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"New diagnoses are more dangerous than new drugs"
December 9, 2012 1:04 PM   Subscribe

On December 2, the American Psychiatric Association's board of trustees voted on the latest revisions to the Diagnostic and Statistical Manual of Mental Disorders, to be published as the fifth edition (DSM-5) in May 2013. The results of the vote have not been released publicly, and some have questioned the limited press coverage of decisions that will affect people worldwide who receive psychiatric diagnoses. Dr. Allen Francis, chair of the DSM-IV revision committee, says that the board "has given its final approval to a deeply flawed DSM 5". (The title of this post is also drawn from this link.)

Previously on MetaFilter: DSM5, DSM, DSMV.
posted by catlet (61 comments total) 19 users marked this as a favorite

 
At my mental health office there is already a sign up from the Effexor company that lists grieving as "Adjustment Disorder" and recommends medication. I'm disgusted every time I see it and now to see grief being mixed in with Major Depressive Disorder is even more disheartening. My therapist quite often says he sends back forms to the doctors saying that he sees no signs of depression but that the person is actually grieving. I'm the farthest thing from anti-meds but I really hope there is a blow back in the other direction some day soon that recognizes people have emotions and sometimes need to feel them without being medicated.
posted by kanata at 1:17 PM on December 9, 2012 [33 favorites]


This is only going to give ammunition to people who do not believe that psychiatry is a valid branch of medicine.
posted by Renoroc at 1:25 PM on December 9, 2012 [2 favorites]


I've been wanting to give Scientology a try anyway, so this seems well-timed
posted by thelonius at 1:26 PM on December 9, 2012 [8 favorites]


I'm pretty sure that at some point in my life I ate too much "12 times in 3 months," so I guess I qualify for binge eating disorder. Show of hands -- you too? Drugs for all of us! Awesome!

Or, if the thought of mass overdiagnosis leaves you feeling a bit glum, don't worry: even justified and explicable grief has now been medicalized.
posted by justsomebodythatyouusedtoknow at 1:27 PM on December 9, 2012 [2 favorites]


Couldn't this also come into play over the next few years in all kinds of court cases involving people with (or without) mental illness?
posted by Red Loop at 1:33 PM on December 9, 2012


"5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder."

Well now, around here we just call that "Thanksgiving through Christmas".


I do find this one interesting, though... TFA goes from:
During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder.

To:
The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services.


I've ranted in support of his first point on a number of occasions; but to then go back and complain that the new definitions might undo merely half (at most) of the recent fad of overdiagnosis? Pick a message and stick to it, Dr. Frances.
posted by pla at 1:36 PM on December 9, 2012 [1 favorite]


That's just crazy....
posted by gallus at 1:36 PM on December 9, 2012 [1 favorite]


This is one fucking incredible rube-goldbergian kabuki dance of experts, corporations and governments, spending uncountable hours cataloging and categorizing personal and social problems and turning them into labels and pills and money and explanations. And the band played on.
posted by crayz at 1:39 PM on December 9, 2012 [8 favorites]


Anything that distracts you from being a happy, productive worker is obviously a serious mental health issue, probably depression.

Have a pill.
posted by Thorzdad at 1:40 PM on December 9, 2012 [9 favorites]


This is only going to give ammunition to people who do not believe that psychiatry is a valid branch of medicine.

Psychiatry really does need to be radically reconsidered. This sort of travesty (the DSM V) would not occur in other branches of medicine. At some point, practitioners need to sit down and agree on which old paradigms have failed and need to be thrown out. Unfortunately, there's no real way this can happen while the majority of psychiatrists were still educated in a time where Freud was cutting edge.
posted by 256 at 1:40 PM on December 9, 2012 [4 favorites]


Couldn't this also come into play over the next few years in all kinds of court cases involving people with (or without) mental illness?

It's looking as though the DSM-5 will not be universally accepted. Many psychiatrists and doctors will continue using the DSM-4. If we don't have undisputed definitions of the criteria for mental illness there's going to be a lot of room for lawyers to muddy the waters in court.
posted by justsomebodythatyouusedtoknow at 1:43 PM on December 9, 2012 [1 favorite]


I'm pretty sure that at some point in my life I ate too much "12 times in 3 months," so I guess I qualify for binge eating disorder. Show of hands -- you too?.

Probably not, given that about 3.5% of women and 2% of men are believed to have met criteria for BED at some point in their lives.

