Dr Allen Frances is a man with regrets.

The man the New York Times once described as “the most powerful psychiatrist in America” is at the career point where others would retire and board a cruise, to endlessly sail the Caribbean. But Frances can’t stop now. His legacy in the field of mental health is something he’s trying both to destroy and to resurrect.

Twenty years ago he chaired the task force of mental-health clinicians and academics who wrote the fourth version of what’s often called the bible of mental health — that is, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It’s compiled and distributed by the American Psychiatric Association and it basically determines which symptoms equate to a mental disorder.

Now, with the fifth edition to be released on May 22 — at a mammoth four-day ‘meeting’ keynoted by none other than President Bill Clinton — Frances is doing everything he can to undermine the manual’s contents.

Drafts have been circulated and tested for a a couple of years, but even before the formal launch of DSM-5, Frances had written two books criticising its content: Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5; and Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life which was released this week). This is despite the fact that DSM-5 still contains the legacy of his own work on DSM-IV. (The publishers dropped the Roman numerals.)

So why such a change of heart?

“Not a change of heart — change of the world,” he says in an interview with The Global Mail. Frances is concerned about the rapid inflation in mental-health diagnoses over the past 35 years. He feels the ups and downs of everyday life are being turned into medical disorders, and he knows from experience that the diagnostic manual can exaggerate that effect, with the result that a disorder label will be attached to more and more people with even mild symptoms.

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Also read, Mental Disorders: The Facts Behind the Marketing Campaign

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The Departments of Defense and Veterans Affairs have spent over $4.5 billion on antidepressants, antipsychotics and anti-anxiety drugs over the past decade despite more than 170 warnings issued by international drug regulatory agencies warning of drug induced suicide, violence, mania, psychosis, aggression, hallucinations, death and much more.

Once again the military and mainstream press are searching for all the reasons for troop suicides except for the quadrupling of drugs being prescribed that cause suicide. Before, during and after deployment, today’s military personnel are subject to a stew of drugs—antidepressants, antipsychotics and anticonvulsants—that carry clear suicide warnings.

Why? Because DOD and VA are Big Pharma’s  last unregulated revenue stream and it’s going to get its money’s worth.

At Fort Hood, where 48,000 troops and their families are stationed, 6,000 soldiers were on antidepressants, and 1,400 were on antipsychotic drugs in 2009, reported USA Today. At Fort Bragg, where 50,000 are stationed, 4,994 troops were on antidepressants, and 664 were on antipsychotics in 2010, reported the Fayetteville Observer, adding that “many soldiers take more than one type of medication.”

“Completed suicide rates were approximately twice the base rate following antidepressant starts in VA clinical settings,” says psychiatrist Peter Breggin, who has testified at congressional hearings. SSRI antidepressants “can cause or worsen suicidality, aggression and other dangerous mental states.”

Between 2005 and 2009, half of all TRICARE (the military health plan) prescriptions for people between eighteen and thirty-four were for antidepressants and epilepsy drugs like Topamax.  Prescriptions for suicide-linked Neurontin increased 56 percent, reports Military Times. In 2008, according to Military Times, 578,000 epilepsy pills and 89,000 antipsychotics were prescribed to deploying troops. Eighty-nine percent of troops with post traumatic stress disorder (PTSD) are given psychoactive drugs, and 34 percent are given antipsychotics—drugs with clear suicide warnings. A study of 887,859 VA hospital patients recommends “close monitoring” for suicide “after an antidepressant start.”

“At least one in six service members is on some form of psychiatric drug,” the Military Timnes site reported in 2010. And “many troops are taking more than one kind, mixing several pills in daily ‘cocktails’ for example, an antidepressant with an antipsychotic to prevent nightmares, plus an anti-epileptic to reduce headaches–despite minimal clinical research testing such combinations.”

One military insider, Dr. Elspeth Ritchie, a fan of SSRI antidepressants,  blames access to loaded weapons and “dear John” letters for the suicides in an Astra-Zeneca funded video.

Right.

