Spitzer asks me at one point “if I’m familiar with the work of Herb Kutchins and Stuart Kirk.” Why yes, their books on DSM (The Selling of DSM [1992] and Making Us Crazy [1997]) are classics in sociologyâoutstanding contributions to the scholarshipâand helped to drive my own investigation into the DSM archives. I quote them several times in my book Shyness. My favorite line from Making Us Crazy …?
âBy simply altering slightly the wording of a criterion, the duration for which a symptom must be experienced in order to satisfy a criterion, or the number of criteria used to establish a diagnosis, the prevalence rates in the US will rise and fall as erratically as the stock marketâ (1997, 244).
Please keep that front-and-center as you read Spitzer’s account of how he and colleagues separated out the 7 anxiety disorders included for the first time in DSM-III. A fuller, more-detailed account of what happened appears in my book.
“With a stroke of his pen, Spitzer turned anxiety and other reactions from effects into causes. People were now anxious because they had an anxiety disorder.” That is spot-on, Brett, and exactly rightâit was (and remains) a major conceptual shift in how we think about and diagnose anxiety. Unfortunately, it’s no surprise to me that Spitzer downplayed the enormity of the shift, to make it seem as if a “reaction TO” something were no longer meaningful. (âDropping the word reaction doesnât really mean anything.â I think thatâs probably true.’) Remarkable in itself. Thanks for your great comments.
Thanks for your comment, Philip. Yes, Spitzer completely minimized what was a radical moveârefused to acknowledge its major implications, then as now. I didn’t know the Ullmann and Krasner quote but agree with it and appreciate it. Will use it more myself, with full credit to you! Thanks also for your very helpful critiques of DSM over the years, which also have shaped mine. Big thanks to you.
Agree. That even well-documented evidence about antidepressant depressants could be couched in 2020 (!) as a “war on antidepressants” also tells you exactly what the challenges have been and just how many remain.
100% Sam. Thank you. Yes, the point isn’t to dispute that they didn’t know; it’s to documentâclearly, for allâwhat they preferred to *not* know and to pretend collectively could be ignored. It can’t be, and I wanted to help convey why.
Thank you, Exit. I agree. I wanted in this and recent posts to document a decades’ long, profession-wide *effort at* denying the existence of antidepressant withdrawal, including to emphasize that the effort *has* failed, importantly because of years of pushback and documented evidence. I wanted readers to see for themselves how even letters published *in the psychiatric journals* themselves failed to make a lasting impact at the timeâthat’s part of the longer history and I’d say it’s crucial that it be recorded as well as reintroduced into discussions today, precisely to ask: How *is* it that so many in the profession managed to turn a blind eye and a deaf ear to something so serious and so widespread?
Thanks for your comment, Sam. Yes, regrettably, “psychosis” almost always is invoked as a validating foundation, even (or especially) when it is not. Of particular interest to me there is that DSM-II in 1968 began the process of deleting earlier references to psychical states as “reactions” and turned them instead into “disorders,” a move consolidated by DSM-III (1980), so we lost situational and social-environmental stressors almost at the stroke of a pen. That’s also one explanation, incidentally, for how the “biological model” and ontologized brain states became predominant, particularly in the U.S. in those decades and really ever since.
Yes, and thanks for your comment. I wanted this put in â hopefully with a clear irony light attached to those quote marks â because, unfortunately, it’s still quite common to hear psychotherapists and psychoanalytically-oriented psychiatrists talk of SSRIs (and psychiatric drugs more generally) as somehow “kickstarting” the therapy and “accelerating” it through a combination treatment. The notion remains widespread despite, as you note, the mounting evidence of serious adverse effects and withdrawal syndrome from the drugs themselves, which obviously would impede a productive therapy and should be increasing caution, but that doesn’t appear to be getting through to many prescribers. Worrying and frustrating.
Spitzer asks me at one point “if I’m familiar with the work of Herb Kutchins and Stuart Kirk.” Why yes, their books on DSM (The Selling of DSM [1992] and Making Us Crazy [1997]) are classics in sociologyâoutstanding contributions to the scholarshipâand helped to drive my own investigation into the DSM archives. I quote them several times in my book Shyness. My favorite line from Making Us Crazy …?
