CHANGE
(Published in the April 2010 edition of the East Bay Psychiatric Association Newsletter)
Two articles about psychiatry recently caught my eye. Each questioned long-standing tenets of psychiatric diagnosis. The February 2010 edition of Psychiatric Annals was devoted entirely to the rethinking of the dichotomy between schizophrenia and bipolar disorder, positing that the two illnesses are on a single continuum of psychosis—not distinct entities after all. The second was an article in the New Yorker magazine, entitled “Head Case: Can Psychiatry be a Science?” (March 1, 2010). This article questioned psychiatric diagnoses altogether, suggesting inaccurate identification of much of normal human behavior as pathological, often encouraged by pharmaceutical companies as a way to sell their products.
Regardless of the accuracy of each of these striking revisions of thinking, what is implicit is the importance of questioning long-held beliefs and teachings as a means of moving any field of knowledge forward. The fact is that psychiatry is only in an early stage of its understanding of mental illnesses.
Current clinical descriptions of psychiatric disorders are vague and non-specific, yet are presented as if they are scientifically determined and clear-cut diagnostic entities. A hundred years ago physicians talked about “fever” and “infection” as terms for specific medical conditions. It was not until the science of microbiology was developed that differing causes of fever and infection were understood. So it is with psychiatry because brain imaging techniques and genome mapping are being rapidly developed, which will allow for the more precise definition of specific mental illnesses. Psychiatrists will then, with greater certainty, be able to modify their understanding of the two major psychotic conditions, as well as most other current diagnostic entities. Older thinking will fall away, just as has the word “neurotic” in psychiatric nomenclature, even though in the past this term was used freely as if it described some scientifically determined entity.
Less than a hundred years ago psychiatry had a very limited understanding of the human psyche. Even 45 years ago, rudimentary behavioral terms like “stimulus,” “response,” “extinction,” and “reinforcement” were being taught as major tenets of psychology in college courses.
The science of human behavior and brain function has come a long way and is evolving rapidly. It is crucial to be open to new ways of perceiving psychiatric illness. Labeling a patient diagnostically today may give one a false sense of security in terms of what really ails the patient. No two human beings look exactly alike, and no two psychiatric patients completely resemble each other, regardless of their diagnosis.
As the adage states: “Change is the only thing that is constant.” How true!
