Danger: Psychiatrists as Moralists

07 Feb Danger: Psychiatrists as Moralists

February 7, 2013

I just read an Opinionator piece in The New York Times on “Depression and the Limits of Psychiatry.” The author is Gary Gutting, is a professor of philosophy at the University of Notre Dame. He tells us he’s been teaching a graduate seminar on Michel Foucault’s work and proceeds to discuss depression, psychiatric diagnosis and the DSM in light of Foucault’s unpacking of the history of madness and psychiatric practice.

It’s a thoughtful piece. From Foucault’s perspective that psychiatric science is moral judgement in disguise, Gutting takes a look at the definition of depression in the soon-to-be released DSM-5— in which the exception for bereavement has been eliminated—and shows the faulty logic in concluding that bereavement and depression are the same. No empirical evidence can determine what is normal when it comes to suffering the loss of a loved one, let alone conclude that this kind of suffering is no different in kind from any other. It’s a value judgement presented by psychiatry as science.

Gutting goes on to raise the question of whether psychiatrists should be the moralists of the 21st century. He answers, “No.” After all, psychiatrists are physicians. They’ve been trained in a model—medicine—that wasn’t designed to judge moral issues. For me, this was the most interesting part of the essay.

“…psychiatrists as such have no special knowledge about how people should live. They can, from their clinical experience, give us crucial information about the likely psychological consequences of living in various ways (for sexual pleasure, for one’s children, for a political cause). But they have no special insight into what sorts of consequences make for a good human life. It is, therefore, dangerous to make them privileged judges of what syndromes should be labeled ‘mental illnesses.’

This is especially so because, like most professionals, psychiatrists are more than ready to think that just about everyone needs their services.  (As the psychologist Abraham Maslow said, “If all you have is a hammer, everything looks like a nail”). Another factor is the pressure the pharmaceutical industry puts on psychiatrists to expand the use of psychotropic drugs. The result has been the often criticized “medicalization” of what had previously been accepted as normal behavior-for example, shyness, little boys unable to sit still in school, and milder forms of anxiety.”

I agree with Gutting that those with a broader view—from humanistic psychology, medical ethics and the philosophy of psychiatry, as well as people who have experienced severe bereavement and their families and friends—are necessary voices, arguably ones with far more expertise on the matter than psychiatrists. They have more than a hammer, so they can see more than nails.