Currently, due to the massive growth in psychiatric drugging of children and youth and the current targeting of them for even more psychiatric drugging, PsychRights has made attacking this problem a priority. Children are virtually always forced to take these drugs because it is the adults in their lives who are making the decision. This is an unfolding national tragedy of immense proportions. As part of its mission, PsychRights is further dedicated to exposing the truth about these drugs and the courts being misled into ordering people to be drugged and subjected to other brain and body damaging interventions against their will.
Britain’s Division of Clinical Psychology is calling for the abandonment of psychiatric diagnosis
Medicine’s big new battleground: does mental illness really exist?
Jamie Doward, The Observer, Saturday 11 May 2013
The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis
But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry’s dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.
Critics claim that the American Psychiatric Association’s increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.
Inevitably such claims have given ammunition to psychiatry’s critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.
A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: “Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?”
Psychiatry’s supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.
But even psychiatry’s defenders acknowledge that the manual has its problems. Allen Frances, a professor of psychiatry and the chair of the DSM-4 committee, used his blog to attack the production of the new manual as “secretive, closed and sloppy”, and claimed that it “includes new diagnoses and reductions in thresholds for old ones that expand the already stretched boundaries of psychiatry and threaten to turn diagnostic inflation into hyperinflation”.
Others in the mental health field have gone even further in their criticism. Thomas R Insel, director of the National Institute of Mental Health, the American government’s leading agency on mental illness research and prevention, recently attacked the manual’s “validity”.
And now, in a significant new attack, the very nature of disorders identified by psychiatry has been thrown into question. In an unprecedented move for a professional body, the Division of Clinical Psychology (DCP), which represents more than 10,000 practitioners and is part of the distinguished British Psychological Society, will tomorrow publish a statement calling for the abandonment of psychiatric diagnosis and the development of alternatives which do not use the language of “illness” or “disorder”.
The statement claims: “Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias.”
The language may be arcane, but the implication is clear. According to the DCP, “diagnoses such as schizophrenia, bipolar disorder, personality disorder, attention deficit hyperactivity disorder, conduct disorders and so on” are of “limited reliability and questionable validity”.
Diagnosis is often described as the holy grail of psychiatry. Without it, psychiatry’s foundations crumble. For this reason Mary Boyle, emeritus professor at the Univerity of East London, believes that the impact of the DCP’s statement marks a dramatic shift in the mental health debate.
"The statement isn’t just an account of the many problems of psychiatric diagnosis and the lack of evidence to support it," she said. "It’s a call for a completely different way of thinking about mental health problems, away from the idea that they are illnesses with primarily biological causes."
Psychiatrists say that such claims have been made many times before and ignore mountains of peer-reviewed papers about the importance that biological factors play in determining mental health, including significant work in the field of genetics. It also, they say, misrepresents psychiatry’s position by ignoring its emphasis on the impact of the social environment on mental health.
Most psychiatrists concede that diagnosis of psychiatric disorder is not perfect. But, as Harold S Koplewicz, a leading child and adolescent psychiatrist, explained in an article for the Huffington Post, “those lists of behaviours in the DSM, and other rating scales we use, are tools to help us look at behaviour as objectively as possible, to find the patterns and connections that can lead to better understanding and treatment”.
Independent experts also say that it is hard to see how the world of mental health could function without diagnosis. “We know that, for many people affected by a mental health problem, receiving a diagnosis enabled by diagnostic documents like the DSM-5 can be extremely helpful,” said Paul Farmer, chief executive of the mental health charity Mind. “A diagnosis can provide people with appropriate treatments, and could give the person access to other support and services, including benefits.”
But even Farmer acknowledged that diagnosis is imperfect. “For example it takes, on average, 10 years before a person with bipolar disorder gets a correct diagnosis, which comes with a number of mental and physical health implications, such as side-effects from the wrong medication,” he said.
But now the DCP has transformed the debate about diagnosis by claiming that it is not only unscientific but unhelpful and unnecessary.
"Strange though it may sound, you do not need a diagnosis to treat people with mental health problems," said Dr Lucy Johnstone, a consultant clinical psychologist who helped to draw up the DCP’s statement.
"We are not denying that these people are very distressed and in need of help. However, there is no evidence that these experiences are best understood as illnesses with biological causes. On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse."
Eleanor Longden, who hears voices and was told she was a schizophrenic who would be better off having cancer as “it would be easier to cure”, explains that her breakthrough came after a meeting with a psychiatrist who asked her to tell him a bit about herself. In a paper for the academic journal, Psychosis, Longden recalled: “I just looked at him and said ‘I’m Eleanor, and I’m a schizophrenic’.”
