Marcia Angell just had the second part of her article on drugs and psychiatry published in the New York Review. She references three recent books on the subject; The Emperors New Drugs by Irving Kirsch, Anatomy of an Epidemic by Robert Whitaker and Unhinged by Daniel Carlat all of which paint a bleak picture of a border-line corrupt US medical institution founded on subjectivity and greed.I've always been suspicious of pharmaceutical companies and the medical profession in general. My policy on being ill is to tough it out and get over it. Anything longer than a week might mean asking someone non-medical for advice but that's as far as it goes. It strikes me as conflicting that an institution that makes money off the sick would want a 'healthy' consumer base. This is of particular concern in the US, where the lack of a welfare state and the proliferation of 'lifestyle' advertising make being sick a hugely lucrative market. The problem is, if people aen't bleeding, it's very hard to sell them bandages. Unless you convince them there's something wrong in their heads;
Of the 170 contributors to the current version of the [American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders] DSM (the DSM-IV-TR), almost all of whom would be described as KOLs [Key Industry Leaders], ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.The DSM is the single source of all knowledge in psychiatric diagnosis. It is the only thing a psychiatrist turns to when looking for answers and it's construction is almost universally recognised as haphazard, subjective and financially motivated. "Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions."
Angell points out that the intellectual clout of a trained medical professional is enough to convince a patient of almost anything and the sheer range and variety of possible diagnoses in the new DSM (version 5) means that, according to one anonymous insider, 30-50% of individuals could now be said to have some sort of medical disorder. Angell points out how psychiatrists and pharmaceutical companies even jumped on board with children when they realised that the main target audience for treatment wasn't young professionals with disposable income as it had been in the 1970's and 80's but the children of those same young professionals:
The apparent prevalence of “juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of “autism” increased from one in five hundred children to one in ninety over the same decade. Ten percent of ten-year-old boys now take daily stimulants for ADHD—”attention deficit/hyperactivity disorder”—and 500,000 children take antipsychotic drugs.She writes of Carlat's experiece, himself a trained psychiatrist:
His work consists of asking patients a series of questions about their symptoms to see whether they match up with any of the disorders in the DSM. This matching exercise, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels.” Often patients meet criteria for more than one diagnosis, because there is overlap in symptoms.
The reason this practice continues is that it works. Whitaker tells us that when a patient is diagnosed with a disorder that could just as easily be anything else they are prescribed drugs that would just as easily treat anything else - an effective placebo effect of both drug and diagnosis which, with the publication of books and articles is gradually working it's way up the chain back to the DSM. The DSM-5 wil feature 365 separate "disorders" - many of which hugely overlap and for the first time there is strong opposition growing to the vice-like grip that the culture of over-diagnosis has over the American public.This isn't even a uniquely American problem. Jon Ronson's The Psychopath Test (see here) deals with the problems of the imperfect definitions of sanity and insanity by simply pointing out that we're all psychopathic to some extent, and applying the standard test for psychopathy - the Robert Hare Checklist - to the world outside of institutions and prisons reveals most of the world's business and political leaders as classic psychopaths. They have the ability to exercise their desire for power and so may never physically eat the heart of another human being maybe, but they make decisions that can shatter people's lives.
It wasn't only Hare who believed that a disproportionate number of psychopaths can be found in high places. Over the following months, I spoke to scores of psychologists who all said the same. Everyone in the field seemed to regard psychopaths in this same way: inhuman, relentlessly wicked forces, whirlwinds of malevolence, forever harming society but impossible to identify unless you're trained in the subtle art of spotting them, as I now was.Ronson writes on the different schools of thinking about mental disorder - exemplified through the severity of psychopathy. There are those who believe it's curable as it's something that has gown through circumstance, those who believe that it's incurable and psychopaths are biologically pre-disposed and those who believe that we're all mad to a greater or lesser degree and so any diagnosis by anyone on anyone else is entirely subjective.
I met an American CEO, Al Dunlap, formerly of the Sunbeam Corporation, who redefined a great many of the psychopath traits to me as "business positives": Grandiose sense of self-worth? "You've got to believe in yourself." (As he told me this, he was standing underneath a giant oil painting of himself.) Cunning/manipulative? "That's leadership."
So we're all mad, and mad people are trained by psychopaths to tell us we're mad so that we'll buy drugs that make us subjectively less mad, and then the years go by and people start to question the madness of an influential, wealthy system of institution and business set up to circulate these beliefs and try not to come across as mad. Sound familiar?
