This past week, the American Psychiatric Association (APA) met in Philadelphia. In response, Dr. Allen Frances, former Chairman of Psychiatry at Duke University and leader of the task force that produced the DSM-4, wrote an editorial entitled Diagnosing the DSM. The DSM represents the Diagnostic and Statistical Manual of Mental Disorders, the Bible of psychiatric diagnosis, which establishes insurance reimbursement and legal guidelines. In his article, Dr. Frances raised concerns that the APA is proceeding with numerous suggestions that would expand the boundaries of psychiatry to define as mentally ill tens of millions of people now considered normal.
For example, in New Guidelines May Sharply Increase Addiction Diagnoses, another New York Times article appearing on the same day, the author describes how the DSM could expand the list of addictions and introduce a category called “behavioral addiction — not otherwise specified”. This will encompass addictions such as gambling (which is reasonable), but, the way the diagnosis is labeled, could also include addictions to shopping, sex, using the Internet or playing video games. Why should we care? Because the DSM dictates whether insurers will pay for treatment, the courts use it to determine if a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research.
Can you imagine how many children could be exposed to pharmaceutical anti-addiction medications for video game use? How many court defenses will be premised on an addiction to the Internet? How many pharmaceutical companies will expand their addiction drug development programs to treat these alleged mental illnesses?
Another important point is that the DSM task force is composed of experts, some of whom are pharmaceutical consultants. One such individual–a consultant for a company that develops drugs for alcohol and heroin addiction–led the addiction working group and got the word “craving” added to the manual’s new list of recognized symptoms of addiction. Dr. Howard B. Moss, Associate Director for Clinical and Translational Research at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, MD, and an opponent to adding “cravings” to the symptom list of addiction wrote: “The more people diagnosed with cravings, the more sales of anti-craving drugs”.
A lot of us crave sweets and many other things when we are under stress and out of balance. The craving is an intelligence signal from our biosystem, informing us that there is a “disturbance in the Force.” It may only be a temporary disturbance based on hormone changes, or a weekend vacation foodie experience; but, it also may reflect a deeper signal that needs to be understood, not merely suppressed.
With more and more frequency, we are suppressing all of our biological signals of distress: from high blood pressure, high cholesterol, headaches, sinus congestion, heartburn, arthritis, to low energy. And by suppressing all our signals, we should not be surprised that the sources of our distress are not being addressed; we are simply treating peripheral symptoms. Without understanding and dealing with the root cause of why our bodies are out of balance, we will watch our symptoms lists grow, and, for certain, watch our medication lists grow and grow. Our quality of life will continue to erode using this strategy.