Saving Normal from DSM-5

Saving Normal, by Allen Frances, the psychiatrist who led the task force for the DSM IV,  is a must read. Its subtitle is: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma and the medicalization of ordinary life.

DSM-I, The Diagnostic and Statistical Manual of Mental Disorders, was published in 1952 to replace various existing diagnostic classifications at a time when psychiatry was booming after WWII. Now, over 60 years later and 19 years since the DSM-IV was published, we have a 900 page tome in DSM-5, capable of classifying every one of us with a mental disorder. This is the classification used to determine treatment and insurance coverage.

Catchy acronyms like ADHD (Attention Deficit Hyperactivity Disorder), OCD (Obsessive Compulsive Disorder), or BiPolar (Manic Depressive Disorder) or Alzheimer’s (for all levels of dementia) encourage lay people to diagnose and, with the help of big pharma media advertising, expect their doctors to prescribe a potpourrie of drugs.

Children are being over-diagnosed and given prescribed drugs early on. Many new disorders have been added.  In the future, tantrums will be labeled Disruptive Mood Dysregulation Disorder. 100% of kids will qualify for this disorder. The rationale seems to be “get them as kids and have them for life pharmaceutically.”

Policy changes Frances sees that will help are: no more fructose subsidies, no more coke and fries with school lunches, no more streets without sidewalks to discourage walking, restore Phys. Ed. in schools, add calorie counts to menus, subsidize vegetables, lower insurance premiums for losing weight, encourage people to eat less and exercise more.

DSM-5 mislabels medical disorders as mental disorders. Irritable bowel syndrome, chronic fatigue, Lyme Disease, fibromyalgia, chronic pain, and more, now carry psychiatric disorder numbers.

Elsewhere in the news, oxycodon is being decried as an abused drug. I’ve observed that small doses given to elderly people for pain often causes them to hallucinate. Because they are elderly, they then risk being pegged with a senile diagnosis and given psychotropics.

Treatment of US service people for PTSD (Post Traumatic Stress Disorder) is under fire in the news this week. After 3 or more deployments to participate in the horrors of war, there are reports that the Army is criminalizing PTSD behavior and discharging service people with PTSD instead of court-martialing them if they agree to give up their health benefits. The PTSD diagnosis without treatment makes it difficult for them to get a job, much less resume their personal lives. Is this how we want to recognize and care for our service people?

The rationale of using drugs to correct a chemical imbalance “for the rest of your life” has been abused, not only with psychotropic drugs but with drugs for medical problems. Frances reminds us that Big Tobacco once seemed invincible, yet was taken down so quickly. The same thing can happen with Big Pharma  when we refuse to accept the buffet of pills it promotes that rob us of our health and financial solvency, when we heed Hippocrates’ caution to let our food be our medicine, and when we intentionally give our bodies the exercise we need to keep all systems running smoothly.



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