Normal behaviour, or mental illness?

A look at the new psychiatric guidelines that are pitting doctors against doctors

Is she a brat, or is she sick?

Jonathan Kirn/Getty Images

Every parent of a preteen has been there: on the receiving end of sullen responses, bursts of frustration or anger, even public tantrums that summon the fear that Children’s Aid is on its way. Come late May, with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), however, such sustained cranky behaviour could put your child at risk of a diagnosis of “disruptive mood dysregulation disorder.” This newly minted condition will afflict children between 6 and 12 who exhibit persistent irritability and “frequent” outbursts, defined as three or more times a week for more than a year. Its original name, “temper dysregulation disorder with dysphoria,” was nixed after it garnered criticism it pathologized “temper tantrums,” a normal childhood occurrence. Others argue that even with the name change the new definition and diagnosis could do just that.

“Disruptive mood dysregulation disorder” isn’t the only new condition under scrutiny in the reference manual owned and produced by the American Psychiatric Association (APA)—and lauded as psychiatry’s bible. Even though the final version of DSM-5 remains under embargo, its message is being decried in some quarters as blasphemous. Its various public drafts, the third published last year, have stoked international outrage—and a flurry of op-ed columns, studies, blogs and petitions. In October 2011, for instance, the Society for Humanistic Psychology drafted an open letter to the DSM task force that morphed into an online petition signed by more than 14,000 mental health professionals and 50 organizations, including the American Counseling Association and the British Psychology Society.

Of fundamental concern is a loosening and broadening of categories to the point that everyone potentially stands on the brink of some mental-disorder diagnosis, or sits on some spectrum—a phenomenon the American psychologist Frank Farley has called “the sickening of society.” One change summoning criticism is DSM-5’s reframing of grief, that inescapable fact of life, by removing the “bereavement exclusion” for people who’ve experienced loss. Previously, anyone despairing the death of a loved one wasn’t considered a candidate for “major depression” unless their despondency persisted for more than two months or was accompanied by severe functional impairment, thoughts of suicide or psychotic symptoms. No longer.

Other updates to DSM-5, the first full revision in nearly two decades, have raised red flags. Forgetting where you put your keys or other memory lapses, a fact of aging formerly shrugged off as “a senior moment,” could portend “minor neurocognitive disorder,” a shift destined to also stoke anxiety. Anyone who overeats once a week for three weeks could have a “binge-eating disorder.” Women not turned on sexually by their partners or particularly interested in sex are candidates for “female sexual interest/arousal disorder.” Nail-biters join the ranks of the obsessive-compulsive, alongside those with other “pathological grooming habits” such as “hair-pulling” and “skin-picking.”

The fuzzy boundary between “generalized anxiety disorder” (GAD) and everyday worries has also been blurred. As Allan V. Horowitz, a sociology professor at Rutgers University, points out, changes in this category are potentially the most important because they affect the largest number of people. Under the new “somatic symptom disorder” (SSD), for instance, people who express any anxiety about physical symptoms could also be saddled with a mental illness diagnosis, which could thwart their attempts to have their physical issues taken seriously. To meet the definition one only needs to report a single bodily symptom that’s distressing and/or disruptive to daily life and have just one of the following three reactions for at least six months: “ ‘disproportionate’ thoughts about the seriousness of their symptom(s); a high level of anxiety about their health; devoting excessive time and energy to symptoms or health concerns.”

DSM-5 represents a step back in mental health care, says psychologist Peter Kinderman, head of the Institute of Psychology, Health and Society at the University of Liverpool. Kinderman, who is organizing an international letter of objection to DSM-5 to be posted on dsm5response.org, which launches March 20, believes many new DSM classifications, among them “female orgasmic disorder,” defy common sense. “If you’re not enjoying sex, it’s a problem, but it’s crazy to say it’s a mental illness,” he says. He also questions the new criteria for alcohol and drug “substance-use disorders.” “According to it, 40 to 50 per cent of college students should be considered mentally ill.” Such diagnoses interfere with the human helping response, says Kinderman. “When women get raped, it’s traumatic; when soldiers go to war, they come back emotionally affected. We don’t need the new label, ‘post-traumatic stress disorder,’ ” he says. “We should identify risk, identify problems, identify the threats people have and then we need to help them.”

DSM-5’s most vocal critic is psychiatrist Allen Frances, who chaired the DSM-IV task force. Frances, professor emeritus at Duke University, calls the approval of the DSM-5 in December 2012 “the saddest moment in my 45-year career of studying, practising and teaching psychiatry.” In an interview with Maclean’s, he slammed the DSM-5’s methodology as lacking rigour and being “scientifically unsound.” Frances cautions clinicians, media and the general public to “be skeptical” and not to “follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful overmedication.” His concern is two-pronged: healthy people will be over-treated; undue focus on them will mean people who need psychiatric help won’t get it. He expects that “somatic symptom disorder” will greatly increase the rates of diagnosis of mental disorders in the medically ill—whether they have established diseases like diabetes or cancer or unexplained symptoms. “Anyone with the slightest bit of common sense knows this is stupid,” he says, adding that people in the DSM world don’t get it. “They have remarkable blinders to common sense.”

