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RS98 - Jerome Wakefield on Psychiatric Diagnoses: Science or Pseudoscience?

Release date: December 8, 2013

Jerome WakefieldWhat qualifies someone as mentally ill? The standard for diagnosis is the Diagnostic and Statistical Manual of Mental Disorders (DSM), which just released a 5th edition in 2013 -- but just how objective is it? This episode of Rationally Speaking features Dr. Jerome Wakefield, psychiatrist, PhD in philosophy, and author of "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder." Julia, Massimo and Jerome talk about the arbitrariness of the DSM and the controversies around the boundaries of various mental disorders, including depression and sexual fetishes.

Jerome's pick: Bertrand Russell's Autobiography


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Reader Comments (12)

Truth is indivisible and anything else a mental disorder. =

December 9, 2013 | Unregistered CommenterMJA

Mental illness runs in my family and I have known quite a few mentally ill people outside of my family as well. Regarding grief vs. depression, why not apply the term "benign disorder" to grief as you do with your skin condition? It's a disorder though it is almost always temporary.

But... the definition of "grief disorder" is someone grieving for an excessive amount of time (more than 6 months). If a person experiencing normal grief does not get adequate support to cope with it, they could become that patient. Why let the person suffer for six months to qualify for help? Why not help the person at the beginning of their grieving process? Where is the concept of alleviating suffering in your thinking?

Imagine the distinction between a sprained ankle and a broken leg. Of course the person with the broken leg has an obvious need for medical intervention. She or he will go to the E.R., have X-Rays, get the bone set, be in a cast for 6 weeks, and then possibly need physical therapy for awhile. The person with the sprained ankle will need only a few days on a crutch and a few doses of Motrin. Just because the intervention is minimal doesn't mean there wasn't a disorder that required intervention. And the person who continues to walk on a sprained ankle may exacerbate the problem, eventually requiring surgery on tendons. Grieving is the sprained ankle of the psyche. It should not be dismissed merely because it's the ordinary and usual outcome of tripping over life.

My understanding of the DSM manuals is that it includes both psychoses and neuroses - i.e., conditions that require serious intervention (hospitalization or medication) and those that would respond to psychotherapy with or without medication. I found this discussion very dismissive of the "minor" disorders that may be "normal" but that a person may not be able to recover from without assistance.

December 9, 2013 | Unregistered CommenterLadyAtheist

A very enlightening conversation! Thank you very much.

I generally enjoy your podcasts, but this one is a classic, which brought out the "best" in all three of you.

By the way, my first glimpse at philosophy (I've never studied it formally) was Bertrand Russell's little book, the Problems of Philosophy. Until I read that (35 years ago), I never realized that so much mental clarity was possible and how beautiful it is.

December 9, 2013 | Unregistered Commenterswallerstein

It seems like the decision to use a certain treatment should depend on whether the treatment is show to be effective and cost-effective, rather than on whether the person or condition being treated is normal or abnormal. That is, if treatments can cost-effectively help people experiencing "normal sadness", they should be administered. If treatments cannot cost-effectively help people experiencing "abnormal depression", they shouldn't. I realize that psychiatry, and medicine broadly, has historically focused on helping people who are unhealthy, but the term unhealthy naturally changes over time as new treatments emerge. I lean towards focusing skeptical analysis on the effectiveness of treatments rather than on the diagnostic process.

December 10, 2013 | Unregistered CommenterBen

Ben, this is one of my complaints against the idea that psychotherapy is "as good as" pharmaceutical intervention. Sure, over the long term they may be equal in success rate, but medicines are effective and quick. If a person is suicidal or could become suicidal wouldn't normalizing their mood as quick as possible be the best course?

Again, the concept of alleviating suffering doesn't figure for some people. If 6 months of psychotherapy slowly improves mood to the same level that 2 weeks of an SSRI does, isn't the SSRI superior? Better yet, why not do both?

December 10, 2013 | Unregistered CommenterLadyatheist

Where are the statistics in the DSM?

December 15, 2013 | Unregistered CommenterFred Gaskin

Regarding the purpose of homosexuality (men), evolutionary, there is a theory and some research from some pacific islander culture. Stats wise, there seems to be a higher rate in certain sibling numbers. Thus, it may be possible that gay men are around to help out there sister and help sisters raise families. This a cultural tradition with gay men in some areas. (This is a response to a comment by Julia on the show.)

Great podcasts in general - maybe someone will be quoting your podcast as the reason for studying philosophy or science ...

I recommend The Brain Science podcast by Dr. Ginger Campbell.

January 24, 2014 | Unregistered CommenterRaincity Canada

I'd like to know how specific these criticisms of depression diagnosis are to the U.S. I'm guessing "very".

The examples of normal sadness being decribed as depression would surely not be diagnosed that way here in the U.K.

As someone with long-term depression, I find the very thought that normal sadness could be perceived as a form of depression a little insulting. Perhaps I shouldn't take it personally, but it seems to cast doubts on the true state of my own condition.

February 1, 2014 | Unregistered CommenterThomas C
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February 7, 2016 | Unregistered CommenterKarissa Dede
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February 7, 2016 | Unregistered CommenterKarissa Dede
The DSM-V actually refers to recalcitrant teenagers as persons who suffer from "Oppositional defiant disorder (ODD)" The DSM-V states that ODD has an estimated lifetime prevalence of 10.2% Actually, teenagers often reject society due to the fact that although the teenagers have obtained adult cognitive abilities, society continues to regard them as juveniles (age 7 to 14), or even as infants (age 0 to 7). This behavior fails to define a true mental illness, but rather describes a societal problem caused by infantization of teenagers specifically, and of society generally. This problem has grown worse in recent years with the rise of paranoid overprotective parents. The people who write the DSM, however, decided that this entirely understandable behavior actually establishes a mental disorder !!

The fact that the DSM-V refuses to recognize ANY anxiety or depression as normal, even stemming from terribly distressing events, tells us that the DSM authors have decided to deliberately over diagnose mental disorders.
January 5, 2018 | Unregistered CommenterJameson
I found this extremely pretentious, misguided and highly offensive. Not only due to the way in which mental illness was referred throughout the discussion, but also by the tone used by each of the participants. ( “Seems hard to believe”, “Normal People” etc.)
Peoples suffering is not to be scoffed at. Perhaps you should do a few shows on the subject of Moral Theory.

The DSM and ICD change over time as research gives us developments and ways in which to help people. More information allows us to better understand ways in which we can improve quality of life. If you feel that a medical diagnostic manual is too cluttered or complicated for your own liking or understanding, maybe you’re in the wrong profession. The world of psychiatry evolves, that’s how medicine works. That is how everything research based works. I’m not sure why that seems to be such a novel or unbelievable concept. Do not belittle a demographic of people who already struggle to break stigmas surrounding their own existence based on your megalomaniacal need to make a name for yourself.
June 14, 2019 | Unregistered CommenterIsla

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