Since his appointment as Australian of the Year, Professor Patrick McGorry has established a prominent profile in the media, calling for major mental health reform. It is clear that many people, including the Federal Government, are listening to him…. Under McGorry’s proposed reform, large numbers of “false positives” – young Australians – would be caught by the wide early intervention net and exposed to serious risks from drugs that have not been proven to be effective.
Among all the problematic suggestions for DSM5, the proposal for a ” Psychosis Risk Syndrome” stands out as the most ill conceived and potentially harmful. It aims to solve a pressing problem in psychiatry- the need for early identification and preventive treatment. Psychotic episodes create tremendous short term impairment and may impact negatively on long term prognosis and treatment efficacy. It would save great suffering if we could get there early and do something useful to reduce the lifetime burden of illness before too much damage is done. But good intentions are not enough.
The irresistible, plus-size piñata for on-the-case journalists is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, now undergoing revision. The DSM famously includes snoring and jet lag as mental disorders. I took a whack last year, calling the 880-page doorstop “a naked land grab by a profession threatened with marginalization by biomedical research.”
There is suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry’s direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off). The Food and Drug Administration has been accused of setting the bar too low for the approval of brand-name drugs. Critics claim that health-care organizations are corrupted by industry largesse, and that conflict-of-interest rules are lax or nonexistent. Within the profession, the manual that prescribes the criteria for official diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, known as the D.S.M., has been under criticism for decades. And doctors prescribe antidepressants for patients who are not suffering from depression.
MEDICAL advances can take your breath away. Over the past decade, medical experts have started decoding the human genome to provide genetically-personalised medicine. The experts behind these advances are geniuses. Perhaps in the same vein, the psychiatric profession imagines that their new bible of mental disorders — more than 10 years in the making — will be hailed as milestone of medical achievement. If so, they’d be wrong.