People in the DSM world disagree. “We sought to be conservative in our approach to revising DSM-5,” DSM-5 task force chair David Kupfer wrote in an email to Maclean’s. “Our work was aimed at more accurately defining mental disorders that have a real impact on people’s lives, not at expanding the scope of psychiatry or increasing the number of individuals diagnosed.” Kupfer says response from the psychiatric community is “largely supportive.” But he welcomes criticism: “It’s an inherent part of any robust scientific discussion,” he says. That’s good, because this discussion—one that delves into what it is to be human— is just beginning. Classification of mental illness in the U.S. dates to 1917, when a committee on statistics, a precursor organization to the American Psychiatric Association, teamed with the National Commission on Mental Hygiene to develop the Statistical Manual for the Use of Institutions for the Insane. It boasted 22 diagnoses. The first DSM was published in 1952 and has been updated to reflect new research in genetics, epidemiology, risk and imaging. The 886-page DSM-IV, published in 1994, lists 297 “disorders.” DSM-5 clocks in at 1,000 pages in its $199 hardcover version and includes approximately the same number of diagnoses as DSM-IV, says Kupfer: “This goes against the trend in other areas of medicine, which typically increase the number of diagnoses.”

DSM is not the only accepted measure in classifying the signs and symptoms of mental disorders. The World Health Organization’s “International Classification of Diseases” (ICD), a diagnostic tool used in epidemiology, health management and clinical research, also provides metrics. But DSM is the benchmark driving mental illness treatment and research, and the reference for insurance companies. “The DSM is a big deal,” says Kinderman. “Even though it’s an American document, it influences research across the world.” Jose Silveira, chief of psychiatry at St. Joseph’s Health Centre in Toronto, says the DSM is integrated into the Canadian system: “We don’t sit with patients saying, ‘Does the DSM say this or not?’ But we use it because insurance companies request it; the government requests it; it’s used in disability claims; it’s used for tracking rates in the population.”

Its utility is in organizing symptoms only, Silveira says: “It’s purely diagnostic; it doesn’t reflect risks associated with conditions.” He believes DSM is not particularly useful for front-line primary care providers—the GPs, psychologists, social workers and family therapists who provide an estimated 80 per cent of mental health services. “Diagnosis can take a trained clinician hours,” he says.

Yet as witnessed with the explosion in use of Ritalin and antipsychotics after DSM-IV identified ADHD and bipolar disorder as bona fide conditions, a new disease diagnosis influences whether millions of patients are placed on drugs—often by primary care doctors with minimal training in psychiatric diagnosis. And this puts children particularly at risk, says psychologist Brent Robbins, president-elect of the Society for Humanistic Psychology and co-editor of Drugging Our Children. He cites one U.S. study that found 72 per cent of pediatricians prescribe psychotropics to children, though only eight per cent say they feel adequately trained to do so.

One group the DSM unequivocally has helped is psychiatrists themselves. The DSM-III, published in 1973, resuscitated the specialty at a time it was facing irrelevancy, says Frances, who contributed to that edition. “Studies showed a lack of agreement between psychiatrists in the U.S; it seemed as if they didn’t know what they were doing.” DSM-III was “a radical step forward in providing diagnostic criteria that had people working off the same page and, under ideal conditions, could result in agreement about diagnosis,” he says.

Its success had a downside. “It became too important in external ways—particularly with drug-company muscle pushing diagnosis to push pills,” the psychiatrist says. “It led to a diagnostic inflation and expanded the boundaries of psychiatry beyond its competence. As a result, it diverted attention from the core effort: taking care of people with real psychiatric illness.”

Frances’s experience on DSM-IV, which came under fire as well, taught him how new diagnoses can spread like wildfire. His task force believed they were being conservative, he says, in vetoing all but three of 94 suggestions for new disease diagnoses: Asperger’s, ADHD and bipolar II disorder. “We expected a three to four fold rise in Asperger’s diagnosis: we never dreamed it could go from less than one in 2,000 to one in 88 in the U.S. and one in 38 in Korea,” he says. Likewise, the diagnosis of childhood bipolar disorder increased fortyfold. “Anything that can be used in DSM will be misused,” he says.

While drug companies are not directly involved in the DSM process, “they’re on the sidelines licking their chops for sure,” Frances says. He’s quick to add that the DSM-5 task force adopted a better system of vetting for financial conflicts of interest than his did. Still 70 per cent of DSM-5 authors have declared ties to pharmaceutical manufacturers; in some categories, it’s 100 per cent. But Frances, author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, sees “intellectual conflict of interest” as an even greater problem. “I know people involved and they are making absolutely dreadful suggestions that will be of enormous use to the pharmaceutical industry and they’re doing it with the purest of hearts,” he says. “Any time you give experts pure freedom they will expand the system to reflect their own interests. No one says, ‘My area has too much emphasis on it; we should be restricting diagnosis to fewer people.’ They worry about the missed patient. And they always overvalue their own research, their friends’ research.”

The DSM-5 process itself is a case study in human co-operation, conflict and dysfunction. More than a decade in the making, and involving 13 work groups and with more than 1,500 contributors from 39 countries, it has been riddled with revisions, delays and high drama. One goal was to better align the DSM to the World Health Organization’s ICD codes. Another was to remedy some of the unforeseen—and unfortunate—consequences of DSM-IV. “Disruptive mood dysregulation disorder,” for example, was intended to address concerns about potential over-diagnosis and over-treatment of bipolar disorder in children. Pediatric psychiatrist Terry Bennett, a professor at McMaster University, sees the change as constructive: “It’s a nice move away from labelling children with bipolar disorder; it doesn’t make claims to predicting that these kids will have bipolar when they grow up and could be helpful in minimizing undue medication.” She believes if the criteria are applied carefully, the diagnosis should capture only a very small group of kids who are severely impaired.

