July 1, 2013

Are We All Crazy?

By  Michael D. Shaw

On May 18, the highly anticipated fifth edition of the Diagnostic and Statistical Manual of Mental Disorders—aka DSM-5—was released by the American Psychiatric Association at its annual meeting. There has been no shortage of critics of this new edition, including Thomas R. Insel, MD, Director of the National Institute of Mental Health (NIMH).

Insel damns it with faint praise: “The strength of each of the editions of DSM has been ‘reliability’—each edition has ensured that clinicians use the same terms in the same ways.” But then he quickly adds, “The weakness is its lack of validity.” Insel is rightly concerned that DSM diagnoses depend strictly on a consensus of particular clinical symptoms, rather than any objective laboratory measure.

As he said, “[S]ymptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

That’s why NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Insel minces no words: “[I]t is critical to realize that we cannot succeed if we use DSM categories as the gold standard.”

Another prominent critic is none other than Allen J. Frances, MD, who chaired the DSM-IV (the previous editions used Roman numerals) task force. His anti-DSM-5 soundbites have been all over the Web, and are summarized in an article he wrote that appeared in the Annals of Internal Medicine last month, entitled “The New Crisis in Confidence in Psychiatric Diagnosis.” Frances is concerned that the door is open to “[H]igh-prevalence diagnoses at the fuzzy boundary with normality.”

To wit: Normal worries over an illness become “somatic symptom disorder”; grief can be classified as “major depressive disorder”; forgetfulness in old age can become “mild neurocognitive disorder”; temper tantrums could be “disruptive mood dysregulation disorder”; overeating is now “binge eating disorder”; and the ever-popular attention deficit hyperactivity disorder (ADHD) will become a more frequent diagnosis, based on loosened criteria.

Ironically, one of the leading proponents—if not the outright inventor—of ADHD, Leon Eisenberg, MD (1922-2009) stepped way back from his brainchild. In 2012, the magazine Der Spiegel ran a piece in which the famous psychiatrist was interviewed seven months before his death. He never would have thought his discovery would someday become so popular.

“ADHD is a prime example of a fabricated disorder,” Eisenberg said. “The genetic predisposition to ADHD is completely overrated. Instead, child psychiatrists should more thoroughly determine the psychosocial reasons that can lead to behavioral problems. Are there fights with parents, are there are problems in the family? Such questions are important, but they take a lot of time,” Eisenberg said, adding with a sigh: “Prescribe a pill for it very quickly.”

So, here are three world-class psychiatrists whose enthusiasm is under control for the current state of affairs. You might bear that in mind while you discover that, according to our own CDC, “[I]t is estimated that 13-20 percent of children living in the United States (up to 1 out of 5 children) experience a mental disorder in a given year.”

If you pore over the more than 13,000-word CDC report “Mental Health Surveillance Among Children—United States, 2005-2011,” you will encounter this little disclaimer, toward the end:

Changes in estimated prevalence over time might be associated with an actual change in prevalence, changes in case definition, changes in the public perception of mental disorders, or improvements in diagnosis, which might be associated with changes in policies and access to health care.

Absorbing all this, and noting that the US is said to consume an astonishing 60 percent of the world’s psychotropic meds (dubbed “Pharmageddon”), just how skewed is conventional health care critic Mike Adams’ description of modern psychiatry?

Here’s how modern psychiatry really operates: A bunch of self-important, overpaid intellectuals who want to make more money invent a fabricated disease… By a show of hands, they then vote into existence whatever symptoms they wish to associated… Thus begins the call for treatment for a completely fabricated disease. From there, it’s a cinch to get Big Pharma to fabricate whatever scientific data they need in order to “prove” that speed, amphetamines, pharmaceutical crack, or whatever poison they want to sell [will treat the disorder].

My take is that if we really do believe that one in five of our children are “mental,” then we ARE crazy.