{"id":40464,"date":"2013-10-02T08:51:17","date_gmt":"2013-10-02T12:51:17","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=40464"},"modified":"2013-10-02T20:28:51","modified_gmt":"2013-10-03T00:28:51","slug":"back-at-you-eu","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/10\/02\/back-at-you-eu\/","title":{"rendered":"back at you, EU…"},"content":{"rendered":"\n

In case you haven’t noticed, European [and World] psychiatry is pulling away from American psychiatry at a fairly brisk pace. Reform of the alliance between the pharmaceutical giants and medicine is centered in Europe [the EMA, the British Journal of Medicine, AllTrials, etc]. Articles critical of the DSM-5 are common in the European journals, but almost absent in ours. The DSM-5’s failed attempt at a paradigm shift to a neuroscience base fooled no one on the other side of the pond, and the DSM is appropriately spoken of as an enterprise past its time. <\/p>\n

The article below begins by discussing the trends in European psychiatry prior to the DSM-III, pointing out that that the divisions commonly spoken of here [Kraepelinian v. Freudian] were not a dichotomous pair, but rather several among many influences in Europe. And the article focuses particularly on Karl Jaspers – psychiatrist turned philosopher [see an anniversary…<\/a>]. Jaspers saw the domain of psychiatry as heterogeneous, as I diagrammed it below:<\/div>\n
     <\/div>\n
Just to insert a piece of pertinent history, during and after World War II, there was a major influx of European psychoanalysts into the US. And contrary to Europe, American psychoanalysis was restricted to psychiatrists, never true in Europe, never recommended by Freud. It became a dominant force in American psychiatry. And there was, in fact, something of a split in international psychoanalysis in that the Americans stuck to the particular school within psychoanalysis of its founders – called ego psychology. The point of mentioning that history  is that a major force in the creation of the DSM-III was to solve the problem of psychoanalytic hegemony in psychiatry – something of a non-issue in Europe. In this discussion piece, de Leon proposes that the DSM-III, driven by the particular problem of the overblown influence of psychoanalysis in American psychiatry, also swept through Europe and derailed the ongoing natural development of European psychiatry. de Leon’s conclusion:<\/div>\n
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A post-DSM-III wake-up call to European psychiatry<\/font><\/strong><\/div>\n
by J. de Leon<\/div>\n
Acta Psychiatrica Scanddinavica<\/font><\/strong> Article first published online: 12 SEP 2013<\/div>\n

<\/p>\n

...<\/div>\n
An epistemology of psychiatry?<\/font><\/strong><\/div>\n
Cambridge University’s German E. Berrios is an expert in the history of psychiatry. Berrios’s main contribution to the future of psychiatry is his focus on the hybridity of psychiatric symptoms, at a time when US psychiatry is intoxicated on neuroscience and European psychiatry mimics those intoxicated moves. At the beginning of the 20th century, Jaspers warned us of the precarious methodological position of psychiatry between the natural and social sciences. Almost no one paid attention to this bad methodological news for 100 years until Berrios reminded us that psychiatry deals with hybrid objects with different levels of difficulty of study using the traditional scientific methods employed in medicine<\/div>\n

Epistemology can be defined as the science that studies the origins and legitimacy of knowledge. Berrios proposes that the studies of epistemology and the history of psychiatry go hand in hand, using the same methods. He says not only that psychiatric disorders are very heterogeneous, as Jaspers proposed, but that psychiatric symptoms are also heterogeneous. When the psychiatric symptoms are closely related to brain signals, such as those in patients with ‘neurological’ disorders, a neuroscience approach and methods such as brain imaging make sense because the presence of a brain disorder explains these symptoms. Conversely, when psychiatric symptoms are related to ‘semantics’ (communication between human beings), a neuroscience approach and methods such as brain imaging make no methodological sense, because these symptoms can only be understood, in the sense of Jaspers, and not explained by brain disturbances. These relatively simple concepts are bad news for psychiatric researchers. Berrios also describes the difficulty of developing new elements in psychiatric language, such as new symptoms, because experienced clinicians reinterpret them using known psychiatric symptoms defined according to 19th century language.<\/p>\n