The elimination of the “bereaved exclusion,” another contentious topic, reflects new research, says Ron Pies, a clinical professor of psychiatry at Boston’s Tufts University who has studied the subject. Most bereaved people do not meet the full criteria for major depressive disorder and don’t need professional treatment, Pies says: “They need ‘TLC’ and what doctors throughout the ages have called ‘tincture of time.’ The relatively small subgroup of recently bereaved persons who meet full DSM-5 criteria for major depression disorder will now be able to receive appropriate professional care.” Pies is emphatic the reclassification “does not mean instant antidepressant prescription, no matter how often critics insist this will be the case.” The risk of overlooking a potentially lethal illness, with a four per cent completed suicide rate, is much greater than “over-calling” an episode of ordinary grief, he says.

At the outset, DSM-5 had an ambitious plan to reimagine diagnosis from the ground up, says Frances (a claim supported by others but refuted by Kupfer): “They wanted a paradigm shift in psychiatry.” But descriptive psychiatric diagnosis can’t support that, Frances says: “There can be no dramatic improvements in psychiatric diagnosis until we make a fundamental leap in our understanding of what causes mental disorders.”

As a result, observers report, the task force focused on a preventive-style of diagnosis that targeted milder conditions with higher rates in the community. Nipping potential problems in the bud is a long-standing medical mandate. But without cause or treatment, it can be problematic, says drug policy researcher Alan Cassels of the University of Victoria. Cassels sees DSM-5 continuing the medical trend of “pre-disease” diagnosis, citing “minor neurocognitive disorder” as an example: “What better way to get perfectly healthy people to start shuffling down the cattle ramp toward a good jolt of the yet-to-be-launched pre-dementia medicines that the drug industry will soon be zapping us with?”

Task force chair Kupfer, whose own career has been devoted to mood disorders, expresses confidence in DSM-5: “By utilizing the best experts and research, we have produced a manual that best represents the current science and will be most useful to clinicians and the patients they serve.”

Not all who participated in the process agree. Last year, Roel Verheul, a professor at the University of Amsterdam, and John Livesley, professor emeritus at the University of British Columbia, resigned from the DSM-5 Personality and Personality Disorders Work Group in protest. In a public email they explained they “considered the current proposal to be fundamentally flawed” with a “truly stunning disregard for evidence.” They called the proposed classifications “unnecessarily complex, incoherent, and inconsistent” and stated “the obvious complexity and incoherence seriously interfere with clinical utility.” They concluded: “The DSM 5 personality section is not readable, much less usable. It will be ignored by clinicians and will do grave harm to research.”

Lack of outside scrutiny has been a problem, says Robbins. The APA countered calls for an independent review claiming that “no outside organization has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria for mental disorders.” Robbins calls that arrogant and ludicrous: “There are hundreds of mental health organizations across the world that would gladly offer their services to review the DSM-5.”

How and why a society defines mental illness is a mutable cultural barometer reflecting current thinking, biases—and assigning stigma. DSM-I, for instance, listed homosexuality as a “sociopath personality disturbance”; DSM-II reclassified it as “sexual deviancy.” It was removed from DSM-III entirely amid political mobilization and protest. Psychiatric diagnoses have a history of reflecting cultural prejudices, says Silveira, who points to “drapetomania,” a purported mental illness described by American physician Samuel A. Cartwright in 1851. The condition, said to have afflicted black slaves, was characterized by a propensity to try to flee captivity. According to Cartwright, it could be almost entirely prevented by proper medical advice, strictly followed.

Mental illness diagnoses also frame mental health. The DSM illustrates how fluid those definitions can be: in DSM-IV, Asperger’s was given stand-alone status; DSM-5 returned it to “autism spectrum disorder.” Now, the reality-TV staple “hoarding” will become an official disorder, while “anxious depression,” “hypersexual disorder” and “parental alienation syndrome” failed to make the cut. The reference book has also introduced a slippery slope with the addition of a new “behavioural addictions” category, which currently only includes “pathological gambling”—though “Internet-use gaming disorder” and “caffeine-use disorder” are listed in section three (disorders needing further research).

Yet for all of the controversy, the DSM is not mandatory for mental health professionals, but rather one tool, says Frances. In fact, the American Psychological Association is gearing up to encourage training in the ICD, says Robbins. “There’s a sense among the higher-ups that the DSM system is a sinking ship. It’s losing its canonical status.” He sees one upside from the controversy: an opportunity to begin constructive conversations about the future of psychiatric diagnosis. He’s spearheading an international summit on diagnostic alternatives about to launch an open online public conversation. Silveira agrees: “Is there a lot of controversy around diagnosis? Absolutely. Should there be? Absolutely. That is its greatest virtue. It provides opportunity for input from lay people, social workers, and brings us all to the table. We’re dealing with conditions where there is a profound degree of complexity and a profound degree of uncertainty.” He points out medicine is far from the pinnacle of understanding the human body: “We’re still embryonic.” Our understanding of the human brain is even more primitive. “The brain doesn’t reveal its secrets easily,” says Frances. “It’s the most complicated thing in the universe.” And there is no more compelling evidence of that than the DSM-5’s new definitions of what it is to be a healthy human—and the very human backlash it has received.