And what about those people who, do routinely undergo compulsive eating binges, to the detriment of their health? There's a large literature showing that cognitive-behavioral therapy is an effective treatment for binge eating disorder. Are you really comfortable saying those people's health insurance shouldn't cover it, because the diagnosis sounds kind of funny and you can imagine it being too broadly applied?
posted by escabeche at 1:43 PM on December 9, 2012 [18 favorites]


I really hope there is a blow back in the other direction some day soon that recognizes people have emotions and sometimes need to feel them without being medicated.

I know what you're saying and I agree, but isn't there validity to medicating for grief on occasion? Say, someone whose entire family has just been killed in a car accident? Are you suggesting that they should not have a name for their acute grief and that it should not be medicated? That they should feel that grief in all its severity for personal growth?
posted by jimmythefish at 1:44 PM on December 9, 2012 [6 favorites]


My therapist quite often says he sends back forms to the doctors saying that he sees no signs of depression but that the person is actually grieving.

These aren't necessarily different things. Depression is a diagnosis based on symptoms. Death often manifests those symptoms in those close to the deceased. Why should grieving be thought to be "natural," and therefore not the same as "depression," yet depression following unemployment, or while working in a meaningless job, isn't? This speaks to the core of psychiatry. It looks for clusters of symptoms, but in order for those symptoms to be worth medicalizing, they have to be socially problematic. That your therapist happens to believe that "grieving" is less problematic than "depression" says more about your therapist (and, to some extent, society) than it does about what illness a patient "really" has. In other words, some clusters of symptoms are considered acceptable or normal, so people think it's absurd that they're labelled as illnesses. But why should people think this? If we're going to treat problematic behaviour as illnesses, why should we distinguish between what caused the behaviour? Unless, of course, doing so helps us treat the symptoms, but there's not much evidence we're interested in that, since there's lots of evidence that both medication and therapy are less effective for treating, say, depression than diet and exercise. And the data show that homelessness and unemployment are actually more predictive of deterioration, even in schizophrenics, than taking medication. Psychiatry is how we justify not doing anything about these things.
posted by smorange at 1:44 PM on December 9, 2012 [18 favorites]


Dude. I'm all for saying emotion is healthy, and people can be variable and variant without being pathologized. At the same time, dismissing this entire process as labeling people for the sole purpose of feeding them pills is silly.

There's a lot of us on Mefi and out in the rest of the world who have found the use of medication to be beneficial - even life-saving, whether in a literal ("I'm not dead") or indirect ("life is meaningful and enjoyable again") sense. Let's recognize flaws in the profession and industry of psychiatry and psychology - but not throw the baby out with the bathwater.
posted by spaceman_spiff at 1:48 PM on December 9, 2012 [18 favorites]


I had a doctor once tell me the reason these keep changing is because new doctors need to write papers and make new discoveries, it's the same reason shell shocked became post traumatic stress. It's not always a bad thing, but since we still know so little about it all, it's easy to do. I have no clue if it's the truth, but it helped me look at these kinds of things a new way.

I saw a part in the changes that self injury isn't something to be covered by insurance, and i get that, but from my own experiences, it can be considered a pre-existing condition, and make it hell to get insurance. It also is a side effect of bigger issues that do need help and not covering those by insurance is a travesty.

there is already a sign up from the Effexor company

Ugh. I know it's anecdotal, but i had a bad, bad reaction to Effexor. A bit after taking it (a week or so being on it), it started to put me into a state of dissociation, constant dissociation. Which was one of the worst things it could do, as before when i'd get that way, i'd end up self harming as i wouldn't feel anything. The doctors were so worried about that reaction that it's now listed as one of my drug allergies. I know this isn't really related to the DSM, but for me it's the trouble of tossing drugs at things.

I would like for a drug to work with me though, so rarely has an anti-depressant worked for me without worse side effects.
posted by usagizero at 1:51 PM on December 9, 2012 [1 favorite]


He wrote me a prescription he said 'you are depressed
But I'm glad you came to see me to get this off your chest
Come back and see me later - next patient please
Send in another victim of Industrial Disease'
posted by Mooski at 1:53 PM on December 9, 2012 [7 favorites]


This kind of thing really pisses me off. But I'm not hving a temper tantrum about it. Nosiree!.
posted by Splunge at 1:54 PM on December 9, 2012 [1 favorite]


I think it is a false dichotomy between normal grief and depression. The standard should always be distress and possible harm for the patient. Too much grief can be a bad thing as well.

It works the other way as well, by defining depression as a disease, we ignore a lot of the environmental factors. The sad truth is a lot of people have good reason to be depressed and I wish we had the wisdom to know how to treat these causes.
posted by psycho-alchemy at 1:55 PM on December 9, 2012 [10 favorites]


There's a lot of us on Mefi and out in the rest of the world who have found the use of medication to be beneficial - even life-saving, whether in a literal ("I'm not dead") or indirect ("life is meaningful and enjoyable again") sense. Let's recognize flaws in the profession and industry of psychiatry and psychology - but not throw the baby out with the bathwater.

