Posts Tagged ‘DSM-IV’

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Too many psychiatric diagnoses for children: an epidemic of labels

Tuesday, June 18th, 2013

“Since the publication of DSM-IV in 1994, the rates of 3 mental disorders have skyrocketed: Attention Deficit Disorder (ADD) tripled, autism increased by 20-fold, and childhood Bipolar disorder by 40-fold.”

Boston.com
By Claudia M. Gold
June 12, 2013

Allen Frances, professor of child psychiatry at Duke University and chair of the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) task force hit the nail on the head in a recent commentary “Why So Many Epidemics of Childhood Mental Disorders?” in the Journal of Developmental and Behavioral Pediatrics. Because he makes his argument so clearly and persuasively (and the full article is only available to those who subscribe to the journal) I will quote it at length.

Since the publication of DSM-IV in 1994, the rates of 3 mental disorders have skyrocketed: attention deficit disorder (ADD) tripled, autism increased by 20-fold, and childhood bipolar disorder by 40-fold. It is no accident that diagnostic inflation has focused on the mental disorders of children and teenagers. These are inherently difficult to diagnose accurately because youngsters have a short track record; are in developmental flux that makes presentations transient and unstable; are sensitive to family, peer, and school stresses; and may be using drugs. If ever diagnosis should be conservative, it should be in kids. Instead, we have experienced an unprecedented diagnostic exuberance encouraged in part by DSM-IV, but mostly stimulated by the powerful external forces of drug company marketing and the close coupling of school services to a diagnosis of mental disorder.

Read the rest of the article here  http://www.boston.com/lifestyle/health/childinmind/2013/06/too_many_psychiatric_diagnoses.html

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Psychiatry’s Weapon of Mental Destruction (WMD)—The Diagnostic & Statistical Manual of Mental Disorders

Monday, March 11th, 2013

By Kelly Patricia O’Meara
March 11, 2013

Photo: Garry Mcleod; Origami: Robert Lang – from Wired Magazine, “Inside the Battle to Define Mental Illness”

In 1952, the first hydrogen bomb was detonated and the American Psychiatric Association, APA, published its first book of mental illnesses: the Diagnostic and Statistical Manual of Mental Disorders, DSM.

No one, then, could have imagined that this seemingly innocuous manual would be more destructive, and result in producing more victims, than a nuclear weapon.

Since then the DSM has mushroomed and with each revised DSM untold millions carry the scars from its devastating effects.

Oddly enough, governments seem oblivious to the fallout of psychiatry’s arbitrary and devastating mental illness labels. Why? Could the answer lie in the extraordinarily profitable relationship between psychiatry and the pharmaceutical industrial complex?

The fact is pharmaceutical companies can’t push their latest mind-altering chemical concoctions until the deep-thinkers of psychiatry first vote the mental illness into existence. Then, unfortunately, the unsuspecting public becomes ground zero for these pharmaceutical Weapons of Mental Destruction (WMD).

How lucky, then, for the pharmaceutical industry. Very soon the APA will introduce its updated book of mental illnesses, the DSM-V.  The APA’s latest book of behaviors it believes are abnormal actually may read longer than Leo Tolstoy’s War and Peace.

More importantly, though, according to recent reports, the newest book of mental disorders is not only horribly flawed but also is more dangerous than its previous version – the whopping 886-page DSM-IV-TR.

In fact, Allen J. Frances, M.D., former chairman of the APA’s DSM-IV Task Force and long-time cheerleader of the APA’s apparent philosophy of “we-can-find-a-mental illness-for-every-human-emotion,” now oddly has become an outspoken critic of the upcoming release of the DSM-V.

Last year Frances published an op-ed in Psychology Today in which he slams the APA for approving “a deeply flawed DSM5 containing many changes that seem clearly unsafe and scientifically unsound.”

The DSM-V is “unsafe and scientifically unsound?” Wow, Frances is just now figuring that out?! That cat long has been out of the bag and, no matter how the APA tries to spin it, psychiatric diagnosing is not now, nor has it ever been, based in science.

It is an important step, however, that the former chairman of the DSM Task Force is openly admitting that psychiatry’s diagnosing bible is “scientifically unsound.” But, Frances doesn’t stop there.

According to the psychiatrist, “the history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good.” Wow, there’s a confession!

One can only assume that it was only due to lack of space that Frances refrained from disclosing which “fad diagnoses” were more “harmful.” However, given that none of the diagnoses are based in science, Frances inadvertently raises a stunning point that lawmakers may want to explore.

For instance, since none of the alleged mental disorders are based in science, how does one determine which are “fads?”

