What is mental disorder? Even the Experts disagree

29 December 2010.

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The American Psychiatric Association, the diagnostic and Statistical Manual OF MENTAL DISORDERS, or approximately updates every 15 years, has detailed descriptions of all the mentally handicapped, officially recognized by psychiatry. It is used by psychiatrists, insurance companies, researchers, drugs, courts and even the school.

Enlarge Mark Strozier/istockphoto.com

Definitions of some disabilities may change.

Mark Strozier/istockphoto.com definitions of certain mental disorders may change.

But not without controversy: the proposed changes suggested in this year sparked a kind of war in psychiatry.

In a small apartment on the beach in San Diego lives Allen Frances, who himself to what he calls "Epidemic Asperger company." Frances edit last version DSM — it is also the greatest critic of the new DSM.

Frances is the one who introduced the term Asperger companies primarily in the DSM, thereby enabling the official mental disorders.

In versions before Francis was the editor, there is one entry for autism, but was characterized by severe symptoms. Francis says doctors felt diagnosis for autism does not include more Mild disorders they were actually encountering.

"Pediatricians and child psychiatrists will see children, who can speak, but which was uncomfortable social — serious social awkwardness and discomfort — very limited and contrary to the interests and activities, and wanted the diagnosis including" Frances says.

The test was done to as joint Asperger was, and the results were clear: this was a vanishingly rare. Then, Frances, place it in the DSM, and number of children with the disorder exploded. Frances remembers, sitting in his apartment reading articles about this new epidemic Asperger through which was sweeping nation.

Enlarge Ellen Webber/NDP

Diagnostic and Statistical Manual of mental Disorders or DSM is a book that contains a list of all mental disorders doctors used to diagnose mental diseases.

Ellen Webber/NDP diagnostic and Statistical Manual of mental Disorders or DSM is a book that contains a list of all mental disorders doctors used to diagnose mental diseases.

"Here or on" Ouch "," he says. "This is a complete misunderstanding. Was bolesnym. Quite bolesnym. "

Surprising incentive

It is not that Frances does not believe that his Asperger exists and is a real problem for some people — does. But he also believes the diagnosis is now definitely overused in such a way that he and his colleagues never intended. And why, in its opinion, his Asperger explode? First and foremost, Allen says, because the school created a strange unintended incentives.

"To get a specialized service, it is often one of education, the child must have a diagnosis of Asperger's or some other autistic disorder," he says.

Adds, the expression ", and so children who previously may have been taken into account at the border, mimosrodowy socially shy, but clear and well in school or typical [to] regular classes. Now if their diagnosis of disorders, Asperger [are] get to the special program, where they can get $ 50 000 year value of educational services. "

Drug Companies factor in

Frances worried about this may cause a deficiency in the distribution of the resources of the school. Frances point another change appearances — which, for him, had even more worrisome effects. In principle, Frances and his colleagues made it much easier to get a diagnosis of bipolar disorder. And says that created this incredible opportunities for drug companies.

"Drug Companies have bipolar disorder treatment for indications," Frances says. "Not only with mood stabilizers, but also with the newer antipsychotic drugs. And they advertising campaigns everywhere very intense. So doubled rates of bipolar disorder. And lots of people got way too numerous antipsychotic and mood stabilizing medications. And they are not safe drugs. "

And Frances, stems from the lessons from these experiences. After the introduction of new diagnostics in the DSM, does not have any control, what happens with it. This is only one thing to do:

"Anticipating the worst. If something can be misused, it will be of use, "Frances says. "If diagnosis can lead to over-diagnosis and treatment, over-which occurs. Therefore, you should be very extreme caution when making changes that can open the doors of the flood of diagnosing SUV. "

In so far as concerns the new DSM proposes too many diagnosis, which are saved too broad to Frances way, which means that ultimately the vast number of new human beings will be categorized as mentally ill.

Good may be greater than Bad

William Carpenter, one of the people behind the new DSM, disagrees. Carpentry works with the sickest with the sick in the Maryland psychiatric research center. And with which he is sitting, the problem with the over-diagnosis is a minor Affair.

Throughout the lounge his tenure persons suffering from psychotic sit in thick clothes, eyes wide, staring silently. These are the people Carpenter sees the day after day — individuals whose problems have been misidentified and "mistreated" in concert years. Therefore strongly Why one Carpenter has been proposed for the new DSM diagnosis believes it can help in the identification of people with Psychosis, when they are in the very earliest stages of their disease, long before they ever get to his waiting room.

"If it identifies many people who otherwise you will not be identified, and then I think that it would be a positive good," says Carpenter.

Carpenter, considers that the introduction of this new diagnostics in the new DSM will prompt you to test, which finally can produce effective treatment.

"This is a potential benefit very positive," he says. "This is possible, that is capable of remarkable difference in the long-term course of life."

The final draft of the DSM-5 will not be published until 2013 in the meantime, people such as Allen Frances will shake the number of diagnoses and their range reduced. And a small group of people responsible will face the difficult question of what to – and what you should leave.