Saturday, May 5, 2012

Psychiatry’s Bible: A Book Based on Revelation

There was a time when a psychiatrist could be counted on for counseling and long verbal therapy sessions. That is a time of the past. Virtually all treatments for "mental illness" involve drug therapies. This is a much more time-efficient and a much more remunerative approach—and it is so simple that almost anyone who can read can do it.

The American Psychiatric Association (APA) is about to publish a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Each new edition manages to unearth another suite of mental disorders that an unaware public did not know existed. Each new malady generates new revenue for the psychiatrists for whom it lobbies and for its sponsors and teammates: the drug companies.

Not everyone is thrilled with this development. Paula J. Caplan, in a Washington Post article titled Psychiatry’s bible, the DSM, is doing more harm than good, is not happy. Marcia Angell, in a New York Review of Books article titled The Illusions of Psychiatry, is also not happy.

The APA is particularly proud of the newest version (DSM-5 or DSM-V). Angell provides this insight.

"In 1999, the APA began work on its fifth revision of the DSM, which is scheduled to be published in 2013. The twenty-seven-member task force is headed by David Kupfer, a professor of psychiatry at the University of Pittsburgh, assisted by Darrel Regier of the APA’s American Psychiatric Institute for Research and Education."

"In particular, diagnostic boundaries will be broadened to include precursors of disorders, such as "’psychosis risk syndrome’ and ‘mild cognitive impairment’ (possible early Alzheimer’s disease). The term ‘spectrum’ is used to widen categories, for example, ‘obsessive-compulsive disorder spectrum,’ ‘schizophrenia spectrum disorder,’ and ‘autism spectrum disorder. And there are proposals for entirely new entries, such as ‘hypersexual disorder,’ ‘restless legs syndrome,’ and ‘binge eating’."

The term "spectrum" allows considerable leeway in defining symptoms, including potential or anticipated behaviors—another way of saying one can be drugged even if there are no definite symptoms at all.

"....Kupfer and Regier wrote in a recent article in the Journal of the American Medical Association (JAMA), entitled "Why All of Medicine Should Care About DSM-5," that ‘in primary care settings, approximately 30 percent to 50 percent of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated.’ It looks as though it will be harder and harder to be normal."

So—the APA is coming with a document that will allow up to 50% of us to be declared mentally ill. Wow, shouldn’t we be worried? Well, actually we shouldn’t be worried, but those foolish enough to believe this claptrap should fear for their lives.

Angell reminds us that psychiatry is not the practice of medicine as we have come to understand it. There is no precise definition of mental illness; there is no way to measure it; and there is no scientific validation for its treatment with the various drugs that are utilized.

"Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that."

Angell quotes Daniel Carlat from his book Unhinged: The Trouble With Psychiatry—A Doctor’s revelations About a Profession in Crisis, as to what this means in practice.

"Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another."

Using DSM as a guide, symptoms are tallied and compared with a list associated with a given condition. If a patient exhibits a specified number of the listed symptoms, the psychiatrist can make a diagnosis. Unfortunately, with over 300 maladies designated, the symptoms are not necessarily unique to a given condition. Carlat reported on a patient who provided him with seven different diagnoses according to the DSM. What is one to do? This matching procedure, according to Carlat, provides:

"....the illusion that we understand our patients when all we are doing is assigning them labels."

The use of a drug to treat depression, for example, leads to side effects that require other drugs to control. This cascading effect leads to patients swallowing what is usually referred to as a "cocktail" of drugs. Again, from Carlat:

"We target discrete symptoms with treatments, and other drugs are piled on top to treat side effects."

From Angell:

"A typical patient, he [Carlat] says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa).’

And again from Carlat:

"Such is modern psychopharmacology. Guided purely by symptoms, we try different drugs, with no real conception of what we are trying to fix, or of how the drugs are working. I am perpetually astonished that we are so effective for so many patients."

All of this might be less scary if one were convinced that DSM possessed a firm scientific basis. Angell provides this perspective:

"Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies."

The contents of DSM are apparently arrived at by selecting a panel of experts in given areas that arrives at conclusions as to what is and (hopefully) what is not mental illness. This is a typical process for arriving at a document.

Legislators proceed along similar lines in arriving at a legislative bill. It is a known, but unfortunate fact that legislators receive campaign donations from those organizations that might benefit from the laws they promulgate. How great would be the outrage if congressional representatives were routinely receiving personal funds, equivalent to a salary or stipend, from those affected by their legislation? Felonious corruption would be the call and a clamor for prison terms would arise.

Not so in the medical profession where corruption is quite common and accepted. Receiving money from drug companies is particularly likely in psychiatry because there is so much of it to be made by all. Participants in formulating DSM take funds for personal use from companies that stand to make billions of dollars from their decisions.