With similar denial, the VA’s Iraq War Clinician Guide says, “We recommend SSRIs as first line medications for PTSD pharmacotherapy in men and women with military-related PTSD,” and “Findings from subsequent large-scale trials with paroxetine [Paxil] have demonstrated that SSRI treatment is clearly effective both for men in general and for combat veterans suffering with PTSD.” Clearly, there is a different kind of “service” going on here–service to Big Pharma’s marketing plans.

Martha Rosenberg is a health reporter and commentator whose work has appeared in Consumers Digest, the Boston Globe, San Francisco Chronicle, Chicago Tribune, New Orleans Times-Picayune, Los Angeles Times, Providence Journal and Newsday.

Also read, Psychiatric Drugs & War: A Suicide Mission

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THE human brain is the most complex object in the known universe. It contains 100 billion nerve cells. Considering how complex that is, it goes wrong remarkably rarely.

But go wrong it sometimes does. Which is why, since 1952, the American Psychiatric Association has published its “Diagnostic and Statistical Manual of Mental Disorders”, the DSM. This book, the newest version of which will hit the shops on May 22nd (see article), contains the association’s thinking on what constitutes a disorder of the mind. It is consulted not only by psychiatrists, but also by insurance firms, drug companies and anxious patients and parents—not only in America, but around the world. It has become the industry standard for defining what is and is not a mental illness, and thus who gets treated, and who pays for treatment.

No other major branch of medicine has such a single text, with so much power over people’s lives. And that is worrying. Because in no other branch of medicine is the scientific reality underpinning the pronouncements of doctors so uncertain.

The categorical imperative

This uncertainty flows from a profound ignorance about how brains actually work. Neuroscientists understand how nerve cells work. They also know which bits of the brain deal with vision, locomotion, language, memory and suchlike. But between these two anatomical levels all is darkness. Psychiatrists have thus had to use behaviour patterns as proxies for underlying problems. And what constitutes a pattern is too often a matter of opinion rather than a statistically rigorous fact.

It is this desire to find and classify patterns which gives the DSM its power. By naming things it gives shape to the fledgling science. That is not a bad thing in principle. But in practice it has gone too far. The main criticisms are that it medicalises normal behaviour and that the strict categories of mental illness it creates are increasingly at odds with what research suggests is actually going on in the brain.

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Deaths reported in children prescribed ‘newer generation’ antipsychotics

Health Canada is receiving growing numbers of reports of serious complications in children taking powerful antipsychotics, including deaths.Once reserved for schizophrenia and mania in adults, the drugs are increasingly being prescribed to children as young as preschoolers.

As of Dec. 31, 2012, Health Canada had received 17 fatal reports in children related to so-called “second generation antipsychotics,” or SGAs, Postmedia News has learned.Four of the reports concerned deaths in babies who were exposed to antipsychotics in the womb.

The government has also received 73 reports of “cardio-metabolic” reactions in children taking the drugs, including dramatic weight gain, high blood pressure and blood sugar abnormalities.

Use of the drugs in children has increased substantially in the last decade. Overall, from 2005 to 2009, antipsychotic drug prescriptions for children and youth in Canada increased by 114 per cent, despite limited evidence about their safety in children.

The drugs are being used for attention-deficit/hyperactivity disorder, “conduct” disorders, mood disorders, aggression and other behavioural problems.

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Search Antipsychotic drug side effects including adverse rections reported to the US FDA, international studies and warnings – here

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There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.

In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood.

The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.

Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.

“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders.

The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.

Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.

The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organisation, but the DSM is still hugely influential – and controversial.

The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors.

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The Pacific Standard, May 10, 2013

Editor’s Note: The post originally appeared on The Fix, a Pacific Standard partner site.

“I don’t think psychiatric diagnosis is necessary, at least not until psychiatry has the knowledge to render diagnoses on the same basis as other medical specialties.”

On May 22, the American Psychiatric Association will release the fifth version of the Diagnostic and Statistical Manual of Mental Disorders—the DSM-5. The last version, the DSM IV, was published in 1994 and has provided the clinical terms for diagnoses that allow for insurance payments, treatment costs, and public support for such afflictions as Asperger’s and grief—all of which, among a host of established disorders, are set to be altered by the new version.

