Sacred Disorder | Cliff Bostock's blog – 'Finally, I came to regard as sacred the disorder of my mind' (Rimbaud)

David Brooks “gets” that psychiatry is an art, not science

David BrooksI’m not a big fan of David Brooks, to say the least. He frequently writes about cultural concerns that have been around for years. Fine. But, as Christopher Lane has observed, he comes across as if he’s sharing revelations that were unknown until he turned on the light of his own brilliance.

His May 27 column, “Heroes of Uncertainty,” falls into that category. Inspired by the huge controversy over the new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Brooks makes the point that psychiatry is far from the empirical science we’d like to think it is. When it works, he observes, it is more like an art than a science. (All of this can also be said of clinical psychology and counseling in general.)

While it’s irritating to see Brooks writing without crediting the many others who have been making this point for years, I’m of course glad to see that the mainstream press is finally catching on. But, hello, Freud made the same point to the press in 1934.

This myth of therapy as science is precisely why, as I’ve explained a zillion times, I scrapped its practice to develop my own work. My greatest inspiration, James Hillman, made the point that the psyche, the soul, cannot be reduced to the brain’s anatomy. And — sorry, folks — the placebo effect is a huge part of the “science” of cognitive-behavioral therapy (CBT), just as it is with pharmaceuticals. CBT wears off as predictably as Paxil and requires frequent “booster shots.”

All of that said, I’m glad for real that Brooks wrote his column. A sample:

Psychiatric phenomena are notoriously protean in nature. Medicines seem to work but then stop. Because the mind is an irregular cosmos, psychiatry hasn’t been able to make the rapid progress that has become normal in physics and biology. As Martin Seligman, a past president of the American Psychological Association, put it in The Washington Post early this year, “I have found that drugs and therapy offer disappointingly little additional help for the mentally ill than they did 25 years ago — despite billions of dollars in funding.”

All of this is not to damn people in the mental health fields. On the contrary, they are heroes who alleviate the most elusive of all suffering, even though they are overmatched by the complexity and variability of the problems that confront them. I just wish they would portray themselves as they really are. Psychiatrists are not heroes of science. They are heroes of uncertainty, using improvisation, knowledge and artistry to improve people’s lives.

The field of psychiatry is better in practice than it is in theory. The best psychiatrists are not austerely technical, like the official handbook’s approach; they combine technical expertise with personal knowledge. They are daring adapters, perpetually adjusting in ways more imaginative than scientific rigor.

The best psychiatrists are not coming up with abstract rules that homogenize treatments. They are combining an awareness of common patterns with an acute attention to the specific circumstances of a unique human being. They certainly are not inventing new diseases in order to medicalize the moderate ailments of the worried well.

The question that always comes up for me is whether psychotherapy can be pulled out of its own delusions and evolve or, better said, return to its former understanding of itself.  I tend to think not, believing that an altogether new discipline should be developed.  But I give Brooks credit for being more compromising than me.  In fact, Hillman was more compromising himself, despite his blistering critiques.

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