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Health See other Health Articles Title: Who’s crazy now? Every couple of decades or so, psychiatrists publish their Diagnostic and Statistical Manual of Mental Disorders, which functions as the instruction booklet for their profession. The manual always attracts its fair share of mockery, and the last one was no exception. That 886-page volume, published in 1994, famously included snoring (“Breathing-Related Sleep Disorder’’; DSM code 780.59), smoking (“Nicotine Dependence’’; 305.10), quitting smoking (“Nicotine Withdrawal’’; 292.0), and jet lag among the nation’s mental disorders. One writer called it “a naked land grab by a profession threatened with marginalization by biomedical research.’’ I am quoting my past self, doubtless a diagnosable disorder of some kind. Surprise, surprise, the psychiatrists are at it again. The fifth edition of DSM is in the making, and already the fur is flying. “What began as a group of top scientists reviewing the research literature has degenerated into a dispute that puts the Hatfield-McCoy feud to shame,’’ wrote Dr. Daniel Carlat, a professor at Tufts Medical School, on his blog recently. What’s going on? For one thing, there is continuing pressure to keep adding questionable diagnoses to the DSM stew. There is talk of expanding the ever-fashionable ADHD diagnosis (attention deficit hyperactivity disorder) to include an adult-onset version. Last time around, some shrinks wanted to include PMS (premenstrual dysphoric disorder, or premenstrual syndrome), an effort headed off at the pass because it risked stigmatizing healthy women. Eating disorders will probably be broadened, too. In an editorial published in Psychiatric Times, Dr. Allen Frances, the editor of DSM-IV, called DSM-V “a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment - a bonanza for the pharmaceutical industry but at a huge cost to the new false positive ‘patients’ caught in the excessively wide DSM-V net.’’ Frances and others say there hasn’t been enough progress in sussing out mental disorders to merit publication of a new $89 volume. “The idea was that in these 20 years the science would have progressed to where it had hard scientific and biological markers for diagnoses,’’ Carlat told me. “It just hasn’t happened. We are wrestling with our identity as medical professionals. The lack of biological markers to help us diagnose has made us feel in some ways inferior to other medical professionals, as if we were not real doctors because we don’t base our decisions on hard science.’’ In a prepared statement, the American Psychiatric Association, publisher of the DSM, accused Frances and another critic of conflict of interest, noting that they “continue to receive royalties’’ on the DSM-IV and “related case book and study products.’’ That seems a little rich to me. Frances said his royalties amount to about $10,000 a year and that he “never regarded this as a motivation for anything.’’ While the APA and Frances were trading insults, Jane Costello, a professor of medical psychology at Duke University, volubly quit one of the DSM-V working groups. In a letter explaining her actions, she wrote: “I am increasingly uncomfortable with the whole underlying principle of rewriting the entire psychiatric taxonomy at one time.’’ Concerning new DSM diagnoses, she writes: “More and more, changes seem to be made for reasons that have little basis in new scientific findings or organized clinical or epidemiological studies.’’ The most serious, recurring accusation is that the pill-pushing shrinks are dreaming up ever-new syndromes at the behest of their funders in the pharmaceutical industry. Such diverse critics as Tufts, the Center for Science in the Public Interest, and the occasionally loony CounterPunch magazine have highlighted the extensive ties between Big Pharma and the DSM’s authors. “The drug barons’ ongoing campaign to pathologize entirely natural emotional responses to hunger, humiliation, financial insecurity, racism, sexism, overwork, and isolation is a mercenary tactic, designed to create markets, maximize profits, and minimize dissidence,’’ Eugenia Tsao writes in the current CounterPunch. You would think the APA would respond to these accusations of self-dealing, but a spokeswoman assured me that DSM representatives were too busy to speak with me. Who are the losers? The mentally ill, of course. Meaning the men and women for whom a few days’ worth of jet lag or the “pain’’ of nicotine withdrawal would be a welcome walk in the park. Because ultimately a profession that medicalizes trivial conditions, and seeks reimbursement for treating them, will find itself being reimbursed for nothing. I am quoting myself again. Maybe I should see someone. Alex Beam is a Globe columnist. His e-dress is beam@globe.com. © Copyright 2009 Globe Newspaper Company.
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#7. To: Original_Intent (#0)
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Turtle had Attention Deficit Disorder as a kid, smokes cigars, drinks wine, eats greasy food, drinks coffee and tea, sleeps with a pug, has no use for minorities...I guess I'm certifiable.
Who you sleep with is your business as long as they are consenting. I rather like a Cuban Cigar, but have to substitute full bodied Hondurans. "...eats greasy food...", and your point? Just watch that extra helping of Pork Chops - it's bad juju. Oh, and ADD does not exist other than as a label. There is NO test for it, no known cause of it, and no proof that it even exists - other than as an excuse to bill your insurance.
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