Healthy Skepticism Library item: 5181

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Publication type: news

Gerstel J.
Road rager, mad spouse: Ill or nasty? : Psychiatric labels cast wide net on human foibles
Toronto Star 2006 Jun 16
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1150408210156

Notes:

Ralph Faggotter’s Comments:

Any deviation from a state of pleasant, compliant, contented equanimity is now likely to be classified as some sort of medical disorder.

Watch out for the next edition of the ‘Diagnostic and Statistical Manual of Psychiatry’ ( DSM-5), which is bound to be overflowing with dozens more new mental illnesses, fresh from Big Pharma’s creative department.

Knowing that many of the authors of the DSM are on the payroll of Big Pharma, don’t be surprised to discover that the recommended treatment for these newly ‘discovered’ disorders is an SSRI.

Full text:

Road rager, mad spouse: Ill or nasty?
Psychiatric labels cast wide net on human foibles
Jun. 16, 2006. 06:37 AM
JUDY GERSTEL
LIFE WRITER

It seems now road rage or getting angry at your spouse may be a surprisingly prevalent mental illness called Intermittent Explosive Disorder, according to psychiatrists.

Do they have many more questionable categories of mental illnesses up the sleeves of their white coats?

They do – to the dismay of Paula Caplan, a Harvard University psychologist who fought against labelling women’s premenstrual symptoms as mental disorders.

And there may be more dubious diagnoses on the way with a revision of the Diagnostic and Statistical Manual of Mental Disorders-IV now underway and due out in 2011.

“Mental illness is whatever people who come up with the definition say it is,” scoffs the former Torontonian.

Hundreds of mental illnesses, from Malingering to Academic Problem, are listed in the current DSM.

Think you’re normal and healthy? A cursory reading suggests you’re likely suffering from self-delusion.

If you have problems with your sister or brother, it may be Sibling Relational Problem.

Friction with your spouse or lack of communication? Partner Relational Problem.

Concerns about getting married or divorced? Phase of Life Problem.

Refuse to deal with your problem? Non-compliance With Treatment.

“Every time they publish, there are more categories,” says Caplan. DSM-IV, published in 1994, added more than 70 new categories, she complains.

“Did 77 new kinds of mental illness spring up? Or are they taking ordinary behaviour and calling it mental illness?”

When the psychiatrists’ diagnostic reference book first appeared in 1952, it contained descriptions of 106 illnesses. Each new version has added about 80.

Dr. Michael First, a Columbia University psychiatrist, is director of the preliminary project to review the DSM-IV. He expects fewer disorders to be added this time because “they’re hard to get rid of. It’s disruptive to eliminate a disorder people have been using.”

He says aggression will likely be a topic for the new DSM, though overall, people with mental illness are no more likely to commit violent acts than the general population. “It has not been a symptom psychiatry has focused on.”

Could that be because aggression is a male trait and psychiatry has tended to pathologize women?

“Certainly women historically are more likely to seek treatment than men and DSM has evolved as a manual for what people come in to be treated for,” he says.

Early work on the new DSM-V will review gender and culture and diagnosis, says First.

According to the website, http://www.psych.org, researchers are discussing diagnostic questions such as “determining the minimum number of panic attacks required in order to justify a diagnosis of Panic Disorder.”

Drawing the line between normal behaviour and mental illness is not simple, especially for laypeople. We tend to think other people are dysfunctional and need therapy while we think we’re perfectly normal or, at worst, mildly neurotic.

For example, is there a woman who hasn’t identified some man in her life as having Intermittent Explosive Disorder?

It’s tricky even for shrinks to decide who is normal and who requires treatment. Critics of the psychiatric establishment castigate them for tending to think that everyone who steps into the office is mentally ill.

“An awful lot of people have personality traits that get, I think, falsely labelled as personality disorders,” agrees Dr. James Morrison, an Oregon University psychiatrist and author of DSM-IV Made Easy: The Clinician’s Guide to Diagnosis and the forthcoming Diagnosis Made Easier.

Because diagnosing and treating mental illness is the raison d‘être of psychiatry – if there were no mental illness, there’d be no psychiatry – critics suggest that letting psychiatrists determine what is normal behaviour and what requires treatment is like letting the fox guard the hen house.

“My personal belief is that we do some over-diagnosis,” says Morrison. “We’ve identified an awful lot of conditions, and given them labels, that don’t necessarily result in real difficulties or problems.”

But while Morrison is dubious about studies “that purport to identify almost half of Americans as having some kind of diagnosable mental disorder” – the figure for Canadians is about one in five within their lifetime – he does believe “there’s an awful lot of mental illness out there that goes untreated.

“Many, many individuals, a substantial minority, have a diagnosable illness,” he says. “If you just think about mood disorder, substance use and depression, then, yes, there are enormous numbers of people running around loose that ought to be under treatment.”

Just because patients come with concerns doesn’t mean they’re mentally ill, says Caplan.

She says she’s been told repeatedly by people coming to her for help that the most important thing she did was to reassure them that they were just fine and not suffering from some serious mental illness.

And not everyone who threatens you on the 401 or keys your car in a parking lot is mentally ill with Intermittent Explosive Disorder. Research published in the June issue of Archives of General Psychiatry suggests that the disorder may affect 7.3 per cent of the adult American population and is 40 per cent more prevalent in males than in females.

Criteria for diagnosis includes a degree of aggressiveness “grossly out of proportion” to the situation.

“If you flip out in traffic twice, does that mean you should be labelled with a DSM-IV label?” asks Lorne Korman, head of the anger and addiction clinic at Toronto’s Centre for Addiction and Mental Health.

He says no. But, yes, there are problems with anger that need to be addressed clinically, he adds. “I have worked with many people with anger problems who did not want to be angry but couldn’t do it on their own.

“On the other hand, calling it a disorder is complicated. It’s not well-defined. I do think anger belongs in the DSM but it’s tricky. The danger in pathologizing anger is you take away people’s responsibility for conducting themselves in a civilized manner.”

Caplan is more blunt.

“It’s ridiculous to call that a mental disorder,” she insists about Intermittent Explosive Disorder.

And although she agrees violent behaviour can be linked to some mental illness, she says, “It can also come from a sense of entitlement, from the fact that no one ever stopped you from behaving that way.”

Korman hopes that, five years from now, the DSM-V will “look less at diagnostic labels and more at dimensions which better explain differences in human traits.”
Additional articles by Judy Gerstel