FmH readers know of my preoccupation with psychiatric diagnosis, its follies and abuses, about which I am more likely to rant here than any other topic (other than George W. bush and his administration). Today, the American Psychiatric Association posted on the web the details fo the next proposed revision, version V, to the DSM (the Diagnostic and Statistical Manual), which is the ‘bible’ of accepted psychiatric diagnoses and their criteria. DSM-V is currently scheduled to come out in 2013 after a period of public comment on the revisions and several years of field trials. The release date has already been pushed back because of controversy about the proposals and the revision process, some of which is pointed to in this NYTimes.com piece.Several different things happen in these revisions. First, the universe of existing mental illnesses is reparsed and some of the afflicted end up going into different pigeonholes. By and large, this is a trend I welcome, as the new distinctions made, and the old distinctions collapsed and erased, appear to be generally in line with the clinical experience of frontline practitioners like myself who spend all our time actually treating the mentally ill. Some of my pet peeves, like the overdiagnosis of attention deficit disorder, of childhood bipolar disorder, and of posttraumatic stress disorder, may be improved. As Gregory Bateson defined it, information is a “difference that makes a difference”, and some of the refined distinctions here will of course be more useful to psychiatric research than to practice, but by and large I find them meaningful.
However, the other thing that goes on from revision to revision of the DSM is a proliferation of diagnoses, leading to a relentless expansion of the scope and incidence of mental disorders among the population. This is what has been referred to as the medicalization of ‘normal’ human variability and of personality differences. If a broader net is cast and more people are diagnosable with mental disorders, you can imagine some of the consequences, which include the increasing use of medications for more and more benign variations; changes in social stigmatization; insurance reimbursement for various states of distress; and various diminished responsibility defenses in criminal proceedings. More profoundly, we are rewriting the concepts of personal responsibility and autonomy and the balance between free will and determinism.
I already have far too much work to do to welcome such a broader net, but then again I don’t make a fortune on the basis of how many prescriptions are written. (Estimates are that anywhere from 50-70% of those working on the revisions derive substantial income or research funding from the pharmaceutical industry.)
Tonight, because one of their reporters has been a reader of FmH, I was interviewed by the BBC about my impressions about the DSM-V proposals. It remains to be seen whether I gave them any juicy quotes they can use.
- Psychiatrists weigh diagnostic manual revision (cbc.ca)
- Psychiatrists’ bible to get new conditions, names (calgaryherald.com)
- Hypersexual Disorder, Autism, Addiction: The New Psych Manual (blogs.wsj.com)
- APA announces draft diagnostic criteria for DSM-5 (scienceblog.com)
- Revised psychiatry manual targets autism, substance disorders (cnn.com)
- Big Changes for Psychiatrist’s ‘Bible’ (abcnews.go.com)
- Psychiatry’s draft new ‘bible’ goes online (newscientist.com)
- DSM-V Task Force Releases Proposed Diagnostic Criteria (bilerico.com)
- Changes proposed in how psychiatrists name illnesses (ctv.ca)
- Rewriting The DSM: Binge Eating And Our Broken Health-Care System [Mental Illness] (jezebel.com)
- Asperger’s, Bipolar Disorder Diagnoses May Change in New Manual (businessweek.com)
- DSM-V To Remove “Retardation” Reference (riehlworldview.com)
- Pediatric Bipolar Disorder & DSM-5 : “Temper Dysregulation Disorder” (bipolarsoupkitchen-stephany.blogspot.com)
- Big changes proposed in eating disorder diagnoses (the-f-word.org)
New phenom: ‘speed-shrinking‘ is like speed dating except you cycle around a room from therapist to therapist. Quickly. (New York Times)
What Mark Edmundson would like to tell the bores in his life: ‘“There is no more infuriating feeling,” says the classicist Robert Greene, describing this sort of an encounter, “than having your individuality ignored, your own psychology unacknowledged. It makes you feel lifeless and resentful.” That’s exactly how I feel when I have these encounters: lifeless and resentful. But why? Why is this kind of treatment so painful? People do all kinds of aggressive and antisocial things to each other—surely I do a few myself—and talking on and on can’t be the worst of them. Still, being on the receiving end of such verbiage reliably sends me close to the edge.’ (American Scholar)
“Out in the culture, suicide notes are often romanticized, quoted as poetry or as laugh lines. But… suicide almost always rises from psychic distress that distorts thinking, distress that might have passed if time allowed. Maybe one day there will be a cryptographer who can decipher the notes left behind and figure out how to stop the next one.” via Chicago Tribune.
A largely incoherent article about an intensely poignant subject. Mental health professionals are all about deciphering messages that arise from distressed distorted thinking, which does not appear to have occurred to the writer of this article. Hard to understand in what possible sense suicide notes are not messages.
- Suicide hotline calls up in MA (wbru.com)
- The “final” chapter (disappearingjohn.blogspot.com)
- I Wanted to Die Last Night (thesplinteredmind.blogspot.com)
- Soldier Attempts Suicide, Then Charged With Defacing Wall With Suicide Note (dvorak.org)
- Teenager killed himself as ‘Christmas present’ to avoid burdening parents (telegraph.co.uk)
“It can be, but it can be good for you, too—a fact scientists tend to ignore and regular folks don’t appreciate.” via Newsweek.