Normal behaviour, or mental illness?

  1. What would be nice is if psychiatrists figured out why people suddenly go berserk on the bus and behead someone. Or why someone goes to a movie theater or worse, a school, and shoots people to death.

    Or why someone shoots a president to impress a movie star, or murders someone because voices in his head told him to.

    Or why someone kills a room full of people, and then carves up their bodies….and even has followers.

    Find a cure for something ike that, and stop fussing over normal temper tantrums.

      • We’ve been doing that that for thousands of years, and it’s cured nothing.

        4.3 people are born every second . 258/minute, 15,480/hour . 371,520/day . 135,604,800/year

    • Religion!!??

      • Well we’ve had ‘religion’ since the cave days, and it hasn’t solved a thing. Probably contributed to the problem, in fact.

        • That was my point>

          • Ahhh well then….if you think we should drop kick religion out the nearest airlock, I’m witcha!!

    • You know people. They all have to say to about anything before doing something about it. Guess they can’t know everything.

      physical therapy billing

      • It would be nice if they tried to do something serious though….to find real solutions for real problems….rather than picking on little kids.

    • How do you know they don’t – after the fact?
      But perhaps you want it done before. That’s a totally different question.

      • And one which isn’t involved here.

    • I’m not a psychiatrist, but after looking at the bus incident, I believe the movie playing on the bus at the time was Zorro, so if you have someone who is off their meds in a confined space with a movie like that playing, I would choose to be on another bus.

      • Zorro? Srysly?

        How about if they’re reading the bible….with all that smiting and genocide?

    • The man on the bus didn’t “suddenly go berserk”. He has schizophrenia. He was having a psychotic episode and could not tell the difference between reality and fantasy. We know what happens to the brain during a psychotic episode. We know how the brain of a person with schizophrenia differs from that of a person who doesn’t from the illness. We are trying to stop people who are at risk of suffering from the illness from getting ill BUT it is difficult to predict who will get it and there is no cure. It is like cancer…no cure YET. Meanwhile, psychiatry only “fusses” over issues like temper tantrums because parents fuss over issues like temper tantrums and these parents want solutions.

      • Why is there no cure?

        It’s not like you haven’t had enough time and patients.

        PS Parents know the solution to temper tantrums

        • Why is there no cure for heart disease? Why is there no cure for cancer? Why aren’t better at stopping strokes from occurring?

          Psychosis occurs when a persons brain releases one or perhaps two different neurotransmitters in very great quantities. There is a bombardment on the brain receptors….dopamine 2 is believed to be one of the receptors. The brain is damaged. It is like it was hit with a Mac Truck. The only way for it to heal is through sleep and no further episodes. That is where the antipsychotics come in. They stop the episodes. It takes 6 months to a year for the brain to heal after an episode. A person loses their ability to express emotion (sense of humor/ ability to cry) until they have healed. We don’t really even know all the mechanics….it isn’t like you can open up the brain and dig around without doing some damage.

          As for parents and children with temper tantrums….the adolescent psychiatric unit is FULL of children who’s parents had NO IDEA how to deal with their temper tantrums. Now these teenagers have something called “oppositional defiant disorder”. Do psychiatrists go looking for kids with behavior issues or do parents seek out psychiatrists to treat their badly behaved kids?

          • I don’t know HI….why aren’t there any cures?

            More money in the treatment than in a cure?

          • No, it really isn’t about keeping people unwell. Some of the medications that keep psychosis from occurring are very old and VERY CHEAP. The problem is that the human body is very complex…especially the brain. It is like the hunt for the answers to Alzheimers…slow to come but making more and bigger strides all of the time.
            What surprises me though is when people say psychiatry is not really based on any science. When you meet someone who is suffering from psychosis or mania, you have no doubt that they are ill. When the treatment starts to work, you have no doubt that this field of medicine is just as legitimate as any other.

          • Instead of excuses why aren’t we getting cures?

          • Emily, you act like humans have the answer to all the mysteries of the universe. They don’t and they don’t have the answers to all the mysteries of the human body. We have had cures for bacterial infections….antibiotics…only to find that the bacteria mutate and so the antibiotics become ineffective. You act like it is easy to pull another cure (antibiotic) out of our hats. The reality is that it takes decades to develop cures. Look at HIV and AIDS. They have been working on cures for it for 30 years. That is ONE illness that gets a lot of focus and a lot of funding. It might surprise you that schizophrenia doesn’t get a lot of focus or a lot of funding. It is not a glamorous illness and it doesn’t affect a large proportion of the population.
            As for the notion that we can cure everything. There is not and likely never will be a cure for the common cold. It is caused by a virus and there is no good treatment for viruses. We may be able to develop a vaccine at some point but that is probably the best we can hope for. It is the reality of how things work.

          • We’ve had several thousand years HI….we should have a lot more answers than we do.

            The reality is, we’re not trying very hard

          • We have not had several thousands of years. We’ve has about a hundred or two years since we discovered the scientific method and applied it to medicine. Read some history. Please.

          • We’ve had thousands of years actually….our progress was delayed for centuries to even get to the scientific method stage.

            Read some history. Please.

