The fanfare surrounding the publication of DSM-5 presents the manual as psychiatry’s bible, a diagnostic decree that clinicians rely on and abide by. Such reception highlights the deficiency of public understanding of mental disorders and their treatment. Last week we asked Liah Greenfeld what she’d most want to convey to the public to help correct that misunderstanding, and below, Richard Noll, author of American Madness: The Rise and Fall of Dementia Praecox, takes on the same question.
“The public here believe in drugs and consider prescription as the aim and end of medical skill,” complained Swiss-émigré neurologist Adolf Meyer in August 1894, “whereas in Germany and in many other places, the people regard the drugs as quite as great an affliction as the disease itself.”
The same is true today. Indeed, since the publication of DSM-III in 1980, even more so.
Since the dawning of the Age of Prozac twenty-five years ago, we have consensually adopted a culture of surveillance medicine which reflexively invokes psychiatric medications as the first-line mechanism of self-mastery and social control for our children, our soldiers, our behavioral deviants, and our selves.
The automatic expectation of a prescription following a DSM diagnosis, usually rendered (perhaps 80 percent of the time) by a primary care physician, clinical nurse specialist, or physician assistant after a 15-minute chat, is so commandingly reinforced by the media and the medical profession that we cannot help but be seduced by the illusion that most of the hundreds of mental disorders in DSM or ICD are “diseases” like any others.
But everyday people have no interest in the philosophical distinction between a DSM or ICD mental disorder and a biological disease concept because the usual treatment they receive for each is medication.