July 18, 2006

Ever-growing list of mental illnesses met by skepticism

Special thanks to Cannonier for pointing out this news story about the ever-growing list of what the APA (American Psychiatric Association) is calling a "mental illness".

We can see the point of Dr. Torrey's opinion - that the more that relatively minor personality defects are classified as "mental illness" - the more the serious mental illnesses like schizophrenia are trivialized. When almost everyone is classified as mentally ill - it really suggests that nobody is (because most people don't consider themselves mentally ill).

It also will tend to result in fewer resources being dedicated to the most serious disorders - like schizophrenia - in terms of research dollars, and clinical emphasis. It also gives "cover" to insurance companies in the US that would like to completely avoid covering any mental illnesses - and if the DSM implies that everyone is mentally ill, then the insurance companies will claim that they can't pay for everyone to get their "mental illness" treated. Similarly, in the court system, lawyers will use these broad DSM guidlines to "prove" that their angry client who participated in a crime is actually "mentally ill" - and it will create a backlash in popular opinion that will further reduce the likelihood that any leniency will be given to the truly mentally ill in the US court system (not that there is much evidence of such leniency at present).

On the positive side - perhaps if a large percent of the population is classified as "mentally ill" - it might reduce stigma.

We also realize - to acknowledge the APA position - that its extremely difficult to categorize and classify mental illnesses. The brain is an extremely complex organ - and we don't understand it as well as we need to.

The story notes:

When researchers announced that 16 million Americans who fly into occasional fits of unwarranted rage may suffer from a mental illness called "intermittent explosive disorder," the diagnosis drew its share of hoots and howls.

"Your grandmother would say these are bad folks who can't control their temper, and she would be right," said Dr. E. Fuller Torrey, an outspoken schizophrenia expert alarmed by the ever-expanding list of behaviors and attitudes branded as illnesses.

Torrey and other critics point to the volume that doctors use to determine mental illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM), as evidence that the world is out of control.

Read the full story: Behaving badly has disorder to call its own


as always, it depends on how the manual is used or misused; the dsm has a very lengthy companion book explaining how they intend diagnoses to be used, and they never suggest that diagnoses should be used in the way Fuller suggests. i have not seen anyone diagnosed with IED who did not have a very, very serious problem that went WAY beyond 'having a bad temper' or 'behaving badly'. both the people i have been more closely acquainted with that had been diagnosed with this, had serious head injuries that severely affected the functioning of their frontal lobes, which help to control and drive behavior. this was along the lines of a pin would drop, and they would explode in such a way that onlookers often were convinced they were actually having seizures. it has to be seen to be believed. one guy, on seeing a video tape of himself in an episode, could only say, 'Oh my God - is that me?' and he was completely serious.

any diagnosis can be misused. when they are, the dsm removes them. they have to pass rigorous examination and testing and can be removed at any time. the dsm committes diligently write up all conflicts, questions and issues regarding each diagnosis, as well as extensive information on the intent of their use, etc.


Posted by: slc2 at July 18, 2006 01:55 PM

i would also like to see evidence that the presence of these diagnoses in a manual causes schizophrenics to be diagnosed improperly or cause some of the other things fuller mentions.

Posted by: slc2 at July 18, 2006 02:50 PM

Intermitent Explosive disorder has been the but of many jokes.At first I agreed its just silly and that it makes the whole proffesion look silly.

But then I read some of the comments about Anger not being biologically based nor being genetic.HMMM?

We all know how pit bulls came to be.Aggresive dogs bred together creates aggresive offspring.Pets and other animals have always been bred for personality traits,temperment,and other qualities.These things are indeed passed on genetically,though there are not alot of human examples.Maybe thats why we dont look at it that way.

What really throws me is that its Dr.torrey who says an explosive temper is just bad manners.Can this really be the same guy who lobbies for forced medication of Sz patients claiming it will reduce violence in america?

His treatment advocacy center has a section titled Preventable Tragedies,cases he claims would have turned out different if the person was medicated,treating their biolgical violence problem.

So I guess Torrey believes violence can be biological but only in schizophrenia.That goes against what most experts say and what the united states gov.says.