Nevertheless, it is Frances’ comments about the relationship between psychiatry and the pharmaceutical industry that finally reveal what the nation’s mental illness epidemic is all about.

“New diagnoses in psychiatry,” says Frances, “are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs…” Bada bing, bada boom! No diagnosis, no drugs. Yep, the APA first has to pull a disorder out of its…ear before the drugs can be prescribed.

Despite this glaring admission, the DSM-V will hit the streets in the Spring and, along with the old invented mental illness stand-bys, like depression, bipolar, ADD, ADHD and such, the APA will add many new mental disorders.

For instance, infant temper tantrums now are labeled as Disruptive Mood Dysregulation Disorder, normal grief becomes Major Depressive Disorder, forgetfulness in old age morphs into Minor Neurocognitive Disorder and excessive eating will now be diagnosed as Binge Eating Disorder.

Does anyone with a drug-free mind doubt that the pharmaceutical companies aren’t already preparing the newest line of mind-altering drugs to “treat” the newly invented mental disorders? And, for that matter, that the top drug pushers aren’t splitting their sides over the temper tantrum diagnosis?

Clearly the APA has yet to find a normal human emotion it can’t twist into a mental illness, and there’s little doubt that the pharmaceutical companies are biting at the bit to cash in on these newly invented labels. After all, peddling psychiatric mind-altering drugs is a booming business.

For example, between 2001 and 2010, the use of psychotropic drugs by adult Americans increased 22 percent, with one in five adults taking at least one mind-altering drug.

In 2010, alone, more than $16 billion dollars was spent on antipsychotics, $11 billion on antidepressants and $7 billion on ADHD drug “treatments.”

There is no doubt that with every revised edition of the DSM, always increasing the number of invented and utterly ridiculous mental illnesses, the pharmaceutical companies kept pace in creating magic mind-altering drugs for “treatment.”

In 2009, total U.S. prescription sales were $300 billion, with psychiatric mind-altering drugs accounting for half of those sales. And these data are based on drugs prescribed for the old stale diagnoses.

If the enormous sales from drugging kids diagnosed with the invented ADD/ADHD is any indication, one can only imagine the profits for the pharmaceutical companies from drugging toddlers whose temper tantrums are now labeled mental illness.

And in order to reap these enormous profits the pharmaceutical companies have to convince the public they’re needed as “treatment.” Between 1996-2005, the pharmaceutical industry tripled its direct-to-consumer advertising, making it easy to understand why today more than one in 10 Americans take antidepressants. Not surprising, antidepressants also happen to be the second most commonly prescribed drugs in the United States.

To add insult to injury the federal government, rather than question the lack of science behind the invented mental illnesses, actually contributes millions of dollars in grants to help develop psychiatry’s DSM—the very vehicle that allows the pharmaceutical companies to reap their enormous profits. In today’s debt-ridden economy, this is one government subsidy in desperate need of a furlough.

Worse still, the Food and Drug Administration (FDA), which is responsible for protecting the public against dangerous mind-altering drugs, is dominated by psychiatrists who shuttle between the drug industry, academia, private practice and government service—a virtual revolving door.

With an estimated 3,000 people dying from psychiatric drugs every month, a serious and immediate retaliatory response from lawmakers is required. The threat to the mental health of the nation can’t get any clearer than Frances’ conclusion that the “DSM 5 violates the most sacred (and most frequently ignored) tenet in medicine – First Do No Harm!”

–

Kelly Patricia O’Meara is an award winning 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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Harvard Expert Ties Mental Illness “Epidemic” to Big Pharma’s Agenda

Friday, July 29th, 2011

Minyanville
By Minyanville Staff
July 28, 2011

When the DSM-II was published in 1980, it became “the bible of psychiatry,” writes Angell, who adds, “but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions.”

For any mental illness or passing mood swing that may trouble a person, the Diagnostic and Statistical Manual of Mental Disorders — better known as the DSM — has a label and a code. Recurring bad dreams? That may be a Nightmare Disorder, or 307.47. Narcolepsy uses the same digits in a different order: 347.00. Fancy feather ticklers? That sounds like Fetishism, or 302.81. Then there’s the ultimate catch-all for vague sadness or uneasiness, General Anxiety Disorder, or 300.02. That’s a label almost everyone can lay claim to.

These codes are used by doctors, psychologists, and regulators to maintain a mutual language; it’s a handy shorthand system for bureaucratic purposes. But over the past few decades, the staggering, ever-expanding influence of the ever-expanding DSM, which is published by the American Psychiatric Association, has also played a lead role in building wealth and off-label product uses for the major drug manufacturers. In an insightful essay in this week’s New York Review of Books, Marcia Angell, a senior lecturer in social medicine at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, explains how.

The medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported."

Angell’s essay is based on a review of three current books examining the psychiatric industry: The Emperor’s New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker, and Unhinged: The Trouble with Psychiatry–A Doctor’s Revelations About a Profession in Crisis, by Daniel Carlat. She also cites the DSM-IV, the most recent edition of the manual, while her review traces big pharma’s role in our current mental disorder epidemic to the DSM-III, published in 1980.

To begin, Angell describes the psychiatric profession’s backlash against a developing perception in the 1960s and 1970s that the practice was a “soft” almost pseudo science:

In the late 1970s, the psychiatric profession struck back–hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible.

Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.

These efforts to enhance the status of psychiatry were undertaken deliberately. The APA was then working on the third edition of the DSM, which provides diagnostic criteria for all mental disorders. The president of the APA had appointed Robert Spitzer, a much-admired professor of psychiatry at Columbia University, to head the task force overseeing the project. The first two editions, published in 1952 and 1968, reflected the Freudian view of mental illness and were little known outside the profession. Spitzer set out to make the DSM-III something quite different. He promised that it would be “a defense of the medical model as applied to psychiatric problems,” and the president of the APA in 1977, Jack Weinberg, said it would “clarify to anyone who may be in doubt that we regard psychiatry as a specialty of medicine.”

When the DSM-II was published in 1980, it became “the bible of psychiatry,” writes Angell, who adds, “but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions.”

Despite its lack of citations, that DSM named 265 disorders doctors were meant to identify by matching (or mostly matching) a list of symptoms in the book with symptoms described by a patient. The drug companies were quick to see this radical shift in psychiatry as an opportunity. From the 1980s until now, as Angell demonstrates, the drug makers have supported the move away from talk therapy to the drug therapy, which also benefits practitioners, since doling out drugs and tweaking prescriptions earns a psychiatrist more money for less time spent with a patient.

Here Angell explains how companies influence the DSM itself. The bold typeface is ours.

Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.

The drug industry, of course, supports other specialists and professional societies, too, but Carlat asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that.

Eli Lilly gave $551,000 to NAMI

In addition to the money spent on the psychiatric profession directly, drug companies heavily support many related patient advocacy groups and educational organizations. Whitaker writes that in the first quarter of 2009 alone, “Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.”

And that’s just one company in three months; one can imagine what the yearly total would be from all companies that make psychoactive drugs. These groups ostensibly exist to raise public awareness of psychiatric disorders, but they also have the effect of promoting the use of psychoactive drugs and influencing insurers to cover them. Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:

“In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.”

And now here we are in 2011, with almost everyone we know taking two or three different mood disorder drugs. (This trend is not limited to mental disorder, mind you. See Disease Branding.)

Work started on the DSM-V in 1999, which is due out in 2013. It will contain many new disorders, such as “binge eating” and “restless leg disorder.” It will also expand existing categories by tacking on words like “spectrum” to the end of a known disorder, Angell reports. “It looks as though it will be harder and harder to be normal,” she writes.

But the curtain gets pulled back further still.

In her review of Daniel Carlat’s book, Angell calls attention to the “disillusioned insider’s” frank admission that when he prescribes a drug, his decision process is largely guesswork. Carlat’s view is that although any psychiatrist will acknowledge that he or she has had great success with mental disorder drugs for say, depression or anxiety, no doctor can say with certainty whether the drugs are working or if a placebo effect has taken effect.

[Carlat's] work consists of asking patients a series of questions about their symptoms to see whether they match up with any of the disorders in the DSM. This matching exercise, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels.” Often patients meet criteria for more than one diagnosis, because there is overlap in symptoms. For example, difficulty concentrating is a criterion for more than one disorder. One of Carlat’s patients ended up with seven separate diagnoses. “We target discrete symptoms with treatments, and other drugs are piled on top to treat side effects.” A typical patient, he says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa).

As for the medications themselves, Carlat writes that “there are only a handful of umbrella categories of psychotropic drugs,” within which the drugs are not very different from one another. He doesn’t believe there is much basis for choosing among them. “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep.”

Messy. And, of course, the whole system is now being exported to China and other countries where the middle class is growing and the mental health industry is still in a developing stage.

