06-08-2011, 12:16 PM
Join Date: Apr 2001
Bipolar kids: Victims of the 'madness industry'?
That's how practically every disorder you've ever heard of or been diagnosed with came to be defined. "Post-traumatic stress disorder," said Spitzer, "attention-deficit disorder, autism, anorexia nervosa, bulimia, panic disorder..." each with its own checklist of symptoms. Bipolar disorder was another of the newcomers. The previous edition of the DSM had been 134 pages, but when Spitzer's DSM-III appeared in 1980 it ran to 494 pages.
"Were there any proposals for mental disorders you rejected?" I asked Spitzer. "Yes," he said, "atypical child syndrome. The problem came when we tried to find out how to characterise it. I said, 'What are the symptoms?' The man proposing it replied: 'That's hard to say because the children are very atypical'."
He paused. "And we were going to include masochistic personality disorder." He meant battered wives who stayed with their husbands. "But there were some violently opposed feminists who thought it was labelling the victim. We changed the name to self-defeating personality disorder and put it into the appendix."
DSM-III was a sensation. It sold over a million copies - many more copies than there were psychiatrists. Millions of people began using the checklists to diagnose themselves. For many it was a godsend. Something was categorically wrong with them and finally their suffering had a name. It was truly a revolution in psychiatry.
It was also a gold rush for drug companies, which suddenly had 83 new disorders they could invent medications for. "The pharmaceuticals were delighted with DSM," Spitzer told me, and this in turn delighted him: "I love to hear parents who say, 'It was impossible to live with him until we gave him medication and then it was night and day'."
Spitzer's successor, a psychiatrist named Allen Frances, continued the tradition of welcoming new mental disorders, with their corresponding checklists, into the fold. His DSM-IV came in at a mammoth 886 pages, with an extra 32 mental disorders.
Now Frances told me over the phone he felt he had made some terrible mistakes. "Psychiatric diagnoses are getting closer and closer to the boundary of normal," he said.
"Why?" I asked. "There's a societal push for conformity in all ways," he said. "There's less tolerance of difference. Maybe for some people having a label confers a sense of hope - previously I was laughed at but now I can talk to fellow sufferers on the internet."
Part of the problem is the pharmaceutical industry. "It's very easy to set off a false epidemic in psychiatry," said Frances. "The drug companies have tremendous influence."
One condition that Frances considers a mistake is childhood bipolar disorder. "Kids with extreme temper tantrums are being called bipolar," he said. "Childhood bipolar takes the edge of guilt away from parents that maybe they created an oppositional child."
"So maybe the diagnosis is good?"
"No," Frances said. "And there are very good reasons why not." His main concern is that children whose behaviour only superficially matches the bipolar checklist get treated with antipsychotic drugs, which can succeed in calming them down, even if the diagnosis is wrong. These drugs can have unpleasant and sometimes dangerous side effects.