Posts Tagged ‘mental disorders’

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The problem with the DSM

Wednesday, June 29th, 2011

The Commons – June 29, 2011

Do you have a shopping addiction disorder? Perhaps an addiction to food? Maybe one of your kids has Internet addiction disorder, or video-game attachment syndrome.

Well, not quite yet, because these kinds of new mental diagnoses are only proposed, not final, for the new revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the American Psychiatric Association (APA).

And there is a terrible problem with this.

The DSM was first created in the 1920s. Based on psychoanalytic theory, it enumerated fewer than 100 mental problems that a psychiatrist could diagnose, all of them attributable to environmental conditions, generally the role of parenting.

We know now that this theoretical stance was limited and, in many cases, wrong. In 1980, the second revision of the DSM took place. Freud was discarded, and the revised bible now included several hundred disorders, all delineated by a list of observable symptoms and a framework for limiting and differentiating diagnoses.

Three versions later, the current DSM lists more than 1,000 disorders. No theories are espoused for their origins, though implicit in it is that there is a mix of genetic and environmental causes that shape neurological development.

During this period of about three decades, the incidence of attention disorders in the general population has increased from 2 percent to 10 percent.

In the 1980s, people diagnosed with bipolar disorder represented less than 1 percent of the population; now the number has increased to 5 percent.

New diagnoses, like oppositional defiant disorder and conduct disorder, now cover as many as 5 percent of children.

Autism, which afflicted a tiny percentage of the population in the 1990s, now accounts for 1 out of every 100 children.

What is wrong with this picture? Do we have an epidemic on our hands? Something in the water we drink, or the air we breathe?

The standard APA explanation is that we now recognize and treat disorders that in the past were overlooked, often judged in moral terms, and left untreated.

In this view, a reasonable estimate of the current percentage of adults with undiagnosed attention deficit hyperactivity disorder would be about 1 out of 20, since we were born too early for the new diagnostic scheme. Maybe you. Certainly me.

There is another way to tell the story, however.

In this story, one could argue that each change in the DSM has essentially recruited a new batch of subjects for identification and treatment.

Instead of seeing difference as a natural outcome of personal characteristics, all of which have their place in the wonderful diversity of humankind, we have come to see individuals as made up of symptoms.

In this view, these symptoms are all treatable, usually by medication, within an implicit vision of normality arising from a dominant culture that is mainly driven by economic considerations.

And that’s the problem. The psychiatric and pharmaceutical industries essentially depend on a tautological logic, a kind of nightmarish Field of Dreams approach in which, if you define it, they will come and take their meds.

But it is not the only problem. The reality is that there are real mental disorders that carry a terrible cost, and that many of these can be treated effectively through a combination of medication, psychotherapy, and environmental support.

That our current approach mixes apples and oranges, the relatively small population that is truly in need of medical help with the much larger group that does not, risks discrediting the field in general, in ways that might ultimately mean that individuals who truly require medical intervention might choose not to get it.

It also adds costs to our yearly health-care budget which are largely unnecessary, though I have yet to hear this discussed in the Sturm und Drang that has attended President Obama’s attempt to make sense out of our broken health-care system.

Perhaps the greatest problem is that children who, in another age, were simply different — odd, quirky, restless, bored, sad, angry — are now disordered, and often drugged to make them more “normal.”

Adults, too. Between 2006 and 2010, the number of prescriptions for antidepressants increased by 43 percent. More than 23 million prescriptions were filled last year.

All of this while the world we have shaped seems to be spinning rapidly out of control, whether in the loss of contact with nature caused by urbanization and suburbanization, the terrible dislocations of a post-industrial society in which 1 percent of the population controls almost all the wealth, or in the simple reality that the climate we live in will change over the next decades in ways that will take a horrific human toll.

Who wouldn’t feel sad, or angry?

* * *

The new DSM is coming, probably in 2013 or 2014 — a lot later than its original projected deadline of 2011, in part because debates over what it should include have been so fierce.

One of the main external critiques of the process is that so many of the shrinks working on the bible are affiliated with pharmaceutical companies. It’s an important point, one that the public has barely seen in the popular press.

To my mind, the more important critique is that the fundamental underpinnings of the DSM are flawed, and that the lack of a theoretical basis means that any quirk or problem a person might express can be categorized as illness. Even expert tautological logic is still tautological.