Angell’s latest book is The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

Read the rest of her essay, which examines the controversial use of brain chemistry drugs to treat children, here.

http://www.minyanville.com/dailyfeed/2011/07/25/harvard-expert-links-our-mental/

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Psychiatry’s Billing Bible, the DSM: The Debate over Diagnosis

Monday, March 21st, 2011

Montreal Gazette
By Donna Nebenzahl

Psychiatric disorders are not discovered in labs, they are voted into existence by the American Psychiatric Association

Expected to be published in May 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – the bible of the American Psychiatric Association – has created a firestorm of controversy in its suggested treatment of individuals who have gender identity issues.

According to the manual, an individual questioning gender identity and meeting certain criteria suffers from gender identity disorder, which is therefore considered a mental disorder. And the new edition, whose revisions have been in the works for more than a decade, is likely to once again disappoint the vocal community that has been arguing for years that being transgendered is not a mental illness. (Preliminary revisions for DSM-5 are available for review at www.DSM5.org.)

Many medical practitioners and activists argue that the inclusion of gender identity disorder, even in its likely DSM-5 configuration as gender incongruence, “pathologizes a normal variant of human sexuality,” as Fordham University researcher Sarah Kamens wrote recently in the magazine of the Society for Humanistic Psychology.

“In the DSM that’s currently in use, it’s classified the same way homosexuality was 30 years ago,” says Dr. Shuvo Ghosh, who treats children with gender identity issues at the Montreal Children’s Hospital.

“The diagnosis stigmatizes trans people; it makes it look like they’re mentally ill, and they’re not,” says Françoise Susset, psychologist and president-elect of the Canadian Professional Association for Transgender Health. “Many of the people I see are very high functioning and have no mental illness whatsoever.”

“It’s being called a disorder and treated as a disorder, and I would say it should stay there,” argues Dr. Pierre Assalian, head of the human sexuality unit at the Montreal General Hospital. “I would say that until we find something biological that explains why somebody feels wrong in their body, I would have to consider it as a disorder.”

The research on biological underpinnings of gender identity issues is being carried out around the world, but in the meantime the American Psychiatric Association’s manual, considered the No. 1 source of diagnostic categories, maintains the condition’s psychiatric listing – with some troubling inclusions. One group of professionals proposed online that new indicators in the DSM-5 such as “strong preference for toys and games of the other gender . and playmates of the other gender” should be struck from the forthcoming manual, since preference for play and playmates, they argue, have “no place in diagnostic criteria for a psychiatric disorder.” http://www.montrealgazette.com/health/Debate+over+Diagnosis/4469318/story.html#ixzz1HFmnUm00

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Shrinks on the couch as they ponder who is and is not crazy

Thursday, March 17th, 2011

Business Day – March 17, 2011

by Marika Sboros

At the heart of this matter is a nasty predilection some psychiatrists have for medicalising normality

Diagnosis is a slippery slope. It involves concepts that are virtually impossible to define precisely with bright lines at the boundaries

SOME psychiatrists — the ones who don’t believe they are godlike creatures — are in a bit of a tizz these days. They are worried about all the damage they might have unwittingly done by misdiagnosing mental illness.

Libyan leader Colonel Muammar Gaddafi could help to ease their furrowed brows.

Some background, before I explain that apparent non-sequitur: In a soul-searching analysis of his profession in Wired magazine recently, US psychiatrist Dr Allen Frances declares that mental disorders “can’t be defined”, and it’s “bull—-” to suggest otherwise.

Frances is lead editor of the DSM-IV, the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual. It’s a publication that has been described as “the bible” and “the imperial doctrine” of psychiatrists.

It’s what shrinks use, in their godlike wisdom, to decide whether or not you are mentally ill — and then to prescribe powerful, dangerous drugs, and other treatments that can turn you into a shadow of your former self.

In the gut-wrenching Wired article, Frances says: “We psychiatrists have made mistakes that had terrible consequences.”

In particular, he believes the manual has inadvertently facilitated the massive increase in recent years of diagnoses of autism, attention deficit disorders and bipolar depression — that used to be called manic depression, because of the manic swings in mood that characterise the condition.

He believes psychiatrists largely bear the responsibility for a massive increase in child bipolar diagnoses, and an epidemic of prescriptions for dangerous, antipsychotic drugs for very young children — below the age of five.

At the heart of this matter is a nasty predilection some psychiatrists have for medicalising normality, or as Wired writer Gary Greenberg says of the DSM, “to chalk up life’s difficulties to mental illness, and then treat them with psychiatric drugs”.

After all, it’s one thing to be thought of as having the blues after a protracted period of difficulty in your life. It’s quite another to be diagnosed as nuts. Mental illness is a serious diagnosis, aggravated by the burden of stigma that weighs down those deemed to have it. It wreaks havoc on lives, families, reputations and careers.

