Psychiatry Governed by US Standards

Professor Maurice Corcos goes to war against the famous American DSM (Diagnostic and Statistical Manual) of Mental Disorders. The psychiatrist and psychoanalyst, who heads the department of adolescent and young adult psychiatry at the Institut Mutualiste Montsouris in Paris, protested against “the new psychiatric,” as it is taught today in medical schools. And he made it known in the book which he has devoted himself to.* He laments that there is only a single consideration of the facts in psychiatry nowadays, and thus the disappearance of any subjective interpretation, which he considers to be a serious setback for the sick. And he rails against the reduction of their existence to being the cause of just simple biological accidents.

Since introduction, the tone has been set: “Students’ thoughts have been sterilized by learning to respond most effectively to the MCQs (multiple choice questionnaires) for filling out their tests, reducing students in psychiatry to gathering the symptoms laid down by the DSM, endlessly adding and subtracting them to achieve a result that they can gladly deliver to the patients, like a good student who solves an equation with one unknown. But the equation has many unknowns, and man, especially when he is ‘crazy,’ is a disturbed machine that no check-list can manage to sum up.”

A Perverse System

Professor Corcos compares the DSM to the invention of universal instructions for haywire machines aimed at computer-phobic doctors in the clinics. With this instrument, the goal of psychiatry is no longer to enter into the inner experiences of a patient, but to respond to his eccentricities by a consistent objective. Corcos denounces, however, this perverse system that has been developed just so that researchers from different countries can work under common diagnostic criteria and then compare their work effectively. But where are the patients in all of this?

Corcos compares the behavior of the observers to that of tourists, who, in museums, at archaeological sites or at weddings, spend most of their time with their eyes glued to the camera lens, without truly looking at what is happening in front of them and without using their senses. “In mental images, they substitute in electronic images, that is to say, a virtual fantasy but without a real effect.” The real is never directly addressed by these psychiatrists, who very often take refuge behind medical imaging (including MRIs) to try to understand the situation.

The first two DSMs (in 1952 and 1968) were “regarded in their day, and were the questions of subjectivity and meaning but were not yet cosidered as acessories to psychiatry,” said Corcos. Moreover, the different avenues of thought were invited to participate in their drafting. But since then, the “scientific” world has taken power. America has managed to take on a new mentality. Ultrascience, the blind profitability, the technological frenzy or even the mechanical and cold barbarity, reigns supreme. This is why Maurice Corco hopes that psychiatrists — at least French ones — will eventually expose the “new social contract that will alienate them” and which tries to put humans in boxes, before responding to requests from a society that does not want more disoreder or insanity. Will it be heard?

*L’Homme selon le DSM, Albin Michel edition, 234 pages, 20 euros.