Last week, Blue Rider Press published Gary Greenberg’s The Book of Woe: The DSM and the Unmaking of Psychiatry, a powerful critique of the entire DSM methodology. Greenberg is a practicing psychotherapist who also authored Manufacturing Depression: The Secret History of an American Disease and The Noble Lie. He has been referred to as “The Dante of our Psychiatric age,” by Errol Morris, and blogs about the DSM for the New Yorker.

With The Book of Woe, written during and after his own participation in the revision process of the DSM-5, Greenberg doesn’t just paint the DSM as irrelevant, but as an arbitrary and totalitarian influence in the treatment of mental and emotional distress. Greenberg makes an unsparing case against the DSM’s hold on the naming rights to our psychic suffering.

What is the most disturbing aspect of the DSM-5 to you?

The most disturbing aspect is not unique to the DSM-5, but intrinsic to any DSM: that a private guild—the American Psychiatric Association (APA)—owns such an important public trust. The DSM plays a significant role in determining who gets treatment, what drugs get approved, what research gets funded, who gets special education services, and the disposition of criminal cases. The APA represents only one of many mental health professions, is rife with conflicts of interest with the pharmaceutical industry, has its own, scientifically questionable approach to treatment, it also stands to make hundreds of millions of dollars from the manual and associated products. That’s unseemly. But even worse, it leaves the public at the mercy of people who are not accountable to anyone except their own organization. It’s the worst kind of privatization.

What effect do you see the DSM-5 having on treatment for drug and alcohol addiction?

I’m not sure the DSM-5 will have any direct effect on treatment; the DSM-5 is not a treatment manual. But any DSM has a major indirect effect on treatment: It provides the diagnoses that are the tickets to treatment resources. To put it more concisely: money. The DSM-5 will most likely eliminate the categories of Substance Abuse and Substance Dependence in favor of a new super-category of Substance Use Disorder. Qualifying for this diagnosis may be easier than for the DSM-IV diagnoses, largely because the number of criteria a patient has to meet has been reduced. Some studies indicate that this will result in a large increase in prevalence. If General Motors comes out with a new car, that doesn’t change the number of drivers, and if the APA comes out with a new diagnosis, that doesn’t change the number of people who will qualify for a mental disorder diagnosis. Whether this happens, and if it does, whether it’s a bad thing (treatment resources are overburdened by an influx of new patients) or a good thing (more people get treatment), or whether it will have any effect at all, remains to be seen.

You say that psychiatry should not have a monopoly on the diagnoses and treatment of human suffering, such as addiction. Who else should be involved? Based on what “expertise” or “interests”?

Diagnosis and treatment are really two separate issues. I don’t think psychiatry claims to have a monopoly on treatment, although it does have (mostly) a monopoly among mental health providers on drug treatments. On this, I think I agree with the psychiatrists. I’m not sure that anyone else besides people who have been to medical school should be prescribing drugs. As for diagnosis, I don’t think psychiatric diagnosis is necessary, at least not until psychiatry has the knowledge to render diagnoses on the same basis as other medical specialties. Psychiatrists don’t treat mental disorders. They treat symptoms. So they don’t really need diagnoses to do their job. But if there has to be psychiatric diagnosis, then it should be in the hands of a public agency, one that doesn’t have a profit motive in fashioning a manual, one that is not wedded to its own professional interests, and one that is not fooling around with the drug industry.

Addiction is increasingly being recognized as a brain disease. One aim of the DSM-5 is said to be to bring diagnoses of substance use disorders into line with the burgeoning neuroscience about addiction. Does the DSM-5 meet its goal?

The only way in which DSM-5‘s addictive disorders section reflects neuroscience is in its reliance on “craving” as one of the two diagnostic criteria for substance use disorder. This change reflects the belief that craving is a single phenomenon with a particular brain chemistry. While there are some indications that this is the case, it is far from proven. 50 or 100 years from now, I am sure our understanding of the brain will seem as laughable as phrenology seems to us. So for the moment, popping people into PET scanners or MRI machines strikes me as wishful thinking multiplied by greed. The fact that addiction is increasingly being recognized as a brain disease does not mean that addiction is—or is best understood as—a brain disease. I don’t doubt that is the direction in which research is moving, but I’m not sure this means we are approaching the truth about addiction, or about the brain and its relationship to the mind.