Predictable that we will see a spate of articles like this as the economy continues to melt down.
- Are You In Control? (indenialhealth.com)
- Is that glass half-empty, or half-full? Be careful – your answer may result in telomere shortening! (ouroboros.wordpress.com)
‘For a few years in the mid-1960s Estelle Bennett lived a girl-group fairy tale, posing for magazine covers with her fellow Ronettes and dating the likes of George Harrison and Mick Jagger. Along with her sister and their cousin Nedra Talley, she helped redefine rock ’n’ roll femininity.
The Ronettes delivered their songs’ promises of eternal puppy love in the guise of tough vamps from the streets of New York. Their heavy mascara, slit skirts and piles of teased hair suggested both sex and danger…
But Ms. Bennett’s death last week at 67 revealed a post-fame life of illness and squalor that was little known even to many of the Ronettes’ biggest fans. In her decades away from the public eye she struggled with anorexia and schizophrenia, and at times she had also been homeless, said her daughter, Toyin Hunter.’ via NYTimes.
- Ronettes Member Estelle Bennett R.I.P. (pitchforkmedia.com)
“In January, 24 U.S. soldiers are believed to have committed suicide — seven confirmed cases and 17 more awaiting confirmation.
By comparison, last January there were only five suicides in the Army.
Last month’s total is not just the highest monthly total since the Army started counting in 1980; it is more deaths than were sustained in combat last month by all branches of the armed forces combined. via NPR.
- 4 recruiter suicides lead to Army probe (msnbc.msn.com)
But is this really such a good idea? A growing number of cautionary voices from the world of mental health research are saying it isn’t. They fear that the increasing tendency to treat normal sadness as if it were a disease is playing fast and loose with a crucial part of our biology. Sadness, they argue, serves an evolutionary purpose – and if we lose it, we lose out.
“When you find something this deeply in us biologically, you presume that it was selected because it had some advantage, otherwise we wouldn’t have been burdened with it,” says Jerome Wakefield, a clinical social worker at New York University and co-author of The Loss of Sadness: How psychiatry transformed normal sorrow into depressive disorder (with Allan Horwitz, Oxford University Press, 2007). “We’re fooling around with part of our biological make-up.”
Perhaps, then, it is time to embrace our miserable side. Yet many psychiatrists insist not. Sadness has a nasty habit of turning into depression, they warn. Even when people are sad for good reason, they should be allowed to take drugs to make themselves feel better if that’s what they want.
So who is right? Is sadness something we can live without or is it a crucial part of the human condition?
…there are lots of ideas about why our propensity to feel sad might have evolved. It may be a self-protection strategy, as it seems to be among other primates that show signs of sadness. …it helps us learn from our mistakes. …even full-blown depression may save us from the effects of long-term stress. Without taking time out to reflect, he says, “you might stay in a state of chronic stress until you’re exhausted or dead”. …By acting sad, we tell other community members that we need support….Then there is the notion that creativity is connected to dark moods. …There is also evidence that too much happiness can be bad for your career…” (More)
via New Scientist.
Posting articles on this theme is, readers may have noticed, a recurrent event here on FmH. I began to be introduced to this notion, that depression might serve a useful purpose and that we had to rethink our knee-jerk readiness to vanquish it (and normal sadness as well, which is difficult to disentangle from pathological depression) whenever we encountered it, early in my career. I think it has fundamentally informed my skepticism about the way we organize and administer psychiatric services in this society. In addition, there are concerns that too readily resorting to antidepressant therapy may reinforce future propensity for depressive reactions and need for medication (which I’m sure will please the pharmaceutical industry to hear). I have always said that getting people off of medications, or refraining from prescribing them, are equally important functions of a psychopharmacologist as is prescribing astutely.
- When Sadness Is a Good Thing (Time)
- Is There Really an Epidemic of Depression? (Scientific American)
- Are shy people mentally ill?: the DSM and SAD (Shelved) [NB: This article uses “SAD” to refer to “social anxiety disorder”, whereas usually it denotes “seasonal affective disorder”. — FmH]
- Why There’s No Epidemic of Depression (Psych Central)
“How does online information on psychosis affect people’s beliefs and knowledge about psychosis? A survey of podcast listeners… If you wish to take part, you will be asked to answer several questions about psychosis, in particular what psychosis means to you and what you know about psychosis. You will be asked to answer some questions both before you listen to the audio information and afterwards. Questions will be about why you are interested in psychosis, what your knowledge and beliefs about psychosis are, and what you thought of the podcast.”
“In 1950, approximately 7,500 children in the United States were diagnosed with mental disorders. That number is at least eight million today, and most receive some form of medication. Is this progress or child abuse?”
— Andrew Weiss via The Skeptical Inquirer.
The results of this study suggest that what has been selected as major signs by psychiatric nosography is regarded as manifestations induced by perceptive peculiarities and strong emotional reactions by the autistic persons who expressed themselves.” (Science Daily)