June 22, 2009

Despondex: Is psych mania overreaching?

First, click the image above to watch this ad for Despondex, the first-ever prescription depressant. It brilliantly captures how the pharmaceutical industry pathologizes human conditions, mints formal diagnoses to label them, and markets lucrative medications to treat them.

Take bipolar disorder in children.

It has gone from a rare condition to a common diagnosis. In an 8-year period (1994-2002), the number of children diagnosed as bipolar increased by 4,000 percent. Yes, that's right. Four thousand percent. As with the ADHD craze a few years ago, with the diagnostic labeling has come medications for about two-thirds of the newly bipolar. Medications that cause severe long-term health consequences, such as obesity and diabetes.

Now, show me a child who doesn't have radical mood swings. As Christopher Lane describes in Shyness: How Normal Behavior Became a Sickness, the steps to creating a disorder are straightforward:
  1. Conduct a study.
  2. Discover a previously overlooked problem.
  3. Label it.
  4. Create a formal diagnosis.
  5. Promote a treatment.
  6. Marginalize the critics.
Through this process, the prevalence of a disorder can be made to "rise and fall as erratically as the stock market" (to quote Kutchins & Kirk from Making Us Crazy) through adjustments to the wording, symptom duration, and the number of criteria required for diagnosis.

Indeed, we are witnessing this manufacturing process in the current effort to create a bizarre new diagnosis of "pedohebephilia" for the DSM-V, as I have blogged about more than once.

But has the psychiatric-pharmaceutical juggernaut gone too far? I am probably being overly optimistic, but I find this past week's developments mildly encouraging.

First came the research study published in the June 17 issue of the Journal of the American Medical Association, announcing flaws in the much-touted 'Depression Risk Gene' study upon which so much of our popular culture's notion of mental illness rests.

That followed exposes, such as one in the Miami Herald, of pharmaceutical drugmakers' use of ghostwriters to produce ''a huge body of medical literature that society can't trust.''

Just today came two more entries in the series of critical articles about psychiatric diagnosis and the pharmaceutical industry, in newspapers on separate continents -- the London Times and the San Francisco Chronicle.

The Chronicle's lead story focused on the diagnosis of bipolar disorder among children. The London Times article promotes a new book by the brilliant Richard Bentall (whose 1994 book, Madness Explained, deservedly won the British Psychological Book Of The Year award).

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? pulls no punches: It "paints a stark picture of a mental health system riddled with corruption and incompetence, in which shrinks live it up on pharmaceutical company cash while patients are disrespected, dehumanised and drugged to the eyeballs."

Bentall isn't some foaming-at-the-mouth anti-psychiatry extremist. He offers rational argument and scientific evidence to back up his claims about the ineffectiveness of modern psychiatric "treatment" and the weaknesses in its underlying biomedical model.

Bentall is not optimistic about change, though, because psychiatry and drug companies "have a vested interest in keeping things are they are."

I am afraid he may be right. Even in the midst of critiques pointing out the long-term harm, more people than ever are popping pills and allowing their children to pop them too. The latest rage, bipolar disorder, has so inundated popular and youth culture that it's even become an aggressive verb on the playground, as in:

"You don't watch out, man, I'm gonna go bipolar on you!"

If we don't watch out, that will be the newest mental defense to violent crime.

Photo credit: Mike "Dakinewavamon" Kline (Creative Commons license)


Neuroskeptic said...

A good post, but one thing you don't mention is that the problem is worse in the US than elsewhere. For example, "childhood bipolar" is not a common diagnosis in the UK, and indeed I've never met a British psychiatrist who would be willing to make such a diagnosis except once in a blue moon (Surely it really does happen... rarely.)

I don't know about the non-English speaking world but I suspect that the same thing holds.

Interestingly, if you go back 40 years, there was much debate over the fact that "schizophrenia" was diagnosed much more often in the US than elsewhere. This was one of the reasons why the DSM was created - in order to try to abolish "national differences" in psychiatric diagnosis.

But ironically, now we have a DSM-IV which defines up to 50% of people as mentally ill. (And I don't think it's a coincidence that DSM-IV is an American product.)

Anonymous said...

There's a label for everything... Too sad->disorder, too active->disorder, being a loner->disorder, feeling crappy before having period->disorder, being a nonconformist->disorder... And now being happy is a disorder too..? Well i'm not surprised. At all.