What is your opinion on the effect of 12-step based programs on recovery—the spiritual solution rather than the medical?

I think the 12-step program is useful for many people, and I have both friends and patients who benefit from it. I also think it is only one of many ways that people can stop using the drugs they are addicted to, and is surely not the only “spiritual” approach. Nor is it necessarily correct to think of it in contradistinction to the medical approach. After all, the 12-step program owes much of its success to a concerted effort on the part of doctors, including psychiatrists, to popularize the disease model of addiction, which Alcoholics Anonymous in many respects originated.

The DSM-5 includes the first “behavioral disorder”—compulsive gambling—in the Addiction section. Proponents say that compulsive behaviors have very similar effects on the brain as substances do. Critics say this is opening the door to the medicalization of more and more of everyday life. What do you think?

I think that long before the behavioral disorders opened the door to medicalization of daily life, that goal had been accomplished. The struggle of psychiatry since 1980 has not been to fashion more and more illnesses, but rather to convince us that when we are unhappy, anxious, compulsive, etc., we have a mental illness. In this they have been successful, at least to judge from the vast increase in numbers of people seeking treatment. It’s a predictable outcome of the DSM approach to mental suffering.

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It’s already old news that the National Institute of Mental Health, NIMH, the mother ship of mental health research in the world, has officially diagnosed psychiatry’s billing bible—the Diagnostic and Statistical Manual 5—as suffering from extreme lack of science, proclaiming it dead on arrival.  What isn’t known are the implications of NIMH’s announcement.

Yes, the NIMH director, Dr. Thomas Insel, is another in a long line of well-regarded experts who have publicly criticized the validity of the DSM, stating “patients with mental disorders deserve better.”

In itself, Insel’s announcement is big news, if not decades late, but it is the Director’s explanation for the abrupt withdrawal of support for the manual that finally reveals the great divide between psychiatric opinion and science, and raises questions that, so far, remain unanswered.

According to Insel, “The weakness of the manual is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS,” says Insel, “the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” In short, there is no objective, confirmable, abnormality for any alleged psychiatric disorder.

While it is an encouraging first step to have the premier mental health research institute reject 60 years of psychiatric opinion, it does not address the coming fallout. For example, given that the NIMH has, for all intent and purposes, made the DSM irrelevant, how will that affect insurance payments for not only billing of DSM diagnoses, but also reimbursements for psychiatric drugs recommended as “treatment” for the diagnosis?

More importantly, since the world’s premier mental health research body has so blatantly admitted the uselessness of the DSM, when will the government, which spends hundreds-of-billions of dollars on mental health, end its funding of the mental illness programs that are based on the DSM, which Dr. Insel says “lack validity.”

Federal funding (taxpayer dollars) for mental health care is skyrocketing.  For example, in 2012, $140 billion was spent on mental health services in the U.S. and treatment of psychiatric disorders, derived from the DSM, costs 200 percent more than general medical care.

When will the government, which spends hundreds-of-billions of dollars on mental health, end its funding of the mental illness programs that are based on the DSM, which Dr. Insel says “lack validity.”

Furthermore, due to the diagnostic criteria of the DSM, in the last 20 years, the rates of Attention Deficit Hyperactivity Disorder (ADHD) have tripled, while “autistic disorder” and “childhood bipolar disorder” each increased by an astounding 40-fold. Will federal and state governments continue to reimburse for mental disorders that have been proclaimed to “lack validity?”

For that matter, one must wonder how pharmaceutical companies will handle the abrupt reversal? After all, psychiatric drugsare alleged to “treat” specific areas of the brain – to increase naturally occurring chemicals because of that oft-stated imbalance – and Dr. Insel has most demonstrably stated that the alleged disorders are not based in science.

Even Columbia University psychiatrist, Dr. Robert Spitzer, the Chairman of the DSM-III, has stated that “no biological markers have been identified” for any alleged psychiatric disorder.  So, if there are no “biological markers” and no validity to the diagnosis, does it not also raise serious questions about the use of pharmaceutical psychiatric drugs?

