The author of a new book about growing is interviewed.
[G]etting a mental-health diagnosis can intersect with the adolescent search for self. Being diagnosed and using medication confers an identity, that of someone with a mental disorder. To an adolescent who is preoccupied with constructing an identity anyway, and looking for clues to who she is, that can be a big deal. Some adolescents feel that having a diagnostic label is clarifying and that it helps them. But others wrestle with it. They ruminate about what it means to be sick. They take that identity deep inside, and sometimes magnify it way out of proportion. A diagnosis event can have lasting, rippling consequences, and I think adults should be very cautious and careful before they impose a diagnostic label, or let a young person self-impose such a label, on what may be ordinary developmental struggles.
But hey. That’s nothing. Because of the work of Joseph Biederman and others, it’s now routine for American toddlers to be given powerful psychotropics.
What? You mean thousands of people aren’t attracted to meetings featuring Charles Nemeroff and Alan Schatzberg?
Allen Frances goes on to say that “Psychiatric diagnosis has become too important to be left in the hands of a small, withering, cash-strapped, incompetent association that feels compelled to regard its bottom line as a higher priority than having a safe, scientifically sound, and widely accepted diagnostic system.”
Look at the Pope over there in Vatican City taking a star turn in What the Butler Saw as his city state fails to “shed its reputation as a scandal plagued tax haven.”
Look at the big happy family of University of Texas scientists who just went ahead and gave the family a huge state grant, without bothering to check with the provost or anything.
And look at another huge bureaucracy, the place UD‘s father spent his entire scientific career: the National Institutes of Health. The NIH just went ahead and gave America’s own tête d’affiche pour conflit d’intérêts (Charles Nemeroff has been called poster boy for conflict of interest so many times, I thought I’d jazz it up by putting it in French) another big grant, since you want to encourage his sort of behavior… or whatever…
I mean, it’s about bureaucracies, isn’t it? In all three cases? You’ve got cronies and histories of you do me and I do you and all… Everybody’s in everybody else’s pocket…
But eventually, as in all three of these cases, things get so brazen that the media notices; and then, if the money involved comes from taxpayers, politicians get all het up about it. As in this what the fuck? letter from Senator Charles Grassley to NIH. Grassley sends a copy to the notorious Donna Shalala.
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More coverage of the nettlesome Nemeroff.
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The latest University of Miami scandal jumps to the Miami Herald. Shalala and Nemeroff are trying out the no comment option, but I don’t think it’s going to work.
… Andrew Scull titles his latest essay in the Times Literary Supplement. It looks to be a good summary of the ongoing scandal of the next edition of the Diagnostic and Statistical Manual of Mental Disorders, but you and I can’t read it without a subscription. Here’s an excerpt (from a post about it in Commonweal):
As diagnostic criteria were loosened [in DSM III], an extraordinary expansion of the numbers of mentally sick individuals ensued. This has been particular evident among, but by no means confined to, the ranks of the young. “Juvenile biopolar disorder”, for example, increased forty-fold in just a decade, between 1994 and 2004. An autism epidemic broke out, as a formerly rare condition, seen in less than one in 500 children at the outset of the same decade, was found among one in every ninety children only ten years later. The story for hyperactivity, subsequently relabelled ADHD, is similar, with 10 per cent of male American children now taking pills daily for their “disease”. Among adults, one in every seventy-six Americans qualified for welfare payments based on mental disability by 2007.
If psychiatrists’ inability to agree among themselves on a diagnosis threatened to make them a laughing stock in the 1970s, the relabelling of a host of ordinary life events as psychiatric pathology now seems to promise more of the same. Social anxiety disorder, oppositional defiant disorder, school phobia, narcissistic and borderline personality disorders are apparently now to be joined by such things as pathological gambling, binge eating disorder, hypersexuality disorder, temper dysregulation disorder, mixed anxiety depressive disorder, minor neurocognitive disorder, and attenuated psychotic symptoms syndrome.
