Letter from Henry J. Friedman to the Wall Street Journal on March 5, 2010 in response to Edward Shorter’s article: “Why Psychiatry Needs Therapy,” in the Wall Street Journal on Feb. 27, 2010.
As a psychiatrist and psychoanalyst who has worked with a wide range of patients since 1963, I believe it is important to refute Prof. Shorter’s brutal attack on contemporary psychiatry. His views are idiosyncratic, to say the least, reflecting as they do his individual appraisal of the diagnostic manual and current treatments.
Paradoxically, Prof. Shorter denounces the very areas of great progress that have made psychiatry a potent force in providing effective treatments for those previously unable to be reached in psychotherapy. The growing number of effective drugs for severe depression, mania and schizophrenia date from a dark period in the 1950s and ’60s when psychopharmacology hardly existed. The attack on drug makers that have produced effective medication is inexcusable, as is the paranoid assertion that the new diagnoses proposed for DSM-V are designed to create new categories of illness that will accommodate the drug companies’ desire for a larger marketing audience.
The possibility of providing combined psychotherapy and psychopharmacological treatments has enhanced our effectiveness and widened the scope of patients who can use these treatments. I certainly don’t join with those who regret the DSM-V moving further away from psychoanalytically based diagnostic categories. The inclusion of theoretical aspects of our thinking that focus on the unconscious causality of human mental functioning has never been an essential aspect of proper psychiatric diagnosis, regardless of how important they are in the actual treatment situation. The impact of basing psychiatric diagnosis on identifiable behaviors and symptoms should be applauded rather than denounced by those who take no responsibility for providing psychiatric care to those in need of it.
Henry J. Friedman, M.D.
Harvard Medical School
Cambridge, Mass.