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[sSRI-Research] Book Review - Psychiatric Hegemony & the Manufacture of

Mental

Illness

 

Book Review -

Psychiatric Hegemony & the Manufacture of Mental Illness

 

http://www.meresearch.org.uk/archive/skewed.html

 

SKEWED: Psychiatric hegemony and the manufacture of mental illness in

Multiple Chemical Sensitivity, Gulf War Syndrome, Myalgic Encephalomyelitis

and Chronic Fatigue Syndrome

 

Martin J. Walker

ISBN 0-9519646-4-X

Published by Slingshot Publications, BM Box 8314, London WC1N 3XX, England

Cover price £12.00

 

Note from publisher: Cheques or postal orders must be sent with orders to

Slingshot — no books can be sent out without payment. Campaigning groups who

wish to raise money by selling the book, can contact Slingshot about

receiving copies at very reduced rates. A press conference/launch is planned

for December 2003 — for an invitation, contact Slingshot.

 

The cover states: " SKEWED is a detailed investigation into the psychiatric

diagnosis of a range of illnesses which some have suggested are actually

caused by chemicals. The book traces the chemical companies' arguments

against their products causing illnesses, and it tracks the growth of the

theory promoted by them that individuals who report symptoms of

chemically-induced ill health have personality disorders. The book asks how

psychiatric theories of 'unexplained illness' have managed to gain

ascendancy and shape the diagnosis, research funding, and public perception

of these illnesses in Britain. "

 

Martin J. Walker's last book was " Dirty Medicine " , described by Christopher

Bird (author of The Secret Life of Plants) as " a masterpiece of

investigative journalism and attentive scholarship, elegantly written. "

 

Foreword

 

Per Dalen, MD, PhD, Associate Professor of Psychiatry, University of

Gothenburg, Sweden

 

Medical culture is obsessed with mechanisms of disease, but actual causes

are not a favourite topic. We don't know enough about causes to inspire the

lay public and ourselves with confidence in our science by discussing them.

Our lack of success in preventing many important diseases is of course

largely due to ignorance. It is not uncommon for a medical scientist to

mention an unsolved problem in terms like " the exact causes are not yet

known, but… " The discussion is then usually moved to the safer ground of

mechanisms.

 

One tacit assumption is that we should first of all learn as much as

possible about the many biochemical and physiological mechanisms that may be

involved in the production of symptoms, autoimmunity for instance, or

changes in neurotransmitter levels. With a more complete biological

'Meccano', it should be possible to build more and more comprehensive models

of how various diseases develop. Will this automatically lead to causal

understanding at the level where prevention becomes possible? Not

necessarily, I am afraid. New causal knowledge may more often be found

serendipitously and in other more direct and less time consuming ways than

this inching along in the search for mechanisms. However, such a direct

approach is usually not encouraged by the scientific community.

 

There is an additional reason why mechanisms are important in medicine. When

we draw the line between science and non-science in the health field, we

usually exclude procedures and theories that cannot be understood in terms

of accepted mechanisms. Homeopathy is a case in point. It doesn't really

matter if it works in practice; its theory is utterly at odds with

conventional medical thought. Any positive results in patients are simply

explained as placebo effects. In this way knowledge of mechanisms becomes

indispensable as a badge of scientific authority.

 

My training in psychiatry started in the late 1950s, when neuroleptics and

antidepressants were already available and the specialty was showing more

scientific promise than ever before. Hysteria was something that

neurologists encountered. Experienced psychiatists would tell stories of

supposedly hysterical patients who had been referred back to their

neurologists or internists without a psychiatric diagnosis, but with the

suggestion that further investigation might be indicated — whereupon a brain

tumour or some other serious illness was revealed. The average psychiatrist

was then (and still is) fully occupied with patients whose histories and

symptoms were predominantly psychiatric. The idea that large numbers of

patients in general practice might need our attention for " medically

unexplained symptoms " ' freely labelled as somatized, was simply unheard of.

'Somatization' is not a novel word. The oldest entry in the Oxford English

Dictionary is from 1925 and shows that the origin of the word is in

psychoanalysis: " conversion of emotional states into physical symptoms. "

 

This is of course a sanitized version of the hysteria concept, a psychiatric

diagnosis. Sigmund Freud put forward a number of psychological postulates

styled as mechanisms that seeped into popular culture but were less

successful in the medical field. Psychoanalysis is perhaps somewhat too

speculative to mix well with ideas based on biology. Medicine has a kind of

vigilance or " immune " system which resists intrusion of thoughts that fall

short of a slightly pedantic standard of scientific credibility. The

grapevine telegraph keeps us alert and updated. Inevitably though, there is

no natural or manmade vigilance without blind spots.

