Psychiatry’s Legitimacy Crisis

1344403039Andrew Scull on Allan V. Horwitz and Jerome C. Wakefield's All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders, in the LA Review of Books:

The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.

In a Cold War context, much was being made about the way the Soviets were stretching the boundaries of mental illness to label dissidents as mad in order to incarcerate and forcibly medicate them. But Western critics also began to look askance at their own shrinks and to allege that the psychiatric emperor had no clothes. A renegade psychiatrist called Thomas Szasz published a best-selling broadside called The Myth of Mental Illness, suggesting that psychiatrists were pernicious agents of social control who locked up inconvenient people on behalf of a society anxious to be rid of them, invoking an illness label that had the same ontological status as the label “witch” employed some centuries before. Illness, he truculently insisted, was a purely biological thing, a demonstrable part of the natural world. Mental illness was a misplaced metaphor, a socially constructed way of permitting an ever-wider selection of behaviors to be forcibly controlled under the guise of helping people.