I don't think anyone is saying it doesn't work. I'm saying it doesn't work particularly well, and that's based on psychiatry's own research. Look, psychiatry is all about labelling people. That's what the DSM is for. It doesn't have to be for the sole purpose of feeding them pills, but if you look at what governments do and don't spend money on, it's hard not to conclude that that's its social function. Giving pills to everyone for anxiety and depression is one way to solve a problem. Redesigning social structures so that anxiety and depression are less prevalent is another. Both of them might be effective, to greater or lesser extents, but it's obvious to me that we only really care about one of them. The system preserves itself by treating problems as individual problems.
posted by smorange at 1:57 PM on December 9, 2012 [5 favorites]


I had a doctor once tell me the reason these keep changing is because new doctors need to write papers and make new discoveries, it's the same reason shell shocked became post traumatic stress.

It's also because PTSD occurs as a result of trauma, not exclusively due to combat.
posted by krinklyfig at 1:58 PM on December 9, 2012 [16 favorites]


The converstaions that would go into documenting these conditions are already difficult enough. The stakes have been raised-up and stupided-up by the misappropriation of the DSM into "what insurance will pay for". That really needs to be its own debate in order for either to have much chance of getting anywhere useful.
posted by Bokononist at 2:00 PM on December 9, 2012 [4 favorites]


I guess I am coming from it and see my therapist coming from it as the doctors in his clinic being more concerned with medicating what we see as "normal" pain then actually discussing the issues. The clinic has a protocol of the standard course of therapy being 15 sessions that revolve around strictly CBT. Of course, extreme grief or any grief that can be helped out with medication is fine with me but I think things like the DSM put too much focus on trying medication first.

I've been trying different medications for 14 years and finally found a combination that works for me but what really has helped is a combination of meditation, exercise, diet, getting a pet, and hard hard work with a therapist that doesn't subscribe to just CBT. In all the years of working with doctors none suggested any of these as additions to my meds and most of the therapists I tried only tried CBT ( I could derail here about how often CBT doesn't fit for people but because science says it should no one experiences anything different ).

Normalization of feelings needing medications pulls the focus away from actual working on aspects of our lives that we can change that take effort on our part.
posted by kanata at 2:01 PM on December 9, 2012


Giving pills to everyone for anxiety and depression is one way to solve a problem. Redesigning social structures so that anxiety and depression are less prevalent is another. Both of them might be effective, to greater or lesser extents, but it's obvious to me that we only really care about one of them.

Assuming what you say is true, there is still only one solution which is within reach of any individual person. It may not be within my power to change the world, but I can change myself. If I am suffering, it's more practical to treat myself.
posted by krinklyfig at 2:01 PM on December 9, 2012 [7 favorites]


I know what you're saying and I agree, but isn't there validity to medicating for grief on occasion? Say, someone whose entire family has just been killed in a car accident? Are you suggesting that they should not have a name for their acute grief and that it should not be medicated? That they should feel that grief in all its severity for personal growth?

Our stupid prescription drug system is part of the problem. People want to use drugs. Drug companies want to sell drugs. In order to legally be prescribed a drug, one needs to be 'sick' or have a 'disease'. Therefore there is a tremendous monetary and political incentive to create new diagnoses for normal human behavior that needs to be 'treated'.

If you want a drug to make you happier, thinner, smarter, more attentive, more loving, whatever, I think that's great. Let's stop pretending it's restoring some mythical state of 'healthiness'. We need to start coming to terms with the fact that drugs can make us better people and improve our lives in many ways. They're as much of a technological miracle as the automobile, and about as dangerous. We need to start acting like adults and treat them that way. If you want to move faster, you get in a car, and nobody judges you for it-- you don't even need to be diagnosed with some kind of motility disorder. Why do people get all judgemental if I want to take adderal so I can focus at work, unless I've got some horseshit diagnosis for ADD, whatever that is?
posted by empath at 2:02 PM on December 9, 2012 [10 favorites]


Why do people get all judgemental if I want to take adderal so I can focus at work, unless I've got some horseshit diagnosis for ADD, whatever that is?

Why do you want to get judgmental about the diagnoses of other people?

I could tell you all about what ADD is, if you're truly interested.
posted by krinklyfig at 2:06 PM on December 9, 2012 [12 favorites]


Psychiatry really does need to be radically reconsidered. This sort of travesty (the DSM V) would not occur in other branches of medicine. At some point, practitioners need to sit down and agree on which old paradigms have failed and need to be thrown out. Unfortunately, there's no real way this can happen while the majority of psychiatrists were still educated in a time where Freud was cutting edge.