There are reasons why people shop when they are sad, or why children stay up all night playing video games. There are reasons that a lot of preadolescent boys find it hard to sit still in class and cause problems for their teachers. There are reasons why children with overstressed parents, children who spend a lot of time living in an internal world of television, music, Facebook, instant messaging, and texting, have difficulty developing the skill of social interaction. There are reasons why children get sad, or angry, in the world they live in.

You won’t find these in the DSM.

Read the rest of the article here: http://www.commonsnews.org/site/site04/story.php?articleno=3712&page=3

For more information see this video featuring CCHR Co-founder, Dr. Thomas Szasz

http://www.cchrint.org/videos/experts/thomas-szasz/

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52% of foster kids are prescribed psych drugs—One of them is fighting back

Thursday, June 23rd, 2011

By CCHR Int
June 23, 2011

At just 6 years of age, still grieving over the death of the only mother he’d ever known, his foster mother, Giovan Bazan received the first of many psychiatric “diagnoses” and drugs that would plague him for the next twelve years of his life. Moved from foster home to  foster home, orphanages and other modes of state care, Giovan was stigmatized with a plethora of psychiatric diagnoses and drugs until the age of 18, when he could finally make his own medical decisions and quit. Now a child advocate working part time at the Division of Family and Children Services (DFCS) in Georgia, Giovan is on a mission: To get a full-time job with DFCS and help enact laws to combat the wholesale labeling and drugging of foster children. In the video below, Giovan tells his story and why he decided to fight back against the abuse of kids in foster care.

(Story continues below)

Foster kids—often removed from family homes because of abuse—are further abused when they are prescribed psychotropic drugs under state care. Many of these children are on cocktails of prescribed drugs, including antipsychotics and antidepressants with documented side effects of diabetes, stroke, mania, psychosis, tumors, coma, suicide and death.

Yet, the rates with which these children are being given drugs has been increasing. The antipsychotic use rate among foster kids increased by 5.6% between 2004 and 2007 (from 11.7 percent to 12.4 percent). Another study in Pediatrics, revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate more than 3 times that of Medicaid-insured youth who qualify by low family income.

Only half of state child welfare systems have a policy to review usage of these drugs, and those are weak policies at that.

The psychiatric drugging of foster kids has caused so much concern nationally that in July 2010, the Government Accountability Office (GAO) started an investigation into the use of these drugs in foster care, as they are widely used in dangerous combinations, and for so-called “off-label” uses to treat symptoms for which they have not been medically approved. The GAO is looking into the estimated hundreds of millions of dollars of fraud arising from this and is collecting and analyzing data from Florida, Maryland, Massachusetts, Minnesota, Oregon and Texas.

For more information on the psychiatric drugging of children, watch these videos:

Psychiatry—Labeling Kids with Bogus ‘Mental Disorders’


Drugging Our Children—Side Effects

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The Illusions of Psychiatry

Monday, June 20th, 2011

New York Review of Books  – From the July 14, 2011 issue

by Marcia Angell

United Artists/Photofest Lan Fendors, Louise Fletcher, and Jack Nicholson in One Flew Over the Cuckoo's Nest, 1975

In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it.1 Here I discuss the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—often referred to as the bible of psychiatry, and now heading for its fifth edition—and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider’s view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.”2 By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.

But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.

When psychoactive drugs were first introduced, there was a brief period of optimism in the psychiatric profession, but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent, and an antipsychiatry movement had taken root, as exemplified by the writings of Thomas Szasz and the movie One Flew Over the Cuckoo’s Nest. There was also growing competition for patients from psychologists and social workers. In addition, psychiatrists were plagued by internal divisions: some embraced the new biological model, some still clung to the Freudian model, and a few saw mental illness as an essentially sane response to an insane world. Moreover, within the larger medical profession, psychiatrists were regarded as something like poor relations; even with their new drugs, they were seen as less scientific than other specialists, and their income was generally lower.

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.