Posted by: symptomatic at July 18, 2006 07:10 PM

This issue is not about IED or any other specific diagnosis. It is about what exactly should constitute a mental illness. At what point does bad behavior become a mental illness instead of just a failure of a person to control him or her self.

There is a very famous case of a diagnosis being removed from the DSM. This is the diagnosis having to do with homosexuality. This diagnosis was removed from the DSM due to political pressure from the gay rights movement. This removal is a highly celebrated event by that movement. Most people do not consider homosexuality to be normal human behavior. There are even people who claim to be able to treat and cure homosexuality although such claims are very dubious. In recent years there has been growing evidence that there are differences in the brains of homosexuals and heterosexuals. Does this mean that homosexuality should be considered an illness after all?

On another front that is very dear to me, many antipsychiatrists claim that the diagnosis of schizophrenia should be removed from the DSM. They point at the fact that homosexuality was removed from the DSM and state that the case with schizophrenia is similiar. One of the most prominent of these antipsychiatrists is Dr. Szaz. We now know with great certainty that schizophrenia is associated with chemical and physical differences between the brains of people that have the illness and those who don't.

This raises a question. Should homosexuality be added back to the DSM? This is probably a political immpossibility even if you do feel it is justified. Should schizophrenia be removed from the DSM? Again this is probably politically immpossible and I certainly would not support it.

So again I think the fundamental question is what determines when something is a mental illness and not just simply bad behavior. If it is not a physical problem existing in the brain what is the deciding factor? Is there evidence for a physical or chemical problem in the brain for IED? If we can't make a valid determination of what is and is not a mental illness, how do we know that any behavior constitutes a mental illness? I believe that this is the point of the debate mentioned in the article and not any one particular diagnosis.

Posted by: cannonier at July 18, 2006 08:26 PM

''This issue is not about IED or any other specific diagnosis. It is about what exactly should constitute a mental illness. At what point does bad behavior become a mental illness instead of just a failure of a person to control him or her self.''

Psychiatrists have a tendency to play fast loose with the question of what is or isn't a mental illness NB the 'PDs are not mental illnesses' stance they have a tendency to adhere to.
The dominant view regarding mental illnesses are that they are a product of environment and genetics and involve irregularities in the brain(to put it very simply).
To give a classic example of this tendency to play 'fast and loose' over the issue of what is or isn't an illness one only has to look at Borderline personality disorder.
A disorder in which a small but growing body of evidence reveals a noticable genetic component, irregularities in the brain and a strong environmental component.
Using the yardstick of the dominant view of the psychiatric profession this
should place it firmly as a mental illness.
However psychiatrists still choose to present it as being a 'personality disorder'.
Much of this stems from psychiatrists latching on to the relative lack of benefit gained by the administration of medication.
The fact that no medications have been specifically formulated for BPD is never really taken on board.

Imagine if you will that there were no medications formulated specifically for schizophrenia but instead individuals were given medication primarily designed for other illnesses ie anti depressants and mood stabilisers.

The sad reality of such a scenario would be a relatively unconvincing response to medication especially in those with a low affective component to their illness.

I personally believe that the categorical approach of the dsm is in itself more of a hindrance than a help and that a 'dimensional' approach should replace it reflecting the reality that real life combination of symptoms are more diverse than is reflected by the category based dsm.

Posted by: Tim at July 19, 2006 03:35 AM

the guidebook for the dsm, however, makes it very clear that the dsm is NOT to be used in the way described here "...categorical approach of the dsm"

Posted by: slc2 at July 19, 2006 04:11 AM

The very construct of the dsm whether intended or not leads to a 'categorical approach'.
An approach that flies in the face of the ever increasing evidence that mental illnesses are best approached from a dimensional perspective.

The issue is not that the dsm needs to be replaced but the gaining of a concensus as to a much needed and long overdue alternative to the dsm.

Posted by: Tim at July 19, 2006 05:16 AM

such as the similar icd used internationally, or something different from both?

Posted by: slc2 at July 19, 2006 07:47 AM

Something that takes a more dimensional approach to diagnosis.

