COMMENTARY

Positivism, Humanism, and the Case for Psychiatric Diagnosis

Ronald W. Pies, MD

Disclosures

August 20, 2014

In This Article

Surfing for Criticism

If sick men fared just as well eating and drinking and living exactly as healthy men do...there would be little need for the science [of medicine]

--Hippocrates

Canst thou not minister to a mind diseased?

--Shakespeare, Macbeth, Act V, Scene 3

If you've never surfed the Web for sites that critically examine psychiatry, I highly recommend it -- though it's not for the faint of heart. These Websites vary from the viscerally enraged to the politely skeptical, the constructively critical, and everything in between.

The worst antipsychiatry websites, in my view, are veritable bastions of bigotry, in which psychiatrists are subjected to invective and abuse[1] that would never be tolerated if directed, say, at some ethnic or racial minority. The best of the critical Websites, in contrast, offer pointed but respectful criticism of psychiatric diagnosis and treatment; for example, the Foundation for Excellence in Mental Health Care[2] hosts some psychiatrists, psychologists, and other bloggers who often dissent from the psychiatric "establishment" (whatever that is) but who usually do so with decency and respect. I often disagree with them, but these critics deserve attentive ears and open minds.

If you look for something resembling a philosophical position in the more vituperative Websites, you usually find objections to psychiatric diagnosis and treatment that stem from 1 or more of 3 basic claims:

1. Only physical (bodily) illness, demonstrated by the presence of a lesion or physiological abnormality, constitutes "real disease." Psychiatry doesn't deal with real diseases, but with invented ones; therefore, its diagnoses and treatments are bogus.

2. Whatever its claims to science, psychiatric treatments are either useless or harmful.

3. Psychiatry is inherently coercive; it stigmatizes people with pejorative labels and forces its (bogus) treatments on unwilling victims, who, in many cases, are hospitalized against their will.

To be sure, some who hold these views have had terrible experiences with psychiatry or psychiatrists, whether through incompetence or malfeasance. These folks are understandably bitter. They are usually not receptive to the evidence that psychiatric diagnosis and treatment (including psychotherapy), when carefully and respectfully rendered, can literally be life-saving and lead to a better quality of life for the afflicted patient.[3,4,5] Nor are these critics mollified by the fact that laws and rulings regarding involuntary commitment are the products of democratically elected legislatures and duly established courts[6,7] -- not the inevitable outcome of a psychiatric diagnosis. (If, as a society, we want change in this area of civil liberties, why not lobby legislators rather than excoriate psychiatrists?)

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