"Of the 170 contributors to the current version of the DSM (the DSM-IV-TR)....ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia."

Caplan describes her experience in working on a version of DSM.

"The marketing of the DSM has been so effective that few people — even therapists — realize that psychiatrists rarely agree about how to label the same patient. As a clinical and research psychologist who served on (and resigned from) two committees that wrote the current edition of the DSM, I used to believe that the manual was scientific and that it helped patients and therapists. But after seeing its editors using poor-quality studies to support categories they wanted to include and ignoring or distorting high-quality research, I now believe that the DSM should be thrown out."

Caplan then provides this noteworthy comment.

"Allen Frances, lead editor of the current DSM, defends his manual as grounded in science, but at times he has acknowledged its lack of scientific rigor and the overdiagnosing that has followed. ‘Our net was cast too wide,’ Frances wrote in a 2010 Los Angeles Times op-ed, referring to the explosion of diagnoses that led to "false ‘epidemics’ " of attention deficit disorder, autism and childhood bipolar disorder. The current manual, released in 1994, he wrote, ‘captured many "patients" who might have been far better off never entering the mental health system’."

The DSM is not likely to be discarded. From Angell:

"When....DSM-III was published in 1980, it contained 265 diagnoses (up from 182 in the previous edition), and it came into nearly universal use, not only by psychiatrists, but by insurance companies, hospitals, courts, prisons, schools, researchers, government agencies, and the rest of the medical profession."

So we have simple recipes for diagnosing mental illness that can be used just about anyone. Do you remember this passage:

"....Kupfer and Regier wrote in a recent article in the Journal of the American Medical Association (JAMA), entitled "Why All of Medicine Should Care About DSM-5," that ‘in primary care settings, approximately 30 percent to 50 percent of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated.’ "

The quote seems to suggest that primary care doctors should be on the lookout for symptoms and initiate treatment with mind-altering and brain-damaging drugs even though they have no training in psychiatry, or even any experience with the drugs themselves. Apparently this actually happens. Caplan provides this example:

"About a year ago, a young mother called me, extremely distressed. She had become seriously sleep-deprived while working full-time and caring for her dying grandmother every night. When a crisis at her son’s day-care center forced her to scramble to find a new child-care arrangement, her heart started racing, prompting her to go to the emergency room."

"After a quick assessment, the intake doctor declared that she had bipolar disorder, committed her to a psychiatric ward and started her on dangerous psychiatric medication. From my conversations with this woman, I’d say she was responding to severe exhaustion and alarm, not suffering from mental illness."

"When a social worker in the psychiatric ward advised the patient to go on permanent disability, concluding that her bipolar disorder would make it too hard to work, the patient did as the expert suggested. She also took a neuroleptic drug, Seroquel, that the doctor said would fix her mental illness."

"Over the next 10 months, the woman lost her friends, who attributed her normal mood changes to her alleged disorder. Her self-confidence plummeted; her marriage fell apart. She moved halfway across the country to find a place where, on her dwindling savings, she and her son could afford to live. But she was isolated and unhappy. Because of the drug she took for only six weeks, she now, more than three years later, has an eye condition that could destroy her vision."

This is an example of what happens when amateurs become convinced that a corrupted document like DSM is valid medical science. This is an example of what can happen when the drug companies and their psychiatrist agents encourage the dispensing of dangerous drugs by amateurs. And physicians are not the only ones involved. There are also teachers, counselors, judges, and lawmakers who have fallen under the DSM spell.

What to take away from this information? As Carlat suggests in his book, psychiatry has become "unhinged" and is appropriately said to be in "crisis." And when drugs are involved, "Just say no!" is always a good first response. Half of us are not mentally ill, so if someone tells you that you are, the odds are that you aren’t. Act accordingly.

Caplan tells us that "patients" are beginning to fight back. How encouraging!

"About 10 people who received diagnoses from the current DSM edition are filing complaints against the manual’s editors. (I have worked with the patients to prepare their complaints, and I’m filing my own as a concerned clinician.)"

"The complainants allege that the DSM’s editors failed to follow the APA’s ethical principles, which include taking account of scientific knowledge and respecting patients’ welfare and dignity. They are asking the APA to order the editors to redress the harm done to them — or in one case, to a deceased relative — and to anyone else hurt by receiving a label. They want the APA to hold a public hearing about the dangers of psychiatric diagnosis to gather information about the extent of the damage and look for ways to minimize it. Additionally, they are asking the APA to make clear to therapists and to the public that psychiatric diagnoses are not scientific and that they often put patients at risk."

Emphasis is mine. Good luck with that. Remember that the drug companies garner 10s of billions of dollars in revenue from these "not scientific" diagnoses.

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