Global Province Letter: I Know Nothing: Modern Psychiatry
March 17, 2010

On Provinciality:  Lately our partner Dr. Steven Martin has been ministering to a panoply of banking officials in New York. They’re high paid fellows and they’d like to think they’re men of the world.  If so, it’s a mighty small world. They do live in cocoons and believe in their own thunder. As Steve is fond of saying, “Any place is provincial, if it’s the only place you know.” These chaps inherit mighty small spaces and, as it turns out, don’t even quite know what’s going on in the financial universe they inhabit.

The D.S.M.  We’re about to see the fifth version of the Diagnostic and Statistical Manual of Mental Disorders, first published in 1952, though it apparently won’t be fully released until May 2013.  But it’s widely thought to be a botch, and arrows have been directed at it from all directions.  Readers can catch the drift of criticism in “That Way, Madness Lies,” Economist, February 6, 2010, p. 88 and in Louis Menand’s “Head Case: Can Psychiatry Be a Science,” New Yorker, March 1, 2010, pp.68-74.  In general, the DSM, in its iterations, keeps on broadening the definition of behaviors and mental estates that qualify as aberrant. What this means is that almost all of us are somewhat out of our minds. While this is good for the drug companies that can cook up concoctions worthy of medical alchemists, it tends to make psychiatry more and more suspect, an expensive hobby like other parts of other healthcare system, which we can ill afford.

 The intellectual historian Menand notes:
            “There is little agreement about what causes depression and no consensus about
              what cures it.  Virtually no scientist subscribes to the man-in-the-waiting-room
              theory, which is that depression is caused by a lack of serotonin…”

When the day is over, psychiatrists and even neurologists are a bit like the hapless waiter in Fawlty Towers, who, in pidgin English widely exclaims, “I know nothing.”  The only difference between them and the endearing Manuel from Barcelona is that he trumpets his ignorance, while they pretend to wisdom.

Widespread Depression.  Nonetheless, as we have remarked often on the Global Province, depression, whatever it is, is running rampant in developed countries, and nobody has come up with anything that will stem the tide. It’s fairly clear that pills and behavioral therapy and all the other popular nostrums of the moment are not helping the afflicted, but are laying waste to our economy.

Implications Aplenty. Years ago we had some dealings with the brilliant 20th century historian Sir John Wheeler Bennett.  We had authored a very learned paper which he reviewed.  Full of praise for the paper, he said, “Bravo. You have discovered there that there’s no story. German higher education simply was not up to that much during the Nazi period.” This is probably what the psychiatrists and neurologists have to learn.  That they are pursuing the wrong line of attack in looking at mental illness, using processes and pursuing theories that are fruitless.  In fact, they keep bumping into dead ends that show them to akin to the trench warfare combatants in World War I who spent a great deal of life and treasure going nowhere.

It would seem that disease theory which looks for causes and effects just does not bring the right set of spectacles to the brain and the central nervous system.  And, in the present day, it would seem that public health activities where we thrust the troubled into a therapeutic community will do more for people than expensive pills and doctors.  That is why, for instance, Alcoholics Anonymous has healed the most alcoholics and other lay groups have had varying degrees of success with disturbed individuals.

Anatomy of Melancholy.  Way back when, Robert Burton authored the Anatomy of Melancholy.  He looked into the humors he thought to be the basis of any and every complaint. Certainly it’s better than the DSM, because it has literary merit and helps one understand literature from centuries past.  While mythic, it attracted a wide and diverse readership, and it drew on all the sciences of his time.  He did five editions incidentally.  If we are to reckon with mental illness, we must look to pathfinders who want to communicate with the whole of society and are willing to draw on sources that go well beyond psychology, psychiatry, and neurology.  



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