"id":537,"date":"2013-05-13T10:01:38","date_gmt":"2013-05-12T23:01:38","guid":{"rendered":"http:\/\/www.eclectic-consult.com\/mooseblog\/?p=537"},"modified":"2013-05-13T10:01:38","modified_gmt":"2013-05-12T23:01:38","slug":"the-death-of-psychiatry","status":"publish","type":"post","link":"https:\/\/www.eclectic-consult.com\/mooseblog\/2013\/05\/13\/the-death-of-psychiatry\/","title":{"rendered":"The death of psychiatry?"},"content":{"rendered":"

A while back I\u00a0wrote\u00a0a post on why I believe that a lot of what’s been classified as mental illness is nothing of the sort (see here<\/a>). I argued that the psychiatric diagnostic manuals, like the DSM-IV, are nothing but descriptions of symptom clusters, and do not explain the underlying\u00a0aetiology\u00a0of psychological dysregulation.<\/p>\n

\"Rorshach1\"<\/a><\/p>\n

Turns out I’m not the only one. A few weeks ago, with reference to the soon to be published DSM-V,\u00a0the director of\u00a0the\u00a0National\u00a0Institute\u00a0of Mental Health (NIMH) in the US\u00a0said pretty much the same thing. The NIMH have decided to ‘drop’ the DSM-V as a classification tool for all future research funded by their organisation. Instead, they plan to develop a classification criteria that examines the underlying biology, as well the brain circuitry, cognitions, genetics\u00a0and degrees of functioning associated with a specific dysregulation. In other words, they’re trying to develop a set of \u00a0classification and diagnostic criteria that will take into account not only the expressed symptoms of a disorder, but the underlying reasons why it’s\u00a0occurred\u00a0in\u00a0the\u00a0first place and, in doing so, open the way for more effective, targeted\u00a0treatment.<\/p>\n

But I’m getting ahead of myself. Let’s take a step back and look at the (largely psychiatrically-led) journey to this point. Although the roots of psychology go back a long way (Freud pretty much rehashed Aristotle), modern psychology began with Sigmund Freud and his contemporaries. Freud was a\u00a0medical\u00a0doctor (the difference between psychiatrists and psychologists, is that\u00a0psychiatrists\u00a0study medicine before psychology – psychiatry is a branch of medicine), and it has remained the ordained thinking within the medical profession that those working with mental disorders should also be medically trained.\u00a0Consequently, as diagnostic manuals were developed, they were done so using a typical medical model (or at least the model of the early 20th century) – observation of symptoms and their categorisation into observable clusters. Alas, whilst the rest of medicine went on to refine classification systems to include substantially more than the expressed symptoms (including understanding of the aetiology and increasingly accurate tests for these underlying causes), psychiatry stayed faithful to the old school. As such, the American Psychiatric Association’s Diagnostic and Statistical manual version 5 (DSM-V) is the latest incarnation of an\u00a0increasingly\u00a0large collection of symptom clusters.<\/p>\n

The problem with this system is that it does very little to help identify the actual causes of psychological dysregulation and, using\u00a0these\u00a0classifications, the only way to determine\u00a0the\u00a0effectiveness of a treatment is to see if the\u00a0symptoms\u00a0reduce following its delivery. Thus, psychological dysregulation has become mental illness and, as\u00a0the\u00a0classifications have become more numerous, the already existing stigma regarding ‘mental illness’ has burgeoned. Further, although there are undoubtedly a range of biological issues that can result in psychological dysregulation, depression and anxiety, the most common ‘mental illnesses’ appear to be normal human reactions to abnormal states (i.e., evolved neurobiological responses to certain environmental\u00a0stimuli). Instead of understanding more about the states that provoke these largely survival-based responses, and the best ways of reducing their impact, the\u00a0research\u00a0emphasis has often been on the diagnosis and treatment (often using medication) of these problems. It’s not surprising,\u00a0therefore, that many\u00a0people\u00a0are terrified of seeking treatment for anxiety or\u00a0depression, because of the weight they carry. It’s also not surprising that most researchers, bound within these classification schemes, have spent their time looking for better ways of reducing the symptoms, rather than properly\u00a0understanding\u00a0the underlying causes.<\/p>\n

