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American Psychiatric Association’s Push to Broaden Definitions of Mental Disorders Sparks Revolt

Wednesday, January 25th, 2012

Jan. 24 (Bloomberg)

An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health-care professionals in the U.S. and the U.K.

A panel appointed by the American Psychiatric Association is proposing changes to the industry’s guide for mental illnesses, which determines how patients are diagnosed and treated, and whether insurers pay for care. The new edition of the Diagnostic and Statistical Manual of Mental Disorders is scheduled to be published next year.

The draft is sparking a backlash among practitioners concerned the expanding mandate will increase the number of patients treated with drugs. The guide would loosen diagnostic criteria on some existing ailments and brand as mental disorders some common behaviors, including having temper tantrums three times a week or a lack of sexual arousal. The changes may spur unneeded and dangerous treatment of the healthy, said Allen Frances, a psychiatrist who helped write the current guidelines.

“Everyday disappointments, sufferings and eccentricities are being redefined as psychiatric disorders, and that could lead to medication treatment,” said Frances, a professor emeritus at Duke University who lives in San Diego, California. “This is expanding the boundaries of psychiatry.”

In many cases, family doctors will use the new definitions to treat patients, Frances said by telephone. Pressure from drugmakers to use medications can combine with media representations to create “an epidemic,” he said. “Once primary care doctors and patients have the idea that they saw a certain condition on TV, it becomes real.”

‘Medicalizing Normality’
Darrel Regier, the psychiatric group’s research director, characterized critics as being unconvinced medical treatment is better than counseling. The idea of “medicalizing normality comes from a perspective that there are no psychiatric disorders, and you need to avoid stigmatizing people by giving them one,” he said in a telephone interview.

An Oct. 22 letter critical of the changes, sponsored by units of the American Psychological Association in Washington, was signed by more than 10,800 people, including psychologists, psychiatrists, counselors, and community activists. The British Psychological Association, based in Leicester, England, sent a similar letter in June 2011.

The letters identify changes such as the one affecting ADHD, or Attention Deficit Hyperactivity Disorder, a long- identified illness that involves hyperactive people who have difficulty staying focused and controlling behavior, according to the National Institutes of Health in Bethesda, Maryland.

ADHD Changes
In the present manual, a diagnosis for ADHD requires six symptoms to be identified in adults, including some present before age 7. The new manual requires only four to be identified and the disorder no longer must present itself in childhood.

The changes consider research findings that impairment persists after age 18 as symptoms decline, basically allowing lesser issues to be addressed, according to the website set up by the Arlington, Virginia-based Psychiatric Association to describe the update. www.dsm5.org

“The definitions of mental illness are becoming so porous, they’re losing meaning,” Frances said. “You overtreat labeled patients, and take resources away from the severely ill.”

The new guide also creates a malady it calls Sexual Interest/Arousal Disorder in Women, though no field trials are being done to support the diagnosis, according to the DSM5 website. This illness should be diagnosed when there is an absence or reduced interest in sex and erotic fantasies tied to distress, the proposal suggests.

Temper Outbursts
Disruptive Mood Dysregulation Disorder, also new, is listed as being characterized by temper outbursts that occur at least three times a week that are out of proportion to a provocation. This disorder is being studied in trials, according to the site.

One in 5 Americans experienced some form of mental illness this year, according to a report this month by the U.S. Substance Abuse and Mental Health Services Administration, using the manual’s current criteria to develop the data. According to the National Institutes of Mental Health, costs in this area rose 63 percent to $57.5 billion in 2006 from a decade earlier.

Critics say those figures may rise quickly if the new manual is approved as proposed.

by Elizabeth Lopatto

Read the rest of the article here: http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2012/01/24/bloomberg_articlesLY8B1S0UQVI901-LYB5B.DTL

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Psychiatry’s Flawed Tool: A book full of subjective checklists—the Diagnostic and Statistical Manual of Mental Disorders

Thursday, December 29th, 2011

First Things – December 29, 2011
by Joe Carter

Photo: Garry Mcleod; Origami: Robert Lang

Someday our grandchildren’s grandchildren are going to sitting in college classroom learning about the early 21st century and wonder how a society so seemingly advanced could have such primitive ideas about mental health.They will no doubt be shocked and appalled that our major diagnostic tool for psychiatry is a book full of subjective checklists—the Diagnostic and Statistical Manual of Mental Disorders (DSM versions I-IV).

I became all too familiar with the DSM in my college days, first as a psychology major and then as a behavioral science major (I switched because I believed behavioral science would be more scientifically rigorous. It wasn’t.) I was constantly shocked that such an utterly absurd book could be considered our primary mental health tool. The diagnostic criteria is often so vague that it is virtually impossible to determine if a patient truly has a mental disorder. Yet almost every diagnosis in America is made based on comparing a patient against the DSM’s checklist of “symptoms.”

Part of the reason the DSM is so flawed is because it is highly politicized. For example, homosexuality was classified in DSM as a sexual disorder until the 1970s. And until 1987, “ego-dystonic homosexuality” was still classified as a pathology. These “mental disorders” were later removed, not because of a change in empirical data (since there is none) but because of the protest of gay rights groups. I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder. But this example shows that the judgments made by psychiatrists are often highly subjective and are rooted more in speculative theories than in scientific fact. (Keep in mind that this is the same profession that, for almost a century, believed the Freudian idea that holding your feces in as an infant affected your personality as an adult.)

