Every era has it?s disorders
Next year May (2013) the new psychiatric manual called Diagnostic Statistical Manual of Mental Disorders (DSM) is coming out. It will include new classifications like; binge eating, mourning, parental alienation, memory problems, internet addiction and hyper sexuality. It also changes criteria for a few personality disorders and puts them in ?weight? categories. Instead of having a disorder or not suffering from it, patients will now be able to be diagnosed with ?a bit?, ?a bit more? or ?severe? (mind you, this is a rough translation). It?s a cash cow for the pharmaceutical companies says an expert. Even minor cases get labeled and treated with medication, no wonder pharmaceutical companies are happy about this. Another expert thinks this will lead to fewer treatments because you can gauge how much of a disorder someone has, and minor treatments don?t necessarily require medication.
?It?s going on for a while? says Jan Derksen. ?The borders of what?s being seen as a disorder are being stretched a lot? till the norm even. This will lead to more people being labeled. That will lead to treatment and more expenses. You?re actually encouraging disorders rather than encouraging a healhty society.?
Derksen is a professor clinical psychology at University Medical Centre St. Radboud in Nijmegen. He?s not the only expert that expects problems come DSM V. American psychiatrist Allen Frances is strongly opposed to DSM V, while he was involved in putting together DSM III and IV years ago. Frances has said to regret this because he feels that there has been an expansion in ?false epidemics? in people who suffer from ADHD and the diagnoses of bipolar disorder for kids with autism.
Professor Rutger Jan van der Gaag doesn?t think these epidemics are ?false?. He?s the chairman of the Nederlandse Verenging voor Psychiatrie (NVvP; or in English, Dutch psychiatrist association) as well as a professor clinical child- and adolescent psychiatry at UMC St. Radboud in Nijmegen. ?Every culture and era has it?s disorders.? Obesity is a problem because people don?t exercise enough and eat too much. The fact that such a ?gift? is in your genes, never changed, it just happens that there is both more food available and less reason to exercise. With ADHD and autism it?s not different. There is no increase in people having said disorders, but education is less structured, and society has different demands making the disorder more prevalent and problematic for those who have it. He does think that stretching criteria is important though, but it masks the effects of societal change.
Van der Gaag sees more purpose in supporting children with minor cases of ADHD and autism to cut back on people that rely on support in the long run. He doesn?t agree with raising the bar for diagnosis, because that would be artificial means to cut back on people with said disorders, but apparently that?s what critics want.
There is some critique on DSM V in the sense that there hasn?t been a lot of field-testing before being used in the book. The big issue therein lies that diagnosis in the book are there to be proven wrong, but all we?re doing now is defining unclear disorders and try different treatments and furthermore try to see if it?s an actual disorder or just something people made up. ?You can?t make a case study without defining the case first? Says Van der Gaag. Derksen adds to it: ?The big problem is that there?ll always be people meddling in this field that don?t have enough knowledge.? He shares some sentiment with the critiques that point out that the pharmaceutical industry is way too involved on the coming together of a book like the DSM. ?Almost 70 percent of the people involved in putting the DSM together have ties with the pharmaceutical industry. As a scientist you should be neutral, the big thing that?s lacking is a neutral system to regulate the industry's involvement?. Van der Gaag: ?The pharmaceutical industry plays a big part, not just in psychiatry, but in the entire field of healthcare. We?re just putting it out there that a lot of people involved with the DSM V have ties with pharmaceutical companies. The moment law and regulation is changed as much that we can also have studies with negative results public and we can offer more transparency, what else can we do? Research for pharmaceuticals is big business and the government isn?t meddling with that.?.
Van der Gaag thinks that the DSM V offers the best ?general idea? to look closer at diagnosis, but all too often it?s been used exclusively. ?It?s a tool to indicate classifications, to communicate between therapists with more research as a goal.? The misunderstanding on how it?s been used comes from the title of the book; Diagnostic manual. The book itself actually is a tool for classification, not necessarily diagnosis. It?s a collection of symptoms that fit with a certain disorder. All too often experts think that because there are a lot of symptoms it is disorder X, and therefore should be treated as disorder X. A DSM diagnosis, as it?s used now, has therefore become a pass to get access to financial support and special needs education. That in general isn?t the problem, but you?re not done there. You don?t have an individual diagnosis for everyone yet. And we?re not even talking about possible treatment.
This is also exactly why Derksen criticizes DSM. ?The system only classifies on the outside. We need a system that also looks deeper. Look to why people have those disorders.? Those changes won?t be there when DSM V comes out next year. Derksen feels that there?s no stopping the coming of DSM V, no matter the critiques. ?The best we can do is spending as little time as possible on using the DSM?.
Derksen and Van der Gaag also have a different opinion about the relationship between psyche and neurology in DSM V. Derksen: ?I think it?s a sad thing that DSM V tries to put every disorder in the brain itself. There are no psychologic causes anymore, only neurological problems. That?s what people are researching nowadays. The DSM is a tool they want to use to reduce psychologic issues back to something that?s basic biology. For psychiatric problems you need psychiatric theory or it won?t help a lot.?.
Van der Gaag sees it differently. ?We know a lot about the brain nowadays we have to use said methods. Classification because of behavior is an old method. I think you should look at genealogy, how neurotransmitters work and how the brain develops. That isn?t fully possible now, so the DSM V is the best we have?.
Van der Gaag also thinks that all the criticism against the DSM V is good. If you?re a scientist and you don?t want to doubt whatever it is you?re working with in your field, you?d be better of calling it quits and joining a church and become fundamentalist. That way you have a book that tells you the truth.?
