Are Psychiatric Disorders “Real”?

  • Leon Eisenberg

Abstract

Psychiatry is dismissed as a medical specialty by some physicians because many of the disorders in its domain have yet to be consistently associated with organ pathology. Critics with a sociologic bent add that psychiatrists misuse medical authority to apply the label “sick” to deviant behaviour which is offensive to community standards. By labelling deviance as a medical disorder, they argue, patients are stripped of the dignity of personal responsibility for their actions and, authorities justify police action by the state to restrict their liberties. Both groups of critics take psychiatric disorders to be less “real” than medical or surgical ones because structural or biochemical defects underlying the pathological behaviour have not yet been demonstrated. The inference is that, were there to be such evidence, the attribution of illness would take on a qualitatively different character.

Keywords

Placebo Fatigue Dust Depression Influenza 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ackerknecht, E. H. (1947). The role of medical history in medical education. Bulletin of History and Medicine, 21, 135–145.Google Scholar
  2. Ackerknecht, E. W. (1982). The history of psychosomatic medicine. Psychological Medicine, 12, 17–24.PubMedCrossRefGoogle Scholar
  3. Al-Arif, L. I., Goldstein, R. A., Affronti, L. F., et al. (1979). HLA-Bwl5 and tuberculosis in a North American black population. American Review of Respiratory Disease, 120, 1275–1278.PubMedGoogle Scholar
  4. Ariel, R. N., Golden, C. J., Berg, R. A., et al. (1983). Regional blood flow in schizophrenics. Archives of General Psychiatry, 40, 258–263.PubMedCrossRefGoogle Scholar
  5. Ballinger, C. B. (1977). Psychiatric morbidity and the menopause: survey of a gynecological outpatient clinic. British Journal of Psychiatry, 131, 83–89.PubMedCrossRefGoogle Scholar
  6. Beecher, H. (1956). Relationship of significance of wound to the pain experienced. Journal of American Medical Association, 161, 1609–1613.CrossRefGoogle Scholar
  7. Brown, G. W., Birley, J. L. T., and Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry, 121, 241–258.PubMedCrossRefGoogle Scholar
  8. Brown, G. W., Monck, E. M., Carstairs, G. M., and Wing, J. K. (1962). Influence of family life on the course of schizophrenic illness. British Journal of Preventive and Social Medicine, 16, 55–68.Google Scholar
  9. Buchsbaum, M. S., Ingvar, D. H., Kessler, R., et al. (1982). Cerebral glucography with positron tomography. Archives of General Psychiatry, 39, 251–260.PubMedCrossRefGoogle Scholar
  10. Byrne, P. (1984). Psychiatric morbidity in a gynecology clinic: An epidemiological survey. British Journal of Psychiatry, 114, 28–34.CrossRefGoogle Scholar
  11. Center for Disease Control. (1979). Tuberculosis in the United States, 1977. Atlanta: Center for Disease Control (DHEW Publication No. (CDC) 79-8322).Google Scholar
  12. Editorial. (1979). Psychiatric illness among medical patients. Lancet, i, 478–479.Google Scholar
  13. Evans, A. C. (1947). Brucellosis in the United States. American Journal of Public Health, 37, 139–151.CrossRefGoogle Scholar
  14. Falloon, I. R. H., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B., &Gilderman, A. M. (1982). Family management in the prevention of exacerbations of schizophrenia: A controlled study, New England Journal of Medicine, 306, 1437–1440.PubMedCrossRefGoogle Scholar
  15. Feingold, A. 0. (1975). Cost effectiveness of screening for tuberculosis in a general medical clinic. Public Health Reports, 90(6), 544–547.PubMedGoogle Scholar
  16. Gage, S. H. (1935). Theobald Smith 1859-1934, Cornell Veterinarian, 25, 207–228.Google Scholar
  17. Gath, D., Cooper, P., Bond, A., et al. (1982). II. Demographic, psychiatric and physical factors in relation to psychiatric outcome. British Journal of Psychiatry, 140, 343–350.PubMedCrossRefGoogle Scholar
  18. Gath, D., Cooper, P., and Day, A. (1982). Hysterectomy and psychiatric disorder. I. Levels of psychiatric morbidity before and after hysterectomy. British Journal of Psychiatry, 140, 335–342.PubMedCrossRefGoogle Scholar
  19. Glassroth, J., Robins, A., and Snider D. (1980). Tuberculosis in the 1980’s. New England Journal of Medicine, 302, 1441–1450.PubMedCrossRefGoogle Scholar