Posted by: Tim at July 19, 2006 11:26 AM

Attention defecit hyper activity disorder.ADHD.does this diorder happens because of deficit attention normally of the parents?why it doesnot affect spouces when there is defecit attention say after 5 years of marriage?
Gulwar syndrome.Why there is no gulfwar syndrome 2?Why there is no vietnam war syndrome? no worldwar I,II,III syndrome?There are plenty of fancy names invented by the psychiatrists with attendant SOCIAL CAUSE like Defecit attention, war etc.Is Post traumatic stress disorder different from gulfwar syndrome?
In India we have recently a string of suicides by farmers who have taken loans.There was lot of noice from politicians,media,social scientists etc but no COMMENTS from mental health professionals.But the stress faced by affluent software professionals occupy pride of place among seminar circuit.why?

Posted by: captainjohann at July 20, 2006 02:32 AM

psychiatric problems in the dsm are not minor, ordinary problems of life.

there is no official diagnosis of gulfwar syndrome at all - gulfwar syndrome is what i call a 'Newspaper Diagnosis'. it is a term that has come up in the media and is often used to refer to gulf war soldiers who have emotional troubles after the gulfwar was finished. in some of them, these are merely 'life problems', and they recovered with no special help other than some encouragement and kindness. for others, the problem was very severe, and might need treatment for depression, anxiety etc.

ADHD is not caused by the lack of attention of the spouse. it is a biochemical problem, so that the person cannot focus on one thing, and moves quickly from one thing to another.

it is not caused by a situation. i have seen this in very small children and you can notice it from birth. it is NOT the restlessness or activeness of a normal child. i saw in my friend, as a small child he had a broken leg, and continued to run around excitedly with a severely injured knee, and could not sit still. this is not a false diagnosis. it exists. do people not understand ADHD? oh yes, all the time. but it really is an illness and it really does exist.

post traumatic stress disorder is when the person seems to continue to feel again, the feelings he or she had during a crisis such as a war, crime or abuse. i have also seen it. yes, people do misuse this diagnosis. i heard someone say in court that they stole a car because of post traumatic stress disorder. it was simply a lie. the person had no post traumatic stress disorder. for many centuries people have tried to blame irresponsible behavior on something or someone else. this is not new. however, this does NOT mean post traumatic stress disorder does not exist. it does.

in fact, i have been to india many times, and i know that poor people in india and many other countries may commit suicide when they have financial troubles of many kinds. i was living in west bengal for some time and it is a very poor state. i lived with the poor people and i am familiar with their troubles. i traveled in the countryside and saw many painful sights and a lot of sadness. poverty is not pretty. rural life in india is not so pretty at many times. these people have a very hard life.

there are many organizations offering aid to these people, but it is not a simple problem. let me give you an example. when i was there, a little girl broke her leg while playing. the parents were very traditional, no education, and afraid of doctors. it really was a very simple fracture and if treated, would heal very nicely. but because of their lack of education, they kept the girl in their little house, and we heard her screaming in pain for three days. they thought no one would want to marry her and the doctor would cut off her leg. but actually, even the worst doctor in the world could fix this break, it was a very simple one. i thought i myself would go mad listening to the child for three days. it took several days of my friends mother talking to the parents before they would take her to doctor. and of course, it was just as i said, the break was perfectly and neatly healed after treatment.

i also saw a mentally retarded child that was tied by his leg to a post all day. of course it is necessary to avoid him having some injury from a car, train or buffalo. he doesn't understand danger. but this boy could have been taught to do many things. but because the parents were afraid of anyone outside their small circle of friends (which i think with your talk you would make them even more afraid), they did not find any schooling or help for this boy. instead he stayed at home and was indulged and not taught anything.

also in india, i had many mentally ill people come to me and beg me to take them to america, so they could have some help. in the rural areas, they are not always treated so nicely. many could be very productive and happy, but people are afraid of them or just give them money from begging, that is not learning independence and recovery.

i did however find some very kind and helpful doctors in india who were working very hard to help poor people. i also stayed in calcutta and there a doctor was providing diagnosis and advice to people on the street for just a few paisa. even that is too much money for some but he seemed to help all. there was a line of people many meters long, down the street, waiting to see him.

i do not feel all doctors are bad or all psychiatrists are bad. i know many who really try to help. we can not hate them because they tell us our diagnosis, or because they advise medication that we need. nor are the problems of india so simple. so please, do not try to tell me that the rural problems of india are all the making of some few snobbish psychiatrists. i know that is not true.