Such criticisms against the DSM have been made for decades (mostly by cranks like me) but they are gaining a new hearing because of who is now making them: Allen Frances, lead editor of the DSV-IV. As Frances says, “there is no definition of a mental disorder. It’s [BS]. I mean, you just can’t define it.” As Wired magazine notes:

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.”

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 more . . .

http://www.firstthings.com/blogs/firstthoughts/2011/12/29/psychiatrys-flawed-tool/

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Therapists revolt against psychiatry’s bible

Wednesday, December 28th, 2011

Mental health professionals say new diagnoses will lead to overmedication

Salon Magazine, December 27, 2011

by Rob Waters

“epidemics of over-diagnosis in child psychiatry” have caused "huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications."

Anyone who’s ever tried to get reimbursed by a health insurance company after seeing a psychiatrist or psychotherapist, or taking a child or teenager to one, has no doubt noticed the incomprehensible numbers that appear on the clinician’s statement, perhaps preceding some slightly less imponderable phrase.

Maybe you are a 296.22 (major depressive disorder, single episode, mild) or a 300.00 (anxiety disorder NOS–not otherwise specified). Hopefully, you are not a 301.83 (borderline personality disorder). Your kid might be a 313.81 (oppositional defiant disorder) or, more likely, a 314.01 (attention deficit hyperactivity disorder, predominantly hyperactive-impulsive type).

Since 1952, a tome called the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been reducing to a few digits the psychological malady said to afflict a patient. This bible of mental health treatment, published by the American Psychiatric Association (APA), provides a list and description of every mental health condition known to—or invented by—psychiatry, from histrionic personality disorder (301.50) to transvestic fetishism (302.3).

Over the decades, the manual, adapted from a guide for mental diseases developed by Army and Navy psychiatrists, has ballooned. The number of listed disorders tripled to nearly 300. A few have been discredited and dumped along the way. Most famous were battles over the inclusion of homosexuality. Successive iterations of the manual listed homosexuality as a “sociopathic personality disturbance,” then modified that to describe a more limited “sexual orientation disturbance” among people who were “in conflict with” their attraction to people of the same sex. That was later replaced by a disorder called “ego-dystonic homosexuality,” applied to those whose homosexual arousal was a source of distress. That item was dropped in the DSM-III-R, published in 1987.

The great book’s coming edition, the DSM-5, is slated for publication in May 2013. As the task force producing it has posted drafts on its website, an undercurrent of dissatisfaction has exploded into a full-scale revolt by members of U.S. and British psychological and counseling organizations. The chief complaint is that the newest version will lower the criteria needed to diagnose some conditions, creating “subthreshold” disorders, and generally making it easier for healthcare professionals to label a person with a psychiatric disorder and medicate him or her.

The latest rebellion against the DSM-5 began with a salvo from across the Atlantic. In June, a special committee of the British Psychological Society complained in a letter to the APA that “clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences.” The committee criticized the proposed creation of an “attenuated psychosis syndrome”—a sort of poor-man’s psychosis with less severe symptoms—“as an opportunity to stigmatize eccentric people.” They also objected to a proposed reduction in the number of symptoms needed to diagnose adolescents with attention deficit disorder (ADD) because it might increase diagnoses and the use of meds.

Then David Elkins, professor emeritus at Pepperdine University and president of the Society for Humanistic Psychology, a division of the American Psychological Association, formed a committee to discuss similar objections and draft a petition enumerating them. In October, he posted the petition online. “I figured we’d get a couple hundred signatures,’’ Elkins said.

The response stunned him and his colleagues. The petition attracted more than 6,000 signatures in three weeks; as of mid-December it had topped 9,300 signatories and garnered the endorsement of 35 organizations. On Nov. 8, American Counseling Association president Don Locke jumped in with a letter to the APA objecting to the “incomplete or insufficient empirical evidence” underlying the proposed revisions and expressing “uncertainty about the quality and credibility” of the DSM-5.

“This has become a grassroots movement among mental health professionals, who are saying we already have a national problem with overmedication of children and the elderly, and we don’t want to exacerbate that,” says Elkins.

For many critics, Exhibit A is childhood ADD. As the disorder describing fidgety, easily distracted kids morphed from “hyperkinetic reaction of childhood” to the current “attention deficit hyperactivity disorder,” the number of children given the diagnosis exploded, fueling, by one account, a 700 percent increase in the use of Ritalin and other stimulants in the 1990s. Diagnosis requires checking six of nine boxes from a list of symptoms that include “often does not seem to listen when spoken to directly” and “often fidgets with hands or feet or squirms in seat.” Sound familiar, parents?

Two other newly proposed disorders singled out as problematic in the petition are “mild neurocognitive disorder” in the elderly and “disruptive mood dysregulation disorder” in children and adolescents. Both lack a solid basis in research and may fuel the use of powerful antipsychotic medications, which cause weight gain, diabetes and a host of other metabolic problems, the petition says.

“We are gravely concerned that if this is published as is in 2013, it will create false epidemics where hundreds of thousands of children and the elderly who really are normal will be diagnosed with a mental disorder and given powerful psychiatric medications that have dangerous side effects,” Elkins says. “That is not tolerable.”

David Kupfer, the University of Pittsburgh psychiatrist who chairs the task force overseeing the manual’s preparation, says he expects the final number of disorders included in the DSM-5 to be about the same as in the current book. He says he welcomes the criticism and that nothing is final. The task force has been testing proposed new diagnoses in 2,300 patients at seven adult treatment centers and four adolescent centers that are acting as field-test sites, he says.