Psychiatric drug sales is a nearly hundred billion dollar a year business

Given that psychiatric drug sales is a nearly hundred billion dollar a year business, one can only wonder what is being said around pharmaceutical board rooms at this moment. Perhaps something along the lines of Insel’s got some “splainin” to do.

However, while there is little chance of crocodile tears being spilled for the pharmaceutical companies possible revenue loss, it does leave one to question how governmental bodies can continue to reimburse for psychiatric drug treatments when its premier mental health agency has declared there is no evidence to support any biological efficacy. After all, if there is no biological abnormality, what is being “treated?”

Taking it to its extreme, one also might wonder if the U.S. Department of Justice might have a few questions for not only the psychiatric and pharmaceutical communities, but maybe even the Food and Drug Administration (FDA), which is responsible for approving the drugs that “treat” the alleged psychiatric disorders. At some point, opinion, guesses, assumptions and wishful thinking may have crossed the line of fraud.

Ultimately, though, the biggest question is how the people who have been diagnosed with these alleged psychiatric disorders, and “treated” with extremely dangerous mind-altering drugs, will respond to the news that there is no validity to the diagnosis.

Only time will tell what the answers are to these questions, but one thing is certain…the people most certainly “deserve better.”

Read more from psychiatrists and MD’s who have exposed psychiatry’s unscientific basis for diagnosing mental disorders

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Kelly Patricia O’Meara is an award winning, former investigative reporter for the Washington Times, Insight Magazine, penning dozens of articles exposing the fraud of psychiatric diagnosis and the dangers of the psychiatric drugs – including her ground-breaking 1999 cover story, Guns & Doses, exposing the link between psychiatric drugs and acts of senseless violence.  She is also the author of the highly acclaimed book, Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills that Kill.  Prior to working as an investigative journalist, O’Meara spent sixteen years on Capitol Hill as a congressional staffer to four Members of Congress. She holds a B.S. in Political Science from the University of Maryland.

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(Stock image) James Davies believes that doctors are too quick to diagnose children with disorders such as ADHD

From depression to anxiety and ADHD, more of us now suffer from mental health problems and need pills to treat them — or so we’re told. But in this shocking indictment of modern psychiatry, JAMES DAVIES suggests that this rise in mental illness is down to the greed of drug companies and the pursuit of medical status. The author is a psychological therapist who has worked for the NHS and the mental health charity Mind.

When I meet Sarah Jones, a mother of two and a care worker in West London, her love for her family and work clearly shine through. But when we talk about her seven-year-old son Dominic, she seems overcome with anxiety. 

‘Dominic is a lovely boy, but last year he started getting agitated and aggressive. He was doing badly at school and then he got into a fight,’ she says.

The school psychologist wanted Dominic to have a doctor’s assessment. After seeing the boy for 25 minutes, the doctor said he was suffering from attention deficit hyperactivity disorder, or ADHD.

‘Dominic is on pills,’ says Sarah. ‘He seems less distracted sometimes, but he also doesn’t seem himself either. It feels as if a part of his spirit has gone.’ Sarah’s distress is palpable.

Year on year, increasing numbers of children like Dominic are having mental disorders such as ADHD diagnosed. In the past ten years, ADHD diagnoses have risen so sharply that around 5 per cent of children in Europe are thought to have it.

This vaulting rise in ADHD is consistent with a growth in childhood psychiatric disorders. It’s estimated up to 15 per cent of children fall under the criteria of a diagnosable mental disorder in any year.

These figures pale in comparison with those for the adult population. On the subject of ‘psychiatric morbidity’, the UK Office for National Statistics reckons that in any given year a quarter of all adults qualify as suffering from at least one disorder.

James Davies has written on the subject of the medicalisation of psychological issues

This is as defined in manuals such as the psychiatrists’ ‘bible’, the Diagnostic and Statistical Manual of Mental Disorders (DSM) or its close equivalent, the International Classification of Diseases (ICD), which they use as the basis of making diagnoses.