Longden writes: “And in his quiet, Irish voice he said something very powerful, ‘I don’t want to know what other people have told you about yourself, I want to know about you.’
"It was the first time that I had been given the chance to see myself as a person with a life story, not as a genetically determined schizophrenic with aberrant brain chemicals and biological flaws and deficiencies that were beyond my power to heal."
Longden, who is pursuing a career in academia and is now a campaigner against diagnosis, views this conversation as a crucial first step in the healing process that took her off medication. “I am proud to be a voice-hearer,” she writes. “It is an incredibly special and unique experience.”
Hers is an inspirational story. But to focus on one person’s experiences would be to ignore the testimonies of others who believe that their mental distress has biomedical roots. Indeed, many people report that they can see no clear reason for their distress and firmly believe their life stories have little bearing on their mental state.
Nevertheless the DCP believes the world of mental health treatment would benefit from a “paradigm shift” so that it focused less on the biological aspects of mental health and more on the personal and the social.
"In essence, instead of asking ‘What is wrong with you?’, we need to ask ‘What has happened to you?’," Johnstone said. "Once we know that, we can draw on psychological evidence to show how life events and the sense that people make of them have led to the current difficulties."
A shift away from a biological focus would give succour to psychiatry’s critics, who question society’s reliance on the use of drugs or interventions such as electroconvulsive therapy to treat psychiatric breakdown.
Prescriptions of antidepressants increased nearly 30% in England between 2008 and 2011, the latest available data.
A recent article in the online edition of the British Medical Journal suggested “that only one in seven people actually benefits” from antidepressants and claimed that three-quarters of the experts who wrote the definitions of mental illness had links to drug companies.
Professor Sir Simon Wessely, chair of Psychological Medicine at King’s College London (KCL), argues that his profession has always emphasised the need to “look at the whole person, and indeed beyond the person to their family, and to society”, and that claims psychiatry is being “taken over by the biologists” are unfounded.
This defence, which will be outlined at a major international conference on the impact of DSM-5, to be held at KCL at the beginning of June, is often lost in a shrill debate.
Indeed, it is noticeable just how vocal psychiatry’s critics are becoming ahead of the publication of DSM-5. In an attempt to pour oil on troubled waters, Professor Sue Bailey, president of the Royal College of Psychiatrists, conceded that “many of the criticisms that are levelled at DSM” were valid but warned that the row was “distracting us from the real challenge, which is providing high-quality mental health services and treatment to patients and carers”.
Bailey insisted the manual’s publication “won’t have any direct influence on the diagnosis of mental illness in the NHS”. But it will frame the wider debate about how people see mental health. As Wessely acknowledged, psychiatry’s critics will seize on the manual’s “daft” new categories of mental disorder to bolster claims that the profession is “medicalising normality”.
There is an irony here. Psychiatry lies wounded and much of the damage appears to be self-inflicted. The emotional scars may take decades to heal.
The American Psychiatric Association is under fire over its new diagnosis manual.
The new version of the world’s most widely used psychiatric guide to mental disorders says grief soon after a loved one’s death now can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain forgetful moments for the aging are called “mild neurocognitive disorder.”
Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common problems into mental illnesses in a trend they say will just make the “pop-a-pill” culture worse.
Says a former leader of the group: “Normal needs to be saved from powerful forces trying to convince us that we are all sick.”
At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.
The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It’s the manual’s first major update in nearly 20 years, and a backlash has taken shape in recent weeks:
— Two new books by mental health experts, “Saving Normal” and “The Book of Woe,” say the manual has lost credibility.
— A British psychologists’ group is criticizing the DSM-5, calling for a “paradigm shift” away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.
— The head of the U.S. National Institute of Mental Health, Dr. Thomas Insel, said the book lacks scientific validity.
DRUG COMPANIES INFLUENCING DOCTORS?
The manual’s release comes at a time of increased scrutiny of health care costs and concern about drug companies’ influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.
Many of the 31 task force members involved in developing the revised guidebook have had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock. Group leaders dismiss that criticism and emphasize they agreed not to collect more than $10,000 in industry money in the calendar year preceding publication of the manual.
"Way too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it," Dr. Allen Frances writes in "Saving Normal." He is a retired Duke University professor who led the psychiatric group’s task force that worked on the previous guide.
He says the new version adds new diagnoses “that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders.”
Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual — including autism, attention deficit disorder and bipolar disorder — and billions of dollars spent each year on psychiatric drugs.
The group’s 34,000 members are psychiatrists — medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.
The most contentious changes include these:
— Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one’s death. Major depression is typically treated with antidepressants.
— Calling frequent, extreme temper tantrums “disruptive mood dysregulation disorder,” a new diagnosis. The psychiatric association says the label is meant to apply to youth who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.