This smacks to me of being a bit of bullshit.

For starters, of course it wouldn't occur in other branches of medicine. We have centuries of medicine and advances and dissections and other things which allow other branches of medicine to prove whether a system is working properly and what might be done to alleviate the problems in said systems and so on. We don't have that for brain activity and mental wellbeing, for a variety of reasons many of which are immediately apparent even without advanced medical knowledge.

Other branches of medicine went through a lot of this kind of sorting out ages ago. Are your humors unbalanced? Do you require a bloodletting? Are you mentally disturbed because your womb is somehow unhappy? No. None of that is true anymore in other branches of medicine because research has proven that these are bad theories of medicine and they have been abandoned.

Mental medicine is still in its infancy because we don't have any effective way to look inside a working brain and see what is going on. We're starting to develop the techology -- fMRIs and other things are giving us much clearer glimpses. But none of them are particularly advanced yet. And doing any real research into how a living mind functions are all sorts of unethical, so we don't do them.

And a "majority" of psychiatrists were educated in a time when Freud was cutting edge? Really? I heartily disagree. I suspect a majority of those working in mental health fields, whether they be licenses psychiatrists or not, were educated in the past 40 years, which is will behind the days when Freud and his theories were considered to be the vanguard of the New and the Current.

From my understanding, one of the big changes to the DSM-V is the "gender dysphoria" diagnosis. Which is a much more humane and human approach to the whole transgender enigma than what had come before.

The DMS-V is seeking to put best current knowledge about how the brain and mind work into the context of modern knowledge and experience. Unless you're advocating for what would likely be really horrible experimentation on live human subjects to determine exactly how these systems work, it's probably best to realize that people who have been dealing with this subject matter all their professional lives are making the best decisions they know how with the knowledge they have are the ones working on this. And while you may disagree with the outcomes, second guessing their decision process without having any real experience outside your own set of circumstances is likely going to lead you down a blind alley which only provides illumination on your own special snowflakeness.
posted by hippybear at 2:08 PM on December 9, 2012 [22 favorites]


empath: " Why do people get all judgemental if I want to take adderal so I can focus at work, unless I've got some horseshit diagnosis for ADD, whatever that is?"

Yeah, I'd tack that onto my earlier comment. 'The misappropriation of the DSM into "what insurance will pay for" and "what drugs can be for"'.

What is purported as a scholarly reference, is in fact national policy on many topics, without properly admitting such or vetting the results appropriately given that role.
posted by Bokononist at 2:09 PM on December 9, 2012


A couple of years ago I found myself in a group suffering from sudden deep grief. We medicated ourselves and it worked. It would have been great if insurance had covered all the scotch, beer, weed, wooden ship set on fire for a Viking funeral and wash and fold for the tear and snot stained shirt sleeves.

The hugs were free and abundant. No need for coverage there.

What I am trying to say here is that humanity discovered thousands of years ago that medication helps in dealing with strong debilitating emotions, natural as they are. I am all for better medications. I am against a bunch of experts with self interests overriding people's well being deciding which medications, under what circumstances and at what price.
posted by Doroteo Arango II at 2:10 PM on December 9, 2012 [1 favorite]


We need to start coming to terms with the fact that drugs can make us better people and improve our lives in many ways. They're as much of a technological miracle as the automobile, and about as dangerous.

I agree with the way you're looking at the issues, but I don't think it's clear that either of those things have been or would be good for us. The automobile analogy is apt. The automobile might literally kill us all via global warming. Widespread automobile use makes them mandatory for everyone, and widespread drug use might well do likewise. These things change both our expectations of individuals and the way we design our societies. I'd rather we didn't depend on drugs to keep us going. There are always unintended consequences.
posted by smorange at 2:15 PM on December 9, 2012 [1 favorite]


You want psychiatry as she should be, Doroteo; the problem is that we have her as she is.

She's like a priest, in that way.
posted by Monday, stony Monday at 2:17 PM on December 9, 2012


thelonius: "I've been wanting to give Scientology a try anyway, so this seems well-timed"

there are a lot of schools of thought that disagree with psychiatry, that are not Scientology. http://behaviorismandmentalhealth.com/, for instance.
posted by rebent at 2:21 PM on December 9, 2012


Pill salesman aid.
posted by telstar at 2:27 PM on December 9, 2012


Okay, slow down folks.

