How to treat mental illness. Reviews of DSM-5

DSM-5 psychiatry

Rewriting DSM – Rewriting Medicine

This powerful essay Mind Field by Talitha Stevenson in the Financial Times should raise concern about psychiatry as a scientific and professional discipline. Many prominent people have queried psychiatry and here, Stevenson reviews some such authors’ new books: The Book of Woe: The DSM and the Unmaking of Psychiatry, by Gary Greenberg; Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma and the Medicalization of Ordinary Life, by Allen Frances; Cracked: Why Psychiatry is Doing More Harm than Good, by James Davies and Our Necessary Shadow: The Nature and Meaning of Psychiatry, by Tom Burns.

But it must be difficult for psychiatrists to do their job considering no-one understands the interplay between mind, brain and consciousness (like the patient during a frontal lobotomy when asked by the surgeon, do you know where I am and the patient replied, yes, you’re in my mind!) and disregarding this, psychiatrists limit themselves to treating “psychic illness,” with a physical approach. As Stevenson says, their treatment is not even based on modern brain science.

The DSM-5 has been published this month but seems to raise more questions according to previous authors. We now have more “diseases” like “adjustment disorder with mixed anxiety and depressed mood.” The DSM-4 taskforce led by Allen Frances says they thought they were dealing with a guidebook, not a bible, not a catalogue of “real” diseases.

Critical of the “diagnostic inflation” of recent years, Allen says people mustn’t be reading the “handbook” or introduction which explains the limitations of the manual.

Stevenson goes on to quote Robert Spitzer who presided over DSM-III as saying, it was a hit because “It looks very scientific…it looks like they know something.” But what do they know? she asks. Only 3% of DSM disorders have a known biological cause, the causes of the 97% are unknown. The theory that chemical imbalances cause mental illness, eg, serotonin deficiency is unproven. Psychiatric diagnoses are based on subjective judgments.

James Davies in his book Cracked quotes a 1995 meta-analysis, “85-90% of people on antidepressants are not getting any clinically meaningful benefit from the drug.”

Should we expect a life free of anxiety, anger, confusion, grief etc? The pharmaceutical industry has convinced us of a capitalist solution to a spiritual problem, Stevenson says. While helping severe disorders is one thing, pathologising normality is another. From DSM-1 to DSM-4 the number of listed disorders increased from 106 to 374 leading to epidemics of depression, bipolar and ADHD. Also, the diagnostic criteria has become more inclusive, so crossing your fingers is verging on OCD and forgetting what one went upstairs for is a brush with dissociative disorder we are warned.

DSM-5 removes a “bereavement exclusion” so grief, a reaction to job loss are now worth noting, she says. Strangely, “If we were to consider a person’s life situation,” according to Spitzer, “the whole system would fall apart.” Yes, very unstable, especially when we acknowledge psychiatry, unlike homeopathy, is not a system.

On Homeopathy and psychiatry, Dr Hahnemann, who discovered Homeopathy (the law of cure) was the first in the history of medicine to treat humanely the mentally ill.

Further Reading
You might be interested in a review of a memoir of one person’s (Barbara Taylor’s) experience of mental health care in Britain. Her book The Last Asylum is reviewed here by By Sarah Wise who  herself is the author of Inconvenient People: Lunacy, Liberty and the Mad-Doctors in Victorian England (Bodley Head).

On mental health and the young in Ireland see Breda O’ Brien’s article in The Irish Times: Click here
On flawed drug research (on Glaxo’s Paxil, known as Seroxat in Ireland) click here
Doctors ‘too reliant’ on depression questionnaire designed by Pfizer, campaigners warn Click here

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