Wednesday, 23.08.2017

Comment (Jose de Leon)

Comment by Jose de Leon on Thomas A. Ban’s Neuropsychopharmacology and the Forgotten Language of Psychiatry. From Psychiatry to Neuronology 

This is my second review on a piece by Dr. Ban that Dr. Blackwell has commented on. To summarize my conflict of interest to them I need to acknowledge that I am neutral toward Dr. Blackwell but I am positively biased toward Dr. Ban.  This time my conclusion is the opposite of the prior review on Dr. Ban’s essay on “conflict of interest” (see Controversies, March 20, 2014); while Dr. Ban has done an excellent job, I tend to disagree with Dr. Blackwell’s perspective.  

I need to acknowledge that I share Dr. Ban’s love for the history of psychiatry and the Heidelberg school of psychiatry which developed “descriptive psychopathology”.

I currently think that US psychiatry has reached an impasse with the DSM-5 and RDoC (de Leon J. DSM-5 and Research Domain Criteria: One hundred years after Jaspers’s General Psychopathology. Am J  Psychiatry 2014; 171: 492-4). Moreover, this end is the result of the process started in 1972 with Feighner’s criteria (Feighner JP, Robins E, Guze SB, Woodruff RA Jr, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972;26:57-63), also known as the Neokraepelinian revolution, that led to the DSM-III (de Leon J.  One hundred years of limited impact of Jasper’s General Psychiatry in the US psychiatry. J Nerv Ment Dis. 2014; 202:79-87). However, as Andreasen described, it had the unintended consequences of killing US psychiatry’s interest in descriptive psychopathology (DSM and the death of phenomenology in America: an example of unintended consequences. Schizophr Bull. 2007; 33: 108-12). Moreover, Dr. McHugh’s warnings about DSM nosology (Striving for coherence: psychiatry's efforts over classification. JAMA 2005; 293: 2526-8) were not heeded. Dr. Blackwell has demonstrated some, but not enough enthusiasm, in my opinion, in reviewing Dr. Ban’s e-book.  I think he should have encouraged all US psychiatrists to read it. 

Other American psychiatrists with compatible views are the before-mentioned Drs. Andreasen and McHugh.  Also, Dr. Weinberger who previously worked in the NIMH but dislikes the NIMH’s RDoC (Weinberger, DR.  RDoCs redux. World Psychiatry 2014;13:36-38).  I would emphasize that Dr. Ban does possess unique comprehensive knowledge of descriptive psychiatry which needs to be complemented by others in the field.  Dr. McHugh is ideal for teaching US psychiatrists how to diagnose, and Dr. Andreasen is ideal for teaching them how to assess psychosis and incorporate descriptive psychopathology in scales.  Although I have read many of Drs. Andreasen’s and McHugh’s articles, I do not remember them ever quoting Leonhard. Thus, Dr. Ban needs to stay active to teach US psychiatry about the Leonhardian system of psychosis diagnosis.  In my experience, 99% of US psychiatrists have no idea who Leonhard was, or what cycloid psychoses are.   Dr. Ban quotes Dr. Pichot’s book (Pichot P. A Century of Psychiatry. Paris: Roger Dacosta; 1983) in his E-book. Dr. Pichot is also an expert in the history of psychiatry and his ideas may help to reorient US psychiatry in a useful direction. .

 

Jose de Leon

May 22, 2014,