… How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, talks about how doctors diagnose personality disorders.
The most recent edition of the DSM series, DSM-IV in 1994, had a whole slew of personality disorders, including histrionic, narcissistic, borderline, and so forth. The editor of DSM-IV, Allen Frances, was a psychoanalyst, and the list is a kind of last gasp. The problem is that patients who qualified for one, tended to qualify for almost all of them. The individual “disorders” were quite incapable of identifying individuals who had something psychiatrically wrong with them; the “disorders” had become labels for personality characteristics that are found in abundance in the population.
Moreover, who needed labels? Psychiatrists had a seat-of-the pants definition of a PD: “If your first impression of your patient is that he is an asshole, then he probably has a personality disorder.”
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You begin to see the basis of Steven Cohen’s defense.
December 2nd, 2012 at 12:38PM
My personal non-expert guess is that psychiatry, psychoanalysis, and clinical psychology probably have done plenty of good, no little harm, with plenty of mischief all around.
Example: the Marine Corps once routinely sent recruits who’d come unglued in basic training for psychiatric evals. Good intentions, sure. But the eval was for the benefit of the employer, who wanted to be rid of the genuinely disturbed.
Ditto the Midwestern telephone company in the 1970s that selectively suggested psych evals for workers who gave notice to quit. As I heard the story, management was somewhat fearful that recently hired black workers, especially, might somehow give the company a black eye should they choose to leave a cushy job. So the eval was something of a corporate CYA tactic, although I can’t recall any details.
I don’t even want to think about how psych referrals, diagnoses, treatment, etc., can be gamed so that interested parties get what they want.
December 2nd, 2012 at 2:32PM
Now I get it… open and shut case… those tiresome whistleblowers who rat on Pharma are cases of Kraepelin’s querulant personality disorder!