Cracked by James Davies Read Free Book Online Page B

“stress disorders” to be biologically explained and pharmacologically treated.
    The issue of medicalization is crucial because it concerns where the very limits of medical intervention should be drawn. At what point does medicalization begin to undermine the health of a population? At what point does it begin to turn what should be a matter for spiritual, philosophical, or political understanding and action into an issue to be managed by medicine alone? This question has particular relevance for psychiatry. For psychiatry, as we will soon see, has been accused more often than any other medical specialism of incorrectly medicalizing our normal actions and responses. The question for us right now, then, is to what extent is this accusation true?
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    In an interview for a BBC documentary in 2007, the film’s maker, Adam Curtis, posed this very question to Robert Spitzer. He asked Spitzer whether the DSM had committed any errors. More precisely, he asked whether when creating DSM-III his taskforce had adequately distinguished between human experiences that were disordered and human experiences that were not. In effect, had the taskforce, when creating its list of mental disorders, wrongly labeled many normal human feelings of sadness and anxiety as indicators of medical disorders that required treatment?
    Spitzer, with noticeable regret, admitted that this had occurred. He then went on to explain why.
    â€œWhat happened is that we made estimates of prevalence of mental disorders totally descriptively, without considering that many of these conditions might be normal reactions which are not really disorders. And that’s the problem. Because we were not looking at the context in which those conditions developed.” In other words, Spitzer’s DSM only described the symptoms of each disorder, but never asked whether or not these so-called symptoms could, in some circumstances, actually be normal human reactions to difficult life situations.
    An incredulous Curtis therefore said to Spitzer: “So you have effectively medicalized ordinary human sadness, fear, ordinary experiences—you’ve medicalized them?”
    â€œI think we have, to some extent,” responded Spitzer. “How serious a problem it is is not known. I don’t know if it is 20 percent, 30 percent … I don’t know. But that is a considerable amount if it is 20 percent or 30 percent.” 31
    In this interview with Adam Curtis, Spitzer admitted that the DSM-III wrongly reclassified large parts of normal human experience—sadness, depression, grief, anxiety—as indicators of mental disorders that required medical treatment. This error occurred because his taskforce was only interested in the experiences that characterized the disorder. It was not interested in understanding the individual patient’s life or why they suffered from these experiences. Because these contextual factors were overlooked, experiences of sadness, anxiety, or unhappiness were often listed as symptoms of underlying disorders, rather than seen as natural and normal human reactions to certain life conditions that needed to be changed. 32
    You’ll remember that I met Spitzer in early May in his house in leafy Princeton. As we sat eating lunch, I took the chance to ask him about the Curtis interview. Once I had recounted to him his exchange with Curtis, he slowly put down his spoon and turned his head in my direction. It was immediately clear to me he was unwilling to elaborate on what he had previously said.
    It also seemed clear that he had shifted his position since that earlier interview with Curtis. While he still agreed that normal reactions were being recast as psychiatric illness, he now seemed keener to locate the cause of this problem elsewhere: not in how the DSM was constructed and written, as he had confessed to Curtis, but in how the manual is being used. As Spitzer explained:
    â€œ[In clinical practice] there is