Science by consensus

Do you have Hypertestosterone Hostility Disorder? Well, you are lucky there aren't more female doctors, because your disorder is not yet in the Diagnostic and Statistical Manual (DSM) used by the pharmaceutical-medical complex. "Premenstrual Dysphoric Disorder" (PMDD), though, is in there. Prozac, when its patent expired, was renamed Sarafem to treat PMDD.

Carol Tavris, co-author of a book intriguingly entitled, Mistakes Were Made, but not by me, writes in the Wall Street Journal that although doctors do not vote on whether pneumonia is a disease, they do vote on the various mental diseases. Homosexuality and narcissism have both been voted in and out of the DSM. She reviews two books critical of the DSM process, one by Dr. Alan Francis entitled Saving Normal, and one by Gary Greenberg, entitled The Book of Woe.

Tavris writes,

The DSM-III (1980) was an effort to jettison outdated theories and terms such as "neurosis" and replace them with an objective list of disorders with agreed-upon symptoms. The DSM-IIIR (1987) was 567 pages and included nearly 300 disorders. The DSM-IV (1994, slightly revised in 2000) was 900 pages and contained nearly 400 disorders. The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, "binge-eating disorder" (whose symptoms include "eating when not feeling physically hungry"), "caffeine intoxication," "parent-child relational problem" and my favorite, "antidepressant discontinuation syndrome." Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the "bereavement exemption," for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.

The DSM committees already tried their damnedest to support their diagnoses with neuroscience or biomarkers, but no lab tests yet exist for depression, schizophrenia, bipolar or obsessive-compulsive disorder, or, for that matter, any other mental disorders. Efforts to find explanations in genes, neurotransmitters, "chemical imbalances" or brain circuits have, Dr. Frances writes, "turned out to be naïve and illusory."

The National Institutes of Mental Health have washed their hands of the DSM, and plan to offer their own version of "precision medicine" by 2020.

The dream of biomedical markers may prove as fruitless as the dream of a scientific DSM: Both try to "pour the old wine of human suffering into the new skin of scientific medicine," Mr. Greenberg writes. Fortunately for us, he concludes, the human mind "has so far resisted this attempt to turn its discontents into a catalog of suffering. And for this we should be glad."

Hat tip Dan Collins