          • Emily we have made huge advancements in the treatment and life expectancy for those who suffer from many illnesses. When HIV was discovered it was a certain death sentence…now it is not and there is a vaccine in human trials. I think the issue is that you don’t understand how many illnesses work. They are often caused by a malfunction in the human body rather than a foreign invader. Therefore a cure involves finding a way to trigger a correction to the malfunction…not easy. If you have some ideas on how to do that, I am sure the researchers would be grateful.

          • I think you don’t understand that we are at least 2000 years behind where we should be.

            And like I said before there is more money in treatment than there is in cure.

          • Whether that is true or not…..we have only been sterilizing our equipment prior to surgery for one hundred years or so. We were careless with our use of antibiotics…we had no idea that bacteria and viruses were so changeable. It isn’t about money in treatment….people bitch about big pharma but now they are begging them to develop new antibiotics because we don’t have any to treat the bacteria that have mutated. How do you cure things that are constantly evolving? You have to treat things so people live long enough for you to find a cure.

          • Really? You know very little about history.

            Stop the excuses.

          • You know little about medicine but that never stops you from giving an opinion. If medicine should have cures for all illness, then surely science should have a cure for global warming.

          • Yes, why doesn’t it?

          • You tell me. As for your assessment of my lack of knowledge of history….physicians at John Hopkins were the first to wear gloves in surgery in 1897…the rest of the country soon followed their practice……cheers.

          • Which is irrelevant to the entire conversation…..but then again you appear to have no idea what we were discussing anyway.

          • What exactly are you doing to find all these cures? You seem to judge pretty harshly. Society accepting mental illness as something that can be treated is far more recent than you assume. What would you like society to do? Take all the money from treatments and pour it into “finding a cure” that may never be found while people who suffer from whatever you want to cure die sooner than they should? Please if you have some undiscovered insight into how to cure all the world’s problems I encourage you to share. Though seeing how this is the only note you seem to hear I suggest that perhaps you should do more research into this and try to avoid being ignorant to realistic challenges.

          • Stop trying to equate Psychiatry with medical science. All the theory in the world does not equal a single proof. No matter how complex the theory is. The vast majority of medical diseases are verifiable by objective laboratory test of some kind. The vast majority (if not all) of psychiatric ‘mental disorders’ are NOT. There are a growing number of psychiatrists who have the integrity to speak the truth about Psychiatry being a pseudo-science and that it doesn’t even have a formal model of ‘mental disorder’ so is not even a science but has only presumptions and assumptions.

          • You have a fundamental misunderstanding of physiology and a gross overestimation of the ability of humanity to solve physiological problems.

            “Cures” are largely not possible for non-infectious disease. You can develop treatments that may lead to long term resolution, in some issues, but even these treatments most often result in physiological deficits.

            Mental health is that much more complicated as it is a complex interplay of genetics, environment, and neurophysiology.

            Please, I would suggest reading up on the systematics and physiology of mental health before trying to pass judgement on an entire sector of healthcare that is trying to make life a little better for many, many people.

          • No, I have a great understanding of human nature….stop making excuses and suggesting outdated reading….and get busy on a cure.

          • That’s a poor conclusion. You cannot get around the FACT that the chairman of the task force of the upcoming DSM5, Darrell Regier, said himself ‘We don’t know the etiology (causes) of really ANY of the mental disorders at this time’. And the FACT that there is not a single clinical objective test that is EVER used to PROVE a person has some psychiatric ‘mental disorder’. Only subjective opinion and theories.

          • Again, the vast majority of medical physical diseases can be verified with objective clinical laboratory proof of one kind or another. The vast majority, if not all, of Psychiatry’s ‘mental disorders’ can NOT be.
            Further what you state about psychosis is THEORY. You yourself use the word ‘believed to be’. All the ‘appears to’ ‘seems to’ ‘generally agreed that’ ‘apparently is linked to’ etc. used by biological Psychiatry are not PROOF. Despite decades of research there does not exist a single biological proof that ‘brain chemical imbalance’ is the CAUSE of any mental disorder. That is why not a single objective clinical test of such is ever used to prove that a person has some mental disorder they’ve been diagnosed with.

      • Big difference in cancer and psychiatry’s ‘mental disorders’. The vast majority of medical diseases can be verified with objective scientific proof. The vast majority of mental disorders (if not all) can NOT be. Psychiatry mimics science but is not real science. It is categorization of human behaviors and ‘symptoms’ and its diagnoses are all subjective opinion. Not a single clinical test, such as CT scan, or MRI brain imaging or anything else, can prove anyone has a mental disorder and someone does not. Including schizophrenia.

  2. It should say most parents, not every parent. I was never one of those children/pr-teens

    • Congratulations, but I do think you suffer from Major Insecurity Disorder by attempting to seek online validation from strangers.

    • Interesting point. (Better ignore the expert trolls replying.) I’ve heard of kids like that but never seen one. How do you know you never blew up when you were younger. They are talking about 6 year olds too. Can you recall actually never having a fit at that age?

  3. They simply want to create all these new mental illnesses so big pharma can sell u more pills you dont need. Kids have out bursts . It does not mean their mentally ill and need to be doped up.

    • Yup; in most cases it just means they are overtired. If it happens frequently, the easiest treatment is to set an earlier bedtime.

      • You are right Keith but parents aren’t really running the show at home.

    • ..and what do we call it when our politicians are having fits (temper tamtrums) at question period, what will their mental illness label be?