“There’s a myth that all the decisions have been made, when in fact, all the decisions haven’t been made,” he says. “Just because [things have] been proposed doesn’t necessarily mean they’ll end up in the DSM-5. If they don’t achieve a level of reliability, clinician acceptability, and utility, it’s unlikely they’ll go forward.”

The most surprising critic of the DSM is a one-time pillar of the psychiatric establishment. Allen Frances, professor emeritus at Duke University, chaired the task force that created the DSM-4. Now he’s railing against both the process and proposed content of the new DSM in blogs on the website for Psychology Today that blast the new revision as “untested” and “unscientific.”

Psychiatric diagnoses are loose enough already, Frances  told me, and that laxity has led to “epidemics of over-diagnosis in child psychiatry” causing huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications.

“DSM has to be a safe, reliable and credible guide to current clinical practice,” he says. “It can’t be an untested program for future research.’’

The user revolt against the DSM-5 has emerged as a major challenge to the document, Frances says, and its future is looking unclear. He and Elkins are proposing that an independent committee of experts review the proposed draft and make recommendations.

The fight over the DSM-5 pits some of the greatest minds and biggest egos in the world of psychiatry, but it’s more than a battle among 301.81s (narcissistic personality disorder). For people seeking help for life’s problems who don’t want to be labeled mentally ill or have their treatment limited to medication, and for clinicians who want to help people without reducing them to a category, the stakes are high.

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/singleton/

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Is the American Psychiatric Association in Bed with Big Pharma? Answer: Yes

Tuesday, November 29th, 2011

Note from CCHR Int:  We’re happy to see more and more press running stories containing the facts about psychiatric diagnoses, that mental disorders are not diseases on par with real medical diseases as the psychiatric/pharmaceutical marketing teams would have you believe, but lists of behaviors and emotions repackaged as disease in order to sell billions of dollars worth of pharmaceutical ‘solutions.’   CCHR was the first organization to point out that psychiatric disorders were not medical conditions discovered in labs, but disorders invented in committee by pharmaceutically funded psychiatrists.  We’re very pleased we’re no longer the only ones reporting the facts about psychiatry and its marketing campaigns.  Get the facts here

Do we really need more mental disorder diagnoses creating the need for more drugs in a society that some would say is already over-medicated?

The Fog City Journal – 11/29/2011
by Ralph E. Stone

“The critics — and the public too — have a stake in the proposed DSM-V. More mental disorders may mean just more drugs in our over-medicated society.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association. The DSM provides a common language and standard criteria for the classification of mental disorders, which is used in the United States and to some extent internationally, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. The DSM is produced by a panel of psychiatrists, many of whom have financial ties to the pharmaceutical industry. It is considered the “bible” of American psychiatry. The latest edition — DSM-IV — was published in 1994.

In 1952, the DSM was a small, spiral-bound handbook (DSM-I), but the latest edition (DSM-IV), is a 943-page magnum opus. Over time, psychiatric diagnoses have increased in the American population and in turn, drugs that affect mental states are then used to treat them. The theory that psychiatric conditions are caused by a biochemical imbalance is often used as a justification for their widespread use, even though the theory in unproven. Since there are no objective tests for mental illness and what is normal and abnormal is often unclear, psychiatry is a particularly fertile field for creating new diagnoses or broadening old ones.

Medications are widely used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder, anxiety disorders, and attention deficit-hyperactivity disorder. Sometimes medications are used with other treatments such as psychotherapy.

While I am sure research in mental disorders account for some of this increase, I cannot help but believe that there is a certain amount of disease-peddling going on. That is, instead of promoting drugs to treat diseases, diseases are promoted to fit the drugs. For example, shyness as a psychiatric illness made its debut as “social phobia” in DSM-III in 1980, but was said to be rare. By 1994, when DSM-IV was published, it had become “social anxiety disorder,” now said to be extremely common, thus, boosting sales of antidepressants. Now, social anxiety disorder is “a severe medical condition.” In 1999, the FDA approved a drug for social anxiety disorder. After a successful marketing campaign, the sales of Paxil soared.

Presently, a revised version of the DSM is set for publication in 2013. The proposed revision has proven quite controversial. A group of psychologists with the Society for Humanistic Psychology, for examle, has filed a petition objecting to many of the revisions, arguing that they broaden the definition of mental health disorders, which, in turn, could lead to over treatment with drugs. Some, but not all, of the objections of the Society — along with the British Psychological Society and the American Counseling Association — to the proposed DSM-V include:

- The proposed DSM “fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Given lack of consensus as to the ‘primary’ causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.”

- “Several new proposals with little empirical basis also warrant hesitation: For example, ‘Apathy Syndrome,’ ‘Internet Addiction Disorder,’ and ‘Parental Alienation Syndrome’ have virtually no basis in the empirical literature.”

- “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

Do we really need more mental disorder diagnoses creating the need for more drugs in a society that some would say is already over-medicated? Let’s look at some statistics. According to the Centers for Disease Control and Prevention (CDC) the percentage of Americans who took at least one prescription drug in the past month increased from 44 percent to 48 percent over the past ten years. The use of two or more drugs increased from 25 percent to 31 percent. The use of five or more drugs increased from 6 percent to 11 percent. And in 2007-2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.

And Americans are spending more on drugs. According to the CDC, spending for prescription drugs in the U.S. was $234.1 billion in 2008, which was more than double what was spent in 1999.

