The Impoverishment of Psychiatric Knowledge


From Psychiatric Times: “GiovanniĀ Fava: Like Moliereā€™s bourgeois who was surprised to speak in prose, the clinician may discover he/she is constantly faced with iatrogenic comorbidity. In pharmacological terms, let us just think of the case of switch into mania of a patient with allegedly unipolar depression treated with antidepressant drugs. You are faced with a modification of illness that is largely drug-induced and that is likely to affect treatment. Or, in psychotherapeutic terms, let us think of a patient who has been unsuccessfully in analysis for many years and is offered a course of cognitive behavioral therapy (CBT): his/her response is likely to be affected by the previous psychotherapeutic experience in terms of expectation, adherence, and motivation. The concept of iatrogenic comorbidity is simply an attempt to conceptualize the problem in a practical way.

Regrettably, psychiatrists, unlike all other specialists, have been taught to consider comorbidity only in terms of diagnoses, and not as problems and treatment experiences. And they are unable to think ‘iatrogenic’ in interpreting clinical problems, simply because they have not been exposed to the concept, which has been submitted to tight censorship by mainstream psychiatry.”

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Empty plastic pill bottles.


  1. “You can blame the illness and the patient, it is easy, but you should also think ‘iatrogenic.’ā€ Blaming the patient is what most of the doctors do, but “think ‘iatrogenic” is the most likely truth with the “invalid” DSM disorders.

    “Aftab: Most of your work on oppositional tolerance has been about antidepressants. How relevant is oppositional tolerance to clinical outcomes with antipsychotics in schizophrenia and mood stabilizers in bipolar disorder?

    “Fava: Similar phenomena have been described by Guy Chouinard7 with antipsychotic medications, subsumed under the rubric of supersensitivity psychosis.” Don’t forget anticholinergic toxidrome creates psychosis, and neuroleptic induced deficit syndrome creates the negative symptoms of schizophrenia. Both bipolar and schizophrenia are illnesses created with the psych drugs, thus iatrogenic illnesses.

    “The Impoverishment of Psychiatric Knowledge,” indeed. Great interview.

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