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 Spitzer’s DSM-III was published in 1980, it contained 265 diagnoses (up from 182 in the previous edition), and it came into nearly universal use, not only by psychiatrists, but by insurance companies, hospitals, courts, prisons, schools, researchers, government agencies, and the rest of the medical profession. Its main goal was to bring consistency (usually referred to as “reliability”) to psychiatric diagnosis, that is, to ensure that psychiatrists who saw the same patient would agree on the diagnosis. To do that, each diagnosis was defined by a list of symptoms, with numerical thresholds. For example, having at least five of nine particular symptoms got you a full-fledged diagnosis of a major depressive episode within the broad category of “mood disorders.” But there was another goal—to justify the use of psychoactive drugs. The president of the APA last year, Carol Bernstein, in effect acknowledged that. “It became necessary in the 1970s,” she wrote, “to facilitate diagnostic agreement among clinicians, scientists, and regulatory authorities given the need to match patients with newly emerging pharmacologic treatments.”3

The DSM-III was almost certainly more “reliable” than the earlier versions, but reliability is not the same thing as validity. Reliability, as I have noted, is used to mean consistency; validity refers to correctness or soundness. If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be “reliable,” but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers, and in the case of the DSM-III mainly of Spitzer himself, who has been justly called one of the most influential psychiatrists of the twentieth century.4 In his words, he “picked everybody that [he] was comfortable with” to serve with him on the fifteen-member task force, and there were complaints that he called too few meetings and generally ran the process in a haphazard but high-handed manner. Spitzer said in a 1989 interview, “I could just get my way by sweet talking and whatnot.” In a 1984 article entitled “The Disadvantages of DSM-III Outweigh Its Advantages,” George Vaillant, a professor of psychiatry at Harvard Medical School, wrote that the DSM-III represented “a bold series of choices based on guess, taste, prejudice, and hope,” which seems to be a fair description.

Not only did the DSM become the bible of psychiatry, 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. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies. (There are four separate “sourcebooks” for the current edition of the DSM that present the rationale for some decisions, along with references, but that is not the same thing as specific references.) It may be of much interest for a group of experts to get together and offer their opinions, but unless these opinions can be buttressed by evidence, they do not warrant the extraordinary deference shown to the DSM. The DSM-III was supplanted by the DSM-III-R in 1987, the DSM-IV in 1994, and the current version, the DSM-IV-TR (text revised) in 2000, which contains 365 diagnoses. “With each subsequent edition,” writes Daniel Carlat in his absorbing book, “the number of diagnostic categories multiplied, and the books became larger and more expensive. Each became a best seller for the APA, and DSM is now one of the major sources of income for the organization.” The DSM-IV sold over a million copies.

As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession. Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly. They showered gifts and free samples on practicing psychiatrists, hired them as consultants and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials. When Minnesota and Vermont implemented “sunshine laws” that require drug companies to report all payments to doctors, psychiatrists were found to receive more money than physicians in any other specialty. The pharmaceutical industry also subsidizes meetings of the APA and other psychiatric conferences. About a fifth of APA funding now comes from drug companies.

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.5

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.

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.

Read the rest of the article here: http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

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At annual convention, psychiatrists collaborate on mental disease mongering to boost profits

Wednesday, June 8th, 2011

Natural News – June 8, 2011

by Monica G. Young

While sipping drinks from coconut shells, psychiatrists from around the world recently met in Honolulu to discuss more ways to capitalize on human behavior and promote drug dependency. The occasion was the annual meeting of the American Psychiatric Association (APA), held in a Hawaiian convention center lined with mental disorder displays and pharmaceutical booths.

“Hot” topics (potential markets for social control and drug pushing) included:

1) Mental health issues during a woman’s reproductive cycle, such as “treating” pregnant women for bipolar – a disorder said to cause unusual shifts in mood and energy levels. In speaking to Medscape News, an APA committee co-chair, Dr. Don Hilty, called this “a really nice-growing area.”

Yet most every woman experiences mood and energy shifts during pregnancy. Despite this, it is not uncommon for pregnant women to be diagnosed as bipolar and prescribed antipsychotics, some of the most powerful drugs on the market. Even the FDA website alerts doctors to “be aware of the effects of antipsychotic medications on newborns when the medications are used during pregnancy.” The site warns of abnormal muscle movements and withdrawal symptoms, and the FDA’s adverse effects reporting program (Medwatch) includes cerebral hemorrhage, heart malformations and death as documented reactions in newborns. Similarly, studies show birth defects and other serious risks for infants whose mothers took antidepressants while pregnant.

