Thanks to
scientific advances dramatic gains against ancient medical foes, such as
diabetes, cancer, and heart disease have been accomplished. In essence, in
medicine scientific approach has been crucial for relief. Not so in psychiatry.
The lives of
people with mental pain have been witnessing a rising tide of misery. For
progress from the patient's perspective is sensitively dependent on access to
science. And, our societal laws and regulations constrain our neuroscientific
growth and its direction. They define what is possible and what is impossible.
As we have witnessed they can shape the lives of millions, as well as when
their misery should end.
Why have we
failed to see the black hole? Possibly because of three influences: The DSM
(the diagnostic statistical manual of mental disorders), the classification of
controlled substances and our flawed registration system of vital statistics. They'll
share a single property: Lack of
scientific integrity. For instance the DSM confuses a disease with
complications arising out from a disease and is incapable of detecting the most
powerful influences of brain function that are not visible or easily observable
to our sensory system. The confusing boundary of disease and disease
complication is of profound significance for it is a major impediment for
progress. As a consequence, more than a dozen of mental disorders, i.e.
schizophrenia, addiction, or depression are considered primary diagnosis while
they should be classified under complications of other diseases which have not
been diagnosed or treated effectively. This would be akin to classifying
blindness due to diabetic retinopathy as a primary disease without realizing
that it is a complication of diabetes mellitus.
Consider our
death reporting system. Regardless of any scientific validity - confirmed by laboratory
or clinical input - any trace of a narcotic is recorded as the cause of death
without taking into consideration other crucial causative factors (1). The end
result of this is a false alarm of phantom epidemics of methadone and narcotic
analgesic related deaths.
Our current
classification of controlled substances that governs almost all aspects of
neuroscientific research and treatment and in particular pain and mental
illness is unscientific (2).
In the
history of mankind people with mental illness have been both vilified and
victimized. In our modern wars against mental illness our current systems are
counterproductive.
There are
many more challenges but not much progress is possible unless we adopt science
based methods to lead psychiatry.
References:
1) Webster L., Dasgupta N. Obtaining
Adequate Data to Determine Causes of Opioid Related Deaths, Pain Medicine
2011; 12: 586-592
2) Salerian AJ. Addictive Potency of a Substance. Medical Hypothesis 2009
2
1