    • When I was a kid I am 58; a number of us kids used to go to shoot gophers on our bikes. Most of the time we were screaming like banshees and shooting our bb guns in the air. In the 1960s this was seen as normal .Today our group would be analized as having ADHD and be drugged up for life. What happened to the concept of letting a kid be a kid

  4. One of the specialists quoted in the article said it was crazy to over-diagnose mental illness. So was he suggesting another entry to the DSM-V? Perhaps physician over-diagnosis disorder?

  5. And in the meantime, we continue to diagnose and drug our children. It’s a nightmare what’s occurring in our schools. Our kids don’t stand a chance.

  6. And in the meantime, we continue to diagnose and drug our children.
    It’s a nightmare what’s occurring in our schools. Our kids don’t stand a

  7. I guess psychiatrists and pharmaceutical companies realize that telling people there is something wrong with them at a young age may result in obtaining a life long customer! Hopefully, parents won’t be buying into it!

    • Bought into Ritalin hook line and sinker, poor kids, poor parents.

      • Ritalin—same biochemistry as cocaine except for speed of onset, labeled by FDA as schedule 2 drug same as cocaine, coke addicts prefer Ritalin if they can get it in a snortable form, get the same high

  8. The creators behind the supposedly upcoming DSM V’s psychiatric bible filled with tangled terms and false labels have no understanding of the human mind.

    But how good they are at listing an innumerable number of normal human behavior symptoms so as to have a label and a number that can be easily cashed in by supporting Big Pharma’s “magic” pills to cure “diseases” that do not exist.

    • Agree, 100%!

    • Ah, an expert. Please provide some evidence for this critique. I’d love to read it.

  9. Psychiatry is a fraud.

    • Well said. Nicely argued. Great contribution.

      • pithy passive-aggressiveness! In DSM-III you’d be diagnosable!

  10. Writing a book with the working title: “Schizophrenia, God & Language: What Each Have in Common?” and what I find almost frighting, yet interesting is the amount of psychiatric professionals who fought against their own in the field to help bring about some compassion, even they were oppressed. http://www.anangelstestimony.com/

  11. Psychiatry labels and drugs you for money.

  12. People may wish to see the documentary ‘As Powerful as God – Children’s Aid Societies’ online. In the documentary there are grave concerns about the illegal drugging of children with drugs not approved by Health Canada for youngsters. This article is quite chilling really, the marriage of child welfare and Big Pharma is a marriage from hell. Simply put, before it gets worse it must be addressed, this new addition could make an already despicable situation all the worse. Some of these drugs can cause organ damage and death. Do peruse it, perhaps responsible doctors will speak out about this matter as they should.

  13. When will people realize that the DSM is the psychiatric profession writing their own rules and permits to they can drug the crap out of society? And guess who profits? Big pharma – who can’t prove how a single solitary one of these drugs even works.

  14. It’s easy to say psychiatry is a fraud, but it probably just shows that you’re an idealogue who doesn’t beleive in science.
    You have to take the bad with the good. On balance, does mental health science help us? I’d say yes. So I’m for support of continued research and continued discussion with helpful comments.

    • Show me the “science” behind psychiatry! They vote in their ‘diseases’ at conventions. “All in favor of ‘mathematics disorder’, say aye… motion stands”, and it becomes an official “disease” with Big Pharma waiting to pawn off thier drugs to “treat” it. You call that science???

      Before you accuse others of not believing in science because they don’t agree with your opinions, do a bit of research into how psychiatry really works, and come back with some facts.

      • Hmmm. Seems you are upset. Probably not a good time to write in.
        You are only presenting one small aspect of psychiatric science. I think that we need experts, even when they don’t behave well. At the moment, it’s all we’ve got between us and superstition. So I’m for support of continued research and continued discussion with helpful comments. Care to say how it could be improved, or if you have an alternative?

        • Upset? Not really, I just get incredulous when someone starts saying that psychiatry has anything to do with science. It doesn’t. The entire industry is based on ‘expert opinion’, opinion that has been warped and twisted over the last 100 years to make more and more money. They are self-proclaimed experts, they have opnions, and they fool you into believing it’s science. In the process they make truckloads of money. Science has nothing to do with it.
          “You are only presenting one small aspect of psychiatric science”.
          Were you expecting a thesis? This is a little comment block on a media peice. All you have to do is a bit of research into the inner workings of psychiatry and Big Pharma to see that it’s a big facade, a fraud.
          If you are looking for alternatives, start with googling “alternatives to psychiatry”. Like any research line, you have to weed out the garbage to get to facts, but the facts are there for the picking. Push all opinion aside, mine included, and look for facts on how this industry operates. If you feel that psychiatry is all there is between us and superstition, with all due respect, you simply haven’t done any meaningful research on the subject.
          Experts are all well and good, but blindly trusting that they are always looking out for your best interests is whistling past the graveyard. History is strewn with ‘experts’ that have happily lead us off the cliff. Trust yourself first, always.

          • Is medicine any different? Do you go to a doctor? We have to do SOMETHING, don’t we, to try to help people. As I said before, easy to dismiss, but what’s the alternative?

          • Correct your English.

            Not we have to do SOMETHING….that means we could rattle beads and burn feathers.

            We have to do something USEFUL

            So far, we’re still on the beads and feathers.

          • The medical world have their own very large problems due to Big Pharma influence. I go to doctors, but take their advise with a grain of salt, especially when they reach for the prescription pad two minutes into the visit. If they prescribe me a drug, my first questions are: How long has the drug been on the market? Is it still on patent? Are there earlier drugs with a better known history that are just as good? Sometimes I follow their advice, sometimes I chuck it in the garbage heap.