2) Childhood disorders were a particularly popular issue at the convention. But they didn’t stop there – prenatal and newborn genetic screening for mental illness has taken on new emphasis in the psychiatric world. “It’s also trying to understand how genetics predict what medications can be used,” stated APA’s Dr. Hilty.

Having already labeled millions of kids “abnormal” and drenched their brains in toxic substances – a multi-billion dollar business – apparently they aren’t satisfied. They aim to brand children as mental patients and destine them for drug-dependency before they’re even born.

The conference even touched upon electroconvulsive shock therapy (ECT) for children – sending electric volts through their heads. That will teach ‘em to shut up and sit still! It will also cause permanent brain damage.

3) ADHD is usually promoted as a childhood disorder but a team of psychiatrists proposed a new definition to make it easier to diagnose (and drug) older teens and adults. They claim people who tend to miss work deadlines and interrupt others deserve this label.

This would surely lead to millions more on daily meds. Who doesn’t know co-workers who miss deadlines or even friends who interrupt you? Not emphasized however is that, per a study published in The Clinical Neuropsychologist, one in four adults seeking an ADHD diagnosis fake it to obtain stimulant drugs.

4) Capitalizing on America’s service men and women was another hot one: diagnosing and drugging the military for post-traumatic distress disorder, depression and anxiety.

Did they mention that 18 U.S. veterans commit suicide daily, largely due to psychiatric drugs? Not likely. As reported by Neev M. Arnell in NaturalNews, “the increasingly high number of deaths among both veterans and active duty soldiers-including suicides, accidental overdose, and lethal drug interactions-have now been linked to the exponential increase in the prescribing of drugs for post traumatic stress disorder, depression and other psychological illnesses.” (http://www.naturalnews.com/032598_v…)

5) Anticipating the “silver tsunami” as the Baby Boomer generation moves into the over-65 bracket, psychiatrists stressed the need for more psychiatric services for the elderly.

Not stressed, if mentioned at all, is the rampant over-use of psychiatric drugs in nursing homes. Elderly patients’ reactions to physical ailments are often squelched with mind-altering drugs. And a recently released government audit shows nearly one in seven elderly nursing home residents are given antipsychotics – nearly all of them dementia patients for whom the drugs can be lethal. Many lawsuits and settlements have revealed that drug companies have falsely promoted these drugs to doctors and nursing homes for years.

6) While not on the “hot” list, another issue that bit was bedbugs. A New York psychiatrist and his colleagues presented a detailed study showing bedbugs can trigger anxiety.

What a remarkable – and potentially profitable – discovery! Gee, with the rise in bedbug infestation in New York City, maybe Bedbug Anxiety should be included in the next edition of the DSM (psychiatry’s diagnostic and billing bible).

Father of psychiatry – the bloodletter

The American Psychiatric Association calls itself “the voice and conscience of modern psychiatry.”

Adorning the convention hall was the APA logo which enshrines Dr. Benjamin Rush (1746-1813) as the father of psychiatry. A very influential doctor, teacher and statesman of his time, Rush propagated his theory that Blacks suffered from an inherited disease called “Negritude.” The only evidence of a cure, he said, was the skin turning white. He warned, “whites should not intermarry with them, for this would tend to infect posterity with the ‘disorder.’” Whites, seeking not to be “infected,” used this fabled disease to justify segregation.

Rush was also a chief proponent of bloodletting as a cure-all for mental and physical illnesses. Widespread in America in those days, he made lots of money at it. One of Rush’s students applied his teachings to a patient who complained of a sore throat: nine pints of blood were removed from the man’s body in twenty-four hours and he died. That patient was George Washington, the first President of the United States.

Sources for this article include:
http://www.medscape.com/viewarticle…

http://www.medscape.com/viewarticle…

http://healthland.time.com/2011/05/…

http://healthland.time.com/2011/04/…

http://www.nytimes.com/2011/05/10/h…

http://www.jstor.org/pss/985399

http://www.websters-online-dictiona…

http://www.cchr.org/cchr-reports/cr…

About the author:
Monica G. Young is a human rights investigator and educational writer with a purpose to expose the truth about the pharmaceutical and psychiatric industries and safeguard human liberty. She encourages non-drug alternative approaches based on healthy lifestyles and human decency. She supports the Citizens Commission on Human Rights and like-minded groups.

