The best of Mad in America

Here are two more articles that caught my eye over the past few days. I like both of these because they are heavy on social criticism in the grand tradition of the muckraking literature of early twentieth century America

The first is written by social worker Jack Carney on New York State’s Assisted Out-Patient Treatment program, which is heavily skewed to issuing treatment orders to black men.

Take-away from this article – two causative factors in the spread and continuation of over-diagnosis in the black male population:

For his part, Metzl tracks the over-diagnosis of schizophrenia in black men to the early 1970’s, the high point of black disillusion with and anger at the societal status quo.

1. The appearance of the modern DSMs – II, III, IIIR, IV and IV TR – their advocacy of the biological model of mental illness, and the introduction of Schneiderian first rank symptoms, particularly paranoid ideation and hostile, aggressive behavior, as indicative of schizophrenia; and,

2. The fear and anxiety provoked in psychiatrists and other professional mental health providers by African-American men, presumed, particularly when undergoing an apparent acute psychotic episode, to have a great potential for violent behavior.

The second piece is by psychotherapist Bob Fancher and titled How talk therapy sold out.

The need to prove that psychology provides appropriate treatment of mental disorders, comparable to medication, changed what counts as good science in talk therapy. (Social work tagged along later, as it generally does.)

In all of science, method is supposed to fit subject matter—and all sorts of methods are used, since life comprises all sorts of subject matters. Now, though, in talk therapy research the methods were being dictated in advance, regardless of subject matter, to serve the purpose of competing with psychiatry.

No form of therapy that was client-directed, or that depended on a patient’s free associations, could possibly meet these criteria. Nothing remotely resembling therapy as it is actually practiced—eclectic, responsive to unforeseen circumstance, oriented toward patients’ problems rather than DSM symptoms—could be studied.1. The appearance of the modern DSMs – II, III, IIIR, IV and IV TR – their advocacy of the biological model of mental illness, and the introduction of Schneiderian first rank symptoms, particularly paranoid ideation and hostile, aggressive behavior, as indicative of schizophrenia; and,