Yet we are almost as far removed as ever from understanding the etiological roots of major psychiatric disorders, let alone these more controversial diagnoses (which many people would argue do not belong in the medical arena in the first place). That these diagnoses provide lucrative new markets for psychopharmacology’s products raises questions in many minds about whether commercial concerns are illegitimately driving the expansion of the psychiatric universe – a concern that is scarcely allayed when one recalls that the great majority of the members of the DSM task force are recipients of drug company largesse.
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New pathologies are breaking out all the time.
There’s a whole other category for Kim Kardashian.
(UD thanks David.)
One quarter of you have already been flushed out and diagnosed!
The massive “naturalist’s field guide” that is the Diagnostic and Statistical Manual of Mental Disorders has already tagged and bagged you.
A most serious problem, common to field guides, is the difficulty of separating entities that are similar in appearance.
The new emphasis on symptoms… has unfortunately encouraged a cursory “top-down” method that relies on checklists and ignores much of the narrative of …patients’ lives.
You coo like a mourning dove. But maybe you’re not depressed!
[P]sychiatrists using the DSM diagnosis “major depression” tend to mingle bereaved patients with both those afflicted by classic melancholia and those demoralized by circumstances. The mixing of similar-appearing patients who have conditions that are distinct in nature probably explains why use of this diagnostic category expanded over time and suggests why the effectiveness of antidepressant medications given to people with a diagnosis of major depression has, of late, been questioned. This tendency to blur natural distinctions may explain why other DSM diagnoses — such as post-traumatic stress disorder (PTSD) and attention deficit disorder — have been overused, if not abused.
And don’t forget Hartz Mountain Industries.
[A] diagnostic category based on checklists can be promoted by industries or persons seeking to profit from marketing its recognition; indeed, pharmaceutical companies have notoriously promoted several DSM diagnoses in the categories of anxiety and depression.
… is the name UD‘s blogpal Allen Frances gives the tendency of the people at the American Psychiatric Association to toss every human behavior they can think of into the soon-to-be released update of the Diagnostic and Statistical Manual of Mental Disorders. The new DSM will guarantee every American man, woman, and child forty acres, a mule, and a diagnosis.
Everybody gets to be something: depressed, pre-psychotic… Everybody gets the same diagnostic-labeling start in life. The children of the very rich will no longer get diagnosed before those of the middle class; everyone starts out with ADD or executive functioning disorder or what have you, and parity is maintained throughout the subsequent years, with adolescent, young adult, middle-aged, and elderly diagnoses following each American all the days of her life. As Frances writes, this “radical expansion of the boundaries of psychiatry … will increase by tens of millions the number of people presumed to be suffering from mental disorders.”
The key is indeed diagnostic exuberance, or what others have called psychosprawl. The combination of a regularly updated official manual massively increasing our diagnosable behaviors, under-informed pill-happy primary physicians, and unremitting advertising, means a psychotropic harvest the likes of which this country has never seen. To picture it, replace the turkey in this woman’s hands with a steaming tureen of tricyclics.
“Is the American Psychiatric Association getting carried away?” as Christopher Lane asks, in an interview about the notorious DSM.
“The risk is that the drug companies will seize on the milder conditions [listed in the DSM] and hype and exaggerate them through very canny marketing to the point where they’re basically represented as an under-reported problem…. The thresholds are [regularly] lowered for these disorders… and consequently vast numbers of the public are suddenly eligible for a diagnosis that they wouldn’t have been before.”
He notes that if the current version of the DSM gets published, children as young as four will be eligible for powerful anti-psychotic drugs, and people still grieving the loss of someone after two weeks will also be eligible for a mentally disordered diagnosis and powerful drugs.
Next month, activists plan to stage an “Occupy the APA” protest in Philadelphia during the organization’s annual conference to show their disdain.
Happy face research articles get published; sad face perish. “Positive studies are exciting and potentially groundbreaking. Negative studies are not particularly exciting,” and tend not to get published in the scientific journals, a pediatrics professor explains in an editorial in one such journal.
