Tuesday, May 09, 2006

Freud set back Psychiatry 100 years

[Rant posted by Roy]

Okay, it was his birthday last week and all, but I think Sigmund Freud single-handedly stalled the progress of psychiatry for nearly a century.

Look at some of the thought leaders in psychiatry in the early 2oth century. Kraepelin. Bleuler. Alzheimer. It was around 1905 when it was found that syphilis could cause a type of psychotic illness, called general paresis of the insane. Most "psychiatrists" were actually neurologists then, and the field was decidedly heading in the what's-wrong-with-their-brain direction. Fifty years later, the first antipsychotic drug was introduced. What happened in those first 50 years, and in the 50 years since?

The locus of pathology switched from the brain to the mind, from the individual neuron to the individual person. We were just starting to realize that psychiatric illness could occur through no fault of one's own (okay, maybe unprotected sex, but you see where I'm going), and then Dr. Freud comes along and we start looking at the mother or the father or Uncle Pete as the source.

And the treatment? Lie on a couch and talk. About whatever comes to mind. Four times per week. For seven years.

The result? Worsening of stigma. Marginalization of Psychiatry from Medicine. Diversion of research interest and resources from the cell to the self. The "psychiatric reduction" and non-parity in health insurance coverage. (The "psychiatric reduction" was Medicare's discriminatory practice of requiring outpatients with psychiatric illnesses to pay 50% out-of-pocket, while all other illnesses cost you 20%. This sham is still on the books today, despite bipartisan efforts to end this anachronism.) Tom Cruise.

So now, with the Decade of the Brain a recent memory, we have now entered the Century of the Genome. We are discovering more and more about how the brain cell is put together, which protein does what, and what goes wrong when the blueprint goes awry. About time.

The damage is fading. People are getting more comfortable to talking about having an illness, less worried about folks wondering about the "dirty little secrets" which have tripped them up.

Don't get me wrong. We learned some things in the process about human psychosocial development... about transference... about id. After all, understanding psychiatric illness cannot be boiled down to neurons and receptors any more than diabetes can be boiled down to insulin and sugar. But we have had a long and winding detour. Time to blow out the candles and get this party started.