It has to be said now, get it out-of-the-way before we dive into discussing the ‘new psychiatry’ and its neuroscience and new lobotomy: modern psychiatry (since the 1800s) has always suffered from an acute case of ‘scalpel envy’. There, I’ve said it.
Psychiatry’ scalpel envy: surgery to remove that sadness from your brain.
Let me give you a recent manifestation of that envy, as expressed recently by Thomas Insel, director of the NIMH, in his blog post Transforming Diagnosis.
There he made that cliché comparison between “the rest of medicine” and psychiatry. Trying to discredit (now) the DSM, he said:
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure… In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.
Can it be, could it be, will it be any other way, the diagnosis of a ‘psychopathology’?
For a case of sadness and ‘major depression due to bereavement caused by the sudden loss of a child in a car accident’, which organ would you look into? Into the heart? As President Bush2 infamously said about the weapons of mass destruction as he bent over to look underneath a table, “no they are not there.”
Would you look into the brain? You are getting warmer! Can you see that ball of sadness blocking my happiness (like a ball of fat clogs an artery) using your X-rays or MRI’s or whatever tool you have now for looking at ORGANS?
Of course you CAN’T see it! A color in a brain imaging is NOT the sadness.
But that doesn’t prevent the new psychiatry from recommending a cyngulotomy, the modern term for lobotomy, if the sadness persists for over a year (more on this later.)
The scalpel envy consists of that self-knowledge of the psychiatric profession that what they do does not constitute ‘medicine’, it is not ‘hard science’, that they are NOT scientists as defined by the ‘real’ scientists. It consist of that painful embarrassing awareness that even ‘regular doctors’ look at psychiatrists with contempt because psychiatrists try too hard to be what they are not: like ‘regular doctors’ who can operate on a particular organ and actually cure the illness (mostly, they have their ‘issues’ too).
Why envy of surgeons and not of, let’s say, psychotherapists or of priests, both of who can actually help in soothing sadness? Because there is not $$$ there nor PRESTIGE, that’s why. Because, as Insel said, psychiatry is not based on science; anyone can do today the job of psychiatrists: treat mental disorders.
It is NOT the DSM that is not based on science, it is the PROFESSION. But don’t expect Insel, or anyone else for that matter in the mental health system, to put it that bluntly. Instead, put the blame on the DSM, boys, paraphrasing that song.
Therein resides the problem with the ‘new psychiatry: it is NOT new and it is going back to the future with lobotomy because ONLY the scalpel can separate them from the old psychiatry, from the psychotherapists and social workers and priests who can do the job BETTER without drugs or scalpel.
It is that envy which has caused so much suffering in our modern society to people suffering from mental disorders or whatever you want to call it.
It comes from the perennial and UNSUCCESSFUL human search to find the seat of ‘sadness’ and joy and the soul. That’s why the meaning of the word ‘psychiatry’ is ‘the medical treatment of the soul’; it has inherited a lot more from ancient civilizations than from ‘modern’ psychiatry.
Tomorrow: the new psychiatry,neurosurgery and, again, experimentation on humans.