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The Fraudulent Nature of Psychiatric Labels Exposed by Human Rights Group

Monday, April 25th, 2011

There are no genetic tests, no brain scans, blood tests, chemical imbalance tests or X-rays that can scientifically/medically prove that any psychiatric label is a real medical condition.

Vancouver, British Columbia — (SBWIRE) — 04/25/2011 — A new must-see video produced by the Citizens Commission on Human Rights International graphically demonstrates the fraudulent nature of psychiatry’s labels.

In real life, 20 million children are now wearing these labels that are based solely on a checklist of behaviors. There are no brain scans, x-rays, genetic or blood tests that can prove the scientific validity of any of the psychiatric labels, yet these children are prescribed dangerous and life-threatening psychiatric drugs based on nothing more than the invented label.

Child drugging is a $4.8 billion-a-year industry.

The psychiatric/pharmaceutical industry spends billions of dollars a year in order to convince the public, legislators and the press that these labels such as Bi-Polar Disorder, Depression, (ADD/ADHD), Post Traumatic Stress Disorder, etc., are medical diseases on par with verifiable medical conditions such as cancer, diabetes and heart disease. This is simply a way to maintain their hold on a $84 billion dollar-a-year psychiatric drug industry that is based on marketing and not science.

Brian Beaumont, president of the Vancouver chapter of the Citizens Commission on Human Rights (CCHR) said, “Unlike real medical disease, there are no scientific tests to verify the medical existence of any psychiatric disorder. Falsely labeling children is fraud and drugging these children is child abuse”.

Despite decades of trying to prove mental disorders are biological brain conditions, due to chemical imbalances or genetic factors, psychiatry has failed to prove even one of their hundreds of so-called mental disorders is due to a faulty or “chemically imbalanced” brain”.

http://www.sbwire.com/press-releases/sbwire-89685.htm

To find out more about psychiatric diagnosing, labels and drugs, click here: http://www.cchrint.org/psychiatric-disorders/

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Psychiatrists Want To Label Grief a Mental Disorder

Monday, April 18th, 2011
The Montreal Gazette, April 18, 2011
By Sharon April 18, 2011

"This is a disaster," says Frances, a renowned U.S. psychiatrist who chaired the task force that wrote the current edition of the DSM

Human grief could soon be diagnosed as a mental disorder under a proposal critics fear could lead to mood-altering pills being pushed for “mourning.”

Psychiatrists charged with revising the official “bible” of mental illness are recommending changes that would make it easier for doctors to diagnose major depression in the newly bereaved.

Instead of having to wait months, the diagnosis could be made two weeks after the loss of a loved one.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders – an influential tome used the world over – excludes people who have recently suffered a loss from being diagnosed with a major depressive disorder unless his or her symptoms persist beyond two months. It’s known as the “grief exclusion,” the theory being that “normal” grief shouldn’t be labelled a mental disorder.

But in what critics have called a potentially disastrous suggestion tucked among the proposed changes to the manual, “grief exclusion” would be eliminated from the DSM.

Proponents argue that major depression is major depression, that it makes little difference whether it comes on after the loss of a loved one, the loss of a job, the loss of a marriage or any other major life stressor. Eliminating “grief exclusion” would help people get treatment sooner than they otherwise would.

But critics fear that those experiencing completely expectable symptoms of grief would be labelled mentally “sick.” Dr. Allen Frances says the proposal would pathologize a normal human emotion and could bring on even wider prescribing of moodaltering pills.

“This is a disaster,” says Frances, a renowned U.S. psychiatrist who chaired the task force that wrote the current edition of the DSM, which is now undergoing its fifth revision. “Say you lose someone you love and two weeks later you feel sad, can’t sleep well, and have reduced interest, appetite, and energy. These five symptoms are completely typical of normal grieving, but DSM-5 would instead label you with a mental disorder.”