Yet diagnosis is a slippery slope. It involves concepts that “are virtually impossible to define precisely with bright lines at the boundaries”, says Frances.

He has accused colleagues “not just of bad science, but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies”, as Greenberg so eloquently puts it.

Frances has joined forces with Dr Robert Spitzer, editor of the previous edition DSM-III, to prevent the current DSM-V from bulldozing its way down the same damaging path.

That’s a battle they look unlikely to win, given the power of the vested interests involved. And while this may all seem a little in-medical-house, it has implications for the many at the mercy of psychiatrists.

Frances fears the DSM will continue the “wholesale imperial medicalisation of normality”. It may create yet another bonanza for the pharmaceutical industry with a proposed, new “pre-psychotic disorder” — as if the manual doesn’t contain enough disorders from which pharmaceutical companies can make massive profits.

Of course, there’s nothing new about the idea that psychiatry is unscientific. The most famous proponent of that is US psychiatrist Dr Thomas Szaz, professor emeritus of psychiatry at the State University of New York Health Science Centre since 1990.

Szaz put his iconoclastic views forward in his books, The Myth of Mental Illness, published in 1960, and 10 years later in The Manufacture of Madness: A comparative study of the inquisition and the mental health movement.

These are damning critiques from a fine mind on psychiatry’s moral and scientific foundations — and mania for social control.

But what, you might ask, has this to do with Gaddafi?

Well, the Libyan leader is nothing if not a fascinating specimen, psychiatrically speaking, and an argument for the existence of mental illness. After all, if something looks like a duck, acts like a duck, walks like a duck, sounds like a duck, it’s a duck.

Gaddafi looks, acts, sounds and struts around like a madman. He provides a veritable smorgasbord of disorders guaranteed to titillate the mental tastebuds of orthodox psychiatrists, and have them reaching for their prescription pads in a flash.

Gaddafi, according to DSM specifications, could be diagnosed with borderline personality disorder — psychobabble psychiatrists have dreamt up to pigeonhole people who don’t or won’t do as others expect them to do.

He’s more likely to be diagnosed with into-the-abyss megalomania, paranoia, psychopathy, with a hint of schizophrenia.

Szaz might argue that Gaddafi’s madness is manufactured, a product of the toxic environment he created over the 42 years of his rule, wallowing in the absolute power that corrupts body and mind absolutely.

His bloated, puffy, sallow complexion suggests bad diet, and other unhealthy lifestyle habits that may contribute to the misfiring of neurons in his grey matter. Yet I doubt even the humane and holistic treatment methods Szaz advocates could bring Gaddafi back from the mad brink to anything resembling rational, normal, decent behaviour.

Marika Sboros is Health News editor.

http://www.businessday.co.za/articles/Content.aspx?id=137544

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DSM: The Book of Woe—Inside the Battle to Define Mental Illness

Monday, December 27th, 2010

Wired—December 27, 2010

by Gary Greenberg

Every so often Al Frances says something that seems to surprise even him. Just now, for instance, in the predawn darkness of his comfortable, rambling home in Carmel, California, he has broken off his exercise routine to declare that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt.

But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career.

One influential advocate for diagnosing bipolar disorder in kids failed to disclose money he received from the makers of the bipolar drug Risperdal.

As a practicing psychotherapist myself, I can attest that this is a startling turn. But when Frances tries to explain it, he resists the kinds of reasons that mental health professionals usually give each other, the ones about character traits or personality quirks formed in childhood. He says he doesn’t want to give ammunition to his enemies, who have already shown their willingness to “shoot the messenger.” It’s not an unfounded concern. In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.

The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.”

At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.

This is hardly the first time that defining mental illness has led to rancor within the profession. It happened in 1993, when feminists denounced Frances for considering the inclusion of “late luteal phase dysphoric disorder” (formerly known as premenstrual syndrome) as a possible diagnosis for DSM-IV. It happened in 1980, when psychoanalysts objected to the removal of the word neurosis—their bread and butter—from the DSM-III. It happened in 1973, when gay psychiatrists, after years of loud protest, finally forced a reluctant APA to acknowledge that homosexuality was not and never had been an illness. Indeed, it’s been happening since at least 1922, when two prominent psychiatrists warned that a planned change to the nomenclature would be tantamount to declaring that “the whole world is, or has been, insane.”

