6 ..9
Of course, the fact that some states of stress and misery are relieved or modified by psychiatric medication does not indicate that these are diseases. A state of unhappiness may be modified by cocaine or heroin, but this does not mean the person is suffering from a cocaine-deficit syndrome.
NICE regards states of distress as ‘specific diseases’ for which it recommends evidence-based ‘treatments’. Yet one of the most consistent findings in several decades of psychotherapy research is the so-called ‘equivalence paradox’ – that when therapies are compared with each other they are more or less equally effective. By contrast the variation in effectiveness between therapists is considerable. Sometimes the absurdity is amusing. Consider Interpersonal Psychotherapy. IPT began as a plausible placebo, a manualisation of supportive psychotherapy – by Gerald Klerman – in studying whether antidepressants combined with supportive psychotherapy was better than antidepressants alone for combating depression. When it was later compared with cognitive therapy it was found to be similarly effective. NICE therefore recommends CBT or IPT in treatments for depression – as if it had been simply serendipity that both psychological treatments that were compared in this trial turned out to be helpful. The ‘equivalence paradox’ is scandalously ignored within NICE guidelines [Mollon 2009].
In contributions to the Cardinal Clinic trauma conference last year, and also in his 1995 book Pseudoscience in Biological Psychiatry (Wiley), Dr Colin Ross explains the ad hoc, somewhat arbitrary, and non-scientific way in which psychiatric diagnostic categories are established, based on his experience of working on DSM committees. One example he gave was of the category of acute stress disorder. Apparently this was originally proposed as ‘brief reactive dissociative disorder’ – but that term would have implied it belonged within the dissociative disorders, whereas its link to PTSD (to which the diagnosis would switch after one month) might place it within the anxiety disorders.
“…there were only two possible solutions to the problem: [a] move PTSD to the dissociative disorders or [b] move brief reactive dissociative disorder to the anxiety disorders. The decision to move brief reactive dissociative disorder to the anxiety disorders was based solely on the greater political power of the anxiety disorders group compared to the dissociative disorders group. One the switch was made, it was necessary to change the name of the disorder, because one cannot have an anxiety disorder called brief reactive dissociative disorder” [p 124]