Andrew Scull on ‘All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders’


English: Emil Kraepelin
Emil Kraepelin

Psychiatry’s Legitimacy Crisis: ‘Horwitz and Wakefield want to argue for the harmful impact of what is often called the neo-Kraepelinian revolution in psychiatry. Emil Kraepelin was the fin-de-siècle German psychiatrist who launched the fashion for descriptive psychopathology and first made the distinction between dementia praecox and manic-depressive illness. Horwitz and Wakefield suggest that the efforts of Kraepelin’s late-twentieth century successors to make psychiatric diagnoses more rigorous and predictable have instead enabled psychiatric pathology to get out of hand. They identify two problems: the psychiatric profession’s obsession with simplistic, symptom-based diagnoses, and the looseness of its criteria for defining mental states as pathology. All sorts of anxieties that are in reality part of the normal range of human emotion and experience have been transformed by professional sleight of hand into diseases. The upshot, they contend, is that whereas thirty years ago less than five percent of Americans were thought to suffer from an anxiety disorder, nowadays some widely cited epidemiological studies have decreed that as many as 50 percent of us do so.” (Los Angeles Review of Books).

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