dreams spawned a revolution in the study and treatment of mental illness during the first half of the 20th Century. Another psychiatric revolution was announced in 1980, with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). DSM-III, not only marked the end of the dominance of Freudian thought, but also replaced Freud’s science of dreams with a Neo-Kraepelinian attempt at making psychiatric diagnosis scientific. DSM-III’s dreams of science involved the creation and use of diagnostic checklists, structured interviews, and other research techniques. Since 1980, advertisements for all new editions of DSM claim that the dream of scientific diagnoses has become a reality. This paper will argue that these key claims made for DSM are often the product of illusions, not those of patients, as Freud used, but those of psychiatrists who developed and promoted the new manuals. The paper will examine three of DSM’s dreams of science: that DSM identifies mental disorders validly; that diagnoses can be made reliably, and that clinicians use DSM appropriately.
Gordon Warme. Author, Psychiatrist, Psychotherapist, CAMH, University of Toronto
The Eternal Illusion: A Brief History of Psychiatric Causality
I'll first make a few comments about the DSM project and why it is so important for psychiatrists. The rationale for the DSM classification system is that it is purely descriptive, and that sticking to such a predetermined naming of syndromes will then lead to reliable research. The problem with this argument is that it presupposes that there is a disease there to be discovered. In other words, instead of discovering a disease and then pinning down how it can be identified, psychiatry has turned our usual medical methods upside down: looking for a cause before a disease has been discovered. I'll also make brief comments about the total lack of evidence that there is anything biologically wrong with the mad. Instead of giving us real evidence, investigators predict that evidence will soon be found, that “evidence is converging,” or that there is “suggestive evidence.” This violates every scientific rule. It’s a bit like saying that they hope soon to find a cancer cell in a patient in whom there is no evidence of cancer. It’s often said that “some” of the people diagnosed as schizophrenic show changes in their frontal lobes. They might as well say that some people diagnosed as schizophrenic have moles on their back: the statement proves nothing. It’s a bit like saying that some patients have cancer cells in their bodies, but some don’t. To be a scientific statement, the so-called abnormality must be present every time.
Madness has always led observers to invent “causes,” an obsessive quest that depends on the idea that there is a disease or ailment for which a cause has to be found. The faultiness of that quest is best illustrated by the common complaint of the mad that their brains have been injured, affected, or influenced by some chemical, radiation, or x-ray, to which psychiatrists react by arguing that these people have such thoughts because their brain has been influenced by some chemical, radiation, or x-ray. A few hundred years ago, the mad claimed that demons or witches possessed and influenced them, to which priests responded by saying that they had such thoughts because demons and witches had possessed and influenced them. I have many such examples of the circular thinking