And the pharmaceutical industry is profiting. According to Fortune 500 (May 3, 2010 issue date), the profits for the twelve largest pharmaceutical companies was almost $64 billion in 2010. Clearly, Pharma has a financial interest in a DSM with more mental disorders because it will mean a demand for more drugs to treat them.

The critics — and the public too — have a stake in the proposed DSM-V. More mental disorders may mean just more drugs in our over-medicated society.

Supreme Court Justice Oliver Wendell Holmes once quipped, “If all the drugs were thrown in the ocean, everyone would be better-off . . . except for the fish.” While this is a an overstatement, it does contain a grain of truth.

http://www.fogcityjournal.com/wordpress/3217/is-the-american-psychiatric-association-in-bed-with-big-pharma/

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Medical mafia in Australia to force parents to drug children diagnosed ‘ADHD’

Tuesday, November 29th, 2011

Natural News – 11/20/2011

Australian government is actually considering mandating parents of diagnosed children accept the prescribed drug treatments or else face the wrath of child protective services.

The typical treatment recommendation for children diagnosed with psychiatric or mental health conditions such as bipolar disorder or attention deficit hyperactivity disorder (ADHD) includes a combination of behavior and drug therapies. Such treatments are legally optional, but the Australian government’s National Health and Medical Research Council (NHMRC) is actually considering mandating that parents of diagnosed children accept the prescribed drug treatments or else face the wrath of child protective services.

Australia’s Sky News reports that authorities originally crafted the proposed measure as a guidance for doctors in how to treat children with such conditions, writing in a draft paper that “combined behavoural-pharmacological treatment is most effective” for normalizing child behavior. In the process, these authorities are essentially pushing a draconian form of medical tyranny that will eliminate health freedom of choice, and force parents to take the drug route with their children.

The entire field of psychiatry and its mental health screening process is questionable to begin with, as ADHD, bipolar disorder, and depression are not verifiable medical conditions like heart disease or cancer. There are no legitimate scientific tests to determine without a doubt the presence of these ambiguous “conditions” — and yet the entire psychiatric industry is built on pushing $84 billion worth of pharmaceutical drugs every year as treatment for them (http://www.cchrint.org/psychiatric-…).

Psychiatric drugs cause drastic changes in the cognitive and behavioral profiles of children. Drugs are not necessarily for the better. Most of these drugs also cause severe side effects, including mind-altering hallucinations, and they are typically far more addictive than illicit drugs like marijuana, cocaine, and heroin, all of which are illegal.

But certain government officials, likely influenced by Big Pharma, are continuing to propagate the lie that psychiatric drugs are the only option for these often-fictitious mental disorders. West Australian Labor MP, author, and anti-ADHD medication campaigner Martin Whitely is quoted in News Tonight as saying that ADHD drugs are “the only possible medical interventions” and that parents who refuse to use them “may see their child put in care.”

Earlier this year, a SWAT team raided the Detroit home of Maryanne Godboldo for refusing to medicate her daughter with dangerous psychiatric drugs. These thugs actually kidnapped the young girl, who was eventually released after it was determined that Maryanne had every right to choose her own daughter’s medical care (http://www.naturalnews.com/032089_a…).

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Psychiatry’s Diagnosis Manual Under Fire – will feed culture of overdrugging/overdiagnosing

Saturday, November 26th, 2011

San Francisco Chronicle – 11/26/2011
by Erin Allday

"Another diagnosis, dysphoric mood dysregulation disorder, is basically temper tantrums," Robbins said. "Next thing you know, you could have 2-year-olds on psychotropic medications."

The “bible” of American psychiatry – a manual of mental health used around the world by doctors, consumers and insurance providers – has come under fire from a growing group of psychologists who worry that proposed revisions will feed into a culture of overdiagnosing, and overtreating, otherwise healthy people.

The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, is undergoing its fifth major revision in the more than 60 years since it was first published by the American Psychiatric Association. The last update was in 1994, and the new manual is expected to be released in spring 2013.

Revisions to the DSM are often hotly debated, but after two decades of major, and frequently controversial, shifts in how mental health problems are diagnosed and treated in the United States, this latest update has become especially contentious, many mental health providers say.

Last month a group of psychologists with the Society for Humanistic Psychology posted a petition against many of the suggested DSM revisions, citing what they see as a broadening of the definition of mental health disorders, which, in turn, would lead to overtreatment with drugs.

7,000 signatures

The petition now has more than 7,000 signatures, and last week it won the support of San Francisco’s Saybrook University, with roughly 60 faculty members who emphasize a holistic approach to treating mental illnesses.

“There’s this propensity to push pills instead of looking at what’s really going on with the person,” said Saybrook President Mark Schulman. “When we saw in the DSM-5 that there was going to be a push in the direction of a more medical, less holistic way of doing things, we felt we should take a stand.”

A work in progress

The American Psychiatric Association has posted an online response to the petition, welcoming critiques to and comments on the proposed revisions. Their response notes that the manual is still a work in progress and, as more scientific evidence becomes available, some of the changes may become more palatable to critics.

Since the last diagnostic manual update, research has increasingly pointed to biological causes for a wide variety of mental health conditions and, in response, treatment has turned toward pharmacological answers, some psychologists say. Drugs are being used to solve mental health problems that aren’t problems at all, they add.

In 2010, 1 in 5 American adults was using some type of mental health medication, a 22 percent increase over the past decade, according to a report released last week by Medco Health Solutions, a pharmacy-benefits management company.