Psychologists have made their share of mistakes as well. Early\u00a0behaviourists\u00a0were convinced that all human behaviour could be described through simple operant conditioning processes. Nevertheless, psychology (the study of the mind) has long been concerned with understanding the human condition by better understanding the ‘software’ platform that makes up ‘us’. Combined with recent advances in neuroscience (understanding the ‘hardware’), psychologists and neuroscientists are starting to identify the underlying systems that are activated during psychological dysregulation. Recently, the idea of a ‘connectome’ has been proposed: effectively, the entirety of all the synaptic and other neurological connections that make us who we are. Unlike the genome, which sets up the\u00a0initial\u00a0conditions for our brain, the connectome is the result of the ever-evolving response of our brains to the myriad experiences of life. It’s been suggested that were we ever able to measure it accurately, we could preserve a person’s ‘self’\u00a0indefinitely, as uploaded consciousness to a powerful computer platform. This might take a while so, in the meantime, neuroscientists and psychologists are attempting to identify the various components that make us tick, and to understand how they can go wrong. Using this focus, researchers recognise that the neural circuitry that underlies psychological dysregulation is insanely (forgive the pun) complex, and that it isn’t particularly useful to simply give it a\u00a0classification. Worse, to assume knowledge of a complex system and then to attempt to correct that system using pharmacological agents (without\u00a0full knowledge of the system of how those agents disrupt it), is downright irresponsible. Perhaps, eventually, with enough understanding, and carefully delivered drugs to specific brain systems, a pharmacological approach will be justified.\u00a0Presently, not so much.<\/p>\n

A short side-step. Many people have had extensive benefit from modern psychotropic medications (including antidepressants). This is both a good and bad thing. The benefit is great, but the assumption that the aetiology is understood because we know which neurotransmitters are stimulated by a medication is false. In fact, recent research has highlighted the fact that, if antidepressants work at all (and there’s some very convincing epidemiological research that suggests the effect is placebo), they do so in ways that aren’t related to serotonin reuptake inhibition…<\/p>\n

Anyway – the psychiatric model appears less and less relevant in the increasingly knowledgable world. Instead of assuming we understand the conditions we’re trying to treat, and then treating them badly with medications, the effects of which are not properly understood, psychologists and\u00a0neuroscientists\u00a0are working to remove our preexisting assumptions and replace them with a more complete understanding of the underlying systems. This is the aim of the new strategy by the NIMH, with the eventual goal of treatment that is truly effective.<\/p>\n

It’s\u00a0important\u00a0that psychologists don’t fall victim the same hubris of the psychiatric profession. Truth be told, currently, the best we have are low-bandwidth ‘software patches’. Yes, the various forms of psychotherapy are\u00a0delivered\u00a0through the medium of language and, currently, language is extremely low\u00a0bandwidth\u00a0– we can only get across a tiny amount of\u00a0information\u00a0through written or spoken communication and, a lot of the time, the content is unreliable (whether it’s understood is dependent on\u00a0the\u00a0client’s ability to understand, something that, ironically, can be reduced by the dysregulation we’re trying to treat). Consequently, research into the most effective delivery systems, given the narrow bandwidth of the medium, is a lot more important than trying to come up with overly simplistic diagnostics. My money is on a better understanding of the underlying processes.<\/p>\n

In the meantime, psychiatry may well be a dying profession. Relying on outmoded classifications and poorly understood pharmaceuticals isn’t much of a business model in the rapidly evolving world of psychoneurobiology. My\u00a0prediction\u00a0is that 20 years from now,\u00a0psychology \u00a0will have taken over the psychiatric niche. Using a strong neuroscientific base, combined with complex imaging technology and massive processing power to identify a person’s connectome, psychologists of the future might be able to identify specific\u00a0dysregulation\u00a0and intervene by modifying the source directly (instead of relying on slow, unreliable language-based therapy). Until then, thanks to forward-thinking institutions like the NIMH, we might learn a bit more, rather than relying on out-of-date, and stigma provoking ‘diagnoses’.<\/p>\n","protected":false},"excerpt":{"rendered":"

