Is psychiatry ever mistaken?

Psychiatry is not absolute.  Our understanding of mental health is as through a glass darkly, and deeply informed and persuaded by social constructs and political correctness (eg remember when homosexuality was removed from the DSM?)

The practice of psychiatry is also susceptible to human fallibility.  TheLastPsychiatrist wrote about the ten biggest mistakes psychiatrists make; two, to my thinking, are particularly relevant to the role of psychiatry in transgenderism:

"Become social policy analysts

Remember how in May, 2005, the American Psychiatric Association endorsed same sex marriage?   And you applauded the moral fortitude and progressive instinct of this august body?  Well, instead of debating whether there should or should not be same-sex marriage, perhaps we should ask what modern psychiatry could possibly contribute to this discussion. The answer is nothing. 

You can't get away with pat answers, such as psychiatrists see the psychiatric ramifications of discrimination or being unable to marry. There are psychiatric ramifications of bankruptcy, and war, but no one felt compelled to write a policy statement on it (and thank God.)

And no, there isn't a difference between bankruptcy and gay marriage-- not to psychiatry. That's the point. These are social problems about which modern psychiatry is definitionally ignorant. The APA did not endorse polygamy. What's the difference? If homosexuality is not a psychiatric disorder, than there is no more reason to be more for or against it than there is for any other kind of marriage. The APA is no better suited to answering these questions than, say, the NFL.

What if the NFL came out against antidepressants in children? This is a perfectly valid analogy, because neither the NFL nor psychiatry have special knowledge that make their statements anything more than opinions. What do psychiatrists know about same-sex marriage that the quarterback for the Patriots doesn’t?  Don’t laugh—I’m serious. What’s the answer? 

Medicine, or the APA, can legitimately express a policy only if  the policy was grounded in science or logic. Perhaps the APA cares to release this intriguing scientific data?  (While it is at it, perhaps it can also release the data supporting the use of half of the medications currently favored by APA Guidelines?)  But this seems pretty much business as usual for the APA. Rather than work on its own serious failings, it involves itself in social policy. 

“Modern” (read: pharmacological) psychiatry is obsessed with reinventing itself as a biological and scientific discipline. Well, if it wants to be a science, it better start acting like one.

The FDA effectively killed Vioxx, and not a peep was heard from the APA about the dangers of letting the government regulate their practice. You can say Vioxx has little to do with psychiatry, but it’s still a lot more than gay marriage.

Determining what is true and what is not, through serious and often disconcerting scientific enquiry, is very difficult. It is much easier to involve oneself in matters of opinion and debate, in activism, because it is both immediately rewarding and it is easy. It’s hard to measure things in psychiatry, and when it is possible the results are often disappointing. So it busies itself with matters of conviction because it feels some responsibility to have convictions. It doesn't. It has a responsibility to the truth, and if it doesn't want to invest any energy in that pursuit, it is on them. But don't mask it with whimsy and dilettantism. 

I should point out that gays, far from being pleased with the APA’s stand, should actually be horrified.  Do you-- does anyone-- want social policy suggested by psychiatrists? Think long and hard. 

Imagine the outrage if the APA had come out against gay marriage, or for the war in Iraq. There would be battalions of people saying, "well, what the hell do psychiatrists know about war in Iraq? Who the hell do they think they are telling gays not to get married?" There is no protection in being confident of the rightness of your current position, as history is loaded with examples of how terribly bad doctors are at determining what is right and what is wrong. Not long ago homosexuality was considered a disease. See?  The Tuskegee experiments were endorsed by the AMA, and the AMA gave its endorsement,  after ethics concerns were raised by Peter Buxtun. Remember that?  How about the speech to the1941 APA meeting, and the 1942 issue of the American Journal of Psychiatry in which euthanizing the “feebleminded” (IQ<65) sounded like a good idea?  

Psychiatry would do well to remember Wittgenstein TLP 7: Whereof one cannot speak, thereof one must be silent.

Don’t refer to therapy

Psychopharmacology without therapy is treating an infection with Tylenol.

Medications do not cure a psychiatric disease; we’re not even sure what the disease actually is.   What they can do is reduce symptoms, give you strength—so that you can learn new behaviors.  That’s the point of medications.  Treating depression with an antidepressant is not the solution; it’s the preliminary step in allowing you to figure out how to handle depression later on.  The adaptation, the adjustment, the physical altering of brain functioning is done by new learning, often this is therapy (though it doesn’t have to be.)  I’m not saying therapy is that great, or necessary, either.  I’m simply saying that trying to improve a person’s long term status using medications alone without some sort of education and training is a waste of time.  It is maybe the most profound disservice of all to tell a patient that their depressive or bipolar symptoms are the result of biology or chemical imbalances and thus absolve them of the responsibility of learning new ways of interpreting and coping with their environment."

Hear hear.