            The point is, you can’t always trust ‘experts’, you can’t always blindly side with ‘authority’. They have been, are, and will continue to be completely wrong on a regular basis, due to their own ignorance, stupidity, fixed ideas, prejudice, vested interest, or just plain evil. All it takes is one or two authority figures to start a whole line of thinking down the wrong road, with everyone following like sheep to the land of insanity beyond, simply because no one thought to see beyond the God-like ‘authority’.

            Obviously this isn’t always the case, but healthy skepticism is what is required when dealing with experts in any area. If your own survival hangs in the balance of their solutions, look long and hard to see just how much real science is behind their solutions. Real science, if followed properly, will weed out a lot of the garbage. Pseudoscience is used to create a facade. If you look and see pseudoscience being used, that is a very red flag, and you would do well to seek help in another direction.

          • I have worked in acute inpatient hospital and community outpatient psychiatry as a nurse since 1996. After reading your comments, I can say without a doubt that you have never met a person who is suffering from mania related to bipolar disorder; or a psychotic episode; or catatonia related to depression like I have seen. I have looked after patients who have been treated with counselling, medications and electro-convulsive shock therapy. I have seen patients who took vitamin therapies for psychosis and remained very ill. Without a doubt, the only treatment for schizophrenia that works at this point is medication. ECT works well for depression but so does cognitive therapy and antidepressants. Your contention that there has not been adequate research in psychiatry or that the research is somehow tied to “big pharma’ is absolutely false. If you look at ground breaking research done by early psychosis programs in Australia and even in Canada, you will find they suggest that people who have suffered a psychotic episode only remain on medication for two years unless they have a relapse. These programs utilize cognitive/behavioral therapy and occupational therapy for all of their patients as well as family counselling programs. Medication is only one of the necessary components.

          • Schizophrenia as a “disease” represents a fundamentally disordered approach to epistemology—one takes oneself, the purported non-schizophrenic, as the human archetype and categorizes all those not sufficiently like oneself as mentally ill—essentially, diagnoses like schizophrenia are a form of cognitive eugenics, and the medications administered to schizophrenics are a form of cognitive sterilization. I am all for having people sterilized if they want to be sterilized, but the use of such medications absent informed consent is a crime that should be punished severely.

            It is tempting to pathologize those who believe in schizophrenia and to suggest that they suffer from a sort of sociopathic disorder that fails to acknowledge the full spectrum of human variation, a spectrum of variation that is ill-suited to factory work and therefore targetted within the industrial-factory model, but to do so would be to make the same epistemic error.

            We will not really have any good work done on mental illness until the abstraction-removing drugs like LSD, psilocybin and mescaline are re-legalized. As an inpatient worker, that is, a warden of a jail where the inmates do not get a trial beforehand, you are heavily biased toward rationalizing your conduct in the same manner that a sociopath rationalizes his or her callousness toward others—again, to label you a sociopath would be to make the same epistemic error. And absent the unstatutable mental health acts, we would have a word for you: criminal conspirator in false imprisonment.

          • Where I live in Alberta people cannot be treated against their wishes unless they are deemed incompetent to make treatment decisions and they pose some sort of risk. It is not enough that they have a diagnosis of schizophrenia or that they have been hospitalized. The patients have the ability to appeal treatment decisions to the courts and they cannot be treated while the appeal is taking place. It is the right of a person to have schizophrenia and never treat it but once they become a risk to themselves or others or they start costing the system a lot of money by ending up hospitalized repeatedly, they run the risk of getting forced treatment under a community treatment order.

          • If they are “hospitalized” (read: gaoled) that is a form of treatment. Really, it is a corporal punishment masquerading as treatment. There should be no such thing as a “treatment order.” There should be civil pleas and criminal pleas. There should not be medical pleas. For goodness sake, if the situation in AB is like in BC, the College of Physicians and Surgeons is a Private Act corporation—essentially a private monopoly. I have reviewed a publication offered by AB’s Government, and it says that the initial certificate for involuntary admission is grounded in the “belief” of a physician that several criteria are met. Mental Health statutes are a remnant of our historical flirtation with eugenics—it is no longer considered a mental disease to be homosexual, but, unfortunately, we have not realized that all mental disease is of the same epistemologically baseless nature.

          • If you read the the rules for certification (what is needed to put a person in hospital against the wishes in Alberta) then you know that they have to meet the criteria of suffering of mental illness; being a danger to themselves or others; or likely to suffer a decline in functioning that will impact their quality of life; and they cannot be suitable to be hospitalized as a voluntary patient.

            The patient who is certified can appeal to a review panel and has to be heard within 7 days. The patient has a lawyer provided for free. The patient has access to the patient advocate. The patient can appeal all the way to the law courts. The patient cannot be given any medications unless the patient is a risk to themselves or others….meaning that they start harming themselves physically or they start physically harming a staff or co-patients.

            Given that the shortage of beds in Alberta, people are not being hospitalized against their wishes unless they meet the criteria. The treatment order requires the consent of a next of kin. The patient can appeal it all the way to the law courts. The only way meds can be given is again if the patient is violent and poses a physical risk to themselves or others.

