Psychiatry's problems, noted again

I posted about another review of this book last month, but this review from Nature contains other highlights of the failures of psychiatry that I hadn't thought about for a long time:

In January 1973, Science published an article called ‘On being sane in insane places’. The author, psychologist David Rosenhan, described how he and seven other healthy people had reported themselves to a dozen psychiatric hospitals, claiming to hear voices uttering odd words such as ‘thud’ or ‘hollow’ — a symptom never reported in the clinical literature. Each person was diagnosed with either schizophrenia or manic-depressive psychosis, and admitted; once inside, they stopped the performance. They were released after an average of 19 days with diagnoses of ‘schizophrenia in remission’ (D. L. Rosenhan Science 179, 250–258; 1973).

One research and teaching hospital, hearing about the study, declared that its own staff could never be so deceived. It challenged Rosenhan to send it pseudopatients. He agreed, but never did. Nonetheless, the hospital claimed to have identified 41 of them.

Psychiatric hospitals, it seemed, could recognize neither healthy people nor those with mental illnesses. Rosenhan’s study exemplifies much of what went wrong in twentieth-century psychiatry, as biologists, psychoanalysts and sociologists struggled for supremacy. Science historian Anne Harrington takes us through the painful history of that struggle in the enthralling Mind Fixers, which focuses particularly on the United States.  

Something new I hadn't known:  it took this long to identify syphilis as eventually caused dementia?:

Certain discoveries, such as the findings in 1897 and 1913 confirming that syphilis causes late-onset psychosis, bolstered biologists’ view that mental disorders were brain-based. 

I also did not realise that psychoanalytic approaches had the sort of revival related here, even though of course I knew the 70's were the heyday of - gee, who was the guy who seemed to blame most  psychosis on families and pressure they put their kids under?*:  

As Harrington relates, the horrors of two world wars generated hundreds of thousands of cases of what we now call post-traumatic stress disorder, indicating a clear role for environmental triggers for some mental illnesses. By the 1970s, the Nazi eugenics atrocities had led most US psychoanalysts to disdain biological approaches even more vehemently, but their reasoning caused its own distress. They extended Freud’s view that mental disorders were rooted in early sexual fantasies to encompass all causes of early childhood anxieties. The idea that families, particularly mothers, were to blame for unexplained mental conditions such as psychoses became mainstream. By the 1950s, psychoanalysts dominated US psychiatry teaching.

Around this time, notes Harrington, social scientists emerged as the third influential force, aligning with psychoanalysts on the purported role of ‘toxic’ families in causing psychiatric disease. Yet within a decade, US psychiatrists experienced a backlash — both from patients’ families, fed up with being vilified, and from the professional ranks. What’s more, a 1962 study showed that two psychiatrists disagreed on the diagnosis of the same person 70% of the time (A. T. Beck Am. J. Psychiatry 119, 210–216; 1962).

*  RD Laing.  Haven't thought about him for a long time, too.