From: unk...@googlegroups.com   
      
   Can Psychiatry Be Reformed from Within?   
   by PHIL on NOVEMBER 26, 2014   
      
      
   Vivak Datta, MD, is a second year psychiatry resident at the University of   
   Washington, Seattle.  He has a website called Medicine and Society, and on   
   November 14, he published a lengthy article titled Science and Pseudoscience   
   in Psychiatric Training:    
   What Psychiatrists Don't Learn and What Psychiatrists Should Learn.  On   
   November 20, the article was published on Mad in America.   
      
   Here are some quotes:   
      
   "...what is currently emphasized [in psychiatric training] is tantamount to   
   pseudoscience."   
      
   "As the DSM-5 debacle has shown, psychiatric diagnoses are not the product of   
   nature but common consensus, a consensus that has been criticized for eroding   
   the range of human behavior seen as normal."   
      
   "In focusing on teaching psychiatric diagnosis à la DSM, psychiatrists are no   
   longer familiar with the rich descriptions of morbid mental life described by   
   Kraepelin, Jaspers, Bleuler, and Schneider, who attempted to feel their way   
   into their patients'    
   experiences and catalog the heterogeneity of human suffering. In contrast, the   
   DSM teaches psychiatrists there are prescriptive ways to suffer or become   
   mentally ill throughout the globe. When the psychiatrist meets a patient who   
   has the audacity to have    
   not read the DSM and not present a constellation of symptoms described   
   therein, the psychiatrist is at a loss, and the patient finds herself 'not   
   otherwise specified'."   
      
   "Though psychiatrists routinely prescribe atypical antipsychotics, which cause   
   metabolic syndrome, few psychiatrists are comfortable with treating   
   hypertension, diabetes and dyslipidemia, and many of our patients are unable   
   to access primary care. It is    
   a shameful state of affairs that psychiatrists are not being trained to treat   
   the very illnesses they cause in their patients and undermines the very basis   
   of psychiatry as a medical specialty."   
      
   "...cognitive psychology offers valuable explanatory frameworks that can be   
   helpful in understanding depression, PTSD, and the formation of delusions and   
   hallucinations."   
      
   "Despite the rich social science contributions to psychiatry that are   
   extremely relevant to clinical practice, most psychiatrists, especially in the   
   United States, are completely unaware of the classic studies in our field."   
      
   "...evidence-based mental health is openly disparaged, and when psychiatrists   
   don't get the results they want, they ignore them, suppress them, or denounce   
   them. The suggestion that antipsychotics could worsen the course of psychosis   
   was such an    
   important one that you would think it would deserve considerable study, yet it   
   has been largely forgotten. The finding that antipsychotics cause significant   
   cerebral volume loss, rather than immediately being published, was analyzed   
   again and again,    
   until the reality of this finding could no longer be denied. When randomized   
   controlled trials, the gold-standard investigation, showed that SSRIs were   
   associated with suicidal ideation, the results were denounced invoking   
   correlational studies showing a    
   inverse relationship between adolescent suicides with SSRI prescriptions,   
   despite these studies being methodologically inferior."   
      
   I think most readers would agree that this material is not what one expects   
   from a psychiatrist.  In fact, it reads more like anti-psychiatry.  And,   
   indeed, it is clear that Dr. Datta has strong reservations about his chosen   
   profession.   
      
   But it is always difficult to make radical changes from within, and there are   
   several indications in the article that suggest that on the fundamental   
   issues, Dr. Datta's feet are squarely planted in psychiatric turf.   
      
   Here are some more quotes, interspersed with my comments.   
      
   "This emphasis on the DSM has ...de-emphasized the construction of the medical   
   and neurological differential for the psychiatric patient..."   
      
   This statement is somewhat obscure, but from the general context, I believe   
   that Dr. Datta is calling for more emphasis on differentiating those problems   
   of thinking, feeling, and/or behaving that are clearly caused by a   
   medical/neurological pathology,    
   and those that are not.  In itself, this is a perfectly valid distinction that   
   most of us on this side of the debate would endorse.  However, on this side of   
   the issue, we draw the logical conclusion:  that problems of thinking,   
   feeling, and/or behaving    
   that are clearly not the outcome of physical pathology are not illnesses and   
   are not the legitimate concern of psychiatrists or medical practitioners   
   generally.  We point out, with justification, that there are no    
   ogical/philosophical reasons why these    
   kinds of problems should be considered illnesses, and we stress the empirical   
   reality that psychiatric intervention in these areas has generally resulted in   
   more harm than good.   
      
   But this is not where Dr. Datta appears to be going.  Rather, he seems to be   
   saying that those problems that are not the direct result of a medical   
   pathology are as much the province of psychiatry as those that are.  Here's   
   another quote:   
      
   "Yet most psychiatrists learn little about when to order EEGs, neuroimaging,   
   viral, autoimmune, and paraneoplastic panels, heavy metal screens and other   
   investigations that can help diagnose their patients' maladies, and how to   
   distinguish between these [   
   problems that are due to a general medical condition or a toxic reaction] and   
   primary psychiatric disorders." [Emphasis added]   
      
   Note the phrase "primary psychiatric disorders," which essentially means   
   problems of thinking, feeling, and/or behaving that are not attributable to a   
   biological pathology or ingestion of a substance.  We don't hear this   
   expression much any more because    
   in  recent decades it has been one of psychiatry's top priorities to promote   
   the fiction that all problems of thinking, feeling, and/or behaving stem   
   directly from biological pathology, particularly the much-touted chemical   
   imbalances.  But here is Dr.    
   Datta, not only using the term, but clearly implying that these "primary   
   psychiatric disorders", although not strictly medical problems in any   
   conventional sense of the term, are, nevertheless, the legitimate province of   
   psychiatry.   
      
      
   [continued in next message]   
      
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