Whatever happened to common sense? You know what I mean—these psychiatrists medicalize every ordinary feeling and behavior, every normal stress and strain of living. Why, the way they want to call ordinary shyness “Social Anxiety Disorder,” or ordinary grief “Major Depressive Disorder”—it’s ridiculous! These so-called diagnoses are just false positives—not cases of disease or disorder. These self-appointed experts keep invading the territory of normal human experience like conquistadors! Then they prescribe all kinds of harmful medications for nonexistent diseases. And now, they are expanding their diagnostic system, to the point where nobody is normal anymore!
Are any of these claims even controversial these days? Even for some readers of Psychiatric Times, I suspect not. After all, we have heard this line of argument from respected academics; many patients, or consumers; some of psychiatry’s own luminaries; and many sincere and conscientious clinicians. Recently, one particularly renowned critic pointed to the “diagnostic imperialism” of DSM. Indeed, before the final text of DSM-5 has even appeared, several books criticizing the manual have been published or are soon to be published.
But does this narrative of psychiatry’s medicalization of normality really represent common sense—or is it mostly common nonsense? In my view, the medicalization narrative contains some kernels of truth, and many defenders of the term proceed from honorable and well-intentioned motives; for example, the wish to reduce unnecessary use of psychotropic medication — and who could be opposed to that? But on the whole, I believe the medicalization narrative is philosophically naive and clinically unhelpful. On close examination, the term “medicalization” proves to be largely a rhetorical device, aimed at ginning up popular opposition to psychiatric diagnosis. It not only stigmatizes the field of psychiatry and those who practice in it, but it also undermines our ability to provide the best care to our patients, by spuriously normalizing their suffering and incapacity…
"Medicalized" isn’t a term made up by critics. It was a battle cry of the group in Saint Louis at Washington University who heavily influenced the APA’s DSM-III in 1980. "Medicalized" was a movement that spread throughout psychiatry from the top down thereafter and changed the specialty in fundamental ways. "Medicalized" describes the treatment mode of the majority of American psychiatrists today. "Medicalized" is the sermon preached from every academic psychiatric pulpit in the country and the table of contents of the majority of our journals. The patients don’t come in saying "I’m depressed." They say, "I’ve been diagnosed Bipolar" or "I think I might be Bipolar" [or "My antidepressant has stopped working"].
Dr. Mickey, I appreciate your gentle attempt in your comment on Dr. Pies article to guide him out of his anosognosia. To his last breath, I’m sure he’ll be blaming criticism of psychiatry on the inexplicable crankiness of the critics. What a clinician!
If they want to consider themselves scientists and medical doctors then what they ‘intended” shouldn’t be an the issue. They don’t get extra credit for meaning well and should not be excused from having to get real honest with themselves, their colleagues, their patients, and their suppliers.
I’ve seen entirely too much prescribing, condescension, and patronizing to give psychiatry the benefit of a doubt in the “meaning well” department. If it weren’t for the rot at the foundations of the field, they could, perhaps, start dealing with their sexism, racism, and objectification of children.
Your civility, dr Nardo, in gently exposing dr Pies, is exemplary. His doublespeak, however, is common parlance among shrinks eager to be on the take inside the upper power-circles of bio-psychiatry, unwilling and unable to listen to those of us who have struggled and lost dear ones in a terrain he so deviously misrepresents.. Giving false maps to disoriented people, let us get lost, maimed, griefstricken, drowned, just to maintain one’s standing within the profession of psychiatry, is utterly despicable. Dr Pies deserves to be weighed and found wanting by consumers and consciencious doctors in full command of all humane faculties.
Katherine Ann Porter’s short story “The downward path to wisdom” is about a little boy witnessing to his beloved parents’ cold, verbal cruelty to each other. Some people dare to prefer truth. Dr Pies dares not, I think.
“stigmatizes the field of psychiatry and those who practice in it, ”
stigmatizes?
http://en.wikipedia.org/wiki/Social_stigma
wikipedia Social stigma
Social stigma is the extreme disapproval of (or discontent with) a person on socially characteristic grounds that are perceived, and serve to distinguish them, from other members of a society. Stigma may then be affixed to such a person, by the greater society, who differs from their cultural norms.
” Social stigma can result from the perception (rightly or wrongly) of mental illness, physical disabilities, diseases such as leprosy (see leprosy stigma),[1] illegitimacy, sexual orientation, gender identity,[2] skin tone,education, nationality, ethnicity, religion (or lack of religion[3][4]) or criminality. Attributes associated with social stigma often vary depending on the geopolitical and corresponding sociopolitical contexts employed by society, in different parts of the world.
Erving Goffman defined stigma as ‘the process by which the reaction of others, spoils normal identity’.[5] The three forms of social stigma according to Goffman are:[6]
Overt or external deformations, such as scars, physical manifestations of anorexia nervosa, leprosy (leprosy stigma), or of a physical disability or social disability, such as obesity.
