Book Review

Pseudoscience in Biological Psychiatry: Blaming the body

N Engl J Med 1995; 332:1796June 29, 1995

Article

Pseudoscience in Biological Psychiatry: Blaming the body
Edited by Colin A. Ross and Alvin Pam. 294 pp. New York, John Wiley, 1995. $37.50. ISBN: 0-471-00776-5

Optimists see the differences among psychiatry's multiple schools of thought as a prerequisite for the healthy debate required for growth. Skeptics see the same differences as ideological squabbling that undermines the field's credibility. Pessimists will always see a battleground for funding, profit, politics, power, and fame. Learners see the multiplicity of perspectives as either challenging or confusing. Many have put their hope for clarity in Science. The promise of definitive answers through the application of empirical research, statistical analysis, and formal inferential logic has created “biologic psychiatry,” now the predominant paradigm in the field. The ascendancy of a psychodynamic approach, derived from an understanding of individual experience, is over. It has been replaced by categorizing signs and symptoms, testing remedies, measuring what is measurable, and searching for underlying biologic pathology to be called “disease.”

Pseudoscience in Biological Psychiatry questions the very foundations of biologic psychiatry. The book consists of eight essays, each of which takes issue with the field from a different vantage point. Pam criticizes the scientific methodology of biologic psychiatry, as well as the reasoning and application of its research into the “psychobiology interface.” His chapter has impressive depth, thoroughness, and organization. The historical explorations add interest and perspective to the argument.

Ross documents what he calls cognitive errors and distortions of logic in the field's literature through an extensive review of articles in the American Journal of Psychiatry from 1990 to 1993. He cites various examples of such faulty reasoning: “if it runs in families, it must be genetic,” “if it responds to medication, it must have a biological cause,” and “greater severity of symptom implies biology.”

Ellen Borges discusses the consequences of a narrow biologic focus, which medicalizes social diversity by reducing actions and personal problems to laboratory values and gene sequences. The sobering insights of her discussion provide justification for the current reformulations of developmental psychology.

In the chapter on psychiatric education, the authors discuss the detrimental effects of what they call biologic psychiatry's false assumptions on the field's educational approaches.

The chapter on trauma-related syndromes articulates numerous perceived failures of biologic psychiatry in addressing today's epidemic of violence and its consequences. The chapter suggests that these failures are inherent in the approach of biologic psychiatry and have themselves contributed to the problem. The book ends with a proposed model that the authors believe provides a more productive medical and scientific framework for a comprehensive understanding of psychopathology.

This book is strong medicine. It argues that the legitimacy and cultural authority granted to an objective and value-free science is undeserved by biologic psychiatry. It presents the case that such a status has been expropriated by hyping promising leads, closing off debate, and dismissing ultimately unproductive results of costly research. Resources are diverted from social ills, now reduced to mere environmental triggers for latent biologic factors. The authors believe that the valid notion of investigating constitutional determinants of psychological disorders has thereby been coopted by a biomedical reductionist ideology. This ideology tacitly claims that biology is destiny. The person, while relieved of responsibility, is blamed for defective protoplasm and treated for, if not as, a disease. The authors predict that the continuation of the field's present orientation will perpetuate its progressive isolation from patients, other mental health disciplines, and society.

The language of this book is compelling but tends at times to convince through passion, raising the very issue introduced by the book's thesis — namely, the power of unstated, underlying agendas. Although there is no doubt a desire to be faithful to the experiences of those whom the authors believe have been hurt by the topics addressed in the book, at times the writing causes one to wonder about unwitting assumptions and the potential for distortion of arguments that are so impassioned. This book will be easy reading for those who agree with its premise and long for closure. It will be easily dismissed by those who disagree and whose minds are closed. Perhaps the book is itself a product of the polarization that characterizes the ideological differences within the field today. It will be appreciated most, however, by psychiatry watchers who are confident of the field's mission to help and heal and are comfortable with the notion that each of its multiple schools of thought has an essential contribution to make to the spirited debate. This book is likely to evoke exactly that kind of response.

Jonathan P. Schindelheim, M.D.
New England Medical Center, Boston, MA 02111