Monday, April 26, 2010

New World Disorder

Some time back I remarked on a new childhood "affliction" to be dealt with by the judicious use of drugs and psychiatrists: "Oppositional Defiant Disorder." If you had four or more of the following as a child, you were ODD, and I guess I was, too:

1. often loses temper [check]
2. often argues with adults [check]
3. often actively defies or refuses to comply with adults' requests or rules [check]
4. often deliberately annoys people [check]
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful or vindictive

To qualify as ODD, those "disturbances" must cause "clinically significant impairment in social, academic, or occupational functioning." But of course that can mean almost anything. Talking back. Fighting back. Asking a lot of questions. Standing up for yourself in a hostile environment.

In those days teachers and jocks simply bullied you into submission. Now it's all white coats and Ritalin.

Creativity? Lateral thinking? Oddball hypotheses? Questioning authority? For goodness sake, tell your kids to leave it at home, for their own good. That's what the Internet is for.

In any case, it looks as though I was onto something. The Diagnostic and Statistical Manual of Mental Disorders is going through another update. The first version of the DSM, published in 1952, listed 128 disorders (including homosexuality, delisted in 1973). DSM-IV, appearing in 1994, listed 357--almost three times the original number. And DSM-5, scheduled for publication in 2013, may swell the list even more.

Dr. Allen Frances chaired the committee that wrote DSM-IV. He has, to put it mildly, had a change of heart, after having had more than a quarter-century to observe the human tragedies that resulted:

Frances says [DSM-IV] unintentionally contributed to vast and sudden increases in the diagnosis of attention-deficit hyperactivity disorder, autism and childhood bipolar disorder (manic depression), after it made changes in those definitions.

Rates of bipolar disorder alone jumped 40-fold in the U.S. after the definition was broadened to suggest that children don't have to experience the typical manic symptoms seen in adults to be diagnosed bipolar -- and that depression in kids can be a persistent irritable mood.

"Most of this was not our fault," says Frances.

Rather, he blames "a runaway fad led by thought leaders and pushed by drug companies and advocacy groups."

Were Michel Foucault alive, he would understand only too well this massive proliferation of diseases invented by the very people who then proceed to "treat" them. Big Pharma* is in there like a dirty shirt as well. It's all about power, expanding taxonomies of "mental illness," and with them more discipline and control.

Remember the scandal when the former USSR put political dissidents in mental wards, after diagnosing them with "sluggish schizophrenia?" Well, it's still happening over there, but the categories are now DSM-compliant:

On March 23, [2006] police and emergency medical personnel stormed Marina Trutko's home, breaking down her apartment door and quickly subduing her with an injection of haloperidol, a powerful tranquilizer. One policeman put her 78-year-old mother, Valentina, in a storage closet while Trutko, 42, was carried out to a waiting ambulance. It took her to the nearby Psychiatric Hospital No. 14.

The former nuclear scientist, a vocal activist and public defender for several years in this city 70 miles north of Moscow, spent the next six weeks undergoing a daily regimen of injections and drugs to treat what was diagnosed as a "paranoid personality disorder."

"She is also very rude," psychiatrists noted in her case file.
[emphases added]

Can't happen here?

One of the most controversial proposals [in the new draft DMV] calls for the establishment of a new condition called "psychosis risk syndrome." The goal is to identify young people at risk of developing a psychotic disorder, such as schizophrenia, and intervene early.
[emphasis added]


"You and I might say, 'Well, there are a lot of adolescents who are just kind of funny, and have funny ideas, and they don't communicate well.' About half my students are like this," says Edward Shorter, professor of the history of medicine and of psychiatry at the University of Toronto, and author of A History of Psychiatry: From the Era of the Asylum to the Age of Prozac.

"The DSM-5 says, 'Ah, no. These people probably have a precursor of schizophrenia, so we'll treat them prophylactically with powerful antipsychotic drugs in the hope of forestalling the eruption of serious illness that we know to be almost inevitable'."

No doubt the whitecoats will see this post as an instance of adult "temper dysregulation disorder with dysphoria," and my daily blogging as a "behavioural addiction." It's in the book.

Tomorrow, the Ottawa Citizen will explore that notion of "temper dysregulation disorder." Just to warn readers, I expect the article will get me pig-biting mad, and I'm liable to blog about it.

*[A]ntidepressants, tranquillizers and other psychoactive drugs have become the second most-prescribed drug class in the country, second only to cardiovasculars, according to prescription drug tracking firm IMS Health Canada.

Across Canada, pharmacies last year dispensed 61.2 million prescriptions for psychotherapeutics, worth nearly $2.4 billion.


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