The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry, New York Review of Books

The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry, New York Review of Books

Post #94 Shortlink: http://wp.me/pKrrB-1dG

Two part review from The New York Review of Books around psychiatry, the DSM and the rise in numbers being medicated for mental illness. Marcia Angell, M.D., is an American physician and author and editor-in-chief of the New England Journal of Medicine (NEJM).

Part One:

The Epidemic of Mental Illness: Why?

June 23, 2011

Marcia Angell

The Emperor’s New Drugs: Exploding the Antidepressant Myth
by Irving Kirsch

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
by Robert Whitaker

Unhinged: The Trouble With Psychiatry-A Doctor’s Revelations About a Profession in Crisis
by Daniel Carlat

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
by American Psychiatric Association

“It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007-from one in 184 Americans to one in seventy-six. For children, the rise is even more startling-a thirty-five fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

“A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were “anxiety disorders,” including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); “mood disorders,” including major depression and bipolar disorders; “impulse-control disorders,” including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and “substance use disorders,” including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment-up from a fifth in a similar survey ten years earlier…”

Part Two:

The Illusions of Psychiatry

July 14, 2011

Marcia Angell

“…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. (There are four separate “sourcebooks” for the current edition of the DSM that  present the rationale for some decisions, along with references, but that is not the same thing as specific references.) It may be of much interest for a group of experts to get together and offer their opinions, but unless these opinions can be buttressed by evidence, they do not warrant the extraordinary deference shown to the DSM. The DSM-III was supplanted by the DSM-III-R in 1987, the DSM-IV in 1994, and the current version, the DSM-IV-TR (text revised) in 2000, which contains 365 diagnoses…”

“…The drug industry, of course, supports other specialists and professional societies, too, but Carlat asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” 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…”

 

Related information:

The Carlat Psychiatry Blog

 

Second DSM-5 public review of draft criteria

 
The closing date for comments in the second DSM-5 public review has been extended to July 15.

Register to submit feedback via the DSM-5 Development website here: http://tinyurl.com/Somatic-Symptom-Disorders

Once registered, log in with username and password and go to page: http://tinyurl.com/DSM-5-CSSD

Copies of submissions for 2011 are being collated here: http://wp.me/PKrrB-19a

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