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The Illegitimacy of the “Psychiatric Bible” by Thomas Szasz, Professor of Psychiatry

Tuesday, March 29th, 2011

The Moral Liberal – March 29, 2011

by Thomas Szasz

Professor of Psychiatry Emeritus, Dr. Thomas Szasz

“Mental health experts ask: Will anyone be normal?” So read the title of a July 27 Reuters report. The “experts” warned that the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in 2013, “could mean that soon no-one will be classed as normal. . . . [M]any people previously seen as perfectly healthy could in future be told they are ill.”

This is not news. More than 200 hundred years ago Johann Wolfgang von Goethe (1749–1832) warned: “I believe that in the end humanitarianism will triumph, but I fear that, at the same time, the world will become a big hospital, each person acting as the other’s humane nurse.”

Moreover, Goethe foresaw the moral hollowness of the “humanitarian science” on which such therapeutic tyranny would rest: “I could never have known so well how paltry men are, and how little they care for really high aims, if I had not tested them by my scientific researches. Thus I saw that most men only care for science so far as they get a living by it, and that they worship even error when it affords them a subsistence.”

The depths to which such men would happily sink when worshiping error brings them fame and fortune became obvious only in the twentieth century.

Joaquim Maria Machado de Assis (1839–1908), the great Brazilian novelist and playwright, advanced the prescient literary satirization of the dark art of psychiatric diagnosis and the engine that drives it: the phony expert’s insatiable vanity and thirst for controlling his fellow man. His short story “O alienista” (1882, “The psychiatrist”) is a fable of a celebrated doctor retiring to a small town to pursue his scientific investigation of the human mind, gradually finding more and more of the townsfolk insane and needing to be incarcerated in his private asylum. Eventually he alone is left at liberty. As soon as modern psychiatry became a legitimate branch of medicine, Machado de Assis recognized and exposed its quintessentially unscientific-sadistic character.

It remained for the French playwright Jules Romains (1885–1972) to call public attention to the corruption of modern medicine by political power. “It’s a matter of principle with me,” declares his protagonist, “Dr. Knock” (1923), “to regard the entire population as our patients. . . . ‘Health’ is a word we could just as well erase from our vocabularies. . . . If you think it over, you’ll be struck by its relation to the admirable concept of the nation in arms, a concept from which our modern states derive their strength.”

Sigmund Freud (1856–1939), too, has played an important part in persuading people that health is an abnormal state. This old joke is illustrative: “If the patient is early for his appointment, he is anxious; if he is on time, he is obsessive-compulsive; if he is late, he is hostile.”

Particular psychiatric diagnoses have not escaped professional criticism. Wishing to make a name for themselves as psychiatrists, “critics” object to one or another diagnosis (homosexuality)—or to “overdiagnosis” (ADHD)—but continue to respect the American Psychiatric Association (APA) as a scientific organization and regard the various incarnations of the DSM as respectable legitimating documents. This is dishonest. Confronted with the DSM, the challenge we face is to delegitimize the authenticators, the APA and DSM, not distract attention from their fundamental phoniness by ridiculing one or another “diagnosis” and trying to remove it from the magical list.

I have consistently rejected this piecemeal approach. In my essay “The Myth of Mental Illness,” published in 1960, and in my book with the same title that appeared a year later, I stated my view forthrightly. I proposed that we view the phenomena conventionally called “mental diseases” as behaviors that disturb others (or sometimes the self), reject the image of “mental patients” as helpless victims of patho-biological events outside their control, and refuse to participate in coercive psychiatric practices as incompatible with the foundational moral ideals of free societies. In short, I rejected the authority of the APA as a legitimating organization and of the DSM as a legitimating document. I believe nothing less can undo the mischief wrought by the successive editions of the “psychiatric bible.”

Settled by Political Power

But times have changed. Fifty years ago it made sense to assert that mental illnesses are not diseases. It makes no sense to do so today. Professional debate about what counts as mental illness has been replaced by political-judicial decree. The controversy about the nature of so-called mental diseases/disorders has been settled by the holders of political power: They have decreed that “mental illness is a disease like any other.” Political power and professional self-interest have united in turning false beliefs into lying facts: “Mental illness can be accurately diagnosed, successfully treated, just as physical illness” (President William Clinton, 1999). “Just as things go wrong with the heart and kidneys and liver, so things go wrong with the brain” (Surgeon General David Satcher, 1999).

