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—

********************************************

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.

————————–

UD thanks Dirk.

Although UD loves this headline, it made her laugh, it’s fun fun fun, she can already see its inclusion in Occupy Wall Street’s Statement of Principles — she feels bound to remind herself, and you, her reader, of what psychological studies are worth these days.

In recent years, psychologists have reported a raft of findings on race biases, brain imaging and even extrasensory perception that have not stood up to scrutiny.

… In a survey of more than 2,000 American psychologists scheduled to be published this year, Leslie John of Harvard Business School and two colleagues found that 70 percent had acknowledged, anonymously, to cutting some corners in reporting data. About a third said they had reported an unexpected finding as predicted from the start, and about 1 percent admitted to falsifying data.

I’m just telling you this so that when in fact only one out of every thirty Wall Street employees turns out to be a psychopath you won’t be disappointed.

… alarms really should go off. You shouldn’t be surprised that people like Bharat B. Aggarwal are under investigation for

fabrication and falsification in a host of published studies [65 and counting, to be precise] about the cancer-fighting properties of plants.

I mean, look at the page, please. This person tells us he has seven professorships:

Member, University of Texas Graduate School of Biomedical Sciences, Houston

Chief, Cytokine Research Section, in the Department of Experimental Therapeutics at the University of Texas M. D. Anderson Cancer Center, Houston, Texas

He’s published over six hundred papers… Of course, this number doesn’t raise eyebrows because other med professors say they’ve published a thousand… two thousand… a zillion squared…. When you’re one of thirty authors listed at the top of a page, when you’re a lab chief who probably did squat on most of the studies, the sky’s the limit. Go for it.

You’re seven professors at once, and you’ve published six hundred papers, and you’ve been invited to give 324 lectures in fifty countries… But you still have time to

[manipulate your] images – adding or subtracting features, cropping, stretching, rotating, flipping horizontally or vertically – to leave the impression the same ones represented different experimental conditions.

… when asbestos companies could sponsor industry-friendly research at some of our best universities!

A letter signed by dozens of prominent scientists, including some McGill faculty members, was sent to McGill’s top administrators the same day a documentary aired on CBC Television on the [asbestos industry]. Both the letter and the documentary suggested McGill researchers had been paid by the … industry to doctor research to make chrysotile asbestos seem less harmful to human health than it is, or than other forms of the fibrous mineral.

Back in ’02, a Brown University professor made the same claim to McGill, but I guess since it just came from one guy they dismissed it. Now a crowd seems to be forming.

The Australian commenter posing this question can look over here, at the States, to see what a national sedation policy might look like.

Not that every one of us has been zoned by Zeneca… mummified by Merck… Lalalanded by Lilly… but, you know, tens of millions of Americans have gotten there, and – out-of-it-wise – we’re way more advanced than the Aussies. Our best poets sing of it:

Let us go then, you and I,
Where America is spread out against the sky
Like a nation etherized upon a table…

In one particular way, Australia looked for awhile as though it might overtake us – i.e., in government-sponsored anti-psychotic dosing of children without psychotic symptoms.

To be sure, we’ve got Joseph Biederman (type his name into this blog’s search engine and enjoy).

But Australia’s got Patrick McGorry who, until he (under pressure from scientists around the world) abandoned the idea, thought it might be clever to experiment with giving fifteen-year-olds he determined to be “pre-psychotic” powerful antipsychotic drugs. Some people thought it wasn’t too cool to give “children who had not yet been diagnosed with a psychotic illness…. drugs with potentially dangerous side effects.” So last summer McGorry dropped the idea.

And now – under equally strong pressure from an outraged scientific community, McGorry has gone one step further.

Concerns about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Drug companies must be mildly dismayed. (Only mildly, because they’ll find a way around this.) Popular American news shows are pointing out that for most people anti-depressants are placebos with serious side effects. Critics are attacking the idea of a grief pill. And now the packed-with-potential idea of pre-psychosis (who ain’t pre-? and when will they figure out that an even niftier idea is clinically pre-neurotic?) is being savaged simply because some people think giving symptom-free people immensely powerful drugs is unethical!

Zoom in on the bigger picture here, if you will. Through incessant advertising, and through incentivized research professors at our universities, the drug industry is slowly rebuilding our basic human self-appraisals. We simply cannot get through life without pills.

… an “explosive” segment on anti-depressants as no better than placebos for the vast majority of people taking them? Will it be, as promised, explosive? Harvard’s Irving Kirsch will talk about his research, featured in The Emperor’s New Clothes: Exploding the Antidepressant Myth – another promised explosion. Marcia Angell’s review of his and other books on the subject in the New York Review of Books was also, I guess, explosive… But so far that essay prompted only a flaccid little response from Peter Kramer in the New York Times.

We’ve heard nothing from the companies that make billions of dollars off the sale of do-nothing, stuffed-with-side-effects drugs except for what they told Stahl: They work. Kramer said the same thing: “[I]t is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not.”

Dangerous!

But why are Kramer and company doing little other than repeating, while speaking darkly of risk, that antidepressants work?

Et alors. I’m not sure major attention even of the sort 60 Minutes represents will constitute a bombshell. Positions here are and have long been entrenched, and you don’t exactly kiss goodbye a ten billion dollar enterprise without a struggle.

And millions of Americans – despite witnessing an extremely loud and incredibly close prescription pill epidemic – seem wedded to a sense of themselves as chemically dependent. Indeed to a sense of life itself as the sort of thing you need Prozac to pursue.