Shifts in Psychiatry

One of the overarching themes present in Horwitz's Creating Mental Illness is the way in which mental disease, illness, and disorders changed over (primarily) the 20th Century alongside changes within and without psychiatry. What is most interesting to me, as much of what Horwitz deals with has a lot to say about what we have read in the past weeks - the pursuit of professionals to maintain their legitimacy and status amongst their peers and with society. Horwitz centers much of his discussions regarding mental health around the changing philosophies of psychiatry; the creation of the DSM is a focal point for his argument.

When looking at the history of psychiatrists, in and out of the institutions, the same story has been told by plenty of other historians - many of which are cited in Horwitz's monograph. So - we must ask what is different here? More importantly, why should the history of mental health be considered today, and how does it play into the history of medicine in general? Obviously, I'm just posing questions (not looking for any real answers), but these are questions I've tried to ask myself with each book.

Horwitz's analysis of particular "mental disorders" that were a part of the DSM-III and DSM-III-r is important to note - eating disorders, MPDs, substance abuse, hysteria, and depression. Statistics are abundant in many forms of media today. The mass media (i.e. magazines, newspapers, television ads, Internet websites/ads) is constantly bombarding consumers with statistics regarding the numbers of people that go without treatment for "depression" or "fibromyalgia" are apparently at an all time high...well, so is the price of gold - it's how the "chicken guy" stays open ;). But on a more serious note, there is money to be had by finding a drug that does something to people, and making a disease be the problem which the drug fixes. But, the "symptoms of most psychological dysfunctions are not direct indicators of discrete underlying disease entities" (p.108). In other words, Horwitz has a major issue in the way psychiatry was morphed from a dynamic to diagnostic model.

Horwitz doesn't go so far as some might to saying that the DSM is worthless (see L.J. Davis: "Encyclopedia of Insanity") for he does find it useful in categorizing the psychotic disorders. However, Horwitz's evidence from the DSM writers is also insightful into analyzing why psychiatry made such a drastic shift in publishing the DSM-III.

Overall, I find Horwitz's point of view helpful in that he is primarily analytical, objective, and stays away from the contemporary smarmy muckraking pieces one would find in a newspaper or journal article criticizing psychiatry and those who practice it as quacks.

Article Mentioned:
L.J. Davis. "Encyclopedia of Insanity: A Psychiatric Handbook Lists a Madness for Everyone," Harpers Magazine. February 1997.