Is Psychiatry Pseudoscience?

Louis Menand at The New Yorker describes a growing critique of the field of psychiatry:

The position behind much of the skepticism about the state of psychiatry is that it’s not really science. “Cultural, political, and economic factors, not scientific progress, underlie the triumph of diagnostic psychiatry and the current ‘scientific’ classification of mental illness entities,” Horwitz complained in an earlier book, “Creating Mental Illness” (2002), and many people echo his charge….There is [also] suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry’s direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off).

This is an excellent article, and I highly recommend that everybody read it.  If nothing else, it will help to make you more literate on psychiatry-related issues and maybe even help you take steps toward making more informed decisions on your own mental health.

Anyway, I’m inclined to agree with this critique of psychiatry.  I do think there are some good psychiatrists out there, but in general they’re fighting the much more powerful influences of pharmaceutical companies seeking ever greater profits and definitions of diseases that bring wider and wider swaths under the umbrella of mental illness.  The focus of psychiatry is moving away from health and toward conformity.

Menand, however, ultimately comes to a different conclusion.  He believes that critics hold an “exaggerated view” of what psychiatry can be, and that psychiatry is basically doing the best it can – it’s a young science, and it has time to shed the social, political, and economic debris holding it back.  He also thinks that “philosophical” decisions about how to when and where to administer psychoactive medication fall outside the purview of psychiatry anyway.

While there may be some truth to what he says, I think that for the most part Menand is making excuses.  Sociopolitical factors are increasing their grip on psychiatry as time goes on, not falling away.  Definitions of mental illness are becoming broader, and medications are targeting bigger populations.  In other words, just sitting back and waiting for progress is letting things get worse, not making them better.  Unlike Menand, I think more people ought to take the critique of psychiatry more seriously.  They shouldn’t assume that these scientists know what they’re doing, or will in the reasonably near future.  Patients need to understand better how medications work and view psychiatric recommendations more critically, and psychiatrists need to work from the inside to make their discipline better serve patients, not the powers that be.

-Aaron Bekemeyer