Dr. Joy Bliss [HT: Bird Dog] has collected a couple more links in the chain from the enhanced diagnostic nosology of DSM-5 to the ongoing efforts to pathologize all the foibles of human behavior. Ace is worried about organized Psychiatry's tendency to pathologize normal variants of behavior and about the purity of their motives:
From the Washington Examiner, the changes "reflect new political realities about how psychiatric medicine gets paid for and by whom." Under the new revisions, almost everyone could be labeled with some kind of disorder. Behavior that has always been regarded as normal is now considered suspect. Some of the diagnoses that are being considered include:
- mild anxiety depression
- psychosis risk syndrome
- temper dysregulation disorder
- attenuated psychotic symptoms syndrome
- binge eating disorder
Maybe I just have a case of too skeptical for my own good syndrome, with a touch of sick of the bullshit fugue. And maybe a little everybody seems to have a way to scam money from the government but me anxiety. Yeah, there's that.
Looking on the bright side, under DSM-5, Ace will have a reimbursable disorder; of course, so will everyone else and the only treatment that will be reimbursed will be pharmaceutical.
A long article in the Washington Examiner is well worth your time to understand how the convergence between government and organized Psychiatry is corrupting the practice of Psychiatry.
Even if you could justify rent-seeking on grounds that taking preventive measures with, say, “alcohol use disorder,” it ought to be difficult to use the primary care rationale for any number of other kooky disorders dreamt up by the APA inner-circle, its lawyers or its supplicants. Oh but they will: If we treat temper tantrums early, there will be less crime, etc. People get creative when it comes to rigging the game..
It’s not just the psychiatrists and Pharma who stand to gain. This is also a subsidy largely for the wealthy. A new bonanza for the so-called “worried well” is likely to pull psych doctors away from helping those who need it most -- the chronically mentally ill poor -- and into practices built to treat wealthy people with newly-minted Cadillac mental health plans.
[Dr. Bliss wrote more about this in The personality disorder kerfuffle, and the silly DSM and I wrote about the misuse of Psychiatric nosology in The Altruistic Will to Power.]
The crucial element from the Psychiatric point of view is that Psychiatry has abandoned any concern with using etiology, ie causation, in its diagnostic manual. All diagnoses are collections of symptoms and all treatments, especially under the pressure of the health department bureaucrats who know nothing about patient care but assume all providers are alternately morons, incompetents, charlatans, or sociopaths and demand numbered lists of problems that can be addressed in notes (which may have nothing to do with the actual person, or client or consumer, the note refers to) devolves to the lowest common denominator, which in most cases means drugs. Psychotherapy is not amenable to problem lists (though some schools of Psychotherapy do focus on specific problems) while symptoms are easy to list and can be assigned numerical values. Drugs are designed to address symptoms, Pt gain symptom relief (perhaps primarily form the placebo effect) while keeping their pathology and diagnosis, and everyone goes home unhappy but afraid to change.
Here is a case in point, a young man entering the system, who was referred for evaluation and treatment of (mild) Depression, Not Otherwise Specified (DSM-IV: 311):
Hector is a 20 year old man born in New York who was referred by his primary care provider (née Doctor) because of depressed mood, low frustration tolerance, and anger management issues.
He described his problems as being caused by his family's financial problems and conflicts with his 15 year old Girlfriend. She lives two hours away (they met on line) and they only see each other two days a month. She is much less invested in the relationship and he feels insecure; when she does not show sufficient interest in their chats, he gets angry. His history includes difficulty learning, he dropped out in 9th grade, and poor work habits. He worked at a hotel on track to join th Union but spent much of each day with his co-workers drinking beer. He was fired. He worked for several months over the summer but his job, moving pallets in a warehouse, was too strenuous and didn't pay well enough. He quit. He is currently working part time and it is insufficient for his needs. He worries about money and his girlfriend and when he discussed his worries with his PCP he was referred to mental health with a provisional diagnosis of Depression.
Hector does not yet realize it but he is on track to enter the realm of Mental health/Social Services where, if he hits the jackpot, he will be discovered, under DSM-5, to have chronic " mild anxiety/depression" (or perhaps, he might better fit "temper dysregulation disorder" or “alcohol use disorder") and given disability. His disability will "earn" him several hundred dollars a month ( not enough to live on but enough to keep him pacified and eligible for subsidized housing in New York), and support a network of Social Service workers (Social Workers, Case Managers, Psychiatrists, et al) who will keep him "treated" with a varying stream of "supportive services" and medications from Pharma.
[For the record, Hector could not leave without a diagnosis and I therefore diagnosed "Adjustment Disorder", did not prescribe medication, and sent him to the Social Worker for Supportive Therapy so that he could negotiate his break up with his girlfriend; it is possible Hector will find the inner strength to resist the pull of the system whose siren song he is just now beginning to hear, but he did not strike me as a modern day Odysseus.]
Hector was naive in the ways of the System; with time and more lost jobs he will discover that if he describes himself as "depressed" rather than unhappy and that he is "self medicating" with beer rather than merely drinking beer and that he has anger management issues rather than poor frustration tolerance and a bad temper, he will be ushered into the system and its financial inducements with alacrity.
The system is becoming so complex and kludgey that it cannot last indefinitely. Able bodied men and women who are limited it their abilities cannot be supported forever by a smaller and smaller number of productive workers. This is the way toward Collapse.