Opinion

We’re all mad here

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Millions of people who went to sleep last night thinking they were normal woke up this morning with a new mental disorder.

Human nature doesn’t change that fast, but the labels used to describe it can follow fickle fashions. The vehicle of today’s fashion shift is the publication yesterday of the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders,” the official compendium of psychiatric diagnoses.

DSM 5 has added many new mental disorders that include many symptoms and behaviors previously accepted as simply part of the human condition. The resulting overdiagnosis of mental disorder will have many harmful unintended consequences — the misuse of medication, unnecessary stigma, high costs, misallocated resources, narrowed expectations, a reduced sense of personal responsibility, and the misapprehension that we are all becoming sick individuals living in an increasingly sick society.

Consider these new additions to the DSM:

* Suppose the love of your life died suddenly just two short weeks ago and you are still feeling sad, have less interest in things, don’t have much appetite or energy and can’t sleep well. Yesterday this was consistent with perfectly normal grief. Today you fully qualify for the DSM 5 diagnosis of major depressive disorder.

* Suppose you are 70 years old and, like me, are having trouble recalling how the movie ended last night, or finding your car in the parking lot, or remembering the names or placing the faces of new acquaintances. Last night, we were just old geezers. Today, DSM 5 has graduated us up to mild neurocognitive disorder.

* Suppose you have a cancer and worry that each headache may represent its having spread to your brain. Yesterday, this was completely understandable — today you have DSM 5 somatic symptom disorder.

* Temper tantrums used to be an annoying, but accepted and expected, part of childhood development. Now they have morphed into DSM 5 disruptive mood dysregulation disorder.

* All of us would like to be less distractible, to really focus our minds to get the job done. No worries. It is now extremely easy to qualify for DSM 5 attention deficit disorder and ask your doctor for a stimulant to help improve your cognitive performance.

* And DSM 5 has introduced the interesting concept that behaviors are just as addicting as substances. Gambling is the first DSM 5 behavioral addiction, but can the Internet, sex, shopping, jogging, golf, model railroading and (my personal favorite, sun worshiping) be far behind? Soon all the passionate interests in life will be relabeled as mental disorders.

Why all the these daffy DSM 5 diagnoses reducing the large pool of normal into a small puddle? This is a classic case of psychiatric experts run riot — overvaluing their pet areas of research and making their mark by getting them included in the diagnostic system. Poorly tested research concepts have been given a diagnostic status they simply don’t deserve. And we, the public, are the guinea pigs in what amounts to a public health experiment.

Potential about-to-be patients, beware. Getting a psychiatric diagnosis can be a life changing moment that provides great benefits if it is accurate, great harms when it is not. The care exercised should be equivalent to picking a spouse or buying a house. Instead, 80% of psychiatric diagnoses are made by harried primary care physicians with little training, in seven minutes visits that are brought to a quick end with the provision of a “free” sample of medication courtesy of a kindly drug salesman.

Nothing is free. My advice: Never accept a psychiatric diagnosis or pill offered this casually.

Quick draw diagnosis and treatment leads to over diagnosis and over treatment. Twenty percent of our population now uses a psychiatric medicine. Rates of use have skyrocketed among our most vulnerable populations — children, the elderly, our armed forces. More people now die of overdoses from prescription drugs sold by drug companies than by street drugs sold by drug cartels.

DSM 5 should have held the line against the resulting diagnostic inflation. Instead, it has promoted reckless changes that will likely lead to hyperinflation with all its associated risks. The great tragedy in the United States is that we provide shamefully inadequate care for the really ill who need it, while falsely labeling as sick so many people who are basically normal and would do better on their own.

Allen Frances, MD, was chairperson of the task force for the fourth edition of the DSM. His new books, “Saving Normal’(William Morrow) and “Essentials Of Psychiatric Diagnosis” (Guilford) are out now.