1 Boring Old Man

On election night last month, we witnessed a powerful example of the phenomenon of Groupthink as the Republican pundits, convinced their presidential candidate would prevail watched the election returns, mouths agape, sputtering on live television as they received a sound shellacking at the polls. The term is just one of the ways Social Psychologists have tried to describe the regular tendency of cohesive in-crowds to misperceive reality or make peculiar decisions – things group members would be unlikely to do acting individually [Ethnocentricity, Religious Bigotry, Racism, Collective Narcissism, Mob Rule, Patriotism, etc.]. Some years back I ran across something written during the late 1970s by my own analyst – an impassioned explanation of why insurance carriers should pay for formal psychoanalysis. He was a smart, reflective guy, but this particular piece was a self-serving rationalization from fifty yards, an example of the rigidity of Groupthink. Groupthink is the reason for my recurrent quote from Lampedusa’s The Leopard "If we want things to stay as they are, things will have to change." It’s an remarkable exception  to that usual rigidity as Prince Don Fabrizio Salina, a Patrician faced with the revolution of Giuseppe Garibaldi, comes to accept the radical change coming to the only life he’d ever known. Those of us raised in the American South lived through an example of an irrational Groupthink that still echos in our daily lives.

Systems maintained by a powerful Groupthink are resistant to adapting to changing circumstances or the negative consequences of their concentration of power – the process we call evolution. We see that nightly on the world news. Opposing the inertia and rigidity of Groupthink is the stuff of change by revolution rather than evolution. And the revolutionary forces often develop a Groupthink of their own, heavily influenced by the group they hope to unseat. So the Communism of the Russian Revolution was opposed to the Tsarist Oligarchy it replaced, but shortly became a Stalinist Oligarchy in its own right. The neoKraepelinian revolution in psychiatry against the hegemony of the psychoanalysts and their ideology of the mind has become a similar ideology, this time an ideology of the brain. And the DSM-III+, designed to table the mind/brain dichotomy, has evolved with the DSM-5 into a vehicle for psychiatry to become a clinical neuroscience discipline.

It would be irrational to assert that all patients reporting symptoms of mental illness have diseased brains. Natural Selection and survival of the fittest have a better track record than that. Even separating patients based on severity wouldn’t necessarily distinguish etiology, and the DSM-5 doesn’t try to make that distinction. But a number of the decisions made in creating this manual were based on another meaning of the term clinical neuroscience – treatment. For example, the rationale for removing the Bereavement Exclusion from the diagnosis of Major Depressive Disorder was to assure patients would get treatment – the assumption being that the treatment of MDD is antidepressant drugs. Much of the modern clinical neuroscience is focused on symptomatic treatment with drugs, regardless of etiology, or even hypothesized etiology. There are obviously many cases of what’s called MDD where the drugs don’t work, perhaps the majority. And there are plenty of others where the treatment of choice is something else – at least it used to be. So the neoKraepelinian Tenet, 6. The focus of psychiatric physicians should be on the biological aspects of illness, now encompasses biological treatments regardless of etiology or circumstances.

That is, more or less, the Groupthink of psychiatry today: treatment = biological treatment. There are some obvious problems, like we don’t have the biological agents to deliver the goods, but also, it leaves out the fact that psychiatrists compose the minority of mental health professionals by a long shot. Prior to this coming May, the DSM-III/DSM-IV has been used by all mental health professionals to code mental illness. But looking at the proposed new definition of mental illness in the DSM-5 [a behavioral or psychological syndrome that reflects an underlying psychobiological dysfunction], it’s hard to imagine that the majority of mental health professionals are going to find anything of much use to them [to be honest, it’s hard to imagine that most psychiatrists can honestly use that definition either]. And it’s not just that definition, the whole Revision is organized around the neoKraepelinian Groupthink of the Task Force. It’s in the spaces between the words when it’s not explicit. It’s the only thing they’ve talked about. So one wonders just who they think will buy their book?