Some of this disputatiousness is the hazard of any professional specialty. But when psychiatrists say, as they have during each of these fights, that the success or failure of their efforts could sink the whole profession, they aren’t just scoring rhetorical points. The authority of any doctor depends on their ability to name a patient’s suffering. For patients to accept a diagnosis, they must believe that doctors know—in the same way that physicists know about gravity or biologists about mitosis—that their disease exists and that they have it. But this kind of certainty has eluded psychiatry, and every fight over nomenclature threatens to undermine the legitimacy of the profession by revealing its dirty secret: that for all their confident pronouncements, psychiatrists can’t rigorously differentiate illness from everyday suffering. This is why, as one psychiatrist wrote after the APA voted homosexuality out of the DSM, “there is a terrible sense of shame among psychiatrists, always wanting to show that our diagnoses are as good as the scientific ones used in real medicine.”

If bad tests are sanctioned in the DSM, insurance companies might use them to cut off coverage for patients deemed not sick enough. It could be a disaster.

Since 1980, when the DSM-III was published, psychiatrists have tried to solve this problem by using what is called descriptive diagnosis: a checklist approach, whereby illnesses are defined wholly by the symptoms patients present. The main virtue of descriptive psychiatry is that it doesn’t rely on unprovable notions about the nature and causes of mental illness, as the Freudian theories behind all those “neuroses” had done. Two doctors who observe a patient carefully and consult the DSM’s criteria lists usually won’t disagree on the diagnosis—something that was embarrassingly common before 1980. But descriptive psychiatry also has a major problem: Its diagnoses are nothing more than groupings of symptoms. If, during a two-week period, you have five of the nine symptoms of depression listed in the DSM, then you have “major depression,” no matter your circumstances or your own perception of your troubles. “No one should be proud that we have a descriptive system,” Frances tells me. “The fact that we do only reveals our limitations.” Instead of curing the profession’s own malady, descriptive psychiatry has just covered it up.

Read the rest of the article here:

http://www.wired.com/magazine/2010/12/ff_dsmv/all/1

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Is Free Thinking A Mental Illness?

Thursday, October 14th, 2010

PrisonPlanet.com

Off the Grid
Oct 14, 2010

Is nonconformity and freethinking a mental illness?  According to the newest addition of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), it certainly is.  The manual identifies a new mental illness called “oppositional defiant disorder” or ODD.  Defined as an “ongoing pattern of disobedient, hostile and defiant behavior,” symptoms include questioning authority, negativity, defiance, argumentativeness, and being easily annoyed.

The DSM-IV is the manual used by psychiatrists to diagnose mental illnesses and, with each new edition, there are scores of new mental illnesses.  Are we becoming sicker?  Is it getting harder to be mentally healthy?  Authors of the DSM-IV say that it’s because they’re better able to identify these illnesses today.  Critics charge that it’s because they have too much time on their hands.

New mental illnesses identified by the DSM-IV include arrogance, narcissism, above-average creativity, cynicism, and antisocial behavior.  In the past, these were called “personality traits,” but now they’re diseases.

And there are treatments available.

All of this is a symptom of our over-diagnosing and overmedicating culture.  In the last 50 years, the DSM-IV has gone from 130 to 357 mental illnesses.  A majority of these illnesses afflict children.  Although the manual is an important diagnostic tool for the psychiatric industry, it has also been responsible for social changes.  The rise in ADD, bipolar disorder, and depression in children has been largely because of the manual’s identifying certain behaviors as symptoms.  A Washington Post article observed that, if Mozart were born today, he would be diagnosed with ADD and “medicated into barren normality.”

According to the DSM-IV, the diagnosis guidelines for identifying oppositional defiant disorder are for children, but adults can just as easily suffer from the disease.  This should give any freethinking American reason for worry.

The Soviet Union used new “mental illnesses” for political repression.  People who didn’t accept the beliefs of the Communist Party developed a new type of schizophrenia.  They suffered from the delusion of believing communism was wrong.  They were isolated, forcefully medicated, and put through repressive “therapy” to bring them back to sanity.

When the last edition of the DSM-IV was published, identifying the symptoms of various mental illnesses in children, there was a jump in the diagnosis and medication of children.  Some states have laws that allow protective agencies to forcibly medicate, and even make it a punishable crime to withhold medication.  This paints a chilling picture for those of us who are nonconformists.

Although the authors of the manual claim no ulterior motives but simply better diagnostic practices, the labeling of freethinking and nonconformity as mental illnesses has a lot of potential for abuse.  It can easily become a weapon in the arsenal of a repressive state.

Read the article here:  http://www.prisonplanet.com/is-free-thinking-a-mental-illness.html

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Now Psychiatrists Want to Repackage Grief as a “mental disorder”

Sunday, August 15th, 2010
The New York Times
by Allen Frances, an emeritus professor and former chairman of psychiatry at Duke University, was the chairman of the task force that created the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Illustration credit: Cyprian Koscielniak

A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem.