At the beginning of the DSM there is a discussion of when psychological diagnoses are appropriate and the most important criteria is that the patient feels out of control and/or is seeing a serious degradation in their quality of life.

In short, something is a disorder only if the patient feels it's a disorder. You can binge twelve times in three months and these diagnoses would still not be applicable or applied unless you sought out help.

The worst abuses of this of course come from parents who are certain their child has the disorder of the week. Children are not in a position to say "actually, no, I'm fine with things as they are."

In any case you can relax. No one but your immediate friends and family is walking around diagnosing you with anything. And when the time comes that you do feel the need for help for bingeing or overwhelming grief or constantly forgetting your own phone number, a professional can look it up in the book and say "Okay, here's the official diagnosis. It's only sort of accurate but insurance will cover it."
posted by Tell Me No Lies at 2:39 PM on December 9, 2012 [11 favorites]


The Stoner's Diagnostic Manuel
Signs of three of the following indicate true potheadedness

1. "Wake and bake"
2. Anxiously shaking the contents of freezer/sandwich bag
3. Deciding to eat breakfast *after* the pot brownies have kicked in
4. Becoming bummed about being diagnosed in the DSM V.
posted by angrycat at 3:12 PM on December 9, 2012 [1 favorite]


For starters, of course it wouldn't occur in other branches of medicine.

Don't be so quick to concede this. There are all kinds of medical interventions that have no established efficacy and quite a few are overturned every year.

Psychology/Psychiatry is more fluid than medicine but don't mistake medicine for being solid. It is very far from it.
posted by srboisvert at 3:22 PM on December 9, 2012 [3 favorites]


Probably not, given that about 3.5% of women and 2% of men are believed to have met criteria for BED at some point in their lives.

And what about those people who, do routinely undergo compulsive eating binges, to the detriment of their health? There's a large literature showing that cognitive-behavioral therapy is an effective treatment for binge eating disorder. Are you really comfortable saying those people's health insurance shouldn't cover it, because the diagnosis sounds kind of funny and you can imagine it being too broadly applied?


I believe the issue is not whether BED exists, but whether the definition in the DMS-V is so broad as to render everyone a binge-eater from a diagnostic standpoint.
posted by schroedinger at 3:27 PM on December 9, 2012


kanata: I'm disgusted every time I see it and now to see grief being mixed in with Major Depressive Disorder is even more disheartening.

The way I heard it explained on NPR isn't quite like that. They said that the idea wasn't to treat grief, but rather, that the current state of psychiatry meant that if you were depressed, and also happened to be grieving, you would have trouble getting treatment for the depression. If you're depressed because you're grieving, they don't want to medicate that, but if you're already depressed and then grieving too, they don't want the grief to make you ineligible for treatment for a deeper problem.

The people who make Effexor may certainly be trying to hijack the idea into 'grief-curing pills', but the DSM folks are at least claiming that's not the goal at all.
posted by Malor at 3:40 PM on December 9, 2012 [5 favorites]


The diagnosis of adjustment reaction is frequently used to put a name to a transitional state of grief or other emotion of potentially debilitating intensity. From a practical view, medication works well in the sense that a person's job, family or other carefully crafted social/emotional scaffolding doesn't remain in stasis for the months or years that grieving takes. In many cases, medication makes it possible for a person tp carry on with the practical day to day work of maintaining the circus of life so when they are finally back on their feet they haven't lost their job, family, friends, etc. who generally expect the grieving process to be done in a few weeks.
posted by docpops at 3:45 PM on December 9, 2012 [1 favorite]


Tell Me No Lies: "At the beginning of the DSM there is a discussion of when psychological diagnoses are appropriate and the most important criteria is that the patient feels out of control and/or is seeing a serious degradation in their quality of life.

In short, something is a disorder only if the patient feels it's a disorder. You can binge twelve times in three months and these diagnoses would still not be applicable or applied unless you sought out help.
"

Psychopharmacy tries to put up a big "scientifically-proven drugs for your scientifically-proven illness" front. However, if what you say is true, then they are basically just very expensive, many-hoops-required over-the-counter drugs.

Would you consider it to be recreational? When someone drinks alcohol as self-medication, we have a name for that. Many currently-prescribed drugs are much more addictive than alcohol; furthermore, I assume that many pharmaceutical companies have an economic incentive to not run addiction studies.

