A Shorter history of psychiatric diagnosis

The Wall Street Journal has an excellent article by historian of psychiatry, Edward Shorter, about the raft of new changes in the proposed revision of the DSM-V ‘psychiatric bible’ and how they reflect our changing ideas about mental illness.

For some reason the piece has been given the stupid of title of ‘Why Psychiatry Needs Therapy’, which is a mystery as it doesn’t mention anything along these lines.

Shorter is one of the most highly-respected historians of the field, well known for his critical approach, and this article has his trademark no-holds-barred criticisms of psychiatry.

In the 1950s and ’60s, when psychiatry was still under the influence of the European scientific tradition, reasonably accurate diagnoses still sat at center stage. If you felt blue, uneasy and generally jumpy, “nerves” was a common diagnosis. For the psychotherapeutically oriented psychiatrists of the day, “psychoneurosis” was the equivalent of nerves. There was no point in breaking these terms down: clinicians and patients alike understood “a case of nerves,” or a “nervous breakdown.”

Our psychopathological lingo today offers little improvement on these sturdy terms. A patient with the same symptoms today might be told he has “social anxiety disorder” or “seasonal affective disorder.” The increased specificity is spurious. There is little risk of misdiagnosis, because the new disorders all respond to the same drugs, so in terms of treatment, the differentiation is meaningless and of benefit mainly to pharmaceutical companies that market drugs for these niches.

Link to WSJ article on Shorter on psychiatric diagnosis.

One Comment

  1. Posted March 5, 2010 at 2:28 pm | Permalink

    As a fellow historian of medicine, I find that Shorter’s work leaves a lot to be desired. For example, in this article he suggests that drugs like Valium work better than SSRIs, but provides no data to support it. He also denies that benzos are addictive, which goes against accepted scientific facts in this area.


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