Louis Menandís New Yorker article earlier this year that reviewed a couple of new books on psychiatry in the context of the confusing state of psychiatric literature posed the compelling question that is the title of this post:
You go see a doctor. The doctor hears your story and prescribes an antidepressant. Do you take it?
However you go about making this decision, do not read the psychiatric literature. Everything in it, from the science (do the meds really work?) to the metaphysics (is depression really a disease?), will confuse you. There is little agreement about what causes depression and no consensus about what cures it. Virtually no scientist subscribes to the man-in-the-waiting-room theory, which is that depression is caused by a lack of serotonin, but many people report that they feel better when they take drugs that affect serotonin and other brain chemicals. [. . .]
. . . As a branch of medicine, depression seems to be a mess. Business, however, is extremely good. Between 1988, the year after Prozac was approved by the F.D.A., and 2000, adult use of antidepressants almost tripled. By 2005, one out of every ten Americans had a prescription for an antidepressant. IMS Health, a company that gathers data on health care, reports that in the United States in 2008 a hundred and sixty-four million prescriptions were written for antidepressants, and sales totalled $9.6 billion.
As a depressed person might ask, What does it all mean?
Following on that provocative article, Russ Roberts’ essential EconTalk series this week presents this fascinating interview of Menand on the state of psychiatric knowledge and the scientific basis for making conclusions about current therapeutic approaches of battling it.
Although hard and fast conclusions are few, Menand is asking the right questions about a subject that desperately needs better societal understanding. His article and interview are valuable contributions to improving that understanding.
can psychiatry be a science?….yes, it is.
“salt contains sodium” = pretty concrete science.
“heartbeat is irregular” = less concrete, more art.
“psychiatry and neurology” = brain physiology which happens to be less well understood than sodium and cardiac physiology = far more art but as “scientific” as finding oil.
psychiatry patients and the general public ought to look at the efforts like the oil companies do: lot of time, effort, energy and money and you might knock a home run, a double or strike out and try again–it IS science-based.
a problem: as medical students decide what to do, psychiatry tends to draw those more artistically inclined, sometimes lacking an adequate tendency to root out and apply the meager threads of hard science that are “psychiatry”.
I would argue no, no moreso than any of the other “social sciences” like sociology, or demography, or even worse, political “science”. Science is about devising testable theories and then collecting and testing them with objective data. But very little that passes for “social science” is objective OR testable. Theories? oh they are a dime a dozen! But testable data? Sorry, everything is subjective. When you can make up your data, or pick and choose what even counts as data, then there is no testability because nothing can be falsified.
Is there ancedotal evidence that psychiatry works? sure, but there is ancedotal evidence that accupuncture works too, but there is no support for the theory behind it. Ergo everything is empirical and subjective.
That is nothing at all like the definition of the scientific method I was trained to follow.
and by the way, the science of finding oil is a heluva lot more scientific than anything the “science” of psychiatry has ever devised. We have technology that would make NASA drool (because we can justify and pay for it, NASA can’t). Finding oil in any quantity is fairly routine. Finding it in recoverable quantities is less common, about 1/3 of exploratory wells find recoverable oil, but much of that is because exploratory wells are used to help delineate the perimeter of a reservoir too.