So we have on one hand the rise of pot legalization, and on the other the broadening of "medicinal" coverage of drugs. And in the end, it all comes down to whether the patient themselves thinks they have a problem, and the doctor helps them select the drug that would help them best.
posted by rebent at 3:58 PM on December 9, 2012


I didn't know there was such a widespread belief that healthy adults are kidnapped by general practitioners and forced to eat Paxil indiscriminately.
posted by bleep at 4:01 PM on December 9, 2012 [11 favorites]


if a doctor says "take this pill, it will cure you," you take the pill.
posted by rebent at 4:21 PM on December 9, 2012


When someone drinks alcohol as self-medication, we have a name for that. Many currently-prescribed drugs are much more addictive than alcohol

That's a non-sequitur. Just because someone self-medicates with alcohol, it does not follow that that person is prescribed a more addictive drug to replace it. Self-medicating is a coping mechanism.

If someone is depressed, they may be prescribed an anti-depressant and talk therapy, which would work better than alcohol. Or they may may find that talk therapy works without medication.

I don't know about you, but alcohol nearly killed me when I used it to self-medicate. Turns out that psychiatric drugs work much better and allow me to be functional. Maybe you'll have a different outcome.

if a doctor says "take this pill, it will cure you," you take the pill.

No psychiatrist or doctor of any kind has ever told me anything like that.
posted by krinklyfig at 4:31 PM on December 9, 2012 [5 favorites]



I've been on a low dose of Effexor for almost two years. Depression runs in my family and for years I managed my moods with diet and exercise. Then one winter it all crashed. It's difficult to explain to someone who hasn't experienced it. It was like my brain went into some sort of revolt. My intellectual understanding was not matching with what my emotions and brain were doing. My thoughts had a mind of their own. The 'me' part was still there but it also felt like I had this other part working against me. Though not suicidal to the point of actually doing anything all I could think about was disappearing. Death and dying was always on my mind. Getting off the couch to even have a shower felt like running a marathon. It was awful and thankfully the 'me' part could still analyse things enough to know that what was going on in my life just didn't warrant that sort of emotional reaction. I was reluctant to take any pills but it was so bad I felt I didn't have a choice. I had to try something different because everything else was not working.

My doctor was and is great. He laid all the positives and negatives out and said right from the beginning that there was no guarentee that the first drug would work well. Thankfully however it did. In less the a week I felt a big difference. In two weeks I felt normal again. I couldn't even get my brain to dwell on the dark thoughts I was having in anymore then an academic way. It felt like the 'me' part was back in control.

I would be lying if I said that I don't freaking love these pills now. To me they're just like a brain vitamin I take everyday.

I still however experience emotional ups and downs. In fact right now I would consider my self depressed. I'm sad all the time, stressed and feeling quite melancoly towards everything. I cry a lot and find myself with the lack of motivation to do a lot of things. The thing that's different though that my current life situation completely warrants such an emotional state. People who are in the know ask how I can even cope as well as I am. I do because I don't have a choice and life isn't always happy rainbows. It's going to be okay.

Now I suppose I could up my dose and make some of this go away. I have no inking to do it because to me it would seem like an artificial crutch and fake. I firmly believe though that if I wasn't on the pills my biological brain would be in control and the my 'me' part would be unable to cope with what I feel is quite a normal response to my situation. I'm perfectly fine with being sad and living in a sad state because right now my situation is quite sad and difficult. It makes me laugh to say that I'm depressed and perfectly fine with being so while being on anti-depression medication because superficially it sounds wrong. lol

I did have a point in relation to the discussion but have lost it in writing. I do worry about over prescribing and the problem of creating disorders in order to prescribe pills for economic gain by big pharma. Though as someone who has benefited and still benefits from big pharma pills my thoughts become more nuanced. I do think as related to my own experience that there are what I can only describe as normal states of emotional depression and states of what I would describe as medical and biological depression. Both can intertwine. I'm really not sure how any list of symptoms in a text could easily differentiate between the two. To me it really comes down to the ability of the person affected to self analyze and see their situation and their practioner. I'm lucky. I have a doctor who treats me more like a partner in my health and doesn't act like someone who knows whats best. We work together on any issues. If all doctors were like this it would be better I think.
posted by Jalliah at 4:46 PM on December 9, 2012 [2 favorites]


The DSM-5 was created in the most transparent and feedback-oriented process ever used for a diagnostic reference manual of this type. The guy who's blog entry is linked to here actually headed the efforts for the DSM-IV -- the edition that brought us many of the problems he believes the DSM 5 should correct. But since he's no longer in charge of it, he's upset they don't listen to his opinions like they once did.

What few people note about the DSM-5 is that the vast majority of disorders and symptom criteria will remain virtually unchanged. Yes, there's a few new disorders (every new edition seems to bring us some new ones), and yes, there's a little re-organization that better reflects our current research understanding of mental disorders.