Deviations in personal traits, including mental illness, drug addiction, alcoholism, and criminal background are stigmatized in this way.
“Tribal stigmas” are traits, imagined or real, of ethnic group, nationality, or of religion that is deemed to be a deviation from the prevailing normative ethnicity, nationality or religion.”
i am reminded of a Seinfeld episode where jerry tells dentist jokes and is accused of being “anti-dentite” and at one point kramer says that jerrry is so biased against dentists he will soon expect dentists to have their own schools.
the term medicalization has been used often in recent years as a criticism of the pharmaceutical industry and some psychiatrists seem to be identifying with the criticism
again from wikipedia
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.
Medicalization is studied from a sociologic perspective in terms of the role and power of professionals, patients, and corporations, and also for its implications for ordinary people whose self-identity and life decisions may depend on the prevailing concepts of health and illness. Once a condition is classified as medical, a medical model of disability tends to be used in place of a social model. Medicalization may also be termed “pathologization” or (pejoratively) “disease mongering”.
Development of the concept
The concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological.[1] The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad and Thomas Szasz, among others. These sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in works such as Conrad’s “The discovery of hyperkinesis: notes on medicalization of deviance”, published in 1973 (hyperkinesis was the term then used to describe what we might now call ADHD).[2]
These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz,1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of “psychotechnology” (Chorover,1973).
I never understood where “medicalization” came from. I wasn’t really sure what it meant?
My understanding of medicine, at least modern medicine, is that every medical field treats a specific organ or tissue of the body. Illness is defined solely as a deviation from the normal function of that organ or tissue.
All fields flag patients for diagnostic testing by using initial subjective observations, usually the patient’s own complaints such as “my stomach hurts” (all though it’s not exclusive, something could just show up on blood-work for example)
None of this applies to the field of psychiatry, which treats no objective part of the body (only the subjective ‘mind’). No diagnostic tests exist for the mind, or are otherwise performed.
I wondered if medicalization was a term for the initial subjective observations used to flag patients? As far as I could tell, the DSM pretty much has a disclaimer the illnesses are not to be used in cookbook fashion (not that anyone respects that). Thus, disorders aren’t even supposed to be ‘medical’, but conjecture. The DSM 5 seems to take the step of declaring however that this is no longer the case.
I really don’t understand what the APA believes it’s doing with it’s ‘diagnostic manual’. I know that critics use the term ‘medicalization’ as a derogatory term. My guess is Dr. Pies doesn’t understand how the rest of medicine works enough to understand there’s a problem with the “diagnostic criteria”.
Most fields of medicine will uniformly agree psychiatric treatments only worked by damaging or disrupting various organs (like the brain) of the patients, rendering them ‘sick’ by the current objective diagnostic criteria (diagnostic test results) they use. I’d have to call that harm even if it wasn’t the intent…
Normal has become a pejorative term these days. Normal is a definition of what society wants, as an assimilation too often. Psychiatry is about what to strive for to be healthy and functional.
What is “normal” for me may not be normal for the next person.
One reason why psychiatry as run by the “leaders” & “KOLs” has failed too many needing patients.
Read the article “five key fantasies embraced by DSM” by Lawrence Blum MD at http://www.psychiatrictimes.com for one opinion. You have to enlist to access it. And not a typo, once you join that site, they innundate your email with spam.
Enjoy.
Of course the late great Thomas Szasz has been writing for years about the medicalization of behaviour deemed deviant by society. This he termed the therapeutic state and his book the Manufacture of Madness is a classic. (Although I know that Szasz is still unpopular even with critics of psychiatry).
http://books.google.co.uk/books?id=Ts6cxoiO-o4C&pg=PA327&lpg=PA327&dq=ronald+pies+thomas+szasz&source=bl&ots=9fzWVciAXG&sig=qPJ9r78X3VcRlPq4F0QsDKMz-jc&hl=en&sa=X&ei=faRzUY2hIcXQObuqgGg&ved=0CFYQ6AEwAw#v=onepage&q=ronald%20pies%20thomas%20szasz&f=false
The debate between Szasz and Pies from the book ‘Szasz Under Fire’ can be read here.
i hadn’t thought about pies previous writing on “medicalization” nor his connections between szasz and pies
pies was a student, colleague and intellectual adversary of szasz
szasa was in psychiatry department at SUNY (Syracuse) Upstate Medical University from 1956-1990
pies MD 1978, residency 1982; SUNY (Syracuse) Upstate Medical University, residency and Professor, Psychiatry Department SUNY (Syracuse) Upstate Medical University
Pies knew Szasz as a student, as a colleague and as an intellectual adversary
Ronald Pies. On Myths and Countermyths: More on Szaszian Fallacies. Arch Gen Psychiatry. 1979;36(2):139-144.
I did not know Pies was a student of Szasz. He must have had a listening problem or maybe did not pay attention. There must be a DSM diagnosis for this disease surely?