The Ambiguity of Psychiatry
The diagnosis of physical ailments is at the core of medicinal practice. From the use of sophisticated functional MRI scans to simple blood pressure cuffs, doctors in a variety of specialties have been able to use technology to detect diseases beyond their own senses. However, the current methods of diagnosis become more difficult to effectively apply when entering the realm of psychiatry.
The human brain is a roughly three-pound organ, differing from the heart or liver only by function and structure, and yet it is arguably the most complex system in the known universe. It is able to influence essentially all other systems of the body subconsciously, and produce coherent conscious thoughts that allow for planning and social interaction. Like any other organ, however, it is susceptible to malfunction and disease, such as the decay of gray matter in the case of Alzheimer’s disease. But there are other manifestations of brain malfunction in the forms of diseases that are not easily measured or detected by reliable instruments. For example, how does one measure the debilitating anxiety one feels in their daily life? Or measure the suffering of a veteran with post-traumatic stress disorder? These afflictions are very real, but while their damage to one’s psyche is evident, the physical source of these afflictions and appropriate subsequent treatments can be less certain. It is this lack of a truly concrete basis for the diagnosis and treatment of certain mental illnesses that arouses a degree of controversy in the field.
In the article “Law Psychiatry: The Problems That Will Not Go Away”, Dr. Thomas Szasz wrote a criticism of the approach to a psychiatric disorder as any other illness, writing that, “…the mind is not a bodily organ…as everyone knows but few acknowledge, the term ‘mental illness’ is typically affixed to misbehavior, not brain disease” (558). The complication of classifying behaviors as diseases is that a relatively broad collection of actions and mannerisms may be deemed unacceptable or unhealthy to one generation of physicians, while another generation may harshly critique the methods and conclusions of its predecessor. As reported by Dr. Neel Burton, the Diagnostic and Statistical Manual of the American Psychiatric Association, the standardized handbook for the classification of mental disorders, classified homosexuality as a mental disorder in its second edition in 1968. It was five years later that a vote was brought at a convention for the American Psychiatric Association to remove it from the list, but a 61% majority vote for its removal only resulted in a compromise to label certain individuals who were “in conflict with their sexual orientation” as having mental disorders (Neel, “When Homosexuality Stopped Being a Mental Disorder). Although the manual for the American Psychiatric Association has been updated to its fifth version in 2013, including a greater understanding of mental illness, the method for classifying certain behaviors as mental disorders has not changed drastically.
The gap between brain and behavior is further exacerbated by the separation of the medical fields of neurology and psychiatry. Although specialists of both fields are interested in the same organ, their practices differ greatly in approach. The article “The Science of Neuropsychiatry: Past, Present, and Future” discusses a field that seeks to marry these two philosophies, noting that, “…the psychiatrist does not necessarily share the neurologist’s quest to identify the underlying neuroanatomical basis of a disorder. The gap between the two disciplines becomes conspicuous in our day, as we see how recent technologies which enable us to better investigate the neural basis of neuropsychiatric disorders have not yet led to significant breakthroughs in the comprehension, monitoring, or treatment of psychiatric diseases” (Arzy and Danziger). Although physicians from these two disciplines may usually work alongside their colleagues to discover the basis of a patient’s affliction and treat accordingly, perhaps more directly combining their approaches into a singular field of study may lead to the most effective and reliable form of diagnosis and treatment of brain disorders.
In general, the field of psychiatry places a spotlight on the fascinating and mysterious nature of the mind. After all, it is a wondrous thing for a practice to involve the use of one’s brain to study another’s. However, it suffers from a disagreement about a possibly narrow definition of normal behavior, and a method of categorization that differs from the other medical specialties in its degree of physical observation and irrefutable evidence. But as technological advancements in medicine continue and understanding of the brain increases, psychiatry and other medical field will hopefully benefit and evolve as result.
References:
Arzy, Shahar, and Shlomo Danziger. “The Science of Neuropsychiatry: Past, Present, and Future.” The Journal of Neuropsychiatry and Clinical Neurosciences, 1 Jan. 2014, www.neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.13120371.
Burton, Neel. “When Homosexuality Stopped Being a Mental Disorder.” Psychology Today, Sussex Publishers, 15 Sept. 2015, www.psychologytoday.com/us/blog/hide-and-seek/201509/when-homosexuality-stopped-being-mental-disorder.
Szasz, Thomas. “Law and Psychiatry: The Problems That Will Not Go Away.” The Journal of Mind and Behavior, vol. 11, no. 3/4, 1990, pp. 557–563. JSTOR, JSTOR, www.jstor.org/stable/43854107.