In the Fifties, the figure was more like one in 100. So why in just a few decades have we apparently all become so psychiatrically unwell?

The explanation lies in an unhappy truth at the heart of mainstream psychiatric practice: much of the profession’s claimed knowledge about diagnosing mental illness is scientifically baseless.

Unlike in other areas of medicine, where a doctor can conduct a blood or urine test to determine whether they have reached the correct diagnosis, in psychiatry no such methods exist.

Such scientifically objective tests don’t exist because psychiatry has yet to identify any clear biological causes for most disorders listed in the DSM, which has grown bigger and bigger with each edition. 

When we look into the manual’s origins, we uncover some disturbing evidence.

I interviewed Dr Robert Spitzer, the Columbia University psychiatrist, who was in charge of compiling the third edition of the DSM, which set the trend for modern psychiatric practice. When it was published in 1980, it became a sensation and sold out immediately. 

In the manual, his team had defined 80 new mental disorders. These became household terms. For example, post-traumatic stress disorder and major depression became as real in the popular imagination as the common cold.

In Britain, the manual had such impact that by the end of the Eighties most British psychiatrists were being trained to use it. 

Yet, as its influence spread, the truth about its construction remained obscure. Most professionals using it didn’t know the extent to which biological evidence or solid research failed to guide the choices its authors made.

SCIENCE? NO,  IT’S A SHAMBLES

When I spoke to Dr Spitzer, he told me matter of factly: ‘There are only a handful of mental disorders in the DSM known to have a clear biological cause. These are known as the organic disorders [such as epilepsy and Alzheimer’s]. These are few and far between.’ 

‘So, let me get this clear,’ I pressed. ‘There are no discovered biological causes for many of the remaining mental disorders in the DSM.’

He replied: ‘It’s not for many, it’s for any! No biological markers have been identified.’

In other words, the definitions were based purely on what the committee who drew up the DSM-III decided should go in. And these discussions were far from rigorous. 

Renee Garfinkel, a psychologist who participated in two committees that helped to compile the DSM-III, told me: ‘What I saw happening on these committees wasn’t scientific — it more resembled a group of friends trying to decide where they want to go for dinner. 

‘One person says “I feel like Chinese food,” and another one says “No, no, I’m really more in the mood for Indian.” Finally, after some discussion and collaborative give and take, they all decide to have Italian.

‘On one occasion there was a discussion about whether a particular behaviour should be classed as a symptom of a particular disorder. 

‘To my astonishment, one committee member piped up: “Oh no, no, we can’t include that behaviour as a symptom, because I do that.” 

‘So it was decided that behaviour would not be included because, presumably, if someone on the committee does it, it must be normal.’

Allen Frances, who led the compiling of the next edition, DSM-IV, has seen how this process of adding new diagnoses can run out of control. 

The fourth manual added Asperger’s syndrome (covering people who don’t have full-blown autism), ADHD and bipolar II — broadly speaking, a milder form of bipolar disorder, or manic depression as it used to be known, in which the ‘up’ swings never reach full-blown mania.

‘These decisions helped promote three false epidemics in psychiatry,’ he told me. 

‘We now have a rate of autism that  is 20 times what it was 15 years  ago. By adding bipolar II, that  has resulted in lots more use of  anti-psychotic and mood- stabiliser drugs. 

‘We also have rates of ADHD that have tripled, partly because new drug treatments were released that were aggressively marketed.’

TURNING GRIEF INTO AN ILLNESS

This month we are due to see the publication of a new edition, called DSM-5. ‘The situation is only going to get worse,’ Frances told me. 

‘DSM-5 is suggesting changes that will dramatically expand the realm of psychiatry and narrow the realm of normality — converting millions more people from being without mental disorders to being psychiatrically sick. 

‘It will have many unintended consequences, which will be very harmful. I am particularly concerned about those that will lead to the excessive use of medication.’

DSM-5 proposes to make ordinary grief a mental disorder. Feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness and low appetite, if they continue for more than two weeks after the death of a loved one, could warrant a diagnosis of depression.

Frances is also worried by the new ‘generalised anxiety disorder’, which threatens to turn the pains and disappointments of everyday life into mental illness. 

