Redefining what it means to be sad
Depression and the Limits of Psychiatry
By GARY GUTTING, NYT
I've recently been following the controversies about revisions to the psychiatric definition of depression. I've also been teaching a graduate seminar on Michel Foucault, beginning with a reading of his "History of Madness." This massive volume tries to discover the origins of modern psychiatric practice and raises questions about its meaning and validity. The debate over depression is an excellent test case for Foucault's critique.
At the center of that critique is Foucault's claim that modern psychiatry, while purporting to be grounded in scientific truths, is primarily a system of moral judgments. "What we call psychiatric practice," he says, "is a certain moral tactic . . . covered over by the myths of positivism." Indeed, what psychiatry presents as the "liberation of the mad" (from mental illness) is in fact a "gigantic moral imprisonment."
Foucault may well be letting his rhetoric outstrip the truth, but his essential point requires serious consideration. Psychiatric practice does seem to be based on implicit moral assumptions in addition to explicit empirical considerations, and efforts to treat mental illness can be society's way of controlling what it views as immoral (or otherwise undesirable) behavior. Not long ago, homosexuals and women who rejected their stereotypical roles were judged "mentally ill," and there's no guarantee that even today psychiatry is free of similarly dubious judgments. Much later, in a more subdued tone, Foucault said that the point of his social critiques was "not that everything is bad but that everything is dangerous." We can best take his critique of psychiatry in this moderated sense.
Current psychiatric practice is guided by the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). Its new 5th edition makes controversial revisions in the definition of depression, eliminating a long-standing "bereavement exception" in the guidelines for diagnosing a "major depressive disorder." People grieving after the deaths of loved ones may exhibit the same sorts of symptoms (sadness, sleeplessness and loss of interest in daily activities among them) that characterize major depression. For many years, the DSM specified that, since grieving is a normal response to bereavement, such symptoms are not an adequate basis for diagnosing major depression. The new edition removes this exemption.
(More here.)
By GARY GUTTING, NYT
I've recently been following the controversies about revisions to the psychiatric definition of depression. I've also been teaching a graduate seminar on Michel Foucault, beginning with a reading of his "History of Madness." This massive volume tries to discover the origins of modern psychiatric practice and raises questions about its meaning and validity. The debate over depression is an excellent test case for Foucault's critique.
At the center of that critique is Foucault's claim that modern psychiatry, while purporting to be grounded in scientific truths, is primarily a system of moral judgments. "What we call psychiatric practice," he says, "is a certain moral tactic . . . covered over by the myths of positivism." Indeed, what psychiatry presents as the "liberation of the mad" (from mental illness) is in fact a "gigantic moral imprisonment."
Foucault may well be letting his rhetoric outstrip the truth, but his essential point requires serious consideration. Psychiatric practice does seem to be based on implicit moral assumptions in addition to explicit empirical considerations, and efforts to treat mental illness can be society's way of controlling what it views as immoral (or otherwise undesirable) behavior. Not long ago, homosexuals and women who rejected their stereotypical roles were judged "mentally ill," and there's no guarantee that even today psychiatry is free of similarly dubious judgments. Much later, in a more subdued tone, Foucault said that the point of his social critiques was "not that everything is bad but that everything is dangerous." We can best take his critique of psychiatry in this moderated sense.
Current psychiatric practice is guided by the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). Its new 5th edition makes controversial revisions in the definition of depression, eliminating a long-standing "bereavement exception" in the guidelines for diagnosing a "major depressive disorder." People grieving after the deaths of loved ones may exhibit the same sorts of symptoms (sadness, sleeplessness and loss of interest in daily activities among them) that characterize major depression. For many years, the DSM specified that, since grieving is a normal response to bereavement, such symptoms are not an adequate basis for diagnosing major depression. The new edition removes this exemption.
(More here.)
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