But all in all, it's a simple update. So much ado about nothing.
posted by docjohn at 4:53 PM on December 9, 2012 [2 favorites]


The DSM 5 is nuts. Definitely screws loose.
posted by nickyskye at 5:00 PM on December 9, 2012


Oddly enough, I think using Roman numerals for contemporary works indicates a mental disorder, so I'm pleased to see DSM 5 and not DSM V.
posted by infinitewindow at 5:23 PM on December 9, 2012 [1 favorite]


if a doctor says "take this pill, it will cure you," you take the pill.
posted by rebent at 4:21 PM on December 9 [+] [!]


Overwhelmingly, if I want any hope or chance of compliance with a medication regimen I spend a long time on the actual likely benefits, side effects, time-to-action etc, of a medication. I can be assured that "take this pill" is a great way to ensure the patient never fills the prescription.
posted by docpops at 5:43 PM on December 9, 2012 [3 favorites]


Can we talk about how much harder it is going to be for people with Asperger's to get hepll from schools now? You tell a school you have Autism they are going to hook you up with a completely wrong set of resources, and try explaining 'not THAT type of Autism' to them is going to be hell. We've just tossed out two decades worth of educating the public, for no good reason. Ok, I can see the argument that they are the same thing, sure, however can't you put in an 'alternate terms' line, or list is as a subset of Autism or something?
posted by Canageek at 6:05 PM on December 9, 2012 [4 favorites]


I had a doctor once tell me the reason these keep changing is because new doctors need to write papers and make new discoveries, it's the same reason shell shocked became post traumatic stress.

Your doctor is George Carlin????
posted by kettleoffish at 6:19 PM on December 9, 2012


I'm a quantitative psychologist, and I say it's very hard to categorize disorders. I don't believe in it (very much at least), but I couldn't tell you how to do a better job.
posted by zscore at 6:22 PM on December 9, 2012


Wow, that Psychology Today link in the post is really savage:

The APA's deep dependence on the publishing profits generated by the DSM 5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA's projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.

Ouch. Leaving aside the merits of each of his 10 potential trouble spots in the new manual, the above is a hell of an accusation.
posted by mediareport at 7:29 PM on December 9, 2012 [2 favorites]


The problem with the DSM is the fact that people seem to think they need a DSM. It's not a flaw of psychiatric medicine, per se, as much as it's a flaw of the American reimbursement system. (AKA: Insurance)

You go to the ER and get treated. The doc notes it down in the chart, the nurse does the work, and everybody gets to go on about their business... everybody but the people footing the bill. At some point in time those people want to have a say in what they're paying for and what they're not, and that's a legitimate claim for someone in that role.

The problem is then that the patient, for the most part, has no clue what procedure X will cost, or exactly how much their insurance will pay for, and how much their co-insurance will cover, if they have it, or even wth co-insurance even means. So now, patient care is being dictated by some unrelated third party.

If you take away the dx as a necessary requirement for reimbursement, you really do fix the underlying problem. And the only real way to accomplish that is to eliminate the need for reimbursement. The only two ways I can think of accomplishing this are telling medical professionals they'll be working for free from now on, or single-payer healthcare (i.e. Socialist medicare for everybody!!!)

tl;dr: The DSM exists because psychiatric professionals need a box to check so the insurance companies will pay their salary. If you really want to fix the underlying problem, you have to take the money out of the equation. Anything else is emotionally unbalanced.
posted by Blue_Villain at 8:42 PM on December 9, 2012 [1 favorite]


B_V: The DSM is still used as a tool in single-payer countries (e.g.: Canada), though.
posted by Monday, stony Monday at 8:51 PM on December 9, 2012 [2 favorites]


Well, if it enables the gummint to cut any social services and allows drug companies to shill their products it's a win-win, isn't it?
posted by BlueHorse at 10:19 PM on December 9, 2012


It's just the sound of psychiatry imploding. There'll be more of it.

Mental illness remains without physical markers, even though everybody thought we'd have a few by now. Categorizing syndromes hasn't proven very useful in regards to treatment, with half of the peeps saying, "No, x treatment really works, but only for major depression and not mild depression," and the other half busy using that treatment for anxiety disorders, personality disorders, whatever they can. None of the DSMs were ever very good. Do you have any idea how many people are institutionalized with the diagnosis of personality disorder, not otherwise specified?

Meanwhile, the whole normalcy thing is increasingly clearly not a compassionate criteria for treatment in the face of pain-- who could imagine a doctor saying, "Yes, but excruciating pain is normal for people who are dying, so we won't be giving any analgesia"? Psychiatry's been slower to catch on to this than the rest of medicine, but the realization is beginning to hit. Abnormal is not a valid criteria for treatment. Unpleasant is.