Then there is ‘disruptive mood dysregulation disorder’, which will see children’s tantrums become symptoms of disorder.

Wherever this manual is used we can expect vaulting numbers of people to become yet more statistical droplets in the ever expanding pool of the mentally unwell.

They will very often then be prescribed drugs. With conditions such as depression, those drugs are purported to remedy so-called ‘chemical imbalances’ in the brain.

But despite nearly 50 years of investigation into the theory that chemical imbalances are the cause of psychiatric problems, studies in respected journals have concluded that there is not one piece of convincing evidence the theory is actually correct.

And if the evidence for the biological causes of this growing number of mental health conditions is almost non-existent, the evidence for the drugs being used to treat them is also most often unconvincing. 

This is particularly true of anti-depressants. The pharmaceutical industry makes more than £13 billion worldwide each year from anti-depressants. Doctors are convinced of their effectiveness. But solid scientific research shows otherwise.

To find out why, I visited Professor Irving Kirsch, an associate director at Harvard Medical School and perhaps the most talked-about figure in antidepressant research.

Kirsch’s reputation stems from an analysis he performed that gathered all the clinical studies he could find that compared the effects of anti-depressants to sugar-pill placebos on depressed patients. He pooled all the results to get an overall figure, which led  to a startling conclusion. 

‘What we expected to find was that people who took the antidepressant would do far better than those taking the placebo. We couldn’t have been more wrong,’ said Kirsch.

In fact, the difference in improvement between placebo and anti-depressant groups was clinically insignificant. So why are so many psychiatric drugs prescribed when the evidence underpinning them is so scant, and when the illnesses diagnosed have no biological basis?

GlaxoSmithKline settled out of courand paid $2.5million for charges of consumer fraud after the Seroxat scandal

Nearly all research into psychiatric drugs is sponsored by the pharmaceutical industry. This has led to the compromise of scientific standards, and the manipulation of research with the aim of maintaining or increasing profits.

In one notorious example, the British company GlaxoSmithKline conducted three studies of its anti-depressant, Seroxat. These investigated whether this drug could reduce major depression in adolescents. 

One trial showed mixed results, another that Seroxat was no more effective than a placebo, while the third suggested the placebo may be more effective with certain children.

A COVER-UP BY THE DRUG GIANTS

Despite these results, the company published only the most positive study. An internal company document, leaked to the Canadian Medical Association, showed that company officials had suppressed negative results from one study because, as they said: ‘It would be commercially unacceptable’.

A U.S. lawsuit was filed against GlaxoSmithKline in 2004 for intentionally hiding negative findings. This was settled out of court two months later when the company paid $2.5 million for charges of consumer fraud; a meagre sum considering it made $4.97 billion in worldwide sales from the drug in 2003.

GlaxoSmithKline claimed that Seroxat had positive results when in fact it had failed several tests

It’s hardly an isolated case. An article published by the New England Journal of Medicine in 2008 reviewed more than 70 major studies of antidepressants’ efficacy and found 33 that showed negative results had been buried or manipulated to convey a positive outcome.

But pharmaceutical companies’ influence runs deep. In the past 20 years the industry has become a major financial sponsor of psychiatry, with unprecedented influence over psychiatric practice and research.

Nearly all research into psychiatric drugs is pharmaceutically financed. Nearly 90 per cent of all clinical trials in the UK are conducted or commissioned by the industry.

The influence of drug companies also reaches into the latest editions of the psychiatrists’ bible. A study by the University of Massachusetts showed that of the 170 panel 

members of DSM-IV, 95 (or 56 per cent) had one financial association or more with the pharmaceutical industry.

This trend has continued with the writers of the forthcoming DSM-5. Of the 29 members of the task force that oversees it, 21 — including the chairman and vice-chairman — have received consultancy fees or funding from pharmaceutical firms.

Cracked by James Davies is out on Thurdsday

Funding psychiatrists at the top of the professional pyramid is a strategy essential to how the pharmaceutical industry markets its pills. 