Posted by: slc2 at July 20, 2006 05:57 AM

Dear slc2,
ADHD is not due to defecit attention but due to brain chemical imbalance according to you.Then why cannot be it called "HYPERACTIVITY DISORDER" only.Why ATTENTION DEFECIT is added?Who is responsible?It is vitally important to patrents because they have to carry this GUILT COMPLEX due to this name and have to answer their ADHD children when they grow up.
i donot know how you got this impression that i hate doctors or psychiatrists as i read my post again and didnot find any idea how you felt this way."Rural problem in India is due to some snobish psychiatrists"How did you get this idea?I am asking why there is SUICIDE PREVENTION helpline in URBAN areas only in India while nearly 4000 farmers have committed suicide in Maharashtra alone in one claendar year.Why there is no comment from MENTAL HEALTH professionals about this suicide phenomenon of farmers?Stress among software professionals are discussed in seminar circuit and even some 5*star hospitals are now offerring "music therapy" "aroma therapy" for fancy prices!!!!
The psychiatrist who is treating my daughter is gem of a humanbeing and that is the sole reason we have shifted to this place in bangalore and the hospital NIMHANS is also the best.
As a psychiatrist one makes specific kind of attribution to schizophrenia like GENETIC DIPOSITION,FAMILY DYNAMICS(DEFECIT ATTENTION) etc.If genetic dispostion has no bearing on the type of DRUG selected or its dosage why it should be asked at all?It has got lot of bearing in the FAMILY because the other partner throws this ARROW whenever a small family quarrel happens.GENETICS has important bearing in RESEARCH but it is routinely asked.Why?I am happy you have seen first hand the poverty in India and how it affects Health in general.You have in your country after 1960 have closed the mental health institutions andgiven the right of VOLUNTARY ADMISSION.This hypocricy has resulted in your Prisons functioning as mentalhealth institutions with 1,80,000 mentallyil prisoners.In India we have only 3200 psychiatrists,70,000 beds to a population of 1 billion people!!!Most of the care/or non care goeson in temples or in the family.PTSD existed even before it got its name from psychiatry.It is a STRESS DIDORDER and whatever tsunami,cyclone,war etc it will exist.

Posted by: captainjohann at July 22, 2006 05:37 AM

Cardiology,opthalmology,Gyeanacology etc etc have COMMON UNIVERSAL standard of identifying a discease and treating them according to the paying capacity of a patient.Why in psychiatry we have DSM IV in america; while it is ICD in India and i donot know about other countries?

Posted by: captainjohann at July 22, 2006 11:54 PM

deficit attention has nothing to do with ADHD or ADD.

Posted by: slc2 at July 27, 2006 10:12 AM

i think newspapers don't concentrate enough on the problems of the poor in india, but i doubt 4000 suicides in a year in maharashtra is rare, i dont think they suddenly began committing suicide last year. it enrages me that these problems are so little recognized too. despite progress of all kinds in india, there is still so much to be done.

Posted by: slc2 at July 27, 2006 10:14 AM

hello sir;

my name is anthuvan, now am working in embcion software embedded system . i have affected mental illness, i dont know whether mental illness or something.

iam affected foolowing problems:
if iam concentrate more, the heart side and left part of the heart iam feel so weight.

iam too tired in every time and also too sad.

so dont concentrate on my jobs, even good knowledge in technical side. please help me.
my netaive place is tamil nadu, now iam working in bangalore, please tell me
famous psychiatrist doctor in bangalore or chennai, because iam dont concentrate on my work,please help me.

Posted by: anthuvan at April 6, 2007 01:24 PM

Hello Anyone..
I am suffering some sort of phsychic problem, I am not sure what it is.. But am facing a very big problem from this.... I am upto feel hell right now.. I dont know what goes to happen to me if this continues..... Please i beg anyone to help me in this..... please sir help me out if any good pshyciatrist is there..... Please reply me as soon as possible

Posted by: Ravi at September 5, 2007 01:55 AM

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