But the worst psychiatrists – and the merely mediocre – and the greedy – are. With hideous effects on our autonomy and our bank accounts.
That’s why, as David Brooks urges, we should regard the DSM with enormous skepticism.
Kessler famously argues that about half of us are mentally ill; really though, he adds, thresholds being what they are, we’re all mentally ill. The only question is where you draw the line.
But there’s no question any more, is there? Kessler’s being faux-naif. The line – given the arbitrariness of science in the matter – the line lies in commerce. At what point does the pharma market become saturated with requests for psychotropics? At what point does demand exceed supply? Look there for the line.
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Demand is huge. All praise to the DSM for holding up its end.
Happily, supply is also robust. Holding up very well indeed.
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Half of us mentally ill? Markets don’t do things by halves.
We’re well on our way to one hundred percent.
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Think like a Buddhist:
Where you do you draw the line?
There is no line.
[Joseph] Biederman, along with Charles Nemeroff, who was then at Emory University, and Alan Schatzberg of Stanford (the 116th President of the American Psychiatric Association) are in many ways poster boys for [pharma corruption]. Ironically, it was Schatzberg, during his presidency in 2009, who responded vehemently to Allen Frances’s criticisms of the DSM 5 task force by pointing to the $10,000 in royalties Frances was still receiving from DSM IV. Apparently, the $4.8 million in stock options Schatzberg had in a drug development company, or the fat fees he received from such companies as Pfizer, had no similar distorting effect on his judgment — just as the $960,000 Charles Nemeroff received from GlaxoSmithKline (while reporting only $35,000 to his university) had no influence on him. And just as the millions of dollars that Biederman and his associates at Harvard received for creating a new diagnosis and a massive new market for antidepressants and second-generation antipsychotics among young children (drugs associated with massive weight gain, metabolic disorders, diabetes, and premature death) had nothing to do with their behavior!
Nemeroff is now at the University of Miami, but that’s not a scandal because Miami isn’t a respectable university. The scandal lies at respectable places like Stanford and Harvard, which will “turn a blind eye to ethical failings if the money on offer is sufficiently tempting.”
… takes you, in miniature, through the moral and financial history of this country. Let us follow it.
The place was founded in 1863 by the Poor Sisters of Saint Francis. This charitable lot opened a soup kitchen during the Great Depression that fed hundreds of people a day. Over the years it’s been sold and sold again, and it’s had lots of financial trouble along the way and presumably compromised somewhat on care … But the story has a happy ending!
Hoboken University Hospital (UD can’t figure out what the “university” is doing in the name, but as long as the word is there, University Diaries will write about it) has recently been sold to investors – featured on the front page of today’s New York Times – who do things like this:
“Their model is to charge exorbitant rates, particularly for emergency room services, and if the insurance companies don’t pay them, they threaten to go after the member for the balance of billing,” said Carl King, head of national networks for Aetna, whose in-network contract was also ended by Bayonne in 2008.
And now their hospitals are doing great! They’re taking struggling non-profits once affiliated with shabby little charitable outfits like those poor sisters and turned them into HUGE profit centers! Look at what’s going on in another of their hospitals – the most expensive hospital in the United States!
Aetna’s internal data showed that Bayonne Medical’s emergency room charges jumped again in 2012 and are running 6 to 12 times as high as those of surrounding hospitals. Last fall, [the chief investor in Bayonne Medical] bought the designer Tory Burch’s oceanside home in Southampton for $11 million, according to public records.
Yes, the story of this hospital’s transformation from a modest charitable endeavor devoted to healing to a cutting-edge collections agency is America’s Story.
… at Inside Higher Education, on the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
It helps for everyone in the world to heap contempt on it, to be sure. And, as we all eagerly await the publication of the latest DSM iteration, everyone is heaping contempt.
But the real way you do it is this: You calmly and amusingly treat it like the joke that it is. You let its absurdity percolate into the culture. For instance, you call your group show of high-profile wacky artists DSM-V.
What? You think this is small potatoes? You get more excited about big-shots like Thomas Insel getting all serious and concerned about the DSM?