âBy simply altering slightly the wording of a criterion, the duration for which a symptom must be experienced in order to satisfy a criterion, or the number of criteria used to establish a diagnosis, the prevalence rates in the US will rise and fall as erratically as the stock marketâ (1997, 244).
Please keep that front-and-center as you read Spitzer’s account of how he and colleagues separated out the 7 anxiety disorders included for the first time in DSM-III. A fuller, more-detailed account of what happened appears in my book.
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“With a stroke of his pen, Spitzer turned anxiety and other reactions from effects into causes. People were now anxious because they had an anxiety disorder.” That is spot-on, Brett, and exactly rightâit was (and remains) a major conceptual shift in how we think about and diagnose anxiety. Unfortunately, it’s no surprise to me that Spitzer downplayed the enormity of the shift, to make it seem as if a “reaction TO” something were no longer meaningful. (âDropping the word reaction doesnât really mean anything.â I think thatâs probably true.’) Remarkable in itself. Thanks for your great comments.
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Thank you Lauren.
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Thanks for your comment, Philip. Yes, Spitzer completely minimized what was a radical moveârefused to acknowledge its major implications, then as now. I didn’t know the Ullmann and Krasner quote but agree with it and appreciate it. Will use it more myself, with full credit to you! Thanks also for your very helpful critiques of DSM over the years, which also have shaped mine. Big thanks to you.
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Agree. That even well-documented evidence about antidepressant depressants could be couched in 2020 (!) as a “war on antidepressants” also tells you exactly what the challenges have been and just how many remain.
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100% Sam. Thank you. Yes, the point isn’t to dispute that they didn’t know; it’s to documentâclearly, for allâwhat they preferred to *not* know and to pretend collectively could be ignored. It can’t be, and I wanted to help convey why.
Report comment
Thank you, Exit. I agree. I wanted in this and recent posts to document a decades’ long, profession-wide *effort at* denying the existence of antidepressant withdrawal, including to emphasize that the effort *has* failed, importantly because of years of pushback and documented evidence. I wanted readers to see for themselves how even letters published *in the psychiatric journals* themselves failed to make a lasting impact at the timeâthat’s part of the longer history and I’d say it’s crucial that it be recorded as well as reintroduced into discussions today, precisely to ask: How *is* it that so many in the profession managed to turn a blind eye and a deaf ear to something so serious and so widespread?
Report comment
Thanks for your comment, Sam. Yes, regrettably, “psychosis” almost always is invoked as a validating foundation, even (or especially) when it is not. Of particular interest to me there is that DSM-II in 1968 began the process of deleting earlier references to psychical states as “reactions” and turned them instead into “disorders,” a move consolidated by DSM-III (1980), so we lost situational and social-environmental stressors almost at the stroke of a pen. That’s also one explanation, incidentally, for how the “biological model” and ontologized brain states became predominant, particularly in the U.S. in those decades and really ever since.
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Gracias por su comentario, Victor. SĂ, esos estudios deberĂan hacerse de forma exhaustivaâsistemĂĄticaây, lamentablemente, no se han hecho, incluso porque las compañĂas farmacĂ©uticas no han querido que los efectos de sus fĂĄrmacos se estudien de esa forma. Por supuesto, todavĂa estamos lidiando con las consecuencias de su negligencia. Es muy frustrante.
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Yes, and thanks for your comment. I wanted this put in â hopefully with a clear irony light attached to those quote marks â because, unfortunately, it’s still quite common to hear psychotherapists and psychoanalytically-oriented psychiatrists talk of SSRIs (and psychiatric drugs more generally) as somehow “kickstarting” the therapy and “accelerating” it through a combination treatment. The notion remains widespread despite, as you note, the mounting evidence of serious adverse effects and withdrawal syndrome from the drugs themselves, which obviously would impede a productive therapy and should be increasing caution, but that doesn’t appear to be getting through to many prescribers. Worrying and frustrating.
Report comment