Therapy is still popular, but part of the problem is that there simply aren’t enough trained counselors to fill the mental health need. Patients are turning to primary care doctors for medical relief from symptoms for everything from depression and anxiety to attention deficit disorder, many mental health providers say.

Because many primary care doctors rely on the DSM to help them understand and diagnose mental health problems, it’s critical that the manual be as accurate and science-based as possible, say psychologists who have signed the petition.

While trained psychiatrists might be able to distinguish between a mental health disorder that needs medical intervention and a so-called normal human response to a difficult time or situation, primary care doctors may struggle.

Critics’ concerns

Critics of the DSM update say that the task force assigned to make the revisions has suggested broadening the definitions of too many mental health problems, opening the door to even more diagnoses and treatments.

Grief after the death of a loved one, for example, may be included under the diagnosis of major depressive disorder. That means a person’s grief could be labeled a pathological disorder, and not a normal human experience, said psychologist Brent Robbins, a professor at Point Park University in Pittsburgh and an author of the petition.

2-year-olds on meds

“Another diagnosis, dysphoric mood dysregulation disorder, is basically temper tantrums,” Robbins said. “Next thing you know, you could have 2-year-olds on psychotropic medications.”

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Drugs Used for Psychotics Go to Youths in Foster Care

Monday, November 21st, 2011

The New York Times, November 20, 2011

by Benedict Carey

Click image to see video on psychiatric drug warnings for kids

Foster children are being prescribed cocktails of powerful antipsychosis drugs just as frequently as some of the most mentally disabled youngsters on Medicaid, a new study suggests.

The report, published Monday in the journal Pediatrics, is the first to investigate how often youngsters in foster care are given two antipsychotic drugs at once, the authors said. The drugs include Risperdal, Seroquel and Zyprexa — among other so-called major tranquilizers — which were developed for schizophrenia but are now used as all-purpose drugs for almost any psychiatric symptoms.

“The kids in foster care may come from bad homes, but they do not have the sort of complex medical issues that those in the disabled population do,” said Susan dosReis, an associate professor in the University of Maryland School of Pharmacy and the lead author.

The implication, Dr. dosReis and other experts said: Doctors are treating foster children’s behavioral problems with the same powerful drugs given to people with schizophrenia and severe bipolar disorder. “We simply don’t have evidence to support this kind of use, especially in young children,” Dr. dosReis said.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system, the government-financed program that provides temporary living arrangements for 400,000 to 500,000 children and adolescents. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system.

The new study focused on one of the most powerful classes of drugs, antipsychotics. It found that about 2 percent of foster children took at least one such drug, even though schizophrenia and bipolar disorder, for which the drugs are approved, are extremely rare in young children.

“It’s a significant and important finding, and it should prompt states to improve the quality of care in this area,” said Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University who did not contribute to the research.

In the study, mental health researchers analyzed 2003 Medicaid records of 637,924 minors from an unidentified mid-Atlantic state who were either in foster care, getting disability benefits for a diagnosis like severe autism or bipolar disorder, or in a program called Temporary Assistance for Needy Families. All of these programs draw on Medicaid financing. The investigators found that 16,969, or about 3 percent of the total, had received at least one prescription for an antipsychotic drug.

Yet among these, it was the foster children who most often got more than one such prescription at the same time: 9.2 percent, versus 6.8 percent among the children on disability, and just 2.5 percent of those in the needy families program.

Antipsychotic drugs, the authors said, also cause rapid weight gain and increase the risk for metabolic problems in many people, an effect that may be amplified by the use of two at once.

Doctors who treat such children are aware of the trade-offs and often prescribe lower doses of the medications as a result. And when they add a second such drug, it is often to counteract side effects of the first medication.

read the rest of the article here:  http://www.nytimes.com/2011/11/21/health/research/study-finds-foster-children-often-given-antipsychosis-drugs.html?_r=3&adxnnl=1&adxnnlx=1321895404-XjlZbL3lXs10CI4v4o6z6w

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Psychiatry fighting over what is and what isn’t a mental disorder…again

Thursday, November 17th, 2011
Note from CCHR: We modified the original headline (below) for the sake of accuracy.
Expanding catalog of mental disorders worries some anyone who is rational

Networks – November 16, 2011 by Maiken Scott

The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.

Thousands of mental health professionals who are not happy with the direction of the new DSM are signing an online petition.

The DSM is a highly influential publication—it guides diagnosis, research and policy. The last edition of the manual was published in 1994, meaning this new edition must reflect almost 20 years of new research and treatment advances. The stakes are high, and so is anxiety around changes and additions.

The online petition posted by several professional organizations for psychologists criticizes those working on the new DSM for what they call “lowering diagnostic thresholds.”

Philadelphia psychologist Cindy Baum-Baicker, who has signed the petition, said the number of different mental health diagnoses is growing too quickly.

“We already have 297 diagnoses. When we started the DSM, we had 106,” she said. “We’re going to have even more.”

She is concerned about several specific aspects of the new DSM, for example changes that could turn prolonged grieving into a diagnosis. Grief, she said, is a natural and important part of life.

“If we pathologize the sadness of grief, and we put people on medicine so that they don’t experience their sadness and feel it through, they oftentimes aren’t going to be making the changes they need to be making to get on with life,” Baum-Baicker said.

University of Pennsylvania psychology professor Marna Barrett has not signed the petition—even though she shares some of the concerns it addresses.

She said the professionals working on the DSM have been receptive to feedback—which she says is a good thing, but can also cause difficulties.

