Are Psychiatrists the Sick Ones?

29 May Are Psychiatrists the Sick Ones?

May 29, 2013

To New York Times columnist and cultural and political commentator David Brooks, psychiatrists are not heroes of science but “heroes of uncertainty.” Such is the title of his May 27, 2013 Op-Ed piece. 

Brooks takes the compilers of the DSM-5 and contemporary psychiatry to task for presenting their field as scientific. At the same time, he praises psychiatrists for their artistry, calling them “daring adapters, perpetually adjusting in ways more imaginative than scientific rigor.”

Brooks is not the first to point out the often-vast differences between the philosophy of a social institution and the philosophy and practice of the actual people who work in a given field. (It’s commonplace to read about teachers who teach in the face of the mandate of the institution of education to raise test scores, for example. And caring doctors who listen to their patients. ) But he does it well—so well, in fact, that readers might rush to make an appointment with a psychiatrist.

According to Brooks, the behavioral sciences—of which psychiatry is one—is not really a science, and so it shouldn’t pretend to be one. But it does pretend—these days, with a vengeance. It’s an obsession. Brooks calls it “Physics Envy.”

“If the authors of the psychiatry manual want to invent a new disease, they should put Physics Envy in their handbook. The desire to be more like the hard sciences has distorted economics, education, political science, psychiatry and other behavioral fields. It’s led practitioners to claim more knowledge than they can possibly have. It’s devalued a certain sort of hybrid mentality that is better suited to these realms, the mentality that has one foot in the world of science and one in the liberal arts, that involves bringing multiple vantage points to human behavior.”

On this we agree. My mentor, the late philosopher and social therapist Fred Newman, and I wrote a whole book on the subject (Unscientific Psychology: A Cultural-Performatory Understanding of Human Life).  In his social therapy practice and writings as a philosopher and a playwright, Newman took the psychology (that is, the pretend science) out of helping people and understanding human life. He tried to help people embrace the uncertainty of living, to themselves be “heroes of uncertainty.”

I liked Brooks’ column. I thought he did a good job in showing the institutional bias of psychiatry and its Physics Envy. But he didn’t go far enough for my taste.

He still holds fast to a disease model: “It’s more important to know what sort of person has a disease than to know what sort of disease a person has.” In doing so, I think he’ll lose the argument every time. (Do you want an artist treating your disease?) More than that, though, he’s reinforcing the belief that there’s something wrong with how we’re feeling and that the doctor knows how to fix it.

One of my favorite philosophers is Ludwig Wittgenstein—a brilliant, eccentric and, by his own account, tormented man. No doubt he would have been diagnosed with a mental disorder were he alive today. In his writings, he showed how trying to create an objective science of the subjective gives us “mental cramps,” causing great confusion and pain. He said, “We can fight, hope and even believe without believing scientifically.”

Fred Newman is another of my favorite philosophers. Following Wittgenstein, he created an approach to helping people in emotional pain with a subjective science of the subjective. In his book, Let’s Develop! A Guide to Continuous Personal Growth, he said, “Therapy should be a culturally transforming experience, teaching us a new, and developmental, way of seeing and creating a new life.”

If psychiatry heeded Wittgenstein and Newman, they might well be cured of Physics Envy.