Look at the bereavement thing in more detail. Before you critique the changes, you want to really understand the way it used to work. "If you have all of these symptoms, you're depressed. Unless a member of your immediate family died in the last twelve months. In that case, you're not depressed."

But that's in full understanding that depressive episodes DO tend to follow precipitating stressful events, of which bereavement is just the strongest for most people. Lost your cat? Depressed. Lost your job, house, significant other left you? Depressed. Spouse that you barely cared about died? Not depressed. It really never made any sense.

Consider the number of people that are terminally ill, and diagnosed with depression. Arguments have been made that these people are suffering advance bereavement-- they are mourning their own deaths. I think there's a strong case for that! But the DSM didn't say that, and so it's okay to diagnose depression (and treat it).

The authors were stuck in this difficult place once they acknowledged that bereavement is just one instance, different perhaps in degree but not quality, in an innumerable list of stressors, and the only rational decision was to allow the diagnosis in the presence of all stressors, or in the presence of none. (And there are never none.)

Yeah, it's the start of "normal" pains falling into psychiatry's domain, and it's sure not the end-- but, again, the only compassionate way of dealing with "normal" pain is to treat it when treatment is both available and desired. (And there's a big can of worms that comes along with that, when it comes to psychiatry.)
posted by nathan v at 2:22 AM on December 10, 2012 [2 favorites]


Can we talk about how much harder it is going to be for people with Asperger's to get hepll from schools now? You tell a school you have Autism they are going to hook you up with a completely wrong set of resources, and try explaining 'not THAT type of Autism' to them is going to be hell. We've just tossed out two decades worth of educating the public, for no good reason. Ok, I can see the argument that they are the same thing, sure, however can't you put in an 'alternate terms' line, or list is as a subset of Autism or something?
posted by Canageek at 9:05 PM on December 9


My son has PDD-NOS, which is one of the disorders that is disappearing from the DMS-V. Apparently, our greatest fears as parents of children with ASDs is not supposed to be founded in the new version.

In fact, it looks like the new criteria are going to be MORE liberal, so while the Asperger's and PDD-NOS disorders are "going away," the new autism diagnosis(es) is going to, hopefully, allow for more children to get help by removing the symptoms appeared before three years of age criterion and specifying early childhood instead and also by including aggression as a possible criterion that has to date only been associated with ADHD and other related disorders of that sort.

I won't lie, I'm nervous as heck about it. But from what I've read that wasn't hyped up on disappearing diagnoses has laid out a pretty sound argument that the new diagnosis could be more beneficial and reach more children in need of services than the current ones allow for.

For reference:

http://www.factfamily.org/fact-blog/changes-to-the-dsm-v.html
posted by zizzle at 5:56 AM on December 10, 2012 [2 favorites]


Dimensional diagnoses are an extension of what has been happening for years in the field; just look at the prevalence of the term "autism spectrum." The DSM 5 was proposed to integrate the existing categorical classifications with a dimensional component, but it kind of seems like they're banging two blocks together. The overall philosophy of creating a diagnostic continuum allows for more nuance, but the DSM-5 specifics (like including nail biting on the OCD spectrum) makes it seems like these contiuums begin with any minor deviation from the perfect. IMO, that's what is garnering all the flack.
posted by Katine at 10:41 AM on December 10, 2012


Katine: I'm not denying that AS is an autism spectrum disorder, or even that they are wrong to carrel it is Autism. My problem is the name going away A) I will get a very different reaction if I tell people I have autism then Asperger's and B) we've spent a lot of time educating schools on Asperger's, and that was all just thrown out.
posted by Canageek at 1:16 PM on December 10, 2012


Oh Canageek, I wasn't reacting to that at all. I agree with you completely. I was speaking more theoretically about what the DSM-5 is hoping to and failing to accomplish. I was using "autism spectrum" as an example of how they're trying to become more nuanced via dimensional diagnoses at the expense of deleting whole categories of arguably more nuanced and well understood categorical diagnoses (i.e., aspberger's on the spectrum), while simultaneously adding common behaviors to a spectrum of disorders that need not be pathologized (i.e., nail-biting to OCD spectrum). The whole thing just seems kind of...confused.
posted by Katine at 1:48 PM on December 10, 2012


Katine: Ah, I've not read it, as I know basically nothing about psych (Having Asperger's myself, psych classes never caught my interests, doubly so given the amount of memorization in them.

I do hope they at least fix the problems with the Asperger's definition in it; Tony Attwood spent a chapter pointing out all the mistakes in the old one.
posted by Canageek at 2:36 PM on December 10, 2012


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