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Diagnosis, Science and Psychiatry

Below are three letters by psychiatrists in response to an editorial by David Brooks in the New York Times in which Mr. Brooks, in commenting on the DSM V, calls psychiatry semi-scientific, while defending psychiatrists as “daring adapters” who combine technical expertise with personal knowledge.   The responses are a refreshing and an important perspective on psychiatry, the new DSM-5, and the importance of what psychoanalysis and the humanities bring to the care of people with mental and emotional disorders. The last letter is by Jack Drescher a member of APsaA who is past president of the Group for the Advancement of Psychiatry.  To read the initial article, “Heroes of Uncertainty,” click here.

Norman A. Clemens, M.D.

 

To the Editor:

Re “Heroes of Uncertainty” (column, May 28):

While I share David Brooks’s frustration over the slow progress in finding the biological causes of mental disorders, I am concerned about his opinions on the scientific basis of psychiatry and the clinical care that it provides to millions of people. The brain has proved to be infinitely more complex than any other organ in the human body, and the functions that mediate behavior are the most highly evolved in the animal kingdom.

Diagnosis is an art as well as a science, and it often represents an approximation of the true illness. Malaria was diagnosed and its symptoms were treated long before its cause was known. Autism was not described in the medical literature until 1943. Migraine and other headaches are diagnosed by symptoms, as there is no physical evidence or laboratory test.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders reflects the current state of our knowledge, limited as it may be. This does not negate its value in helping clinicians evaluate and treat patients, as well as the fact that it can and will continue to be improved as subsequent research enables us to better understand the biology of the brain and mental illness.

JEFFREY A. LIEBERMAN

New York, May 29, 2013

The writer is president of the American Psychiatric Association and a professor of psychiatry at Columbia University College of Physicians and Surgeons.

 

To the Editor:

More than 50 years ago I chose to become a psychiatrist precisely because it was not scientific. Unique among medical specialties, psychiatry allowed doctors to use their most human qualities — intuition, sensitivity, imagination, compassion and capacity to tolerate ambiguity — in the service of helping fellow human beings in greater pain than themselves.

Since the 1970s I have seen a succession of pseudoscientists, in collusion with the pharmaceutical and insurance industries, systematically dismantle our specialty in the name of “scientific rigor.” They have put us on the defensive about our insistence that if we are to help our patients, they need to talk to us and we need to talk to them.

It is long past time for us to stop pretending we know more than we really do. No one has stated this position more cogently or succinctly than David Brooks. I thank him.

VICTOR A. ALTSHUL

New Haven, May 28, 2013

 

To the Editor:

David Brooks correctly points out that psychiatry is not, and should never be, a purely scientific endeavor. Like the rest of humanistic medicine, a science of the mind should never lose its heart.

In comparing psychiatry with astronomy, however, Mr. Brooks should remember that in 2006, the International Astronomical Union voted on whether Pluto is a planet. Even astronomy, the hardest of sciences dealing with the most irrefutable of facts, is dependent on its human practitioners’ subjectivity and interpretation of data.

From that perspective, D.S.M.-5 is not much different from any other scientific consensus document. It is not as much a “bible” as it is a dictionary or user’s manual.

The test of D.S.M.-5’s scientific merit will be its utility. If it is not useful, and as new science emerges, it will undoubtedly evolve.

JACK DRESCHER

New York, May 28, 2013

The writer, a psychiatrist, served on the D.S.M.-5 Work Group on Sexual and Gender Identity Disorders, but the opinions in this letter are his own.

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