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Why Americans Should Distrust “Mental Health Experts”

A couple of psychiatrists appeared on CNN on Sunday to discuss the president, and their exchange serves as an apt reminder of why Americans, and conservatives in particular, should distrust these so-called mental health experts. One of them, Bandy Lee, has been trying to undermine the Trump presidency for the past three years. Her palpably biased and unprofessional efforts were the subject of my Aug. 10, 2018, column. An assistant professor of clinical psychiatry at Yale, Lee is editor of the widely criticized book The Dangerous Case of Donald Trump (2017), whose circular argument is that Donald Trump’s mental health poses a “clear and present danger” to “the nation and individual well being.” In a review of the book, Theodore Dalrymple, a retired psychiatrist and harsh critic of the field, described it as “little more than re-description of easily and publicly observable traits and conduct…an echo-chamber for the thoughts and feelings of those who already abominated [Donald Trump].” It goes against medical ethics (the Goldwater Rule) for a psychiatrist to diagnose a person he or she has not examined. Lee, however, seems to enjoy an unflappable faith in her own expertise and mission, and so continues to do her “duty to warn” us about the dreadful man in the White House.

Lee was joined by Allen Frances, chairman emeritus of Duke University’s department of psychiatry and behavioral sciences, and himself the author of a book on the Trump presidency. Trump doesn’t suffer from mental illness, Frances claims in his Twilight of American Sanity (2017); the problem, rather, is the American people—we’re mad for electing him. This point Frances stressed in his CNN remarks. It seems that he was brought on to be a foil to Lee, for he was critical of “medicalizing politics,” since he thinks it stigmatizes the mentally ill and distracts people from addressing Trump’s awful policies. Frances also dismissed The Dangerous Case of Donald Trump as “silly” and “amateurish.”

The best comment on “mental health experts” belongs to the Austrian satirist Karl Kraus, who quipped that “psychoanalysis is itself the disease for which it purports to be the cure.” Owing to the complexity of human nature, to the ingenuity of the imagination, to the limits of reason, and last but not least, to bad methodology, psychology and psychiatry are inexhaustible labyrinths in which one can find pretty much anything one wants. Much of what passes for science is mere confirmation bias. The replication crisis is a well-known scandal. The same ostensibly causal factors are found to be consistent with any number of conditions. Both overdiagnosis and underdiagnosis of disorders are common. New disorders spring up like weeds. Personal preferences in politics and other areas can be smuggled in under the guise of official, expert knowledge. Often the experts are blind to their own biases and lack of objective justification, themselves guilty of the same errors they accurately perceive in others.

So it is with Allen Frances. His 2013 paper “The New Crisis of Confidence in Psychiatric Diagnosis” makes a case against “unpredictable overdiagnosis,” finding that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests.” Frances chaired the task force that produced the fourth revision of the Diagnostic and Statistical Manual (DSM-IV), and has found fault with the current version, DSM-V, for (among other things) lowering the thresholds for diagnosing existing disorders and for adding new speculative disorders…[ ]

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Posted by Firepole

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