Wrong. When the very letters DSM become universal shorthand for whoa way over the top baby you know it’s the beginning of the end.
Well, wow. The psychic landscape around here resembles the setting of Waiting for Godot – raw.
Or it’s like Mad Max – a Hobbesian war of all against all, played out on America’s busiest media highways, with desperate gangs (TheraPeuts, PsychíaCrips, DataDevils) truncheoning each other for the biggest piece of the pathology pie.
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Our depressed nation has long taken its orders from the Diagnostic and Statistical Manual of Mental Disorders; but the DSM has – like much of its clientele – grown mulish, morbidly obese… Even as each edition trumpets new and improved deficits, the high-tech, data-gathering world is passing it by.
So the DSM is in denial. Facing obsolescence and repudiation, its editors brightly inform us that it remains America’s go-to book for the blues.
But, you know, the bottom line isn’t about this approach or that approach to psychic disturbance. The bottom line is that more and more observers are simply disgusted at the massive numbers of people in this country who have been persuaded – by television commercials, by the DSM, by doctors – to think there’s something clinically wrong with them for which they have to take pills for years. (‘[S]ome pharmaceutical companies that have enriched themselves by selling psychiatric drugs are now cutting back on further research on mental illness. The ‘withdrawal’ of drug companies from psychiatry, Steven Hyman, a psychiatrist and neuroscientist at Harvard and former NIMH director, wrote last month, “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.” Funny how this view isn’t incorporated into ads for antidepressants and antipsychotics.’) The DSM has helped to make a lucrative fetish of pseudo-debility in the American population, and as long as there’s money in it and a total absence of biomarkers, it will, it seems, keep doing that.
Even when we get somewhere with biomarkers it won’t make any difference. Do you think an absence of any discernible ground for mental illness will stop a person who has been taught by this culture to think of herself in that way? To think of all of life’s difficult passages as illnesses rather than difficult passages? “The struggle of psychiatry since 1980 has not been to fashion more and more illnesses, but rather to convince us that when we are unhappy, anxious, compulsive, etc., we have a mental illness. In this they have been successful, at least to judge from the vast increase in numbers of people seeking treatment. It’s a predictable outcome of the DSM approach to mental suffering.” The science can tell us what it likes; until we stop liking the image of ourselves as debilitatingly neurotic it won’t make any difference.
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Remember what Nietzsche said about the DSM.
“The DSM is a mobile army of metaphors, metonyms, anthropomorphisms, in short a sum of human relations which have been subjected to poetic and rhetorical intensification, translation and decoration … The DSM is an illusion of which we have forgotten that it is illusion, a set of metaphors which have become worn by frequent use and have lost all sensuous vigor… Yet we still do not know where the drive to produce DSMs comes from, for so far we have only heard about the obligation to have DSMs…”
… of The Love Song of J. Alfred Prufrock, it’s been pretty clear that yiddishizing almost anything is liable to amuse. Even the translation of “Pumshtok” back into English is good (“On the wall of the kosher restaurant / Hangs dirty bedding / And bedbugs dance in circles. There is a stink / Of gefilte fish and wet socks. / Oy, Bashe, don’t ask questions, why bother?”).
The idea of doing this to the Diagnostic and Statistical Manual of Mental Disorders is so immediately obvious, so madly self-evident, that UD can only be ashamed it never occurred to her. You can buy the whole thing here (only 74 pages, as opposed to the much more expensive, 1,000-page, totally discredited — most recently by NIMH! — other one). Or you can sample the table of contents here.
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The non-parodic DSM-5 is a funny fat man about to fall over from a speedball overdose.
Along with the discrediting, there will be more parodies.
