Article: "medicine's Big New Battleground: Does Mental Illness Really Exist?"
Posted 21 December 2014 - 07:33 PM
The Guardian (UK), 5/11/2013
From the article:
The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis.
It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.
But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.
Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.
A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"
Posted 21 December 2014 - 07:50 PM
It is essentially human nature to label things why would mental health specialists be any different?
If we as a group think that mental health specialists (ie psychiatrists) work strictly from this one book and can't tell the difference between a temporary problem and a serious mental health issue then we do need help.
Big Pharma doesn't just manufacture drugs for mental health, there are thousands of other medications that they produce that have saved or improved millions of lives.
Again we are guilty of doing that very human thing of labeling an entire industry as bad when it is only a small portion of what they do that is questionable and the demand for antidepressants was started not by them to begin with but by experimentation of research people which is how many diseases have been cured or survivable. Yes mistakes have been made over the years in many fields but again, human nature being what it is, we keep trying.
"I have not failed, not once. I've simply discovered 10,000 ways that don't work." ~ Thomas Edison
Posted 21 December 2014 - 11:29 PM
successful healthcare is the result of a partnership between a doctor and the patient. that means the patient is best served by applying the feedback they get from their physician. Examples include dietary changes to lower cholesterol and/or blood pressure, quitting smoking to reduce the risk of heart disease and losing weight to reduce the risk of diabetes 2. when the patient does not chose to change their behaviors and/or lifestyles, the chances for success are diminished.
as healthcare systems begin to implement a pay for performance model of compensation, physicians will rely more and more on the quick fix to lower blood pressure, lower cholesterol and create other "positive outcomes" that will result in their increased compensation. they can't afford a non-cooperative patient. the results shifts the burden of success onto the doctor not the patient.
i just read in the orlando sentinel today that $117 BILLION dollars are spent in the united states every year on smoking related healthcare. that alone presents a sobering argument on a patient's unwillingness to participate in their own successful health outcomes. so what is a doctor to do? write more 'scrips.
the pharmaceutical industry is at the forefront of pushing the pay for performance model in nationalized healthcare systems as well as other forms of government subsidized care.
when it comes to behavioral medicine, the quickest "successful" outcome is through psychiatric drugs. when it comes to depression, in study after study, talk therapy such as CBT has demonstrated a higher rate of success than antidepressants alone. however, drugs are now the go-to method, often bypassing the psychiatrist altogether with the general practitioner more likely to put a patient on antidepressants for the first time - not a psychiatrist. additionally, there is a growing trend of creating expanded uses of psychiatric drugs as well as creating new diagnoses that require treatment from those same psychiatric drugs. as adoption of the pay for performance model grows, so will the prescription rates for these drugs, they are not the only tool in the box and often should not be the first one used.
in his editorial in today's orlando sentinel, scott maxwell discusses florida's mental health crises . i agree that it is tragic that most state-funded mental health care exists in florida's jails. it is in everyone's best interest for the seriously mentally ill - those suffering from schizophrenia, bipolar disorder and depression with psychotic features - to get the help they need before they end up behind bars. no doubt there is a serious need for psychiatric drugs.
i wish i could provide links to both referenced articles, however they are behind the "pay wall" on the orlando sentinel's web site.
the take away here - there must be a balance. there are good doctors and there are bad doctors. there are good drugs and there are bad drugs. there are good practices and there are bad practices. its our responsibility to be aware and get educated.
Posted 22 December 2014 - 09:51 AM
Posted 22 December 2014 - 10:26 AM
FN: thanks for checking on that. originally it was only avail to those who subscribe, but as you've discovered its unlocked. as for the reuters article, yes that is the same one. i was citing from memory so yes, you got the correct figure. the once thing that also makes me a little uncomfortable in scott's commentary is the suggestion of teachers and the school system reporting what they see. while this on the surface sounds almost like a no brainer, it has produced mixed results when it comes to kids who eventually receive a diagnosis of ADHD. the teachers reporting is often used to a great degree in the diagnosis. getting the kids on a med is easier for him/her. this is NOT always the case, they are often showing genuine concern and there are many doctors who catch the bias and reject ADHD as the problem. its also important for the doctor to recognize that the teacher's viewpoint is not as a medical expert, but as an educator who has to juggle many kids in a dynamic environment. not to mention that teachers are also facing the pay for performance model of compensation - known as "merit pay". much of the influence of a student's or patient's outcome is beyond the control of a teacher or a doctor. the added pressure or desire to increase compensation drives the "quick fix" option.
these links provide some insight into the teacher's "role" in the ADHD diagnosis.
this wiki article gives some better understanding of the pay for performance model in healthcare. something that i neglected to mention is that it is creeping up in private insurance as well
i'd also like to add something that i posted months and months ago about where our healthcare dollars go. for every dollar you spend on insurance premiums, 20% goes to pharmaceutical companies - they get the largest single piece of the pie. and if you were wondering how much the insurance companies themselves get to keep? 3%.
i searched and cannot find that article, i provided a link and even copy and pasted a graphic. FN maybe you can find that one?
again this is all food for thought. i am no expert,
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