Edward Shorter of the University of Toronto keens over the bloated corpse of the latest Diagnostic and Statistical Manual.
The pharmaceutical industry, writes Shorter in the Wall Street Journal, “seeks the largest possible market for a given drug, and advertises huge diseases, such as major depression and schizophrenia, the scientific status of which makes insiders uneasy.”
The DSM provides pharma a market-expanding facade of empiricism. Its ever-broadening girth is a result of “increased specificity” of diagnosis within these immense major disease categories, but the specificity “is spurious. There is little risk of misdiagnosis, because the new disorders all respond to the same drugs, so in terms of treatment, the differentiation is meaningless and of benefit mainly to pharmaceutical companies that market drugs for these niches.” As a commenter on Shorter’s piece puts it, “We’re slicing up illnesses in small portions, we’re treating illnesses with very different names and symptoms with basically the same medications, and we’re at least partly doing this because drug companies have discovered the primary marketing mantra of differentiation. ”
Smartly tricked-out pills for your tailor-made depression; a whole other set for your very own anxiety. Yet “these indications are more marketing devices than scientific categories, because most depression entails anxiety and vice versa.”
The latest draft of the DSM fixes none of the problems with the previous DSM series, and even creates some new ones.
A new problem is the extension of “schizophrenia” to a larger population, with “psychosis risk syndrome.” Even if you aren’t floridly psychotic with hallucinations and delusions, eccentric behavior can nonetheless awaken the suspicion that you might someday become psychotic. Let’s say you have “disorganized speech.” This would apply to about half of my students. Pour on the Seroquel for “psychosis risk syndrome”!
DSM-V accelerates the trend of making variants on the spectrum of everyday behavior into diseases: turning grief into depression, apprehension into anxiety, and boyishness into hyperactivity. [One of Shorter’s commenters calls this disgusting development “psychosprawl.”]
If there were specific treatments for these various niches, you could argue this is good diagnostics. But, as with other forms of anxiety-depression, the SSRIs [a major category of pills] are thought good for everything. Yet to market a given indication, such as social-anxiety disorder, it’s necessary to spend hundreds of millions of dollars on registration trials to convince the FDA that your agent works for this disease that previously nobody had ever heard of.
See why your placebo with strong side effects costs so much?
And we haven’t yet touched on advertising and litigation budgets.
With DSM-V, American psychiatry is … defining ever-widening circles of the population as mentally ill with vague and undifferentiated diagnoses and treating them with powerful drugs.