Suppose your spouse or child died two weeks ago and now you feel sad, take less interest and pleasure in things, have little appetite or energy, can’t sleep well and don’t feel like going to work. In the proposal for the D.S.M. 5, your condition would be diagnosed as a major depressive disorder.

This would be a wholesale medicalization of normal emotion, and it would result in the overdiagnosis and overtreatment of people who would do just fine if left alone to grieve with family and friends, as people always have. It is also a safe bet that the drug companies would quickly and greedily pounce on the opportunity to mount a marketing blitz targeted to the bereaved and a campaign to “teach” physicians how to treat mourning with a magic pill.

It is not that psychiatrists are in bed with the drug companies, as is often alleged. The proposed change actually grows out of the best of intentions. Researchers point out that, during bereavement, some people develop an enduring case of major depression, and clinicians hope that by identifying such cases early they could reduce the burdens of illness with treatment.

This approach could help those grievers who have severe and potentially dangerous symptoms — for example, delusional guilt over things done to or not done for the deceased, suicidal desires to join the lost loved one, morbid preoccupation with worthlessness, restless agitation, drastic weight loss or a complete inability to function. When things get this bad, the need for a quick diagnosis and immediate treatment is obvious. But people with such symptoms are rare, and their condition can be diagnosed using the criteria for major depression provided in the current manual, the D.S.M. IV.

What is proposed for the D.S.M. 5 is a radical expansion of the boundary for mental illness that would cause psychiatry to intrude in the realm of normal grief. Why is this such a bad idea? First, it would give mentally healthy people the ominous-sounding diagnosis of a major depressive disorder, which in turn could make it harder for them to get a job or health insurance.

Then there would be the expense and the potentially harmful side effects of unnecessary medical treatment. Because almost everyone recovers from grief, given time and support, this treatment would undoubtedly have the highest placebo response rate in medical history. After recovering while taking a useless pill, people would assume it was the drug that made them better and would be reluctant to stop taking it. Consequently, many normal grievers would stay on a useless medication for the long haul, even though it would likely cause them more harm than good.

The bereaved would also lose the benefits that accrue from letting grief take its natural course. What might these be? No one can say exactly. But grieving is an unavoidable part of life — the necessary price we all pay for having the ability to love other people. Our lives consist of a series of attachments and inevitable losses, and evolution has given us the emotional tools to handle both.

Read the rest of this article here http://www.nytimes.com/2010/08/15/opinion/15frances.html

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The Huffington Post—Life is Not a Mental Disorder

Tuesday, July 13th, 2010

The Huffington Post
By Ronald Ricker
July 13, 2010

The Bible (or really any religious text) can be made to say and mean anything the author wishes.

The “Bible” of psychiatry, that fabled and hoary text, the DSM-IV-TR (Diagnostic Statistical Manual of Mental Disorders written by the American Psychiatric Association), is no different. Conceived as an instrument to identify and help heal disorders of the mind, it has morphed as to both form and function. Too often, psychiatrists wield the DSM-IV-TR like a blunt instrument, desperate in their drive to assign names to supposed “mental conditions” and thus to be able to assign numbers to these “conditions.” Discover a new widely inclusive “condition,” give it a name and number and you have a winner: One more brick in the wall of sicknesses.

DSM-IV-TR is very large book. We have lots of diagnoses, the number rapidly growing. We need lots of page room. Aside from blank pages, Chapter Heading Pages, and long lists of Contributors, etc., DSM-IV-TR is chuck full of diagnoses, with detailed descriptions and code numbers for each diagnosis. This book is 952 pages long. It weighs 4.8 pounds.

There is an odd situation in DSM-IV-TR. Really odd. In its entirety, all 952 pages, there is no “No Disorder” option. Therefore, everyone is seen by DSM-IV-TR as sick, the only question being from which sickness(es) they suffer. The annual physical checkup many of us get, usually, unless there is something wrong, ends with “everything is fine.” This, apparently, doesn’t exist in mental health.

I have always felt that I was a crummy writer, starting from college and thereafter (including medical school, internship, National Institute of Mental Health, Psychiatric Residency). However, in writing this poorly written piece, while trudging through DSM-IV-TR, I found 315.2 – “Disorder of Written Expression.” It was an AH-HA moment. I may be a crummy writer, but it’s because I have a disease. Criteria, according to DSM-IV-TR, for this disease (315.2) are 3:

  • a) Writing skills below those expected given the person’s chronological age, measured intelligence and age appropriate education;
  • b) The disturbance in criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g, writing grammatically correct sentences and organized paragraphs);
  • c) If a sensory deficit is present, the difficulties in writing skills are in excesses of those usually associated with it.

