Psychiatry’s Intellectual Crisis: Giovanni Fava, MD

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From Psychiatric Times/Conversations in Critical Psychiatry: “Psychiatry is going through an intellectual crisis. This crisis is shared by other areas of clinical medicine and stems from a narrow concept of science that neglects clinical practice as a source of fundamental research questions. Fewer and fewer academic psychiatrists actually assess and treat patients. Most of published research has no relevance to practice. The progress of neurosciences in the past 2 decades has often led to the belief that clinical problems in psychiatry were likely to be solved by this approach. Such hopes are understandable in terms of massive propaganda operated by biotechnology and pharmaceutical corporations.

An increasing number of psychiatrists are wondering, however, why the cures and clinical insights promised by neurosciences have not come to fruition. Biological reductionism has resulted in an idealistic approach, which is quite far from the explanatory pluralism required by clinical practice. Neurosciences have exported their conceptual framework into psychiatry much more than serving as an investigative tool.”

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5 COMMENTS

  1. I could believe in “intellectual crisis” in psychiatry if there was something intellectual going on within the industry. And no, they are not the innocent sheep simply jumping when big pharma says jump.
    We obviously cannot believe that “doctors” are so silly and mindless that they have to give subjects the poisons.
    We know what happened. Psychiatry created “disease” and “illness”, and we know what follows. Drugs to treat those illnesses will be created.
    Cancer was discovered through scientific manner, and somewhat understood, yet the medical community can offer very little to actually treat it and certainly not without bad effects.

    Yet psychiatry started prescribing drugs despite nothing scientific being found. The only science ever found within psychiatry are words and phrases that sound scientific. The rest is pure hogwash and bias towards people, bias which results in horrid abuse.

    I do like the article right under the presented article with Dr Houda. “The Medical Model in Theory and Practice”:
    “Many others and Wakefield view disorder and diseases as a dysfunction (a purportedly value neutral term which can include biological or psychological dysfunctions) that is negatively valued. Both disorder and disease carry negative connotations. If you tell someone their personality is disordered, well, that’s fighting talk where you are armed with medical terminology and they are defenseless—there’s nothing more personal than personality (leaving aside that these are arguably not disorders of personality per se rather than psychological reactions to trauma in the context of other vulnerability factors). Both disorder and disease carry the assumption of something “wrong” or “dysfunctional” located within the individual.”

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    • Lol Stuart, I think you’re spying on me, regarding my skipping some content.
      Actually I have seen Fava say some really insightful things, so did a few others. The problem is with final actions and conclusions and conclusions is something psychiatry needs to stay away from. Those conclusions are never fact, and many lead to ‘desperate’ actions.
      And really, if they could admit this, first to each other and then the public.

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  3. It’s interesting some psychiatrists are starting to talk about the problems with antidepressants causing a shift to mania, which resulted in millions of iatrogenic bipolar misdiagnoses. And they’re talking about the issues with the common symptoms of antidepressant discontinuation syndrome being misdiagnosed.

    Yet the DSM5 writers’ response to Whitaker’s ‘Anatomy’ was to take this disclaimer out of the DSM5.

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    Definitely, “Psychiatry is going through an intellectual crisis.” But they also have a lack of ethics crisis as well.

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  4. I hope there is more objective appraisal of ‘iatrogenic comorbity’. I have writtten about some of my own experiences with such issues. Here is an excerpt:

    Neuroleptic induced deficit or negative symptom of schizophrenia? When 22 years old, after my first episode of psychosis I was treated with olanzapine, I do not think that it really did much to improve my perception of my circumstances, or any delusional beliefs, well only very slowly. On the olanzapine I was very blank mentally not having many ideas for things to do or say. I put on weight rapidly.
    I remember being assessed by a psychiatrist who told me, that my face looked like a mask and that I seemed unresponsive. I now think he took the stultifying effects of the olanzapine as being signs of ‘negative symptoms of schizophrenia’. I was thus diagnosed with schizophrenia. It would not be the last time that doctors would take the unhealthy and retarding effects of the neuroleptics as being evidence of underlying illness, which warranted in their professional judgment, further more aggressive treatment.
    Fourteen years later a similar dynamic presented itself. I had been experiencing paranoia and again olanzapine was the treatment tried first. It did nothing to resolve my psychiatric symptoms and the effect of facial masking was noted by the young doctor. I was switched to different meds, but became agitated and uneasy. Later, in a different unit and due to an administrative oversight, I was put back on olanzapine. This oversight would have predictably dire consequences for my well-being. As if a zombie paralysed with fear I would get somehow stuck in place when walking in the corridors, freezing in front of others in the ward. The swollen effect on my face meant I didn’t look right at all. After this period a duty doctor surmised that I had treatment resistant schizophrenia and that the facial masking was due to my illness. Much as the doctor had done 14 years before. I would then have my health affected by being on heavy-duty medication unnecessarily. After being transferred again to a different unit, staff noticed my ‘slowness’ – no doubt a result of my heavy exposure to neuroleptics over the previous months. However, the psychiatrist felt, in his wisdom, that this slowness was a negative symptom of the illness that might benefit from the dose being raised. Despite it being generally established that the so-called negative symptoms do not respond to anti-psychotics. Luckily, I just managed to dissuade him from that course, attributing perceptions of my slowness to depression.

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