Psychiatry’s Next Civil War? McHugh forum for Try to Remember

As the battle over repressed memory winds down, experts warn of other ‘fads’ in the field

by Aalok Mehta

December 17, 2008

Recovered memory syndrome may be largely discredited now, but the bad science that allowed that “false disease” to blossom to ruinous effect has infected other areas of psychiatry, including overdiagnosis of post-traumatic stress disorder, prominent scientists warned recently.

“There are still people who defend the indefensible,” said Paul McHugh, a professor of psychiatry at Johns Hopkins University, after a panel discussion at the Dana Center in Washington, D.C., on Dec. 3. The three experts convened to chat about McHugh’s new book, Try to Remember, which outlines his experiences battling the boom in the 1990s of diagnoses of people as having repressed memories of childhood sexual abuse.

Lives and families were deeply damaged then not only by false abuse accusations but also through intense, inappropriate psychotherapy that aimed to find supposedly buried memories even when they weren’t there, McHugh said. Similarly, many people are now being diagnosed with PTSD even when their symptoms are relatively minor or are expected reactions to stressful experiences.

“War is a terrible thing. We used to recognize that, to call [veterans] heroes and give them medals,” McHugh said. “Now we call them victims and give them diseases.”

PTSD is a real condition that is often crippling enough to require treatment and therapy, McHugh added. But it’s being overused as a diagnosis and is often miscategorized as a much more serious category of illness than it should be.

J. Raymond DePaulo, psychiatrist-in-chief at Johns Hopkins Hospital, agreed. “Is [PTSD] a brain disease or just a normal human reaction to something no one should ever see? It’s a normal human reaction,” he said.

Struggling for acceptance

Their discussion painted a bleak picture of a profession still struggling to regain scientific and public acceptance, in large part because of periodic fads largely driven by societal forces. “Standards of psychiatry are so low,” said Kay Redfield Jamison, a Johns Hopkins professor of psychiatry. “The American public has no expectation of science.”

One problem, the experts agreed, is psychiatrists themselves. “There are many therapists in this country—we have more of them than we do mailmen,” McHugh said. “Not all of them are well-trained psychiatrists.”

What’s startling is that these therapists can be led astray by the supposed brightest minds in the field. “[Therapists] spread the errors, but they learned them from leading psychiatrists from leading institutions,” he said. In the case of repressed memory, “it was not an error of the poorly trained. It was an error of the well-trained.”

Further fueling the fire, the scientists said, is a public yearning to assign greater meaning to mental illness than is warranted. “The public is interested in drama—a particular kind of drama,” such as abuses of trusted authority, McHugh said. “Victimology had become the big theme in psychiatry.” Many psychiatrists, he added, feed this drama through suggestive, “seductive” treatment methods.

“A lot of the appeal of psychotherapy is it tells stories,” Jamison said. But improvements in drug therapy, while helping many get better, doesn’t offer the same narrative pull. As medicine, it’s a great success, “but it’s not appealing story,” she said.

The three experts also suggested that the media does not question critically psychiatry’s most outrageous claims. “I don’t think there is much significant coverage of fads,” Jamison said.

But McHugh added that the repressed memory incident offers lessons on how to improve psychiatry and restore public confidence. The field needs to become more like other areas of medicine, he argues, with diagnoses rooted not in symptoms but in an understanding of the causes for mental disease.

With advances in the brain sciences coming ever more quickly, he added, that day is not far off. “Unity,” he said, “is coming to psychiatry.”