Fun interview with Gary Greenberg about the Diagnostic and Statistical Manual controversy. Greenberg’s much more radical in his dismissal of the latest edition of America’s Icelandic psychosaga than UD‘s buddy Allen Frances (“We agree that the DSM does not capture real illnesses, that it’s a set of constructs. We disagree over what that means. He believes that that doesn’t matter to the overall enterprise of psychiatry and its authority to diagnose and treat our mental illnesses. I believe it constitutes a flaw at the foundation of psychiatry. If they don’t have real diseases, they don’t belong in real medicine. Al’s … really trying to keep scrutiny off of the whole DSM enterprise. That’s why he’s been so adamant that you don’t throw the baby out with the bathwater — he believes that the DSM-IV, for all of its flaws, its still worthwhile. I disagree.”). He has a new book attacking the DSM from many angles. It’s called The Book of Woe: The DSM and the Unmaking of Psychiatry and its cover is done up just like the posters for Psycho.
UD is mulling going to Politics and Prose bookstore to hear Greenberg talk. The guy has a sense of humor.
Very thoughtful essay on the big new Diagnostic and Statistical sampler, bursting with psychiatric diagnoses for everyone in the family. Like Adam Phillips (“[H]appiness is the most conformist of moral aims. For me, there’s a simple test here. Read a really good book on positive psychology, and read a great European novel. And the difference is evident in one thing — the complexity and subtlety of the moral and emotional life of the characters in the European novel are incomparable. Read a positive-psychology book, and what would a happy person look like? He’d look like a Moonie. He’d be empty of idiosyncrasy and the difficult passions.”), Patricia Pearson perceives the philosophical destitution of a culture that’s handed the task of self-consciousness over to clueless family physicians — nice people desperately paging through the DSM for tranquilizers. To be sure, the difficult passions are difficult. That doesn’t mean you should pill them away.
… you’ll enjoy the fact that the thing gets funnier and funnier. Watch the Colbert interview with Thomas Herndon.
More update here.
“If you are making $3 billion a year on Gleevec [a cancer therapy], could you get by with $2 billion?” Dr. [Brian] Druker, who is now director of the Knight Cancer Institute at Oregon Health and Science University, said in an interview.
A group of cancer researchers and physicians calls for reductions in some drug prices.
Here’s another good one:
Dr. John M. Goldman, emeritus professor of hematology at Imperial College in London and a co-author of the commentary, said he knew several researchers who declined to become authors because they feared losing research money from the industry.
Dr. Kantarjian, the lead author, said that was a risk.
“I am sure I am going to be blackballed,” he said. “My research career will be hurt.”
But he said it was time to speak out. “Pharmaceutical companies have lost their moral sense,” he said.
A New Yorker writer anticipates the release, next month, of the latest Diagnostic and Statistical Manual of Mental Disorders. He finds it bizarre and unsettling, as does UD, that so many Americans are willing to medicalize their experience of life. Their children’s experience of life. He wonders why this organization, the American Psychiatric Association, retains its mental illness franchise.
The market for mental disorders is already enormous, thanks in part to the relentless effort of the A.P.A. to use the D.S.M. to convince us that our psychological suffering is best understood as diseases that should be treated by doctors.
— as King Henry might have said if he’d been around today to watch the entire nation go the way of Alexandra, Virginia, where forty percent of the population is currently on antidepressants. Who told so many people that, whatever they were experiencing, they had to take pills of uncertain utility and serious side effects? Possibly for years?
Despite escalating outrage and dismay at hugely growing numbers of Americans being told they are mentally ill and must be medicated, the psychiatrists who have just completed the latest DSM (the medical and insurance establishments’ official list of mental disorders) stuffed it full of yet more ways for us to think of ourselves as mentally ill.
Inevitably, those among us even somewhat eccentric are increasingly unprotected from pharma’s it’s a mad mad mad mad world business model. Children are especially vulnerable; they must rely on the common sense and protective instincts of their parents to keep doctors like Kajoko Kifuji from laying waste to them.
We all know about the hundreds of thousands of twitchy little boys who are having ADHD meds thrown at them; we should also, as UD‘s pal Allen Frances points out, think about gifted kids, whose sometimes unusual affect also excites the madness mongers. He quotes an expert on gifted children: “When pediatric diagnoses are carelessly applied, gifted children are frequently mislabeled with ADHD, autistic, depressive, or bipolar disorders.”