The claim that “mental illnesses are diagnosable disorders of the brain” is not based on scientific research; it is a deception and perhaps self-deception. My claim that mental illnesses are fictitious illnesses is also not based on scientific research; it rests on the pathologist’s materialist-scientific definition of illness as the structural or functional alteration of cells, tissues, and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor, and asserting that view is stating an analytic truth not subject to empirical falsification.

For centuries the theocratic State exercised authority and used force in the name of God. The Founders sought to protect the American people from the religious tyranny of the State. They did not anticipate, and could not have anticipated, that one day medicine would become a religion and that the alliance between medicine and the State would then threaten personal liberty and responsibility exactly as they had been threatened by the alliance between church and State.

The Founders faced the challenge of separating the cure of souls by priests from the control of people by politicians. Today the therapeutic State exercises authority and uses force in the name of health. We face the challenge of separating the consensual treatment of patients by medical doctors from the coercive control of persons by agents of the State pretending to be healers.

When psychiatry was in its infancy the belief that all human “dysfunctions” are manifestations of brain diseases was a naive error. In its maturity the mistake was treated as a valid scientific theory and the justification for a powerful ideology and the powerful institutions based on it.

Today, in its senescence, psychiatry is deceit and self-deceit—coercion concealed as objective science (“medical diagnosis”) and benevolent help (“medical treatment”). As a result, paraphrasing Orwell, telling the truth becomes “a revolutionary act.”

http://www.themoralliberal.com/2010/12/20/the-illegitimacy-of-the-%E2%80%9Cpsychiatric-bible%E2%80%9D/

Dr. Thomas Szasz is a Professor of Psychiatry Emeritus at the State University of New York, Adjunct Scholar at the Cato Institute and a Lifetime Fellow of the American Psychiatric Association. Considered by many scholars and academics to be psychiatry’s most authoritative critic, Szasz has authored more than 35 books on the subject, the first being The Myth of Mental Illness, a book which rocked the foundations of psychiatry upon its release more than 50 years ago.  Read more here: http://www.cchrint.org/about-us/co-founder-dr-thomas-szasz/

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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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Psychiatry has devolved from personalized therapy to shameless drug dealing

Wednesday, March 9th, 2011

NaturalNews.com March 9, 2011
by Jonathan Benson

Back in the day, psychiatrists used to actually consult intimately with their patients and provide some type of personalized, talk-based therapy as part of their practice. The modern-day approach to psychiatry, however, has become more like a series of drug dealing sessions in which psychiatrists will briefly consult with their patients and prescribe them drugs for their problems.

A recent report at Ocala.com explains that over the past several decades, many psychiatrists have abandoned the personalized approach to therapy partly because insurance companies will often not pay for it, and thus it is not worth their time. But another likely reason for the switch to drug vending is that it simply pays better than actually having to deal with patients and try to help them in a non-drug way.

The Ocala.com report mentions a psychiatrist who has been practicing for nearly 40 years. In his early days, he consulted with and treated, at most, 60 patients once- or twice-weekly, which included a 45-minute talk therapy session. Today, he sees roughly 1,200 people every week for quick 15-minute sessions, and sends them on their way with drugs. This approach has become the norm, not the exception. And this particular psychiatrist is even quoted as saying that he has had to train himself out of actually caring about people’s problems, and instead focus on basically getting them out the door and on their way.

“It’s a practice that’s very reminiscent of primary care,” said Dr. Steven S. Sharfstein, former president of the American Psychiatric Association (APA) and the president and chief executive of Sheppard Pratt Health System, to Ocala.com. “They check up on people; they pull out the prescription pad; they order tests.”

The entire field of psychiatry has been on a downward spiral for years, though, as the “Disease Mongering Engine” literally invents new diseases every year — which are really just normal, everyday human behaviors that vary based on personality, by the way — and comes up with drug interventions to treat them. It is a highly lucrative drug dealing business that profits at the expense of human health (http://www.naturalnews.com/028280_p…).

To see a psychiatrist in today’s environment is like playing Russian Roulette with your health. If able to evaluate every person on the planet, the average psychiatrist would surely find a problem or two with each one. And within five-to-ten minutes, he or she would be able to prescribe a laundry list of medications to treat those alleged disorders. So in other words, if you value your health, stay far, far away from modern-day psychiatrists.

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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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