Despite the fact that The Huffington Post has become a swamp for all sorts of lunacy, everything from anti-vaccine myths and cancer quackery to creationism and New Age, there are some glimmering diamonds in the seeping cesspool of ignorance. Dr Nada Logan Stotland, who is the Professor of Psychiatry and Obstetrics/Gynecology at Rush Medical College, has written a timely piece entitled Myths About Psychiatry, where she lays out and refutes some of the most common myths and misconceptions about psychiatry. It is a bit dated, but it is worth reading. The myths she dethrones includes the notion that psychiatric illnesses do not exist or are poorly defined and that treatment does not work, but is, in fact, dangerous. Let us look at a few of them, in turn.
Myth #1: Definitions of psychiatric conditions are severely suspect.
A common claim is that psychiatric conditions are labels on healthy human variation, or that is an arbitrary convention. Stotland explains that while
It’s true that some psychiatric conditions exist on a continuum with normal reactions, normal states of being. Differentiating them from normal is no different than deciding what level of blood pressure is ‘hypertension,’ how many pounds add up to ‘obesity,’ or how many hours of labor it should take before a baby is born. A condition rises to the level of disease when it handicaps a person, is associated with bad outcomes, and/or can be treated — in psychiatry just as in the rest of medicine.
In other words, a mental disorder is often a condition with strongly interferes with the day to day life of a person. This fits neatly into the three Ds: distress, dysfunction and deviance as guidelines for deciding if a psychological variation should be labeled as a mental condition: does it cause distress or dysfunction for the person or people around them? Is it just so deviant that it cannot reasonably be counted as healthy human variation? Stotland’s response also fits with how other medical conditions work, such as hypertension and obesity. In other words, mental disorders is a disease of the brain/mind, just like other medical conditions are diseases of the heart, or lungs etc.
Another popular claim is that diagnoses are just voted on and are not supported by evidence. Stotland points out that
This notion assumes that medical diagnoses are handed down on tablets like the Ten Commandments. On the contrary; specialists have to look at the evidence and then make judgments about the criteria for medical diagnoses. The difference between a benign tumor and a cancer is a matter of how many sick cells appear under the microscope. Of course oncologists have to make that decision, and they presumably they have some sort of vote to make it official.
In other words, psychiatrists, as well as other medical doctors, look at the scientific evidence and try to make the best judgment possible about definitions and criteria. This also emphasize the continuity between physical and mental health. Granted, there are limitations to the diagnostic manuals, but the solution is better manuals, not throwing the baby out with the bathwater.
Myth #2: Psychiatrists are diagnosing people to fill practices.
Do psychiatrists just label people with mental disorders just so they will have work to do? As it turns out
There is a shortage of psychiatrists. I don’t know any psychiatrists with time on their hands. Our incomes are at the lower end of the medical totem pole, along with family medicine and pediatrics, which makes it difficult to repay the over $100,000 in student loans we have, on average, but we make a good living.
I find the conspiracy theory that people become doctors just to make money interesting. While I am sure that medical doctors have high wages, it is also true that they work hard, long hours and that they have high debts to pay off.
Myth 3# Psychiatric drugs hurt people more than they help
Next to conspiracies about large pharmaceutical companies, this has to be a very common myth. Stotland asks the rhetorical question
Do psychiatric medications turn people into ‘zombies,’ or change their personalities? Any medication can cause ill effects in some people, especially if they take too large a dose. Are psychiatric medications ‘brain-altering’? A person who recovers from depression, post-traumatic stress disorder, or obsessive-compulsive disorder can seem to have a changed personality — a healthy one. People treated for schizophrenia can use their brains to make contributions to society and have fulfilling lives because their brains are no longer cluttered with hallucinations and delusions.
Ultimately, it is a matter of cost-benefit analysis. The best treatments often combine medications with things like cognitive behavioral therapy. Stotland finishes of by noting that
Prejudice against psychiatry, psychiatric patients, and psychiatrists goes back millennia. It’s hard enough to have a painful and possibly disabling disorder, or to treat one, without suffering from stigma as well. The brain is not only the most complicated organ of the body — it’s one of the most complicated entities in the universe. So psychiatric problems don’t have simple answers. Just like our colleagues in other branches of medicine, no more and no less, there is much more that we don’t know than that we do know. Like our medical colleagues, we’ll keep relieving the suffering of people who are ill, and we’ll keep doing research to understand and treat them ever better.
Dr. Stotland discusses several other myths as well as giving some pretty interesting references. We need more like her, taking on the myths head-on, particularly in enemy territory, like the Huffington Post.