In reality, Friedman explained, most psychiatrists are as eager as any other doctor to move away from symptom-based diagnoses. They understand that as their field matures, it will look more and more like internal medicine. Friedman referred to discovering the neural basis of mental disorders as “the holy grail of psychiatry.”
Yet after maligning the adolescence of psychiatry in his column for the Times, Brooks censures this desire to come of age. Accusing psychiatrists of “piggybacking” on the authority model of biology and physics, he makes a bizarre case for the status quo:
All of this is not to damn people in the mental health fields. On the contrary, they are heroes who alleviate the most elusive of all suffering, even though they are overmatched by the complexity and variability of the problems that confront them. I just wish they would portray themselves as they really are. Psychiatrists are not heroes of science. They are heroes of uncertainty, using improvisation, knowledge and artistry to improve people’s lives.
Well, yes and no. As Brooks writes a paragraph later:
The best psychiatrists are not coming up with abstract rules that homogenize treatments. They are combining an awareness of common patterns with an acute attention to the specific circumstances of a unique human being. They certainly are not inventing new diseases in order to medicalize the moderate ailments of the worried well.
But that’s just the best of them. The worst take advantage of the uncertainties in their field to rack up patient visits, dole out prescriptions and pad their wallets. There are also the lazy ones, who don’t heed their field’s shortcomings and disrupt their patients’ lives in the process.
Maia Szalavitz’s first-person account of dealing with psychiatrists, published May 17, shows, as the headlines notes, “what’s right—and wrong—with psychiatric diagnoses.” Szalavitz, who covers neuroscience for TIME.com, spent decades going in and out of psychiatrists’ offices and received at least five different diagnoses for mental illnesses based on DSM criteria. None really fit, however, and some exacerbated her anxiety. The appropriate diagnosis, Szalavitz now believes, would have been Asperger’s Syndrome, and it would’ve helped, but it didn’t exist when her problems emerged and it doesn’t exist any more, having been folded into autism spectrum disorder in the latest edition of the DSM.
Refining the current diagnostic system will be difficult, to be sure—so difficult that nobody’s sure how long it will take—but few doubt that it can be done. Still, Brooks suggests that psychiatrists should stick with what they’ve got.
The solution he sees is not scientific progress in psychiatry, but rather admitting that it is a “semi-science” and accepting that that’s the best we can do. In his words:
The desire to be more like the hard sciences has distorted economics, education, political science, psychiatry and other behavioral fields. It’s led practitioners to claim more knowledge than they can possibly have. It’s devalued a certain sort of hybrid mentality that is better suited to these realms, the mentality that has one foot in the world of science and one in the liberal arts, that involves bringing multiple vantage points to human behavior.
Wrong again. Yes, there will always be some artistry involved in medical practice, but psychiatry is not like economics, political science, and other behavioral fields. It is a hard science in the very early stages of development, and its diagnostic methods will improve. Brooks’s failure to understand that caused his blanket attack on psychiatrists, and his blanket defense of them, to be sorely misguided.