A while back I\u00a0wrote\u00a0a post on why I believe that a lot of what’s been classified as mental illness is nothing of the sort (see here). I argued that the psychiatric diagnostic manuals, like the DSM-IV, are nothing but descriptions of symptom clusters, and do Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":539,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"jetpack_publicize_message":"The Eclectic Moose has a new blog post! The death of psychiatry? 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As a part of this, I touched on the notion that most so-called \"mental\u00a0illnesses\" are actually normal human reactions to difficult situations. I've been thinking a lot about this idea lately and wanted to expand on it\u2026","rel":"","context":"In "General"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.eclectic-consult.com\/mooseblog\/wp-content\/uploads\/2012\/09\/Client-300x300.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":577,"url":"https:\/\/www.eclectic-consult.com\/mooseblog\/2013\/06\/18\/the-zen-of-butt-sniffing-what-we-can-learn-about-psychological-wellbeing-from-dogs\/","url_meta":{"origin":537,"position":1},"title":"The Zen of butt-sniffing: What we can learn about psychological wellbeing from dogs…","date":"18\/06\/2013","format":false,"excerpt":"First up, I'm on holidays at the moment but am going to try to update the blog as often as possible (it might not be quite weekly) - will do my best! Today, I wanted to write about a topic near to my heart: dogs. Don't worry, I'm not going\u2026","rel":"","context":"In "General"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.eclectic-consult.com\/mooseblog\/wp-content\/uploads\/2013\/05\/Image-e1372839776271.jpg?fit=320%2C240&ssl=1&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":996,"url":"https:\/\/www.eclectic-consult.com\/mooseblog\/2017\/01\/16\/therapy-aint-no-picnic-and-its-not-life-coaching-either\/","url_meta":{"origin":537,"position":2},"title":"Therapy ain’t no picnic (and it’s not life coaching either)….","date":"16\/01\/2017","format":false,"excerpt":"It's a commonly held misconception that people see psychologists for\u00a0ego massaging, an opportunity to experience catharsis (the idea that letting things out makes you feel better), or some sort of self-fest where the therapist builds up self-confidence in a Tony Robbins-style 'ra ra' session. I suppose some of the blame\u2026","rel":"","context":"In "General"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":703,"url":"https:\/\/www.eclectic-consult.com\/mooseblog\/2014\/03\/03\/psychologists-vs-psychology-its-time-we-started-practising-science\/","url_meta":{"origin":537,"position":3},"title":"Psychologists vs. psychology: It’s time we started practising science…","date":"03\/03\/2014","format":false,"excerpt":"This week, I'm going to rant. Actually I'm going to rant about my own profession. As you probably know, I'm a psychologist. I first became involved with psychology as a student 25 years ago. Since then, I've spent 11 years at university studying it, and about 15 years practising it.\u2026","rel":"","context":"In "General"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.eclectic-consult.com\/mooseblog\/wp-content\/uploads\/2013\/11\/Rorsarch-e1382228033772.jpg?fit=250%2C350&ssl=1&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":602,"url":"https:\/\/www.eclectic-consult.com\/mooseblog\/2013\/07\/03\/the-perils-of-self-esteem-or-why-self-confidence-is-bad-for-you\/","url_meta":{"origin":537,"position":4},"title":"The perils of self-esteem (or why self-confidence is bad for you)…","date":"03\/07\/2013","format":false,"excerpt":"This week's blog comes to you from Paris. Last week - I wrote about how believing in a particular identity can screw you up. I was writing about how buying into the notion of what comprises an 'adult' can lead to all sorts of feelings of inadequacy and failure. 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