On the pathologisation of everyday life as mental illness

"Because of diagnostic inflation, an excessive proportion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds. We are becoming a society of pill poppers. One out of every five U.S. adults uses at least one drug for a psychiatric problem; 11 percent of all adults took an antidepressant in 2010; nearly 4 percent of our children are on a stimulant and 4 percent of our teenagers are taking an antidepressant; 25 percent of nursing home residents are given antipsychotics. In Canada between 2005 and 2009, the use of psychostimulants went up by 36 percent, and SSRIs by 44 percent.

Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs. When their products are used carelessly, the drug companies can be as dangerous as the drug cartels...

Expenditure on antipsychotics has tripled, and antidepressant use nearly quadrupled from 1988 to 2008. And the wrong doctors are giving out the pills. Eighty percent of prescriptions are written by primary-care physicians with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed seven-minute appointments, with no systematic auditing.

There is also a topsy-turvy misallocation of resources: way too much treatment is given to the normal “worried well” who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don’t get treated for it, and many suffering with schizophrenia wind up in prisons... DSM-5 seemed to be moving in just the wrong direction, adding new diagnoses that would turn everyday anxiety, eccentricity, forgetting, and bad eating habits into mental disorders. Meanwhile the truly ill would be even more ignored as psychiatry expanded its boundaries to include many who are better considered normal...

By far the most disturbing conversation was with one of my oldest friends in psychiatry—a man of wisdom, experience, and integrity whose entire career had been dedicated to reducing the suffering caused by schizophrenia. He was convinced that DSM-5 could make a game-changing difference by introducing a new diagnosis called “psychosis risk syndrome” that would encourage the early identification and preventive treatment of youngsters who might otherwise eventually become schizophrenic. My friend wanted to provide an ounce of early prevention that could substitute for a pound of later cure. Once the brain has already become sick, it is harder to make it well again—the more practiced are the circuits generating delusions and hallucination, the more difficult it will eventually be to turn them off. How wonderful then to prevent schizophrenia altogether, or failing that, at least to reduce the overall burden of the illness.

My friend’s goal was noble, but there were five compelling strikes against it. Strike 1: most people getting the scary-sounding diagnosis “psychosis risk” would in fact be mislabeled—in the normal course of events, only a very small proportion would ever become psychotic. Strike 2: there is no proven way to prevent psychosis, even in those really at risk for developing it. Strike 3: many people would suffer collateral damage—receiving unnecessary antipsychotic drugs that can cause obesity, diabetes, heart disease, and likely a shortened life expectancy. Strike 4: think of the stigma and worry caused by the completely misleading implication that psychosis is just around the corner. Strike 5: since when is having a “risk” the same as having a “disease”? I tried but failed to change his mind, or even to open it the slightest bit. “Psychosis risk” was off and running. My friend’s dream would surely cause a nightmare of disastrous unintended consequences.

As I drifted around the party, I met many other friends working on DSM-5 who were similarly excited by their pet innovations and soon discovered that I personally qualified for many of the new disorders that were being suggested by them for inclusion for DSM-5. My gorging on the delectable shrimp and ribs was DSM-5 “binge eating disorder.” My forgetting names and faces would be covered by DSM-5 “minor neurocognitive disorder.” My worries and sadness were going to be “mixed anxiety/depressive disorder.” The grief I felt when my wife died was “major depressive disorder.” My well-known hyperactivity and distractibility were clear signs of “adult attention deficit disorder.” An hour of amiable chatting with old friends, and I had already acquired five new DSM diagnoses. And let’s not forget my six-year-old identical twin grandsons—their temper tantrums were no longer just annoying; they had “temper dysregulation disorder.”...

Bob Spitzer, the great psychiatric innovator who had been most responsible for creating DSM-III, had for years been sounding loud public alarms. He was upset that the American Psychiatric Association was forcing the people working on DSM-5 to sign confidentiality agreements intended to protect APA’s “intellectual property.”...

If “psychosis risk” made it into DSM-5, innocent kids might become obese and die early receiving unnecessary medication for a fake diagnosis."

--- Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life / Allen Frances