Jaspers was ignored when he proposed that psychiatric disorders are heterogeneous and some should be studied with social science methodology. Berrios may also be ignored when he emphasizes that psychiatric symptoms\/signs are heterogeneous and some of them are in ‘semantic space’ (a concept entering the cognitive sciences) and cannot be ‘explained’, in Jaspers’s sense, by neuroscience. Berrios is proposing that 21st century European psychiatrists must develop a 21st century language for descriptive psychopathology to build a new psychiatric nosology.<\/div>\n<\/blockquote>\n
While I have a few comments, I ought to start by simply saying, "That’s right," as I’ve lived it over my time in American psychiatry. That is what happened, and what needs to happen. It’s not going to happen here in the US any time soon. Our system of medical reimbursement, the influence of Corporate America [Pharmaceutical and Hospital Corporations], and our difficulty sustaining Social Services that endure, all point to an extremely low probability of any natural evolution. Our government on this day in history is suspended primarily over the issues of Healthcare funding in general and a tax on medical devices. That battle is being largely driven by the strength and wealth of corporate interests. That’s just how America has always seemed to work – an eternal pendulum. And right now, organized psychiatry is in there, a corporation fighting for a piece of the pie.<\/div>\n

The DSM-III wasn’t intended to be a call to a not-yet-defined neuroscience. It was shepherded by psychiatrists who had rejected psychoanalytic hegemony from within – Melvin Sabshin, Robert Spitzer, Allen Frances, all trained in psychoanalysis. To put it crudely, "You can take the boy out of the country, but you can’t take the country out of the boy." The more humanistic case-oriented focus remained. But the DSM-5 was turned over to a different breed – and they blew it in a major way. And so the ball is passed back to Europe. This time, when they send it back at some point in the future, I hope they’ll send us an eclectic Karl Jaspers version instead of two warring factions to fight it out in the now not-so-new<\/em> world:<\/p>\n

\"Emil<\/div>\n

The fate of psychoanalysis is an interesting sidelight. About the time of the DSM-III, the psychiatric captivity of American psychoanalysis was also ended by a monopoly suit won by the psychologists against the Institute that trained Drs. Spitzer and Frances [and me]. Psychoanalysis is now a multidisciplinary discipline. And speaking of hegemony, it’s no longer frozen in time with the ego psychology  of the early American founders or the exact methods of Freud. Our institutes are, as always, financially stretched, but are well populated with all kinds of mental health types as students, some of whom are psychiatrists, and teach the full breadth of psychoanalytic thinking about human mental life and psychotherapeutic approaches to change. It’s comforting. I didn’t care too much for the way it was either. I’m pleased to say that I’ve finally been relieved from teaching the once marginalized British schools’ theories by some very competent non-physicians – some ten years after retiring. <\/p>\n

So, the social democracies are a better environment for the development of a patient focused psychiatry than the United States in the early 21st century. There are too many forces acting on our psychiatry and medicine in general right now to expect a natural medical science to prevail. It’s obvious. And this blog is neither a defense of nor an indictment of psychiatry. It’s about a malignant force within, including colluding psychiatrists. We now know who you are…<\/div>\n","protected":false},"excerpt":{"rendered":"

In case you haven’t noticed, European [and World] psychiatry is pulling away from American psychiatry at a fairly brisk pace. Reform of the alliance between the pharmaceutical giants and medicine is centered in Europe [the EMA, the British Journal of Medicine, AllTrials, etc]. Articles critical of the DSM-5 are common in the European journals, but […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-40464","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40464","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=40464"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40464\/revisions"}],"predecessor-version":[{"id":40492,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40464\/revisions\/40492"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=40464"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=40464"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=40464"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}