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“Diagnostic Exuberance”…

… 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.

Margaret Soltan, May 12, 2012 10:10AM
Posted in: march of science

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10 Responses to ““Diagnostic Exuberance”…”

  1. adam Says:

    … a steaming tureen of tricyclics – now there’s a good alliterative image, UD.

    How about a Prozac pot pie for a side dish, along with Abilify in aspic and Seroquel sauce?

  2. Margaret Soltan Says:

    adam: Yummy!

  3. GTWMA Says:

    What I’ve never understood about this common focus at UD, is why psychiatry and mental health is singled out. This pattern of diagnosing (and treating) every “disorder” is characteristic of all American medicine, and the negative impacts of it are far greater in physical health than in mental health.

  4. MattF Says:

    By the time of the next edition of the Diagnostic Manual, the majority of Americans will be diagnosed with a disorder of some kind– so it will be appropriate to define a new (treatable!) disorder of ‘normality’, a condition endured by the few individuals who got missed the first time around.

  5. Margaret Soltan Says:

    GTWMA: I guess the reason I say little about it is the same reason one reads little about it in the larger culture: It’s a much more complicated subject. We can agree that high blood pressure is over-diagnosed and over-treated in this country, and that certain medical devices are implanted in bodies that don’t need them. (Indeed this blog has posted a lot about orthopedic scandals.) We can certainly talk all day about dangerous weight-reduction surgeries and some plastic surgeries. But is it really true to say that physical health is more imperiled by over-diagnosing and treating than mental? The lack of any biomarkers for mental offers an absolutely open field to medical practice and the pharmaceutical industry.

  6. Bernard Carroll Says:

    An important difference between psychiatry and the rest of medicine is the issue of CONTROL. The American Psychiatric Association imposed a top-down style of revisions in diagnostic criteria. The guiding principles were pragmatism, palatability, and payoff. Clinical science took a back seat, but it was used as a veneer. In other branches of medicine the process is bottom-up and is driven by emerging evidence as new information is gained, understood, and synthesized. A second difference is that the periodic DSM revisions aim immodestly to cover the psychiatric waterfront whereas the process occurs one disorder at a time in general medicine: When new criteria for the diagnosis of diabetes are decided, nobody feels compelled at the same time to tweak the criteria for, say, osteoporosis. A third difference is that no other professional medical organization has so assiduously profited from this activity – to the tune of tens of millions of dollars.

    At least in earlier days the process for DSM-III and DSM-IV was reasonably transparent. The architects of DSM-5, however, give a sham appearance of transparency. They have acted vindictively towards critics; they have threatened legal action to protect their trademark through contrived SLAPP notices; they shut down at least one website that provided commentary; and, in my experience, constructive suggestions simply disappear into a black hole, never to receive a collegial response.

    Who needs these people or their work product?

  7. Mickey Nardo Says:

    Who needs these people or their work product?

    Eli Lilly, JNJ, GSK, Forest, Pfizer, Upjohn, AstraZeneca, Novartis, and others…

  8. Edward Shorter Says:

    Let me just supplement Dr Carroll’s penetrating comment by pointing out that the disease-designers at DSM believe that they, too, are evidence-driven — and the studies that the Task Force bats around are legion. The problem is that all this data is being poured into corrupted vessels. Let’s say you have tons of data on the diagnosis “hysteria,” or the diagnosis “moonbeams.” The data, though ample, would be meaningless. Similarly, the main concepts of DSM, such as “major depression,” are meaningless artifacts, and gathering information on age at onset, response to treatment etc would be like lumping measles and tuberculosis together and then gathering data on that entity. DSM will never right itself in these seas of artifact. It needs to be scrapped, but, of course, won’t be.

  9. david foster Says:

    Old saying: Never ask a barber if you need a haircut.

    And if the American Barber’s Association puts out a diagnostic guide of “signs that you need a haircut right now,” one shouldn’t be surprised if it skews a little to the “yes, you sure do!” side.

  10. GTWMA Says:

    Is there a lot of over-treatment in physical health?

    Damn straight!

    While there is, no doubt, the opportunity for better evidence in physical health, there is rampant conflicts of interest that create misleading evidence, contribute to huge costs and threaten health.
    “A study published in the October 2011 issue of the British Medical Journal showed that almost half of doctors involved in setting clinical guidelines in the United States and Canada for diabetes and cholesterol between 2000 and 2010 had conflicts of interest.”

    And, yes, UD, when errors and hospital acquired infections, are causing tens of thousands of deaths, when 2 percent of all cancers in the US are attributed to overuse of CT scans, when overuse of antibiotics is responsible for runaway resistant strains that cause death and injury, overtreatment in physical health, I think any objective observer would say, is at least as big, if not a much bigger, threat to health.

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