Revising Book on Disorders of the Mind

List of psychiatric medications

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.


Enough Already

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)


Suicide notes not messages

Suicide rates by Health Service Area (HSA), 19...

“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.


Who Says Stress Is Bad For You?

Dolphin Stress Test

“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.


A Life of Troubles Followed Estelle Bennett’s Burst of Fame

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‘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.