Psychiatry is not a science – in practice and theory

Psychiatry is not a Science – a Recent Practical Example

The trial took place in the Central Criminal Court in Dublin last week of Saverio Bellante. Mr Bellante was accused of brutally killing his landlord Tom O’Gorman. He didn’t deny the killing and the DPP did not have to prove it.

psychiatry practice theory science

Tasso in the Madhouse by Eugène Delacroix

Mr Bellante had received a psychiatric diagnosis in Italy in 2005; “religious hysterical deliria.” (His Irish psychiatrist diagnosed schizophrenia.)† Two days before the killing, Mr Baellante had attended a psychiatric outpatient clinic in Dublin and Mr Bellante’s medication, Olanzapine was stopped.

Consultant forensic psychiatrist Dr Stephen Marks told the court a psychiatrist at the clinic had told Mr Bellante he could gradually come off his medication – contrary to the instructions of Bellante’s psychiatrist in Italy who said Mr Bellante should be on medication for life, for public safety.

Journalist Michael Kelly said questions remain. Questions such as why the change in treatment against another psychiatrist’s advice? Was there a rational or scientific basis to this change in treatment plan?

Psychiatry – The Lack of Science in Theory

Further to my post on psychiatry and science (here), it’s good to find confirmation from a clinical psychologist, Linda Blair, in her weekly column for the Daily Telegraph. Her article What’s the Point of Diagnosis? makes a number of pertinent points, points which sceptics of homeopathy would quickly point against homeopathy without realising the lack of science in medicine, especially psychiatry.

Ms Blair begins by explaining that making a diagnosis is “tricky”. She then tells us diagnosing is a matter of ticking a medical category with the largest number of key symptoms. In other words, pigeonholing. That might be nice and convenient, especially from a prescribing point of view as it reduces the prescription to a few possibilities. That’s all it is, convenient, not rational or scientific.

At least doctors (she means physicians treating physical diseases – if diseases can be reduced to the physical) have some objective markers such as blood tests and scans etc, but psychiatrists can only observe behaviour and then either guess at intention or ask the patient to explain their thoughts and feelings. When the patient can’t or won’t comply, she says, the psychiatrist “must rely on guesswork.” “There’s an enormous amount of speculation involved.”

Then, as she correctly tells us, cultures complicate matters; what’s normal in one culture may be pathology in another.

Another problem is that many problems are thought to be permanent, so once a person is diagnosed, it can be difficult to ever regard them as “well”, she says.

I agree with her when she tells us symptoms can be treated without attempting to categorise them. Unfortunately, she doesn’t explain how. Having not diagnosed the patient, i.e. not categorised them, a psychiatrist cannot prescribe. It is however feasible for  a homeopath and psychologist to treat without having pigeonholed a person into a category box as these two methods appreciate that medicine is an art as well as a science – something not necessarily appreciated by critics of homeopathy or the medical profession.

The problem for psychiatry – and homeopathy’s sceptics – remains when the diagnosis is arbitrary and subjective, then how can one make a rational and scientific prescription? So, Linda, what is the point of diagnosis? No doubt a psychiatrist will find an answer – but one that fits with science? I’m not so sure.

Footnotes
† Does science change from country to country? Here Mr Bellante had received two different diagnoses, begging the question: does science change depending on location? It seems so in medicine. Twelve years ago an aunt of mine was diagnosed in Ballina with depression (based on her husband of 30 years being an alcoholic. Suddenly this, the doctor surmised, is depression, despite her husband having abstained from alcohol for five years! – Life had never been better). A few days later in Castlebar she was diagnosed with a urinary tract infection and a few days thereafter in Galway, another practitioner of medical “science” told her she had a kidney tumour with metastases in the brain. She died a week later. Does science change from place to place? Does science change from practitioner to practitioner? Does science change every few days?

Further Reading
On psychiatry being unscientific and the dangerous side-effects see my post on the mind-brain split

On medicine as art see my posts here 

On psychiatric medications visit Rxisk.org

Some new publications on experiences of psychiatry generally:
The Last Asylum: A Memoir of Madness in Our Times by Professor Barbara Taylor link

Books by Dr David Healy, professor of psychiatry, here

Sectioned: My Experiences While Detained Under the Mental Health ACT by Hilary G Coveney link

Psychiatrists don’t understand their own discipline. Professor George Makari says in his New York Times article: “Psychiatry’s Mind-Brain Problem.”

Now available: Deadly psychiatry and organised denial by Peter C. Gøtzsche. The first chapter can be read here for free

Updates
The dramatic increase in filicide-suicide appears to largely coincide with an increase in the use of anti-depressants.

Does long term use of psychiatric drugs cause more harm than good? BMJ.com

Is change afoot?: New Urine Test Could Tell if a Person is Suffering from MDD or Bipolar Disorder link

October 2016: Teenagers 80% more likely to suffer depression if they took the contraceptive pill. A commentary on this research is available here: The Pill has been linked to depression. Why isn’t this more of a scandal?: Because it is a sin to suggest that oral contraceptives may not be the greatest gift ever given to womankind

Rows over study which claims antidepressants double suicide risks (link)

Antidepressants were discovered by accident, not by science! (and similarly with penicillin). Should you take antidepressants, asks a clinical psychologist? The Telegraph
June 2017: Doctors ‘too reliant’ on depression questionnaire designed by Pfizer, campaigners warn Link
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