“In no other aspect of medicine do we have a handbook of disorders where the public can put their two cents in as to what is a disorder or not, where colleagues can say this is a disorder or not,” Barrett said.

Barrett said decisions about the DSM should be firmly based in evidence and research and not yield to social and political pressures, or lobbying efforts from interest groups such as advocacy organizations headed by parents or consumers.

The online petition criticizing the DSM has collected more than 6,000 signatures so far.

 

 

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How PTSD took over America

Wednesday, November 16th, 2011

Salon Magazine- November 15, 2011 by Alice Karekezi

The diagnosis is now being applied to everything from muggings to childbirth. An expert explains why it’s bad news

We’re not saying that people don’t have difficult emotional experiences and aren’t suffering. What we’re saying is this is not necessarily a disorder that people are experiencing, and if people think like that, it can be very disempowering to them. ( Photo Credit: David Royal Hanson via Shutterstock)

In the past 30 years, post-traumatic stress disorder has gone from exotic rarity to omnipresent. Once chiefly applied to wartime veterans returning from combat, it is now a much more common diagnosis, still linked to traumatic events but now including those occurring outside the battle zone: the death of a loved one on a hospital bed, a car crash on the highway, an assault in the neighborhood park. Many would argue that this is a good thing: greater recognition of psychologically distressing events will lead to more people seeking treatment and a decrease in the preponderance of PTSD – a win-win.

Stephen Joseph disagrees. In his new book, “What Doesn’t Kill Us,” the professor of psychology, health and social care at the University of Nottingham (in the U.K.) warns that our culture’s acceptance of PTSD has become excessive and has led to an over-medicalization of experiences that should be considered part of ordinary, normal, human experience. This has kept us from proactively working through our grief and anxiety: We’ve become too quick to go to the shrink expecting him to fix us, rather than allowing ourselves the opportunity to grow and find new meaning in our lives as a result of painful, but common, events. Joseph advocates for a push toward post-traumatic growth as therapy to treat the stress of trauma, which he distinguishes as being different from the hokey, blue skies and rainbows, pop psychology that he claims has exploded in our culture in the past decade.

Joseph spoke to Salon over the phone to discuss our misunderstanding of the disorders, the meaning and usefulness of suffering, and if some cultures are more prone to PTSD than others.

How would you define a traumatic event? Is it subjective or are there some basic requirements that must be met?

I see trauma as a psychological rupturing. It’s when something happens to us that ruptures our psychological skin. Or, something which shatters our assumptions about ourselves in the world. That’s what I think of as traumatic, and in a way that can be many things. So, that can include a wider range of experience, and I can understand trauma in that broader way. There are lots of different experiences, such as being in a road traffic collision, or experiencing an illness – those sorts of things can be traumatic to people. It can be experienced as psychologically traumatic. But whether it’s necessary to create a psychiatric diagnostic category to capture those experiences is perhaps not necessary.

Do you believe that PTSD is over-diagnosed?

Well, that’s a really, really tricky question to answer because in a way it’s diagnosed pretty much exactly as it’s described in the Diagnostic and Statistical Manual (DSM). So whether the definition of PTSD is too broad is a different question, if you see what I mean. When PTSD was first introduced in 1980, it was defined much more tightly. The gatekeeper criterion to the diagnosis was: Have you experienced a traumatic event? In 1980, it was defined in such a way that only people who had experienced an event that was really outside the range of usual human experience, [like] Vietnam or the Holocaust, had experienced the sorts of experiences that were thought to elicit PTSD. So if you experienced something like a car accident or a traumatic birth, then you couldn’t get a diagnosis of PTSD, because, by definition, you hadn’t experienced a traumatic event.

In 1994, the definition changed in such a way as to include other, broader experiences. Equally persistent was the person’s subjective experiences of what they thought was traumatic. When that happened, people who had experienced car accidents, traumatic births, what we would have otherwise thought of as more ordinary life events, insofar as they are not statistically unusual, could then be diagnosed as a having PTSD. So now we are in a position where lots of people are able to receive the diagnosis of PTSD. So it’s not that it’s being over-diagnosed in that sense. The difficulty or problem, if there is one, is whether, generally speaking – PTSD would be part of this – the DSM over-medicalizes human experience. Things which are relatively common, relatively normal, are turned into psychiatric disorders.

Can you describe some of the typical symptoms of PTSD?

When people experience trauma, when their assumptions about themselves and the world come crashing down, there’s often a period of avoidance. People just try to block out what happened. Switch off. Turn their attention to other things. That’s quite understandable. Then, over time, that gives rise to memories and emotions that come flooding in as the person sort of begins to try to make sense of what happened, and that can become so powerful and distressing that they have to push that away again and go back into a period of avoidance. So sometimes people go through that, periods of avoidance and intrusion. That seems to me as a healthy and adaptive way of working through something painful, emotionally painful, that has happened to us. So those are the experiences. PTSD is when those experiences become so overwhelming that the person can’t function anymore – at work, or school, or in their social life. It takes over so much. But otherwise the symptoms of PTSD are fairly normal, natural ways of dealing with adaptation.

It’s important to see those experiences as quite normal and natural. They are not symptoms of a disorder by themselves. They’re just the way that people deal with an upsetting event in order to be able to make sense of things and to move on. It’s only when they become so overwhelmingly intense that they might be considered a disorder. I think that’s where we get into the problem with what PTSD is: when people are going through that normal experience, but they see it as having a disorder rather than a normal process of adaptation.

That will diminish over time?

Exactly.

Is the emotional pain overblown in such cases?

