The Diagnostic and Statistical Manual of Mental Disorders is a list that can be abused to the detriment of patients and benefit of drug companies.

Miller-McCune
By Arnie Cooper
June 8, 2010

“My dear Sir, take any road, you can’t go amiss. The whole state is one vast insane asylum.” — James L. Petigru

Spend just a few minutes watching prime time television with its endless pageant of commercials for antidepressants and anti-anxiety meds and you start to wonder if USA really means the United States of Affliction.

Such “direct to consumer” drug advertising ties into one of the most far-reaching criticisms in revising the Diagnostic and Statistical Manual of Mental Disorders: the potential to transform normal human behavior into a mental disorder.

This issue didn’t arise with the ongoing revision of the DMS-V. It’s long been a concern for psychiatry, which must exist uneasily alongside pharmaceutical companies’ hopes of expanding their markets and Americans’ desire for take-a-pill quick fixes. But past experiences suggest new diagnoses will reap a harvest of not fully intended consequences of patients larded with labels — and prescriptions.

Christopher Lane, an intellectual historian who has written extensively on psychiatry and culture, detailed the inclusion of “social anxiety disorder” in the DSM-III in his 2007 book, Shyness: How Normal Behavior Became a Sickness.

Lane revealed how the 15-member DSM-III task force, in its quest to establish psychiatry as a legitimate science (and riding the wave of drug companies looking to expand their markets for anti-psychotics and tranquilizers), spit out “almost over night” various new disorders, including one for those uncomfortable with social situations.

No longer need shyness be a variant of normal. Now it can be a neurochemical disorder addressable with GlaxoSmithKline’s multibillion-dollar marvel Paxil. Before safety concerns and patent expirations raised their ugly heads, antidepressants had become the second-largest selling class of drugs in the United States.

“In this desire to biologize and medicalize, with the idea that every personal crisis or problem is due to a disorder of the brain, we’ve lost sight of the vast complexity of behavioral responses to external stresses,” Lane says. Add to that some possibly dangerous side effects. Along with Prozac and Zoloft, Paxil was found to increase thoughts of suicide, especially among teens, prompting an FDA warning in 2004.

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