Sunday, June 3, 2012

Big news on the psychiatry front when I wasn't looking

I've not had much time for blogging in the last few weeks and I've missed some important developments in the last couple of months regarding the upcoming edition of the "bible of psychiatry", the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An early-intervention mental health diagnosis that has been championed by Prof Patrick McGorry, who has great influence on the Gillard Government and a high-profile in Australia, has been rejected by the American Psychiatric Association (APA). This supposed disorder which is thought to be a milder early sign of the onset of a psychotic mental illness, typically in teens and young adults, will not be included inthe fifth edition of the world-famous manual of psychiatric diagnosis, but will be relegated to the appendix where disorders requiring more research are placed and forgotten. This controversial condition went by a bewildering range of names: "psychosis risk syndrome" "prodromal symptoms" "prodrome" "high-risk syndrome" "ultra-high-risk syndrome" "at-risk mental state" etc. The ad hoc nomenclature gives the impression that the professor was just making it up as he went along. 

Don't be overly distracted by the rejection of one proposed new mental illness by the APA. The crashing and burning of the prodrome is not really the big news from last month on the subject of modern psychiatry's revision of it's great big guidebook. The big news was that two diagnostic categories in some of the most supposedly common and also some of the most aggressively promoted types of mental illness in Australia, major depressive disorder and generalised anxiety disorder, have been found by psychiatry researchers to be diagnostic categories which cannot be reliably identified, in that there was found to be a major lack of consensus from one doctor to another about who did or did not meet some diagnostic criteria for these types of disorders. What kind of diagnoses are these, which cannot be identified with any certainty or reliability? If modern psychiatry was an emperor, he'd be looking very bare and very embarrassed right now.

Why are these recent developments important to Australians? The Gillard Government has committed a huge sum of money to reforms in mental health services, guided by controversial figures such as Pat McGorry, Ian Hickie and John Mendoza. We don't only have the government spending big on psychiatry and shoving the message down our throats that we all need more of it, we also have some very powerful and influential charities and organizations inflicting very pervasive and long-standing public awareness campaigns about mental illness onto the general public. Two that come to mind are Beyondblue and the Brain and Mind Research Institute, but there is a mental health message promoter lurking around every corner in Australia. Awareness campaigns actively recruit ordinary unqualified, uneducated members of the public as peer-support spreaders of the word that mental illness is everywhere and needs to be treated yesterday. Psychiatry propaganda seeps into ordinary social exchanges and is impossible to avoid. TV news stories hammer the message that we should be uncertain and concerned about the minds of others and our own. Journalists have swung from one extreme to another regarding the reporting of suicide (which is universally assumed to be the result of mental illness). I remember the days when it was a subject banned from news reports based on the belief that reporting might trigger copy-cats. These days suicide is the flavour of the month on current affairs reporting, and journalists jump to label crimes and deaths as suicide, sometimes mistakenly. Because of this tasteless and horrible focus on the morbid and the sordid it is now impossible to sit through the news hour on TV in the company of young children. For many years now Australians who watch late-night commercial television have been assailed by TV commercials for the network of Headspace psychiatric clinics aimed at young people, often with scant or no indication that this is what these clinics actually are. Now I find that there is absolutely no place except home where I can go to escape messages about mental derangement. Even in a public toilet I have psychiatry propaganda about depression and anxiety (the two disorders that can't apparently be reliably diagnosed) shoved in front of my face. We now have full-page illustrated advertisements advocating the identification of mental illness and the use of the services of professional mental health services on the back of dunny doors! They are found in toilets in shopping centres, universities, you name it. ENOUGH!

What's wrong with spreading awareness, you might ask. If the message is a misrepresentation, then it is all bad, and the message is indeed mostly lies. We are told that the treatments work. In fact, there is a load of good evidence that many of the drugs prescribed for depression and other mental illnesses do not act as chemical treaments and have troublesome or dangerous side effects. If they were just sugar pills, that would only be a con, but it's worse than that. An active placebo works because the person taking the drug can feel definite and troublesome side effects, and he/she unconsciously takes this as evidence of the potency of the drug, and this gives rise to a powerful placebo effect (which is a real effect, but not the result of any drug action). These drugs cost patients and the taxpayer dearly, many have serious side effects and many of them basically don't work, and in the process the patient is often unjustifiably convinced that she/he has a defective brain which needs ongoing chemical assistance to work adequately. We are told that modern psychiatry is based on a solid foundation of decades of research evidence that meets the highest scientific standards, but in fact one of the trials which was part of the evidence foundation of the recent DSM revisions had a grand total of nine (9) ill patients as subjects. And they are trying to make you and I feel guilty for not going along with this debacle? Pull the other one, mate!
Aldhous, Peter (2012) Trials highlight worrying flaws in psychiatry 'bible'. New Scientist. 17 May 2012 issue 2865. p.6-7.
Maxmen, Amy (2012) Psychosis risk syndrome excluded from DSM-5. Nature. May 9th 2012.

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