Expansion of Psychiatric Turf

BACKGROUND On 3-4 June, the Institute of Psychiatry in London hosted an international conference to mark the publication of DSM-5. On June 10, Sir Simon Wessely, a department head at the Institute, published a paper called DSM-5 at the IoP. The paper is a summary of the conference proceedings, and also, in many respects, a defense of DSM-5. The article touches on many issues that are central to the current anti-psychiatry debate, and for this reason, I thought it might be helpful to take a close look at the piece. ...

PRESIDENT’S SPEECH On June 3, President Obama delivered a speech on the expansion of mental health services. The occasion was the National Conference on Mental Health, which was held at the White House. "The truth is," the President told us, "in any given year, one in five adults experience a mental illness — one in five." In most human endeavors something is true only if it can be shown to be so. In psychiatry and politics, however, a statement becomes true if it's repeated often enough. For the past 60 years, the APA has been systematically expanding their diagnostic net until – surprise, surprise – it now envelops 20% of the population. With the lowering of thresholds in DSM-5, we can be sure that this number will continue to rise, and whoever is President then will be able to tell us that one in four of the population has a mental illness. Gosh! Note also that the President uses the term “mental illness” as opposed to “mental disorder.” The APA use the latter term in their manual to make the concept somehow more acceptable. But these “disorders” always morph into illnesses in application. ...

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 in the May 2013 issue of the British Journal of Psychiatry. It’s called “The future of academic psychiatry may be social” by Stefan Priebe, Tom Burns, and Tom K. J. Craig. You can see it here. The abstract states: "The past 30 years have produced no discoveries leading to major changes in psychiatric practice. The rules regulating research and a dominant neurobiological paradigm may both have stifled creativity. Embracing a social paradigm could generate real progress and, simultaneously, make the profession more attractive." ...

BACKGROUND On April 29, Thomas Insel, Director of NIMH, published a paper called Transforming Diagnosis. You can see it here. Dr. Insel is critical of DSM: "While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each." "The weakness is its lack of validity." This has created quite a stir, in that it appears to support the position of those of us who have been criticizing the DSM on these kinds of grounds for decades. It also suggests a fundamental rift between the NIMH and the APA, two groups who up till now had appeared to be joined at the hip. The article has generated a great deal of comment. So far, there’s been nothing from the APA. ...

I keep two dictionaries on my desk. The first is a 1964 Webster’s; the second is a 2009 Webster’s. This morning I looked up the word “depression” in both books. 1964: n. 1. a depressing or being depressed. 2. a depressed part or place; hollow or low place. 3. low spirits; dejection. 4. a decrease in force, activity, amount, etc. 5. a period marked by slackening of business activity, much unemployment, falling prices and wages, etc. ...

There’s a new post on Mick Bramham’s website called “A time to grieve, a time to console, and a time to profit?” You can see it here. You might have thought that, given the adverse publicity that pharma has been receiving in recent years, they would be easing up on their expansionist agenda. But you would be wrong. The APA has declared open season on bereavement, and although DSM-5 won’t be released for a few more weeks, Eli Lilly is already grooming their SNRI Cymbalta as a “treatment” for this pseudo illness. ...

BACKGROUND The primary purpose of the bio-psychiatric-pharma faction is to expand turf and sell more drugs. This is a multi-faceted endeavor, one component of which is disease mongering. This consists of using marketing techniques to persuade large numbers of people that they have an illness which needs to be treated with drugs. With regards to postpartum depression, it is an obvious fact that some mothers do indeed experience a measure of depression in the period after giving birth. The term postpartum depression has in the past been generally understood to mean that the problem had something to do with hormones. Today brain chemicals are blamed. ...

The DSM-5 drafting committee considered including Internet addiction in the upcoming revision, but eventually backed off, at least for now. Apparently they decided to put it in the category “requiring further study.” So it’ll be in DSM-6. Meanwhile, people are being given the “diagnosis” anyway – and of course, the “treatment.” AN ILLUSTRATIVE CASE I’m grateful to Tallaght Trialogue for sending me a link to a recent article in the UK’s MailOnline. It was written by Rebecca Seales and Eleanor Harding. You can see it here. ...

BACKGROUND The “diagnosis” of separation anxiety disorder has been around since DSM-III. In DSM-IV it is defined as “…excessive anxiety concerning separation from the home or from those to whom the person is attached.” (DSM-IV-TR p 121). The APA’s prevalence estimate is 4%. This “diagnosis” is listed under the heading: “Other Disorders of Infancy, Childhood, or Adolescence.” One of the criteria is that the problem must begin before age 18, and in practice the “diagnosis” was generally confined to children under the age of 10 or so. ...