Most Americans believe that their health care system is the best in the world. Yet they do not recognize the extent to which many claims about the causes of disease, therapeutic practices, and even diagnoses are shaped by beliefs that are unscientific, unproven, or completely wrong. To so argue is not to condemn American medicine, which admittedly has many strengths, but rather to point to rhetorical claims and practices that rest upon shaky foundations. What we have chosen to do in this book is to present a series of case studies that illustrate the weaknesses of many prevailing beliefs and...

In the early twentieth century peptic ulcer aroused the attention of physicians and, especially, surgeons, many of whom believed that its incidence was on the rise. Initially, surgery became the cutting-edge therapy. But it was quickly followed by claims that diet or psychological intervention could best treat the condition. Rivalry between competing specialties thus became characteristic despite the fact that evidence demonstrating the efficacy of each was weak to nonexistent. At the same time theoretical explanations about etiology that had little to do with therapy proliferated. The history of peptic ulcer in the twentieth century suggests that theories and therapies...

For much of the twentieth century tonsillectomy (generally with adenoidectomy) was the most frequently performed surgical procedure in the United States. Despite the fact that relatively little was known at that time about the precise function played by this organ, theoretical speculation served as a justification for a procedure for which there was little persuasive evidence. Moreover, despite intense criticism, it took decades before tonsillectomy rates began to decline, only to begin a modest increase in recent years. The checkered history of tonsillectomy provides a cautionary lesson and suggests that the enthusiasm that often accompanies new therapies should be weighed...

In contemporary America cancer and coronary heart disease are the two leading causes of mortality. They arouse fear and anxiety among many, and there are perennial calls for “wars” to conquer them. A variety of groups—physicians, scientists, epidemiologists, and others—provide bewildering and ever-changing explanations of the causes of these two diseases. These explanations shape surgical and medical therapies as well as preventive interventions. Scarcely a day passes without new behavioral and dietary advice that presumably will lessen the risk of developing cancer and CHD. Yet, as we shall see, many of the claims about the etiology of these...

Psychiatry has always helped set many of the most important social boundaries. These include distinctions between abnormality and normality, disease and deviance, symptoms of illness and natural feelings, and states deserving of sympathy or of stigma. During the last half of the nineteenth century, culturally suitable diseases began to require specific diagnoses, sharp boundaries, and particular etiological mechanisms. By the latter decades of the twentieth century, this trend was firmly established and any respected medical specialty had to treat delineated disease entities. Specific diagnoses were necessary for professional authority, legitimate treatments, and monetary reimbursement. Yet the psychiatric profession actually dealt...

Major Depressive Disorder (MDD) has become firmly entrenched in psychiatric research, treatment, and teaching; the mental health and health care systems; media reports about the condition; pharmaceutical advertisements for anti-depressants; and patient self-conceptions. It is so taken-for-granted and widely institutionalized that it is difficult to realize that it only emerged in its current form in 1980. Although depressive conditions have been recognized since the earliest known medical writings, the diagnostic criteria for MDD in theDSM-IIIwere a major departure from previous conceptions of depression. Indeed, as late as 1979 numerous controversies raged on how to measure depression, the number...

Post-traumatic stress disorder and its historical antecedents have always been problematic diagnoses for psychiatry. Their basic tenet—that some traumatic event in the external environment can lead to lasting psychopathological consequences in previously normal people—does not easily fit the psychiatric profession’s traditional focus on the biological and/or psychological roots of mental illness. While psychiatric explanations have periodically emphasized how a heterogeneous range of social, moral, and lifestyle factors influence who becomes mentally ill, they generally regarded these environmental forces as precipitants of mental disorder in already predisposed individuals. The view of trauma found in the PTSD diagnosis, in contrast,...

The “lessons” of history are far less clear and often obscure and contradictory. Indeed, history suggests that there is a price to be paid for implementing ideology ungrounded in empirical reality and for making exaggerated rhetorical claims. In this volume we have employed both historical and contemporary materials to deal with some fundamental problems within the American medical care system. Our goal has not been to denigrate the theory and practice of the American medical care system. Nevertheless, there are numerous elements that raise important doubts about the validity of many medical explanations, diagnostic categories, therapeutic interventions, and claims. It...