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"This book, now revised in a section edition, examines the problem of over-diagnosis in psychiatry, focusing on problems with current diagnostic systems. It will show that diagnosis is not always a good guide to treatment selection, and that diagnoses have bee expanded in scope to justify currently popular methods of pharmacotherapy or psychotherapy. The most important categories that are over-diagnosed are bipolar disorders, major depression, attention-deficit hyperactivity disorder, and post-traumatic stress disorder. The boundary of pathology and normality remains unclear. This edition will also discuss dimensional systems that are transdiagnostic, and show how over-diagnosis is linked to the practice of aggressive psychopharmacology"--
“Gary Greenberg has become the Dante of our psychiatric age, and the DSM-5 is his Inferno.” —Errol Morris Since its debut in 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has set down the “official” view on what constitutes mental illness. Homosexuality, for instance, was a mental illness until 1973. Each revision has created controversy, but the DSM-5 has taken fire for encouraging doctors to diagnose more illnesses—and to prescribe sometimes unnecessary or harmful medications. Respected author and practicing psychotherapist Gary Greenberg embedded himself in the war that broke out over the fifth edition, and returned with an unsettling tale. Exposing the deeply flawed process behind the DSM-5’s compilation, The Book of Woe reveals how the manual turns suffering into a commodity—and made the APA its own biggest beneficiary.
As one of the few resources to thoroughly examine the critical problem of over-diagnosis in psychiatry today, this title covers how over-diagnosis in psychiatric practice may lead to over-treatment. It considers the complications of the DSM-5 classification system, with particular reference to major depression, bipolar disorder, Post-traumatic Stress Disorder (PTSD), and Attention-Deficit Hyperactivity Disorder (ADHD). While each of these conditions have given rise to diagnostic fads and epidemics, the classification of mental disorders remains provisional without any biomarkers for mental disorders. It then covers the importance of conservative diagnoses, recognizing that normal variants are not necessarily disorder, and that in many cases, under-, rather than over-diagnosing may be best practice.
Blurred boundaries between the normal and the pathological are a recurrent theme in almost every publication concerned with the classification of mental disorders. Yet, systematic approaches that take into account discussions about vagueness are rare. This volume is the first in the psychiatry/philosophy literature to tackle this problem.
From "the most powerful psychiatrist in America" (New York Times) and "the man who wrote the book on mental illness" (Wired), a deeply fascinating and urgently important critique of the widespread medicalization of normality Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. These challenges are a normal part of being human, and they should not be treated as psychiatric disease. However, today millions of people who are really no more than "worried well" are being diagnosed as having a mental disorder and are receiving unnecessary treatment. In Saving Normal, Allen Frances, one of the world's most influential psychiatrists, warns that mislabeling everyday problems as mental illness has shocking implications for individuals and society: stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, misallocation of medical resources, and draining of the budgets of families and the nation. We also shift responsibility for our mental well-being away from our own naturally resilient and self-healing brains, which have kept us sane for hundreds of thousands of years, and into the hands of "Big Pharma," who are reaping multi-billion-dollar profits. Frances cautions that the new edition of the "bible of psychiatry," the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), will turn our current diagnostic inflation into hyperinflation by converting millions of "normal" people into "mental patients." Alarmingly, in DSM-5, normal grief will become "Major Depressive Disorder"; the forgetting seen in old age is "Mild Neurocognitive Disorder"; temper tantrums are "Disruptive Mood Dysregulation Disorder"; worrying about a medical illness is "Somatic Symptom Disorder"; gluttony is "Binge Eating Disorder"; and most of us will qualify for adult "Attention Deficit Disorder." What's more, all of these newly invented conditions will worsen the cruel paradox of the mental health industry: those who desperately need psychiatric help are left shamefully neglected, while the "worried well" are given the bulk of the treatment, often at their own detriment. Masterfully charting the history of psychiatric fads throughout history, Frances argues that whenever we arbitrarily label another aspect of the human condition a "disease," we further chip away at our human adaptability and diversity, dulling the full palette of what is normal and losing something fundamental of ourselves in the process. Saving Normal is a call to all of us to reclaim the full measure of our humanity.
Thirty years ago, it was estimated that less than five percent of the population had an anxiety disorder. Today, some estimates are over fifty percent, a tenfold increase. Is this dramatic rise evidence of a real medical epidemic?In All We Have to Fear, Allan Horwitz and Jerome Wakefield argue that psychiatry itself has largely generated this "epidemic" by inflating many natural fears into psychiatric disorders, leading to the over-diagnosis of anxiety disorders and the over-prescription of anxiety-reducing drugs. American psychiatry currently identifies disordered anxiety as irrational anxiety disproportionate to a real threat. Horwitz and Wakefield argue, to the contrary, that it can be a perfectly normal part of our nature to fear things that are not at all dangerous--from heights to negative judgments by others to scenes that remind us of past threats (as in some forms of PTSD). Indeed, this book argues strongly against the tendency to call any distressing condition a "mental disorder." To counter this trend, the authors provide an innovative and nuanced way to distinguish between anxiety conditions that are psychiatric disorders and likely require medical treatment and those that are not--the latter including anxieties that seem irrational but are the natural products of evolution. The authors show that many commonly diagnosed "irrational" fears--such as a fear of snakes, strangers, or social evaluation--have evolved over time in response to situations that posed serious risks to humans in the past, but are no longer dangerous today.Drawing on a wide range of disciplines including psychiatry, evolutionary psychology, sociology, anthropology, and history, the book illuminates the nature of anxiety in America, making a major contribution to our understanding of mental health.
National Academies of Sciences, Engineering, and Medicine
Author : National Academies of Sciences, Engineering, and Medicine Publisher : National Academies Press Page : 473 pages File Size : 17,51 MB Release : 2015-12-29 Category : Medical ISBN : 0309377722
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
In this stirring and beautifully written wake-up call, psychiatrist Daniel Carlat writes with bracing honesty about how psychiatry has so largely forsaken the practice of talk therapy for the seductive—and more lucrative—practice of simply prescribing drugs, with a host of deeply troubling consequences. Psychiatrist Daniel Carlat has noticed a pattern plaguing his profession. Psychiatrists have settled for treating symptoms rather than causes, embracing the apparent medical rigor of DSM diagnoses and prescription in place of learning the more challenging craft of therapeutic counseling, gaining only limited understanding of their patients’ lives. Talk therapy takes time, whereas the fifteen-minute "med check" allows for more patients and more insurance company reimbursement. Yet, DSM diagnoses, he shows, are premised on a good deal less science than we would think. Writing from an insider’s perspective, with refreshing forthrightness about his own daily struggles as a practitioner, Dr. Carlat shares a wealth of stories from his own practice and those of others that demonstrate the glaring shortcomings of the standard fifteen-minute patient visit. He also reveals the dangers of rampant diagnoses of bipolar disorder, ADHD, and other "popular" psychiatric disorders, and exposes the risks of the cocktails of medications so many patients are put on. Especially disturbing are the terrible consequences of overprescription of drugs to children of ever younger ages. Taking us on a tour of the world of pharmaceutical marketing, he also reveals the inner workings of collusion between psychiatrists and drug companies. Concluding with a road map for exactly how the profession should be reformed, Unhinged is vital reading for all those in treatment or considering it, as well as a stirring call to action for the large community of psychiatrists themselves. As physicians and drug companies continue to work together in disquieting and harmful ways, and as diagnoses—and misdiagnoses—of mental disorders skyrocket, it’s essential that Dr. Carlat’s bold call for reform is heeded.