Therapy and the lightbulb

How many psychotherapists does it take to change a lightbulb?
Only one, but the lightbulb has to want to change.

How many group therapists does it take to change a lightbulb?
None. Group therapy doesn’t change anything.

How many psychiatrists does it take to change a light bulb?
One, provided the lightbulb is fully compliant with all components of treatment. Otherwise, it’s the lightbulb’s fault that it doesn’t get changed.

How many clinical psychologists does it take to change a lightbulb?
Well, they’ll be able to change it quickly and efficiently, once they’ve figured out the correct DSM-V diagnosis. Until then, how do we know it needs changing?
(The DSM is the diagnostic ‘bible’ of the American Psychiatric Association)

How many depressed psych patients does it take to change a lightbulb?
Who cares?

These are my favourites from a longer list of psychiatric lightbulb jokes posted by Dysthymia Bree. This is a link to her blog.


Homosexuality as a disease

According to DSM II (the Diagnostic and Statistical Manual of Mental Disorders), homosexuality was a mental disease. It was listed as a ‘sexual deviation’ and so found itself an unwilling bedfellow of paedophilia.

How did this change? Was it, for example,  as a result of painstaking research?

It was changed in 1974 at a meeting of the American Psychiatric Association (publishers of the DSM). When the issue was put to the vote 5854 psychiatrists voted to remove homosexuality from the list of mental diseases, 3810 voted to retain it. As a result, homosexuality was not listed as a mental disease in DSM III or subsequent editions.

So there we have it. What constitutes a mental disease or disorder can be decided by a show of hands. There’s nothing like democracy, right?

What’s wrong with psychiatry?

This is the first of four reports from the Edinburgh International Book Festival.

The event was a talk by James Davies about his recent book, ‘Cracked’, the subject of which is made clear in the publisher’s blurb.

‘Why is psychiatry such big business? Why are so many psychiatric drugs prescribed – 47 million antidepressant prescriptions in the UK alone last year – and why, without solid scientific justification, has the number of mental disorders risen from 106 in 1952 to 374 today?’

Davies couldn’t cover all this ground in one talk, especially since he left time to answer questions, so he concentrated on the DSM (Diagnostic and Statistical Manual of Mental Disorders). Since a large increase in the number of named conditions occurred with the publication of DSM 3 (we are now on DSM 5) he has attempted to find out how this has come about. There being very little in print on this subject, he travelled to the United States to interview those behind this project. Given how they had gone about their task, they were surprisingly cooperative.

Using slides, he showed his audience examples of replies to his questions, the burden of them being that certain self-selecting experts had got together in committee and agreed among themselves what qualified as mental disorders and what the symptoms of these disorders were. There was no scientific basis for their definitions.

Davies also maimtains that there is no scientific basis for the belief that some mental conditions result from chemical imbalances in the brain which may be corrected using medication. Davies is therefore critical of SSRIs (selective serotonin re-uptake inhibitors) which aim to ‘restore’ the balance.

James Davies was very articulate throughout, not only in his talk but also in responding to questions. The event was well attended and, as far as I could tell, the audience was persuaded by his arguments, though many were clearly sympathetic to his views before the event began. The reaction was positive. There were no hostile questions.

It seems to me that if we accept this analysis there are two ways to go here. The first is to change direction, to stop making it up as we go along and base as much as we can on biological research. We can attempt to place the study of mental function on a more scientific basis, to make it more objective. Moves in this direction are already taking place.
An alternative reaction would be to drop the pretence of being scientific altogether, to stop aspiring to it. This is the response of the narrator in my novel, Time to Talk. Max Frei has set himself up as a psychotherapist based entirely on his reading. He has no formal qualification but takes what he does very seriously. He inclines to the subjective, is aware of that fact, and considers it an advantage in psychotherapy.