            I respect your opinion about the treatment orders however, given that patients with schizophrenia have done violent acts during psychotic episodes, not everyone is going to agree with you that they have the right to remain psychotic and free in society. I am not sure how you think people end up at the hospital if they psychotic and no one is concerned. We inpatient acute mental health don’t go outside the hospital searching for psychotic patients, they come to us….usually via the police

          • Yes, there are people who have been given Psychiatry’s label of ‘schizophrenic’ who rebel against that labeling. There are some who view Psychiatry as social engineering, a pseudo-scientific construct that authoritatively decides what is normal or not normal, too much, or too little, etc. That it is influenced by societal pressures and ideas and fads, not science, which may explain why homosexuality was once a psychiatric mental disorder, then removed as one. That’s science? Lol. Psychiatry has a direct and substantial foundation of eugenics in it’s history. And not many decades ago either.

          • The problem with terms like ‘bipolar’ ‘schizophrenia’ and any of the other 374 or so ‘mental illnesses’ is almost all of them are terms created BY Psychiatry. They are diagnoses OF Psychiatry. And other people simply parrot these terms—the person in the street, md’s, psychologists, you name it. Yet there is not a single proven CAUSE of any mental disorder PROVEN by some objective scientific laboratory or clinical test, of any kind whatsoever, or any objective scientific test that proves someone even has any psychiatric ‘mental disorder’. Just subjective opinion and theories. That people can have extreme states of mind does not EQUAL what Psychiatry says it is.

  15. I love how even normal behaviour these days is considered a mental illness. Equally loveable is the fact that they have an expensive drug for each and every one of them. Child wont pay attention in a boring class room? Drug them! Feeling melancholic? Drug yourself! Sore arm? Load up on Oxy’s!

  16. Jesus came to heal the brokenhearted, and set the captives free……….Ask Him to save you, forgive you of all sin, and He will come into your heart, and fill you with His Holy Spirit………

    ……..2 Timothy 1:7……..
    For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.

    • I work on a forensic psychiatry unit. I’d say we have a more religious patient population than the general population. They are still in-patient though.

  17. Pharmaceutical companies and the power behind them. The goal
    is to get everybody to take medication, whether you need it or not. You’ll be
    forced at some point if you don’t comply. After that comes control,
    manipulation and the end of human free will as we know it today. Wake up

  18. I think it’s important that clinical judgment needs to play a role as well. As a mental health nurse, what matters to me is whether a client is experiencing symptoms (or whatever you would like to call them) that are distressing for them and preventing them from leading the life they want to live. A diagnosis is a way to put a name to those distressing symptoms, but treatment strategy is based on the consideration of many factors. If someone is grieving that doesn’t mean they automatically need anti-depressants, but it does mean I as a nurse should keep an eye out for emerging symptoms of depression that my client and I may agree should be treated, whether that involves medications or other strategies.

  19. The diagnostic criteria is not reflective of “an outburst from time to time..” there are parameters. All that’s changed is the information stated in the DSM-V, not how we go about making an actual diagnosis, which we know includes a variety of assessments such as interviews, self-asessed reports, etc. A good clinician will recommend an alternative to drug therapy as much as they do now; this includes psychotherapy such as CBT. If we follow the research in psychopharmacology, we will see that treating a psychological condition medically, such as using SSRI’s for treating depression, shows a comparable treatment outcome to good psychotherapy. Furthermore, having an official “diagnosis” may make treatment more accessable and finacially manageable (i.e. insurance coverage).

    However, I do agree that we should not slap a diagnosis on a kid just because their parents have poor disciplinary skills. Calling a temper tantrum a mental disorder is like blaming the teacher for your kid’s bad grades in school; no one (such as the parents) wants to take responsability for their contribution to the problem.

  20. The diagnostic criteria is not reflective of “an outburst from time to time..” there are parameters. All that’s changed is the information stated in the DSM-V, not how we go about making an actual diagnosis, which we know includes a variety of assessments such as interviews, self-asessed reports, etc. A good clinician will recommend an alternative to drug therapy as much as they do now; this includes psychotherapy such as CBT. If we follow the research in psychopharmacology, we will see that treating a psychological condition medically, such as using SSRI’s for treating depression, shows a comparable treatment outcome to good psychotherapy. Furthermore, having an official “diagnosis” may make treatment more accessable and finacially manageable (i.e. insurance coverage).

    However, I do agree that we should not slap a diagnosis on a kid just because their parents have poor disciplinary skills. Calling a temper tantrum a mental disorder is like blaming the teacher for your kid’s bad grades in school; no one (such as the parents) wants to take responsability for their contribution to the problem.

  21. I feel the quote ” anything that can be used in DSM will be misused” sums up my feelings for the changes and DSM in general, this is why although psychiatry is admittedly considered a more scientific pursuit, I prefer psychology- no drugs

  22. Genetic c

  23. This is some pretty brilliant trolling.

  24. We all have sanity issues, its more like a lot of shades of gray with very little pure white and pure black. But most of us, fortunately, are int he range of having enough sanity we function well, most of the time.

    Was watching a program on PBS, the government shrink suggested anyone with above average IQ should be treated especially if they didn’t conform as their creativity kicks in. Having fallen off the chair as I have a better than average IQ, I just have to say maybe time we call ignorance a disease far too many have.

    There is a huge difference between a psychopathic break and intelligence people. Just because people are different doesn’t mean you lock them up.

    Real issue is when people don’t care for their mental health, bad things happen. Deal with the problem people, not a Salem like witch hunt mentality.

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