Indeed, it’s difficult to get hold of the results of studies showing that this or that drug or class of drugs has no effect on a condition:
Current U.S. law requires that investigators submit a summary of the results of drug trials on ClinicalTrials.gov, a national registry of clinical studies. But often, researchers don’t submit their results, and the information is never published on the government website…
After all, the drug market has hundreds of millions of anti-depressant pills to sell, and, if you’re a researcher, you have a career to make.
Things only begin to get real when someone actually makes an effort to do a meta-analysis.
The Italian professor who led an experiment which initially appeared to challenge one of the fundaments of modern physics by showing particles moving faster than the speed of light, has resigned after the finding was overturned earlier this month.
… all gone!
In the age of Big Pharma, we have, of course come to medicalize [anxious] thoughts — not to mention just about every other whim and pang. When I once confided with a physician friend that one of my children seemed to overheat with anxiety around tests, he smiled kindly and literally assured, “No need to worry about that, we have a cure for anxiety today.” On current reckoning, anxiety is a symptom, a problem, but Kierkegaard insists, “Only a prosaic stupidity maintains that this (anxiety) is a disorganization.” And again, if a “speaker maintains that the great thing about him is that he has never been in anxiety, I will gladly provide him with my explanation: that is because he is very spiritless. ”
“It is not a disease and it has no place in a book dedicated to listing mental disorders,” write two observers in Slate, as they anticipate (dread, really… dread is probably a billable disorder too… or will soon be…) the phenomenon of our grief at the loss of people we love entering the Diagnostic and Statistical pantheon. “The new diagnosis, spearheaded by two professors of psychiatry, Katherine Shear and Holly Prigerson, at Columbia and Harvard University,” will go after melancholic malingerers, sickos who stay sad beyond happiness’s due date.
So what are the downsides of treating grief as a disease? For one thing, more people will be prescribed antidepressants that can have adverse physical and psychological side effects, including increased risk of suicide and addiction and withdrawal problems. (To date, the research has consistently shown that grief counseling and medications do not alleviate grief; they seem most helpful in the cases of people who had pre-existing mental health issues.) It also means that more people will feel shame and embarrassment about not grieving “properly” or getting over their loss fast enough. And the very language of “symptoms” and “duration” seems only to further diminish the significant event that precipitated these feelings in the first place — the death of a beloved person who can’t be replaced.
On the other hand – America’s already crawling with millions of people who shouldn’t be on antidepressants – what’s a few more? C’mon in! Water’s fine!
And there’s so much money in it. Think of it! Convincing non-mourning people they’re depressed is tricky – you need wall-to-wall advertisements. Convincing mourning people? Piece of cake.
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Once pill distribution begins, mentally disordered poems like this one will be a thing of the past:
The Eden of the Author of Sleep
By Brian Teare
for Jean
And sleep to grief as air is to the rain,
upon waking, no explanation, just blue
spoons of the eucalyptus measuring
and pouring torrents. A kind of winter.
As if what is real had been buried
and all sure surfaces blurred. Is it me
or the world, risen from beneath?
Mind refining ruin, or an outside
unseen hand, working—as if with
a small brush, for clarity—the details?
To open my eyes is the shape of a city
rising slowly through sand. Cloudy
quartz, my throat, cut unadorned
from the quarry, stone of city cemetery
and roads, to breathe is a mausoleum
breached. To think of Eden is speech
to fill a grave, tree in which knowledge
augurs only its limits, the word snake
a thought crawling in the shadow
of its body. Was it, Adam, like this
always, intellect in the mind’s small sty
miming confinement for meaning, sleep
to grief as air is to the rain, upon waking,
the world’s own weapons turned against it—
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I mean, just look at this guy, luxuriating in it (how long has it been since his dedicatee died, I wonder?), wallowing in his misery instead of getting over it!
The Eden of the Author of Sleep
By Brian Teare
for Jean
And sleep to grief as air is to the rain,
[Lost in vaporous air. Disturbing symptom right off the bat. Sleep disturbance.]
upon waking, no explanation, just blue
spoons of the eucalyptus measuring
and pouring torrents. [Describes himself as permanently under a rainstorm. Classic sign of depression. Nice assonance on the u‘s of blue, spoons, eucalyptus, by the way.] A kind of winter.