— Diagnosing mental decline that goes a bit beyond normal aging as “mild neurocognitive disorder.” Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize so-called “senior moments.”
— Calling excessive thoughts or feelings about pain or other discomfort “somatic symptom disorder,” something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness.
— Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they’re alone and then feel guilty about it.
— Removing Asperger’s syndrome as a separate diagnosis and putting it under the umbrella term “autism spectrum disorder.”
Many of the protesters want reform in the shape of alternatives to drug treatment. As protest organiser Susan Rogers explained: “People here are for choice, for the right to decline as well as choose treatment. We want [mental health consumer and psychiatric survivors] to know there are alternatives to hospitals and medication — they can go into peer support run by people like themselves.”
“The best success rate for a diagnosis of schizophrenia is in rural Finland, where there is a slogan that problems aren’t in our heads, but between our heads,” says fellow organiser David Oaks. “They emphasise the importance of peer support in recovery.”
by Paula J. Caplan, Ph.D.
Many people have presented me with the following challenge: ‘People suffer. Often, good therapists can help relieve suffering, and suffering people deserve to have insurance pay for their therapy. But insurance companies won’t pay unless the person gets a psychiatric diagnosis. However, psychiatric diagnosis is unscientific and has often caused both direct and indirect, devastating effects in people’s lives. So what is the solution?”
Of course, I totally agree with all of the above statements. What do I think is the solution?
For years, my answer was: “I don’t know what the solution is, but I do know that we must not keep silent when we know that people are being harmed. So first we have to expose the harm, and then we have to brainstorm about a solution.”
However, the work of a student, Meadow Linder, in her brilliant undergraduate thesis at Brown University, combined with what countless therapists have told me over the years, suddenly revealed a solution to me. I will describe it here, but be aware that it may seem overly simplistic, and you may immediately think, “But that will never happen!” I do not believe it is overly simplistic, and as for whether or not it will ever happen, well, if we don’t aim for honesty and the repair of the world (what in Hebrew is called Tikkun Olam), then we can be sure we won’t get there.
In her thesis, Meadow Linder (see her chapter in Bias in Psychiatric Diagnosis, Caplan & Cosgrove, Editors) found through interviews with some really fine, ethical psychotherapists that when a traumatized, suffering person comes to them for help, they do not worry about whether or not the person meets the number of criteria for Post-traumatic Stress Disorder that it says they must meet in the psychiatric diagnosis manual. Because the person is traumatized, and they think they can be of help, they assign the PTSD label, and then the insurance company will pay for the therapy. They do this on the most humane grounds, and many of them are even more comfortable doing this because they are aware that the psychiatric diagnostic manual is not grounded in good science, so it does not make sense to stick to unscientific rules when it means sacrificing the welfare of the patient. As a member of two of the committees that wrote the current version of the diagnostic manual, the DSM-IV (until I resigned after seeing how unscientific and how politically motivated the writing of this manual is), I saw firsthand that good scientific research is ignored, distorted, or lied about when it suits their purposes, and poorly done research is used to support whatever they want to put in or keep out of their manual.
I have been working with therapists since 1969 and cannot count the number of times that excellent, compassionate, ethical therapists have told me that they don’t worry about what psychiatric diagnosis to give patients, because they know that that rarely, if ever, is of any help. Instead, they consider what the insurance company will and will not pay for and how the companies often agree to pay for more or fewer therapy sessions, depending on the diagnostic label given to the patient. Then they, to a greater or lesser extent, base their choice of labels on what will enable them to provide the best and most appropriate kind of help. So many therapists do this, and know that others do it, and even the insurance companies are surely aware that this goes on. So what is happening in fact is that, once a person has been licensed as a psychologist or psychiatrist (in some states, people from other disciplines can be licensed therapists), right now, the therapist’s judgment of the patient’s needs is what is really the basis of insurance coverage. In spite of this, insurors and some therapists throw up their hands and ask, “Without diagnosis, how would we know whose therapy to pay for?!”
My Proposed Solution:
In light of what I have just described, my solution is simply that everyone involved — therapists, insurance companies, the DSM authors — start being completely candid about what is happening, and we all skip the step of assigning a diagnostic label. In addition to the importance of an increase in honesty and ethical conduct all around that this would entail, there is an added, important clinical advantage that would accrue; the advantage is that, as the brilliant psychologist Jeffrey Poland has described in one of his chapters in the book Bias in Psychiatric Diagnosis, therapists would be encouraged and even liberated to try to learn about the whole patient, including their strengths and resources, instead of focusing too much (as many do today) on figuring out which set of DSM symptoms the patient most closely fits.