  20. Gottesman, I. I., &Shields, J. (1982). Schizophrenia: The Epigenetic Puzzle. Cambridge University Press, Cambridge.Google Scholar
  21. Gur, R. E., Skolnick, B. E., Gur, R. C., et al. (1983). Brain function in psychiatric disorders, I: Regional cerebral mood flow in medicated schizophrenics, Psychiatry, 40, 1250–1254.Google Scholar
  22. Hogarty, G.E., &Goldberg, S. (1973). Collaborative study group. Drug and sociotherapy in the aftercare of schizophrenic patients. Archives of General Psychiatry, 28, 54–64.PubMedCrossRefGoogle Scholar
  23. Imboden, J. B., Canter, A., &Cluff, L. E. (1961). Convalescence from influenza. Archives of Internal Medicine, 108, 393–399.PubMedCrossRefGoogle Scholar
  24. Imboden, J. B., Canter, A., Cluff, L. E., &Trever, R. (1959). Brucellosis: III. Psychologic aspects of delayed recovery. Archives of Internal Medicine, 103, 406–414.PubMedCrossRefGoogle Scholar
  25. Kass, E. H. (1971). Infectious diseases and social change. Journal of Infectious Diseases, 123, 110–114.PubMedCrossRefGoogle Scholar
  26. Kleinman, A., Eisenberg, L., &Good, B. (1978). Culture, illness and care. Annals of Internal Medicine, 88, 251–258.PubMedGoogle Scholar
  27. Leff, J. P., Knipers, L., Berkowitz, R., Eberlein-Vries, R., and Sturgeon, D. (1982). A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141, 121–134.PubMedCrossRefGoogle Scholar
  28. Leff, J. P., Knipers, L., Berkowitz, R., Vaughn, C., and Sturgeon, D. (1983). Life events, relatives’ expressed emotion and maintenance neuroleptics in schizophrenic relapse. Psychological Medicine, 13, 799– 806.PubMedCrossRefGoogle Scholar
  29. Martin, R. L., Roberts, W. V., and Clayton, P. J. (1980). Psychiatric status after hysterectomy: A one-year prospective follow-up. Journal of American Medical Association, 244, 350–353.CrossRefGoogle Scholar
  30. McDermott, W. (1978). Medicine: The public good and one’s own. Perspectives in Biology and Medicine, 21, 167–187.PubMedGoogle Scholar
  31. M. (1984). Twin concordance for operationally defined schizophrenia. Archives of General Psychiatry, 41, 541–545.PubMedCrossRefGoogle Scholar
  32. McKeown, T. M. (1976). The role of medicine: Dream, mirage or nemesis? London: Nuffield Provincial Hospitals Trust.Google Scholar
  33. Moffic, H., and Paykel, E. S. (1975). Depression in medical inpatients. British Journal of Psychiatry, 126, 346–353.PubMedCrossRefGoogle Scholar
  34. Murphy, H. B. M., Raman, A. C. (1971). The chronicity of schizophrenia in indigenous tropical peoples: Results of a twelve-year follow-up survey in Maritius. British Journal of Psychiatry, 118, 489–497.PubMedCrossRefGoogle Scholar
  35. Peterson, W. L., Sturdevant, R. A. L., Frankl, H. D. (1977). Healing of duodenal ulcer with an antacid regimen. New England Journal of Medicine, 297, 341–345.PubMedCrossRefGoogle Scholar
  36. Shepherd, M. (1978). Epidemiologic perspective: Psychosomatic medicine. International Journal of Epidemiology, 7 ,201–205.PubMedCrossRefGoogle Scholar
  37. Smith, B. E. (1981). Black lung: the social production of disease. International Journal of Health Services, 11, 343–359.PubMedCrossRefGoogle Scholar
  38. Snyder, S.H. (1982). Schizophrenia. Lancet, ii, 970–974.CrossRefGoogle Scholar
  39. Szasz, T. S. (1960). The myth of mental illness. American Psychology, 15, 113–118.CrossRefGoogle Scholar
  40. Vaughn, C., &Leff, J. P. (1976a). The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.PubMedCrossRefGoogle Scholar
  41. Vaughn, C., &Leff, J. P. (1976b). The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157–165.PubMedCrossRefGoogle Scholar
  42. Waxier, N. E. (1979). Is outcome for schizophrenia better in non-industrial societies: The case of Sri Lanka. Journal of Nervous and Mental Disease, 167, 144–158.CrossRefGoogle Scholar
  43. Weinberger, D. R., Wagner, R. J., and Wyatt, R. J. (1983). Neuropathological studies of schizophrenia: A selective review. Schizophrenia Bulletin, 9, 193–212.PubMedGoogle Scholar
  44. Wood, C. S. (1979). Human sickness and health: A biocultural view. Mayfield, Palo Alto.Google Scholar
  45. World Health Organization. (1979). Schizophrenia: An international follow up study. New York: John Wiley and Sons.Google Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Leon Eisenberg
    • 1
  1. 1.Department of Social Medicine and Health PolicyHarvard Medical SchoolUSA

Personalised recommendations