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I appreciate these excellent points, Steve. Isn’t it interesting that until you can “bill” for something, it doesn’t actually exist? As a heart attack survivor like you, I’m very interested in the subject of PTSD following heart attack. As the Canadian Medical Association Journal has reported: “…a heart attack can leave people as psychologically traumatized as victims of violence…”
Cheers,
C.

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I have to use the DSM-IV on a daily basis; one can’t bill insurance without it….

Part of the problem is the whole “medical model”, which assumes the metaphor of physical illness when dealing with matters of the mind and soul…. (Jung talks about the problem of our times being “Modern Man in Search of a Soul” — I don’t think you can bill insurance for this deep cultural and personal problem… better just to see it as “anxiety” or “depression” )

And I think over-diagnosing kids as bipolar was a travesty….

On a positive note, I would suggest that the inclusion and recognition of Post-Traumatic Stress Disorder in the DSM-IV (a story in itself) has been a very important shift in cultural consciousness about how trauma can affect people….

Like everything else, the DSM-IV is political… the decisions are made by committees of people with vested interests and opinions, reflective of the culture biases…

Thanks for bringing this to people’s attention….

steve

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Interesting points, John. Anti-depressants are not, however, usually prescribed ‘for life’. The U.K.’s Royal College of Psychiatrists, for example, reports that “without any treatment, most depressions will get better after about 8 months. Current recommendation is that it is best to take antidepressants for at least six months after patients start to feel better, except for those with two or more attacks of depression, in which case treatment is continued for at least two years.” Regardless of the duration, however, it does seem that “bundling” two diagnoses for the price of one certainly expands market share for Big Pharma.
Thanks for your comments.
Cheers,
C.

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The bundling of two previously unrelated disorders, one common (hyperactivity) and one uncommon (attention deficit) to spread the drug market share (Ritalin – a dopamine agonist for attention deficit) of the uncommon disorder to the much larger market, hyperactivity.

On reading the diagnostic criteria for ADHD in DSM IV, I cannot find a single “sign” which does not describe the normal behaviour of children. To prescribe stimulants for children with “hyperactivity” (the new word for behaving like a child), even if the diagnosis were correct, is appalling!

Anxiety/depression? Anxiolytics (drugs which “dissolve anxiety” – an interesting metaphor) are only taken when needed but anti-depressants are for the rest of your life “regardless of how good you feel because that just means the drugs are working well”.

To move occasional customers over to permanent daily consumers is no doubt good for pharamaceutical market share, but what does it do for the patients? Anxious people can now worry about the depression they did not previously know they had, and depressed people can also become more depressed about their newly discovered anxiety disorder.

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Hi Dr. Joe – When a credible source like Dr. Frances reveals his own concerns like this, it unfortunately casts doubt on the entire profession, even upon those who work hard in the mental health field to help those who genuinely need help. But the pervasive financial influence of drug companies on even clinical practice guidelines is frightening. Thanks so much for your comments.
Cheers,
C.

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