 

Emotional states can give rise to bodily symptoms; this is a matter of

everyday experience. It is, however, deceptively easy to exaggerate the

importance of this mind-body connection. The necessary question therefore

becomes what, and how much can be reliably attributed to which emotional

causes and for how long. This can only be answered from experience and

common sense, since the actual mechanisms are very poorly understood and

systematic clinical evidence is scarce.

 

A generation ago physicians usually trusted their own clinical judgements,

but in recent years the notion of " evidence based " medicine has altered

this. We are now supposed to look for evidence, preferably statistical

evidence, in the current literature. In some areas, such as somatization,

there is simply no solid evidence, and yet the grapevine is silent about

this. A vacuum is created where other forms of persuasion can find their way

to the medical profession.

 

It is interesting that another blind spot can be found in the area of

placebo. Somatization and placebo are like the two sides of a coin. Both are

believed to possess great power, the one of causing disease, the other of

restoring health, Their mechanisms of operation are essentially unknown, and

systematic studies have in fact yielded little or no evidence in clinical

situations.

 

There is no denying it; medicine uses a double standard in relation to

scientific evidence. The placebo has been an integral part of our medical

culture since the 1950s. Somatization gained prominence relatively recently.

Scientific ideas normally have an interesting history, including a genealogy

and a record of arguments pro and con. Important ideas rarely enter the

scene fully fledged and unruffled by controversies, but somatization was

presented even without a reference to psychoanalysis.

 

Today we are sometimes told that somatization is the disease process to

consider when physicians fail to explain the symptoms of the patient. The

rather too flattering implication would be that medical science can now

explain so many things that most of the remaining problems can be bundled

together under a collective psychiatric label without further investigation.

The truth, however, as we have seen, is that causal understanding is poorly

developed. Explaining symptoms means something else here.

 

When an officially accepted diagnosis has been found in a given case, for

example, multiple sclerosis, the principal symptoms of the patient are seen

as constituent parts of a familiar picture, and predictions can be made

about prognosis, possible treatments can be chosen, et cetera. The physician

is satisfied by this result, even though the cause of multiple sclerosis

remains unknown, prevention is impossible, and treatments do not offer much

hope of permanent recovery.

 

An accepted diagnosis is not always enough, however. Recurrent or chronic

low back pain is sometimes mentioned as a possible form of somatization. The

reason for this is that most cases show no structural changes upon thorough

investigation. Orthopaedic surgeons see innumerable patients with this very

common affliction, and treatment results are poor. So why not call this a

psychiatric problem? To my knowledge, psychiatry has never been officially

or openly asked whether it is acceptable to use, or abuse, the concepts and

tools of this specialty in new and unexpected ways. Psychiatrists tend to be

hungry for acceptance by their non-psychiatric colleagues, and have not so

far protested very audibly against what is going on under the label of

somatization. GPs aided by psychologists skilled in cognitive behaviour

therapy can apparently do the actual work with the patients.

 

A major problem with the somatization approach is that its proponents take

for granted that the causes of all those illnesses relabelled as psychiatric

are psychological. In modern psychiatry the trend has long been in the

opposite direction, away from the dogmatism once inspired by psychoanalysis.

Classical psychiatric illnesses have unknown causes just as often as do

somatic illnesses, and wholesale psychological explanations are increasingly

a thing of the past.

 

For some years now I have been convinced that the concept of somatization is

being exploited for reasons that are only partly transparent. Scientifically

there is no basis for the remarkable expansion of this field. The lives of

large numbers of patients are touched and often made more difficult by what

is going on. Psychiatry is apparently being abused, and it is, of course,

very important to find out more about the background in order to do

something about it. This is an area where concerned citizens have already

begun to organise.

 

In Skewed, Martin Walker investigates the vested interests involved in the

problem of somatization and " unexplained illness " . On reading the

manuscript, I found that viewing this apparently medical question from a

sociological perspective gave me a new insight into this growing area of

ostensibly psychiatric disorders. Readers who are not yet familiar with the

tragic erosion of the truth-seeking scientific spirit in medical research

will, I hope, also find this book an excellent introduction to these

problems

 

See also:

 

" Dirty Medicine " by Martin J Walker

http://www.sonic.net/kryptox/reviews3.htm#dirty

 

 

--

 

" Mercury is a heavy metal that is very toxic even in small doses. Exposure

to mercury can lead to damage of the brain, spinal cord, kidneys and liver. "

 

The New York Times / May 7, 2003

http://www.nytimes.com/2003/05/07/international/asia/07INDI.html?ex==%1053316

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