How psychiatry went crazy
May 18, 2013 3 Comments
There’s a review of the DSM-5 in today’s Wall Street Journal. I’ve always wondered about how something can claim to be scientific when it makes its decisions by popular vote. That seems like politics rather than science. Yet, this seems to be how the psychiatry and it’s bible, the “Diagnostic and Statistical Manual of Mental Disorders,” are put together.
… the DSM grows by leaps and bounds with every revision. The first edition, published by the American Psychiatric Association in 1952, was a spiral-bound pamphlet that described 11 categories of mental disorder, including brain syndromes, personality problems and psychotic disorders. (The final category, “Nondiagnostic Terms for the Hospital Record,” contained Dead on Admission, the one diagnosis that psychiatrists have ever agreed on.) The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973. In the general excitement about that progressive decision, few noted that voting didn’t seem to be the most scientific way of determining mental illness. Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years?
Do medical doctors vote on whether the flu or rheumatism or skin cancer are diseases?
The DSM-III (1980) was an effort to jettison outdated theories and terms such as “neurosis” and replace them with an objective list of disorders with agreed-upon symptoms. The DSM-IIIR (1987) was 567 pages and included nearly 300 disorders. The DSM-IV (1994, slightly revised in 2000) was 900 pages and contained nearly 400 disorders. The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, “binge-eating disorder” (whose symptoms include “eating when not feeling physically hungry”), “caffeine intoxication,” “parent-child relational problem” and my favorite, “antidepressant discontinuation syndrome.” Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems.
If people treated the DSM the way most treat the other Bible—nod their heads to it, say they believe in it and continue sinning—we might be all right. Many psychotherapists who still practice therapy, rather than prescribe a cocktail of Zoloft and Risperdal with a tincture of Ritalin, do just that. They find a label that suits, for insurance purposes, and then get on with helping the client.
Eventually financial incentive come into the picture.
But the DSM has grown too powerful to ignore; it is the linchpin of the pharmaceutical-medical complex. Adding more disorders allows doctors to be compensated for treating any kind of problem, from garden-variety sorrow to incapacitating depression. Drug companies encourage new disorders so that they can create medications or repackage old ones: Prozac, when its patent expired, was renamed Sarafem to treat “Premenstrual Dysphoric Disorder.” PMDD had been relegated to the kids’ table (that is, an appendix) in the DSM-IV, thanks to protests by women clinicians who wondered why menstrual symptoms constitute a “mental disorder” when, say, Hypertestosterone Hostility Disorder is nowhere to be found. Alas, PMDD has moved to the adults’ table in the DSM-5. HHD is still MIA.
The review is rather long but worth a read if you’re interested in mental health issues and the power this book plays in treatment and giving incentives for treatments.