A Behavioral Approach to Mental Disorders

Today I received the following email from Emily Underwood, a reporter with Science Magazine. I am a reporter with Science magazine -- after reading your Twitter feed and blog I thought you might be interested in a live video chat I’m hosting this week on the controversy surrounding the DSM V. My guests are Allen Frances of Duke University, William Eaton of Johns Hopkins University, and Frank Farley of Temple University; given their different takes on the subject it promises to be a lively conversation! ...

GBI Research provides business intelligence reports based on “… the insights of key industry leaders to ensure you stay up-to-date with the latest emerging trends in your markets.” GBI stands for Global Business Intelligence. I’ve recently come across one of their releases titled Europe Adopting US Strategies to Diagnose and Treat ADHD. This is essentially a business analysis of the potential sales of ADHD drugs. Here are some quotes: "European countries are increasingly adopting the US diagnostic criteria (DSM-IV), resulting in more and more diagnoses of ADHD. Clearer guidelines for diagnosis of ADHD in both adults and children and revisions to ADHD treatment methods will be released in the DSM-V in 2013, superceding [sic] the DSM-IV which was last revised in 2000. This may possibly result in a rise in ADHD diagnoses in the US, and potentially further afield." “The US leads the pack in terms of ADHD treatment, holding the highest diagnosis rate for both adults and children. The ADHD market has shown a steady increase in the number of prescriptions in the pediatric population, although this has started to slow down and has potentially reached a plateau. The market will continue to grow, however, due to the increase in the number of adult patients being diagnosed and treated. A relatively open attitude to psychiatric treatment, as well as direct-to-consumer and physician marketing, is leading to increased rates of adult ADHD diagnosis in the US.” ...

Routine screening for depression sounds like a very good thing, and in fact it is recommended by NIMH, and by the Agency for Healthcare Research and Quality (a division of the Department of Health and Human Services), and various other groups. Medicare will pay the total cost of one depression screening per year. But it has long been suggested by those of us on this side of the debate that routine screenings, especially those “free” screenings that are paid for by pharmaceutical companies, have had a distinctive flavor of disease-mongering. ...

Mental Health Europe (MHE) is a non-governmental organization “… committed to the promotion of positive mental health and well-being, the prevention of mental health problems, the improvement of care, advocacy for social inclusion and the protection of the human rights of (ex)users of mental health services and their families and carers.” It is composed of associations, organizations, and individuals who are active in the mental health field, including users and ex-users of services, volunteers, and professionals. MHE subscribes to the following values: dignity and respect; equal opportunities; freedom of choice; non-discrimination, social inclusion, democracy and participation. You can read more about them here. ...

Of all the evils perpetrated by American psychiatry in the past 60 years, the administration of neuroleptic drugs to children is arguably the worst. And it is a practice that is growing each year. The essential purpose of these drugs is to make people more docile and more easily managed by destroying brain tissue. The side effects are devastating. Recently Gabrielle Carson, MD, a psychiatrist at Stony Brook Children’s Hospital, wrote a paper on The Dramatic Rise in Neuroleptic Use In Children: Why Do We Do It and What Does It Buy Us? You can see Dr. Carlson’s commentary here. (Thanks to yobluemama2 on Twitter for flagging the article.) ...

On June 1, 2012, I wrote a post titled There Are No Mental Illnesses. Yesterday a comment came in on this post. Here’s a quote: "When my brother was thirty years old, he started to see objects, which was far away, like hawk. His "mind" wanted to understand it, so he started to think he became a cybrog. Doctor said: you are ill". When I saw strange things, I said to myself: "Well, I see strange things" that's all. And I'm healthy..." ...

There’s an interesting article in the NY Times Sunday review. You can see it here. It was written by Sally Satel MD, a psychiatrist, currently a resident scholar at the American Enterprise Institute. The article is called: “Why the Fuss Over the DSM-5?” Dr. Satel’s central point is that psychiatrists only treat symptoms anyway and pay little attention to the DSM. She expresses the belief that the manual’s diagnoses are “…passports to insurance coverage, the keys to special education and behavioral services in school and the tickets to disability benefits.” ...

It’s widely known that Thomas Insel, MD, Director of NIMH, recently proclaimed that the DSM’s diagnostic categories are invalid, and that this agency would no longer use these categories as the basis for research. But he went on to reaffirm his agency’s commitment to a biological model of “mental illness” and to funding research into biological causes of these problems. He has since issued a joint statement with Jeffrey Lieberman, President Elect of APA, which makes it clear that they’re still the best of friends, but he didn’t really recant his earlier statement. ...

Well, as I guess everybody knows by now, Dr. Insel has changed his mind. On April 29, he stated that the weakness of DSM “…is its lack of validity.” He went on to express the view that his agency, NIMH, (the US government’s mental health research arm) “…cannot succeed if we use DSM categories…” You can see his full statement here. This statement was widely interpreted as a significant rift between NIMH and the APA. But apparently they’ve made up their differences and are pals again. On May 13, just two weeks after his divorce statement, Dr. Insel and Dr. Lieberman, APA president elect, have issued a joint statement in which they express the belief that the DSM “…represents the best information currently available for clinical diagnosis of mental disorders.” Patients, families and insurers, we are told, “…can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care.” It’s hard to believe that this is the same DSM that he earlier criticized as lacking validity! ...

There’s an interesting article on Vermont’s Seven Days. It’s called Burlington’s HowardCenter Tries a New Approach to Treating Mental Illness: More Talk, Fewer Meds. You can see it here. (Thanks to Steven Coles on Twitter for the link.) Apparently Vermont’s Department of Mental Health is promoting a “new” kind of treatment for psychosis: talk therapy. The project leader is Dr. Sandra Steingard, who for most of her career accepted the orthodox view of schizophrenia and the need for neuroleptic drugs. ...