As if what is real had been buried
and all sure surfaces blurred. [Diminished sense of reality. Pre-psychotic.] Is it me
or the world, risen from beneath? [It’s you. Consult your doctor.]
Mind refining ruin, or an outside
unseen hand, working — is if with
a small brush, for clarity — the details? [Mentally going over and over the details of the lost loved person, life before, whatever. ]
To open my eyes is the shape of a city
rising slowly through sand. [Slowed thoughts – Depression 101.] Cloudy
quartz, my throat, cut unadorned
from the quarry, stone of city cemetery [Strikingly morbid poem.]
and roads, to breathe is a mausoleum
breached. [Reports feeling that every breath he takes is an approach to the loved one’s grave. Abnormal.] To think of Eden is speech
to fill a grave, tree in which knowledge
augurs only its limits, the word snake
a thought crawling in the shadow
of its body. [Hopelessness. Words seem meaningless, understanding impossible.] Was it, Adam, like this
always, intellect in the mind’s small sty
miming confinement for meaning, [Seems to feel he can only function by becoming a mental midget.] sleep
to grief as air is to the rain, [Note the recurrence of this phrase. Circular thinking.] upon waking,
the world’s own weapons turned against it— [Clear cry for help here.]
UD thanks Dirk.
In academia, the competition for grant money and prominent journal publication breeds exaggeration as to the importance of research programs, their past successes, and their future chances. The worst of these cross over the line into fraud, some of which makes the headlines, but even the honest stuff (the huge majority) is best-foot-forward all the time. You learn, after a short time doing research yourself, to mentally adjust for the titles of papers, presentations, and (most especially) press releases.
Derek Lowe reminds us of a basic and abiding truth behind many of the posts on this blog, and other blogs, like Health Care Renewal and Retraction Watch: The system’s pretty well rigged against strict research integrity, a fact that endangers universities in particular and everyone’s health in general.
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UPDATE: A Case in Point.
Brown’s cozy friendship with pharmaceutical companies should concern every one of us. The University’s failure to launch a public investigation into Keller’s research threatens the integrity of other research coming from Brown. Not only does it discredit Brown’s integrity as a research university, but it also threatens patient safety since doctors are misinformed about the negative side-effects of drugs they are prescribing. The University should be devoted to researching medicine for the sake of benefiting humanity, not corporate profits.
An eloquent opinion piece by a Brown University undergrad revisits the ongoing scandal of Martin Keller. Background here.
UD thanks Roy.
UD has been following the effort of legitimate scientists in Australia to keep pseudo-science out of university classrooms there.
I mean, it’s already in. There’s lots of reflexology and aromatherapy and shit in Australian university curricula. The Friends of Science in Medicine are trying get some of that out, and to prevent new stuff from entering.
The real leader in these legitimizing efforts is England, which has not only been making it more difficult for doctors there to throw antidepressants around like candy (for many people, they seem to be expensive, side-effect-ridden, placebos), but has also made it “no longer … possible to receive degrees in alternative medicine from publicly funded universities.”
UD‘s US of A has also been good at keeping out the pseuds (see Florida State’s successful battle to break the back of the chiropractors), but backwaters like Australia will take longer to grasp the concept of empiricism. We must be patient with them.
In time, Australia will do what we’ve done here – establish a system of diploma mills that hand out Decompression Therapy degrees.
Some of the arguments the cornered pseuds make are quite something. One popular line is that you want pseuds in college rather than out, because they may as well get some training – it’s less dangerous to the general population that way. As the head of an Aussie pseud group pompously puts it: “In order to safeguard the public, practitioners of these modalities need to be part of the same rigorous training and education as other health professionals.” Yeah and there’s mucho, mucho modalities out there, aren’t there… So… you want to safeguard the population by putting all the modalities in the university. Millions of people organize their lives around what astrologers tell them, and yet we have no way of being sure those astrologers are properly trained, so we need to offer PhDs in astrology.
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UD thanks Dirk.