The suffering is very real. We’re not saying that people don’t have difficult emotional experiences and aren’t suffering. What we’re saying is this is not necessarily a disorder that people are experiencing, and if people think like that, it can be very disempowering to them.

What is the detrimental effect of over-medicalizing these more common human experiences of grief and pain?

When we think of ourselves as suffering from a disorder in a medical sense, well we go to the doctor and we expect the doctor to prescribe whatever the medical treatment is. We’re not in the driver’s seat. We go along – we tell them [our] symptoms, they listen to us, they diagnose what the problem is, and then they work out what the appropriate treatment is. That’s the mind-set when we’re working within a medical framework and we think of ourselves as suffering from a disorder. We sit down in front of the therapist and we expect the therapist to be like a doctor – to be looking out for what the symptoms are so that they can make the correct diagnosis and prescribe us the right treatment. The language of PTSD invokes those ideas, and I think it’s those ideas that can be quite unhelpful at times. For what we’re talking about here, if it’s a normal, natural process, what’s really important is for the person to be in the driver’s seat for themselves – to make their own choices, their own decisions, because we’re dealing not with a disorder, but a battle within the person to find new meanings and new ways of understanding the world. That’s what they have to do. Nobody else can do that for them.

What is “post-traumatic growth”?

Post-traumatic growth is when people come out of trauma having learned new things about themselves and about the world and about their relationship with the world. People develop new philosophies of life. They develop new priorities in life. People learn an awful lot about themselves: their strengths; what they’re good at; having new respect for themselves. They sort of see their lives as divided into two halves: before the event happened and after the event happened. There is a clear demarcation. And they recognize that something happened to them that sliced their world in half in that way, and things for them are now completely different. How they lead their lives has been transformed – their priorities about life, their relationships.

I think one of the things that captures that the most [starts with] the idea that, sometimes, people lead their lives in a way that is dictated by external forces of status and wealth, which are very much big drivers in our capitalist society. We often, in our everyday lives, forget about the small things that are quite important – our relationships: remembering to nurture them, to look after the people around us, to be giving, to be compassionate. When traumatic events happen, people are often shaken back to reality, and remember what really matters to them. Often it is those other things – remembering somebody’s birthday; nurturing our friendships; looking after our parents, the people around us; really embracing our relationships; and letting go of a more materialistic outlook. People often describe it as getting back to who they really are, or feeling more true to themselves, or being more genuine or more authentic. Somehow the idea of the false self that people create around them is shattered, like Humpty Dumpty falling off a wall. The essence of who they are emerges.

Yes, becoming truer to oneself captures the idea very well. Realizing that life is short and sometimes there isn’t as much time left as we thought to put up facades.

This kind of makes trauma sound like a blessing (you even mention people describing it as a “gift”). Is finding meaning the same thing as condoning the traumatic event? And doesn’t this talk of growth all sound very “kumbaya-ish” and unrealistic?

One of the reasons, sometimes, that post-traumatic growth can be seen unfavorably is that it seems like saying that trauma can lead to greater happiness; that for people who have been through trauma, it’s a good for them – they’re happier. That’s just so not the message. It’s not saying that trauma leads to happiness, in terms of smiling and feeling good and laughing and joy – not that type of happiness. What we’re talking about is how trauma can lead to a deeper, more existentially meaningful and fulfilling life, and that in turn may lead to greater happiness further down the road. But, post-traumatic growth is not about happiness in the sort of yellow, smiley face sense.

In essence, post-traumatic growth is a very simple idea, but it has been overshadowed by this mass of psychiatric literature over the past 30 or 40 years about the overwhelming destructive side of trauma, and about how these lead to medical problems. It’s a very simple idea, but [post-traumatic growth] sits, on the one hand, very uncomfortably within mainstream culture of the world of psychology and psychiatry, and on the other hand it seems to sit very comfortably with some other parts of Western culture, such as positive thinking, but it also clashes with some of that literature which is quite superficial, and not grounded in scientific research, and makes unsupported claims.

So, no, post-traumatic growth] doesn’t mean that [people] value or cherish the bad thing that has happened to them. They just accept that it has happened to them. People will often say they wish it hadn’t happened, or they wish they could go back, but there is a realism that they know they can’t. So it’s accepting that they can’t go back; they can’t change things. The only way forward is to go forward. It’s when people can’t accept that something has happened, and they [try] to go back to how they were before, is when they struggle. Acceptance is just being realistic – not seeing it as a good thing.

And someone not experiencing growth — or experiencing PTSD — is that person always trying to go back?

I think that often that’s what gets people stuck – trying to go back, trying to rebuild their lives exactly as it was before. That can lead people to get very stuck because it just isn’t possible when traumatic events happen and we’re presented with new information about the world, or with losses. It just isn’t possible to go back and make things as they were. We have to somehow accept what has happened to us and move on.

Is post-traumatic growth something completely in opposition to PTSD or post-traumatic stress? Either you have one or the other?

They can sit together. The way I see it, post-traumatic growth mostly arises out of post-traumatic stress. So it’s how people deal with the post-traumatic stress; how they manage to deal with the intrusive thoughts that are plaguing them; and the new sense they make of their experiences. So it’s through the post-traumatic stress, through the struggle of post-traumatic stress that post-traumatic growth arises. So often there’s a period of time in which people will begin to talk about post-traumatic growth but they will still be suffering from post-traumatic stress. They’re not in opposition. In a way, they are opposite sides of a coin.