Read entire article:  http://www.huffingtonpost.com/ronald-ricker/life-is-not-a-mental-diso_b_644606.html

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Pre-Crime? Try Pre-Diagnose and Pre-Drug: Psychiatrists target infants as mental patients

Tuesday, June 29th, 2010

By CCHR International
June 23, 2010

A new study, published in the American Journal of Psychiatry and headed by psychiatrist John H. Gilmore, professor of psychiatry and Director of the UNC Schizophrenia Research, claims to be able to detect “brain abnormalities associated with schizophrenia risk”  in infants just a few weeks old.   We would like to point out the obvious flaw in this bogus study; there is no medical/scientific test in existence that schizophrenia is a physical disease or  brain abnormality to start with.  There is not one chemical imbalance test, X-ray, MRI or any other test for schizophrenia, not one.   So with no evidence of medical abnormality to start with, the “associated with schizophrenia risk” amounts to what George Orwell called Doublespeak (language that deliberately disguises, distorts, misleads)—it means nothing.

For decades, psychiatrists and Pharma have spouted lines to the press and public amounting to, “researchers now believe” they have medical evidence of schizophrenia as a physical/biological abnormality, or “new evidence suggests” evidence of schizophrenia as a real disease.   But despite millions of dollars in research funds and countless tales of “belief” —no evidence to support the theory.  One of the most common tricks employed by the Psycho/Pharmaceutical industry to mislead the public, legislators and the press, is to take X-rays or brain images of people who have been long-term users of antipsychotic drugs (known to cause brain atrophy/shrinkage) and then claim people with schizophrenia have smaller brains.   They’ve spouted similar studies on kids with ADHD having smaller brains, but the bottom line to that study was that the kids with smaller brains, were…smaller kids. These are just a few of the many PR spins employed by Psycho/Pharma to try and maintain the “belief” in psychiatry, in their credibility as a science.   As evidenced by the recent statement of psychiatrist Allen Frances, former DSM- IV Task Force Chairman, this belief is falling apart even within their own ranks, “There are no objective tests in psychiatry-no X-ray, laboratory, or exam finding that says definitively that someone does or does not have a mental disorder.” —Allen Frances (And Frances isn’t the only psychiatrist exposing the fraud of the biological brain disease model; click here for more.)

The logical question the press should be asking is what are the American Journal of Psychiatry and “the Director of UNC Schizophrenic Research” really after?  What is their goal?

As we have exposed in the article “Australian Psychiatrist Patrick McGorry Wants His Pre-Drugging Agenda to Go Global” there is a concerted push being headed by Australian psychiatrist Patrick McGorry and other pharmaceutically funded psychiatrists for the global implementation of a new mental health paradigm; preventative mental health, i.e., pre-diagnosing (diagnosing children before they develop a “mental disorder”) and pre-drugging children ( before they show “signs” of the mental disorder).   There is an obvious push for the same pre-diagnosing and pre-drugging agenda with this latest study, which claims ”major cases of schizophrenia are usually not diagnosed until a person begins witnessing its related symptoms like delusions and hallucinations as a teenager or adult . However, by that time, the disease [notice the term disease despite no medical evidence of disease] crosses the stage of preliminary treatment and is difficult to treat.”   In other words, if we wait to administer drugs to them it may be too late.  That along with Gilmore’s statement,  “It allows us to start thinking about how we can identify kids at risk for schizophrenia very early and whether there are things that we can do very early on to lessen the risk.” This is the pre-diagnosing, pre-drugging agenda being pushed and the new “preventative” model of mental health that is more akin to a Brave New World than anything previously witnessed.  And this latest “study” tells us infants are also on the agenda.

And finally,  to psychiatrist and lead study author John H. Gilmore, we think you should take a lesson from the former National Institute of Mental Health (NIMH) Chief of the Center for Studies in Schizophrenia, the late Loren R. Mosher, M.D. who stated in his letter of resignation to the American Psychiatric Association, “The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant.  What we are dealing with here is fashion, politics and money. This level of intellectual/scientific dishonesty is just too egregious for me to continue to support my membership…After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this is my belief I am actually resigning from the American Psychopharmacological Association.  Luckily, the organization’s true identify requires no change in the acronym…”

To read more from Loren Mosher, including his two-year outcome study treating patients diagnosed “schizophrenic” without the use of drugs, his vehement stance against the biological psychiatric model of “disease” and more,  click here.

To read the latest bogus psychiatric study, click here.

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