By Sue Poole
The whole world is our hospital
Wherein if we do well
We shall die of
The absolute paternal care
That will not leave us
But prevents us everywhere.
-- T.S. Eliot in "East Coker"
If reliability is the litmus test of true science, the DSM [Diagnostic and Statistical Manual, the standard reference text listing so-called mentall illnesses] flunks.
Research by Robert Spitzer and others has shown that psychiatrists seeing the same patient at different times agree on Axis I [major "mental illness"] diagnoses 54 percent of the time, making any diagnosis suspect and raising serious questions about unexamined psychiatric authority to force human beings into high-risk therapies involving electricity and dangerous drugs.
The agreement rate for Axis II (personality) disorders was 66 percent, meaning that 34 percent to 46 percent of psychiatric patients are probably assigned mistaken labels and then treated based on discretionary judgments of psychiatrists who cannot even make the same assessments of the same patients after years of training and clinical practice.
When therapists observed the same patient simultaneously with opportunities to compare notes and impressions, the agreement percentages rose to 78 percent for Axis I categories and 61 percent for Axis II.
There is a caveat. The percentages in the simultaneous studies were skewed by a number of factors. Seven out of 25 diagnostic categories considered got a 100 percent agreement rate..helped along by the fact that no more than five patients were observed in any sample. Indeed, in three samples, only one patient was observed.
The next highest inter-rater reliability rate that helped produce the overall percentages was 90 percent for 33 patients identified as having substance abuse problems...hardly a behavioral category even a lay person could mistake in comparison with other choices.
The assessments of the unmistakable behaviors served to boost reliability substantially. The power of suggestion may have also been a factor, since the psychiatrists who observed the same patients at the same time were able to influence one another's choices.
Categorical subsets of the major DSM classifications were never a subject of inquiry in the studies, so the abysmal inter-rater reliability rates for subcategories containing finer distinctions can only be imagined.
In reliability research, if inter-rater agreement is poor, it is doubtful the categories represent anything in reality. On the flip side, a low reliability index may mean the categories are valid but the therapists have poor diagnostic abilities. In the DSM studies, either conclusion is manifestly up for grabs.
So, despite the American Psychiatric Association's claims of scientific rigour in a "three-stage empirical review," we are left doubting that many of the categories are real...or even that they are accurately described or evaluated by competent clinicians.
Based on inadequate and substandard science...and in the absence of documented field trial methodologies and results...psychiatrists have full discretionary power to prescribe radical and patently hazardous drugs and electrical interventions for sets and subsets of behaviors (not proven diseases) about whose validity even psychiatrists cannot agree 30 percent to 46 percent of the time.
Yet the public, the politicians, the lawyers, the judges issue no challenges and raise no objections to this fiasco fuelled by psycho babble and the arrogant presumptions of what is, essentially, a special interest group determined to consolidate power for purposes of profit and prestige.
Without empirical evidence and documented case studies proving the categories are, in fact, diseases, the only logical assumption remaining is that some patients in distress respond favorably to certain drugs which psychiatrists are empowered to administer by force despite the absence of unbiased and reliable research concerning their long-term effects on the brain and, by extension, the physical. behavioral and psychological well-being of those coerced into chronically ingesting them.
The power of suggestion is always a danger when subjective evaluations are under way. A study by Maurice Temerlin and William Trousdale illustrates the dangers of shared professional impressions, the power of suggestion working in society at large and of training that conditions therapists to look for behavioral aberrations where none may actually exist. The study results underscore the perils of walking into a therapist's office for help with problems in living or even to express curiosity about the therapeutic process.
Temerlin and Trousdale had a professional actor visit a therapist asking questions about therapy as though he were simply interested in making an informed decision about it. The tape was shown to undergraduate students, law students, psychology graduate students, practicing psychologists and practicing psychiatrists. The groups were asked to assess the man using a menu of disorders or the category "healthy, normal person."
The authority figures who showed the tapes - a psychologist and a law professor - remarked casually that the person on the tape looked "neurotic but is actually quite psychotic." The group of psychiatrists was told that two psychiatry board members had heard the tape and determined the man was psychotic although he appeared to be only neurotic.
Three other groups were also recruited to perform assessments. One group was told the man was normal and healthy. Another received no suggestion at all. The third was told the tape portrayed a personnel interview. For the third group, the interview had been removed from a clinical to a business setting.
Not a single member of any of the last three groups diagnosed the man as psychotic.
Significant numbers of the first five groups did.
Not a single psychiatrist chose either "neurotic" or "healthy, normal person." All the psychiatrists, influenced by secondhand opinions of prestigious colleagues, perceived the taped subject as suffering from an array of serious mental disorders.
The study demonstrates that therapists are often influenced by their training and by their colleagues' opinions (e.g., the patient's psychiatric history) to look for the abnormal even though it may not be manifest or present. The consequences evince a kind of herd mentality at work in circles of professionals who ought to be mature and intelligent enough to make independent judgements, especially when they hold people's reputations, child custody arrangements, adoption eligibilities, livelihoods and liberties in the palms of their hands.
The power of psychiatric suggestion operates on the same principles throughout society at large, effectively cutting mental patients off from the legal, political and community resources they need to defend themselves against malpractice, reckless disregard, mistreatment from misdiagnosis and wrongful imprisonment.
Meanwhile a duped society rejects the voices of psychiatric inmates, patients and ex-patients who have had their personalities mangled and their bodily functions impaired by the arbitrary and unwarranted -- often involuntary -- administration of drugs and therapies calculated to control behaviour rather than to cure legitimate and well-defined diseases.
Thomas Scheff, author of "Being Mentally Ill," says mental illness may be more usefully considered as a social status rather than a disease since the symptoms are vaguely defined and widely distributed and the definition of behaviour as symptomatic is usually dependent upon social rather than medical contingencies.