You make a claim that true happiness is something that in and of itself cannot be pursued, and one is doomed to fail if one tries. How is that?

Well, that’s an idea that some philosophers have put forward. Some of the research seems to suggest that what’s really important to finding happiness is meaning and purpose in life. If we think our road to happiness is through seeking hedonistic pleasures night after night, then that’s not likely to lead to a deep, fulfilling level of happiness. But, if we find ways of finding meaning and purpose, wherever that might be, then we’re not setting out directly aiming for happiness but that’s what we’re going to get. We’re going to find a more fulfilling life. Happiness is a byproduct, but in a sense it’s more guaranteed.

When we think of psychological therapies, and the helping professions in general, they often have been about helping people feel better. [For] people with various problems of depression, anxiety or post-traumatic stress, therapy is about getting the person to have a more positive emotional state. That’s been, really, what the therapy world has been about for 50 years, and yet that’s only half the picture. The other half is about the meaning we put on things, our purpose in life, our sense of ourselves, our sense of autonomy, our relationships. Psychology can also be about those things. I’m not saying that therapists have ignored them altogether; for sure, they haven’t, but those more existential ideas have been overshadowed by trying to feel good. This is the idea between what psychologists call subjective well-being, which is about feeling good, and psychological well-being, which is what you could call “meaning-good,” and it’s just about getting the balance between those two things right.

Are there some cultures that are more prone to post-traumatic growth?

That’s a really good question. I don’t think the research has really documented that yet as to whether it may be more common. What the research has shown, however, is that post-traumatic growth is something observed in pretty much all cultures that have been investigated, though differently defined in slight ways. “Post-traumatic growth” sounds like a very Western idea, but [it’s one that] gets back into history and into all sorts of cultures. It’s an idea that’s very resonant with Buddhist and some Chinese philosophy ideas, as well as ideas in Western religion.

http://www.salon.com/2011/11/15/how_ptsd_took_over_america/singleton/

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Drugging of children for “ADHD” has become an epidemic

Thursday, October 13th, 2011

New York Times – October 13, 2011

by Dr. Peter Breggin

click image to read Psychiatric Disorders - The Facts Behind the Billion Dollar Marketing Campaign

The drugging of children for A.D.H.D. has become an epidemic. More than 5 million U.S. children, or 9.5 percent, were diagnosed with A.D.H.D. as of 2007. About 2.8 million had received a prescription for a stimulant medication in 2008.

The A.D.H.D. diagnosis does not identify a genuine biological or psychological disorder. The diagnosis, from the 2000 edition of the “Diagnostic and Statistical Manual of Mental Disorders,” is simply a list of behaviors that require attention in a classroom: hyperactivity (“fidgets,” “leaves seat,” “talks excessively”); impulsivity (“blurts out answers,” “interrupts”); and inattention (“careless mistakes,” “easily distractible,” “forgetful”). These are the spontaneous behaviors of normal children. When these behaviors become age-inappropriate, excessive or disruptive, the potential causes are limitless, including: boredom, poor teaching, inconsistent discipline at home, tiredness and underlying physical illness. Children who are suffering from bullying, abuse or stress may also display these behaviors in excess. By making an A.D.H.D. diagnosis, we ignore and stop looking for what is really going on with the child. A.D.H.D. is almost always either Teacher Attention Disorder (TAD) or Parent Attention Disorder (PAD). These children need the adults in their lives to give them improved attention.

Stimulant drugs “work” by suppressing all spontaneous behavior in normal children — and even in chimpanzees and other animals. This suppression of behavior and production of compulsive activities looks like an improvement in a classroom or home where the child has seemed uncontrollable and required a great deal of attention. The drugs do nothing to improve learning or psychosocial development. I document these observations in many scientific articles and books, most recently in the second edition of my medical textbook “Brain-Disabling Treatments in Psychiatry.”

Drug company marketing has focused on selling the diagnosis and the drugs to American parents and teachers.

Why are the A.D.H.D. diagnosis and the use of stimulants so prevalent in America? The idea that American children are somehow genetically or even culturally predisposed has no scientific or common sense basis. For several decades, starting in the 1970s, drug-company marketing has focused on selling the diagnosis and the drugs to American parents and teachers. As I first documented in my book “Toxic Psychiatry” in 1971, “Astroturf” organizations like Children and Adults with Attention-Deficit/Hyperactivity Disorder and National Alliance on Mental Illness masquerade as representing families while taking millions of dollars from drug companies in support of their promotion of psychiatric medication for children. The National Institute of Mental Health, the American Psychiatric Association and even the American Neurological Association have promoted the A.D.H.D. diagnosis and stimulant medication, which leads to considerable business for mental health clinicians.

As the American market gets saturated, promotional efforts are increasing in other countries, like Canada, Britain, Australia and Germany, which are also experiencing increased rates of diagnosing and drugging children. In Australia, the controversy has been especially heated in recent years. Everywhere that A.D.H.D. and stimulants are promoted, they substitute for needed modern reforms in education and family life.

In all cases of so-called A.D.H.D., the diagnosis is harmful. The child instead needs a real medical and psychosocial educational evaluation, and usually the child will quickly respond to improved teaching and parenting. We are diagnosing and drugging millions of our children instead of providing them the improved educational and family life that they truly need.

Peter R. Breggin, a psychiatrist in Ithaca, N.Y., is the author of more than 20 books

http://www.nytimes.com/roomfordebate/2011/10/12/are-americans-more-prone-to-adhd/adhd-is-a-misdiagnosis

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