Companies know they must recruit senior psychiatrists to convince less senior doctors to spread the message to medical students, junior doctors, primary care physicians and GPs.

In fact, the vast majority of antidepressants are prescribed by GPs, not psychiatrists.

But there is one positive trend. A small band of vociferous psychiatrists is beginning to question the ‘more diagnoses and drugs’ approach. One is Dr Sami Timimi, a consultant psychiatrist and director of medical education in the NHS.
He told me: ‘The current framework of diagnoses doesn’t help patients at all. In fact, it seems to do the opposite.’

What the evidence shows, according to Timimi, is that what matters most in mental healthcare is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems. Sometimes the right care means giving drugs, but often it does not. 

The problem with putting labels on people, he believes, is that it ends up medicalising problems that are not medical in nature.

This isn’t helped by successive expansions of the DSM and ICD, which encourage practitioners to wrongly medicalise more and more emotional troubles as mental disorders.

CRACKED by James Davies, is published by Icon Books on Thursday at £10.99. ©2013 James Davies. To order a copy for £8.99 (incl P&P) call 0844 472 4157.

http://www.dailymail.co.uk/health/article-2320493/Does-child-really-behaviour-disorder-A-shocking-book-leading-therapist-reveals-millions–including-children–wrongly-labelled-psychiatric-problems.html

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Salon Magazine – May 6, 2013—this article originally appeared in Scientific American

What is mental illness? Schizophrenia? Autism? Bipolar disorder? Depression? Since the 1950s, the profession of psychiatry has attempted to provide definitive answers to these questions in the Diagnostic and Statistical Manual of Mental Disorders. Often called The Bible of psychiatry, the DSM serves as the ultimate authority for diagnosis, treatment and insurance coverage of mental illness.

Now, in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.”  Thomas Insel’s statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual. Insel writes:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’–each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

Read the rest of the article here

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What is mental illness? Schizophrenia? Autism? Bipolar disorder? Depression? Since the 1950s, the profession of psychiatry has attempted to provide definitive answers to these questions in the Diagnostic and Statistical Manual of Mental Disorders. Often called The Bible of psychiatry, the DSM serves as the ultimate authority for diagnosis, treatment and insurance coverage of mental illness.

Now, in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.” Thomas Insel’s statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual. Insel writes:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’–each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better.”

Insel said that the NIMH will be replacing the DSM with the “Research Domain Criteria (RDoC),” which define mental disorders based not just on vague symptomology but on more specific genetic, neural and cognitive data. But then, immediately after making this dramatic announcement, Insel added that “we cannot design a system based on biomarkers or cognitive performance because we lack the data.”

Hunh? So the NIMH is replacing the DSM definitions of mental disorders, which virtually everyone agrees are profoundly flawed, with definitions that even he admits don’t exist yet! What more evidence do we need that modern psychiatry is in a profound state of crisis?

Insel’s statement is also an implicit admission that there is no real theoretical basis for drug treatments for mental illness. As I have pointed out previously, drug treatments have surged over the past few decades, while rates of mental illness, far from falling, have risen.

Ironically, some pharmaceutical companies that have enriched themselves by selling psychiatric drugs are now cutting back on further research on mental illness. The “withdrawal” of drug companies from psychiatry, Steven Hyman, a psychiatrist and neuroscientist at Harvard and former NIMH director, wrote last month, “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.” Funny how this view isn’t incorporated into ads for antidepressants and antipsychotics.

NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year. Insel, I suspect, is hoping to form an alliance with neuroscience, which now seems to have more political clout than psychiatry. But as I pointed out in posts here and here on the Brain Initiative, neuroscience still lacks an overarching paradigm; it resembles genetics before the discovery of the double helix.

Since I became a science writer 30 years ago, I have heard countless claims about breakthroughs in our understanding and treatment of mental illness. And yet as the NIMH decision on the DSM indicates, the science of mental illness is still appallingly primitive. Instead of forming fancy new programs and initiatives and alliances, leaders in mental health should perhaps do some humble, honest soul searching before they decide how to proceed. And they should think of what’s best not for their professions or the pharmaceutical industry but for those suffering from mental illness, who deserve better.

http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/

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