We're living in an empirical age. The most impressive intellectual feats have been achieved by physicists and biologists, and these fields have established a distinctive model of credibility.
To be an authoritative figure, you want to be coolly scientific. You want to possess an arcane body of technical expertise. You want your mind to be a neutral instrument capable of processing complex quantifiable data.
The people in the human sciences have tried to piggyback on this authority model. For example, the American Psychiatric Association has just released the fifth edition of the Diagnostic Statistical Manual of Mental Health Disorders. It is the basic handbook of the field. It defines the known mental diseases. It creates stable standards, so that insurance companies can recognize various diagnoses and be comfortable with the medications prescribed to treat them.
The recent editions of this manual treat mental diseases like diseases of the heart and liver. They leave the impression that you should go to your psychiatrist because she has a vast body of technical knowledge that will allow her to solve your problems. With their austere neutrality, they leave a distinct impression: Psychiatrists are methodically treating symptoms, not people.
The problem is that the behavioral sciences like psychiatry are not really sciences; they are semi-sciences. As the handbook's many critics have noted, psychiatrists use terms like "mental disorder" and "normal behavior," but there is no agreement on what these concepts mean. When you look at the definitions psychiatrists habitually use to define various ailments, you see that they contain vague words that wouldn't pass muster in any actual scientific analysis: excessive, binge, anxious.
Mental diseases are not understood the way, say, liver diseases are understood, as a pathology of the body and its tissues and cells. What psychiatrists call a disease is usually just a label for a group of symptoms. As the eminent psychiatrist Allen Frances writes in his book, "Saving Normal," a word like schizophrenia is a useful construct, not a disease: "It is a description of a particular set of psychiatric problems, not an explanation of their cause."
Medicines seem to work but then stop. Because the mind is an irregular cosmos, psychiatry hasn't been able to make the rapid progress that has become normal in physics and biology. As Martin Seligman, a past president of the American Psychological Association, put it in The Washington Post early this year, "I have found that drugs and therapy offer disappointingly little additional help for the mentally ill than they did 25 years ago — despite billions of dollars in funding."
All of this is not to damn people in the mental health fields. On the contrary, they are heroes who alleviate the most elusive of all suffering, even though they are overmatched by the complexity and variability of the problems. I just wish they would portray themselves as they are. Psychiatrists are not heroes of science. They are heroes of uncertainty, using improvisation, knowledge and artistry to improve people's lives.
The best psychiatrists are not coming up with abstract rules that homogenize treatments. They are combining an awareness of common patterns with an acute attention to the specific circumstances of a unique human being. They are not inventing new diseases in order to medicalize the moderate ailments of the worried well.
Hippocrates observed, "It's more important to know what sort of person has a disease than to know what sort of disease a person has." That's certainly true in the behavioral sciences and in policymaking generally, though these days it is often a neglected truth.
David Brooks writes for The New York Times.