Americans sometimes forget we live in a capitalistic society where decisions can come down to issues of profit or loss. It should come as no surprise when this same principle also applies to the medicalization of Americans. But because of the normalization of medication in the past decade, few dare question the legitimacy of an industry so closely tied to the business of pharmaceutical sales even when it comes to their children.
In recent weeks, I’ve seen an alarming trend among clinicians working with young children. Some are working with kids (as young as 4 years old) getting medicated on some form of anti-anxiety or psychotropic medication to quell their “excitability”, “hyper-activity”, or “autism-type” behaviors. Drug companies are marketing more to both ends of the spectrum where both the very young and the elderly are becoming dependent on medication.
It’s no coincidence that the upsurge in medication is due to a couple of inter-related factors: The broadening definition of behaviors as a “disorder” and the explosion of DTCPA (direct to consumer pharmaceutical advertising).
After years of research, the DSM otherwise known as the “bible” of mental disorders released its fifth edition in May of 2013 (Diagnostic & Statistical Manual, fifth edition). It’s the first change of the DSM in more than a decade since its last publication. While it may sound like a noble deed, critics view this latest edition as being blasphemous, since a wider net of behavioral conditions now reach the threshold of a “medical disorder” for which insurance companies will pay for coverage. In the same vein, psychiatrists, pediatricians, registered nurses, and your primary care doctor can now have even more latitude in designating and prescribing medication for your afflictions.
Examples of some of the additional “disorders” in the latest version of the DSM include:
▪ "disruptive mood dysregulation disorder” for kids with frequent, extreme temper tantrums (that’s every “strong-willed child”)
▪ ”mild neurocognitive disorder” for the elderly that are mentally declining faster than “normal” (you better start doing those crossword puzzles)
▪ "major depression" is now a new disorder following the death of a loved one (better not grieve too long or too hard)
▪ "hoarding disorder" will be defined as “persistent difficulty discarding or parting with possessions, regardless of their actual value” (stop collecting your comic books, coins, and anything you enjoy)
▪ "binge-eating disorder" when you eat to "excess" 12 times in 3 months (you better stay away from Old Country Buffet)
▪ "Internet disorder" has been included and listed under “further research" (get offline or else)
Keep in mind that with the new diagnoses, all of the above can be “treated” with medication. Consequently, this is leading to an abuse of a system intended to help the truly sick where clinicians and clients alike are diagnosing themselves with the use of the DSM beyond its intended purposes.
The DSM was meant to be a guide, not the final arbiter of normal or abnormal behavior. But with its technical jargon and specific taxonomy for each “diagnosis”, Americans are intimidated with psychology and too readily trust their mental health to that of psychiatrists and therapists alike.
But as a psychotherapist, my loyalty is limited to “talk therapy”. I’m not authorized to prescribe medication and am free of the possible lure of abuses inherent in a field rife with greed and profit margins. But others in the field such as psychiatrists, family care physicians, pediatricians, could have an ulterior motive in the form of better compensation by pharmaceutical companies for prescribing drugs to those who are marginal at best in even needing medication.
"The business model of the pharmaceutical industry depends on extending the realm of illness-using creative marketing to expand the pool of customers by convincing the probably well that they at least mildly sick." This coming from Dr. Allen Frances’ book, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.
Dr. Frances is a psychiatrist who headed the task force in charge of the previous edition of the DSM. He is an outspoken critic of how the DSM is being abused especially by psychiatrists and the pharmaceutical industry.
Frances is part of a growing chorus of those in the healing profession critical of the industry’s additional “disorders” in the latest DSM-V leading not only to over-diagnosis but over-medicating of today’s populace; not just the general population but also our armed forces.
Dr. Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College in New York. Friedman cites these alarming statistics. “The military tests prospective enlistees with an eye toward screening out those with serious psychiatric disorders. So you would expect that the use of these drugs in the military would be minimal—and certainly less than in the civilian population. But the opposite is true: prescriptions written for antipsychotic drugs for active-duty troops increased 1,083 percent from 2005 to 2011; the number of antipsychotic drug prescriptions in the civilian population increased just 22 percent from 2005 to 2011.
Friedman adds, in 2012 alone, more active duty soldiers committed suicide than were killed in combat. I believe that statistic is more than depression, it’s about the misuse and abuse of prescription drugs.
Dr. Gary Greenberg also released a book this year, The Book of Woe: The DSM and the Unmaking of Psychiatry, where he excoriates the latest edition of the DSM as a tool that turned normal suffering into a commodity. In this behind-the-scenes look, Greenberg sheds light on the disturbing process of the re-making the DSM into a diagnostic catch-all for anyone of any age who’s ever felt grief, sadness, or anxiety as reason enough to get prescribed medication.
One must also recognize the exponential growth of pharmaceutical revenues that have led to this uneasy union between the helping profession and the pharmaceutical industry.
C. Lee Ventola is a medical writer who wrote about the impact of direct to consumer pharmaceutical advertising (DTCPA) in a journal article for the National Institutes of Health. In the article, Ventola informs us that Direct-to-consumer (DTCPA) is fairly new and only exists in the United States and New Zealand. Prior to 1997, the FDA did not allow for explicit commercials of pharmaceutical drugs on your television set. Just a year after, the budget for drug advertising tripled to $1.2 billion in 1998. It quadrupled during the following decade topping off at over $5 billion and has since leveled off around $4 billion annually.
In the real-world of therapy, prior to the laxing of FDA regulations for DTC (direct to consumer) advertising, clients would see a psychiatrist and the doctor would give medication as needed. The doctor chose the medication. Now, clients demand to see a psychiatrist and demand to get medication. They even come to me demanding a referral to a psychiatrist for medication as opposed to trusting my professional opinion that it’s not warranted. Medication is now seen as the cure and fix to any and all emotional turbulence in their lives and the lives of their children.
Despite the many relational and emotional issues we all face, what’s really insane is this blinding devotion Americans have towards worshipping at the altar of pharmaceutical drugs all in the name of “health” and “well-being”.
Frances, Allen, M.D. Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life
Friedman, Richard Wars on Drugs retrieved from http://www.nytimes.com/2013/04/07/opinion/sunday/wars-on-drugs.html?page...
Greenberg, Gary, The Book of Woe: The DSM and the Unmaking of Psychiatry
Ventola, Lee C., MS, Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic? retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/