{"id":35520,"date":"2013-04-19T09:31:40","date_gmt":"2013-04-19T13:31:40","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=35520"},"modified":"2013-04-19T09:31:40","modified_gmt":"2013-04-19T13:31:40","slug":"a-listening-problem","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/04\/19\/a-listening-problem\/","title":{"rendered":"a listening problem…"},"content":{"rendered":"
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Psychiatry and the Myth of “Medicalization”<\/a>
Psychiatric Times <\/font><\/strong>
By Ronald W. Pies, MD
April 18, 2013<\/div>\n

Whatever happened to common sense?<\/em> 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!<\/em><\/strong><\/sup><\/p>\n

Are any of these claims even controversial these days? Even for some readers of Psychiatric Times,<\/em> 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<\/a>. 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.<\/strong><\/sup><\/p>\n

But does this narrative of psychiatry’s medicalization of normality really represent common sense—<\/em>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<\/em>? 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…<\/strong><\/sup><\/div>\n<\/blockquote>\n
When I wrote about Dr. Pies’ take on this before, I said, "I bear Dr. Pies no ill will. He’s a retired psychiatrist like me… I expect if I knew him, we could find plenty to talk about. My impression reading his blogs from time to time is that he’s had a long career and been seen as something of an expert, well earned.<\/em>" In this piece, he goes on to argue that normal<\/em> is undefinable. I’d more or less agree with that in the privacy of my  own mind. He points out that psychiatrists need to have disease labels to properly classify and treat people. No real argument there. He’s put off but the term "medicalize" when talking about this process of disease identification. I guess he thinks the critics are being unfair, or histrionic, or demonizing, rather than voicing some kind of legitimate criticism or concern. He’s reflecting on his understanding of his own experience as a psychiatrist and his dealings with his patients over a long career. He’s been a good guy, and he’s pretty sure he didn’t hurt people by using diagnostic terms along the way. I’ll bet he’s right about that, or close to it.<\/div>\n

"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"]. <\/p>\n

Dr. Pies doesn’t want that to have had any impact on our patients, the movement to "Medicalize." I expect he might say that there was no intent to harm in that movement. The motive was pure – not imperious or demeaning. That may well be correct. By creating a compendium of labels based on symptoms organized as disorders, no one meant for those labels to have any adverse effects. The complaints are just some kind of literary device made up by misanthropes who don’t understand medicine clearly. I think perhaps Dr. Pies retired at about the right time. He has lost his capacity to listen. And if he actually believes that because there was no intent to harm, no harm occurred,  he may not have been listening very well the first time around…<\/div>\n","protected":false},"excerpt":{"rendered":"

Psychiatry and the Myth of “Medicalization” Psychiatric Times By Ronald W. Pies, MD April 18, 2013 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 […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-35520","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35520","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=35520"}],"version-history":[{"count":3,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35520\/revisions"}],"predecessor-version":[{"id":35523,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/35520\/revisions\/35523"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=35520"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=35520"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=35520"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}