PsychWatch Australia Inaugural
Disease-Monger of the Month (August 2019)
and Lifetime Achievement Award to the
AMERICAN P$YCHIATRIC A$$OCIATION for D$M5
With an honourable mention to the
Royal Australian and New Zealand College of Psychiatry
Judge’s commendation (25 August 2019)
For the inaugural PsychWatch Australia Disease-Monger of the Month Award, there could only be one winner. This month and every month, Down Under and across the globe, the American Psychiatric Association (APA), via its Bible of Psychiatry the Diagnostic and Statistical Manual of Mental Disorders (DSM), sets the agenda by inventing and exporting hundreds of ways of labelling people as mad.
The DSM is now 67 years old and DSM-5 (2013), the fifth edition, was a great leap forward in the APA’s ongoing quest to eliminate sanity, and make ‘disordered’ the new normal. So forget Hollywood, Coca-Cola and McDonald's, the APA are without doubt the most influential exporters of American culture ever.
The Royal Australian and New Zealand College of Psychiatry also richly deserve their honourable mention for having continued the great Aussie tradition of whinging about American influence and then doing exactly what the Yanks tell us to do. By keeping their critical analysis of the DSM5 to a bare minimum and then embracing DSM5 as the definitive diagnostic guide for common disorders like depression, the RANZCP has smoothed the transition from DSM-IV to DSM-5 and helped millions of ordinary Aussies realise they and/or their kids are not normal.
But seriously, America has terrible mental health outcomes.
So why does Australia follow its lead?
Americans spend the most per-capita on mental health interventions, primarily psychotropic drugs, and have the highest rates of diagnosed psychiatric disorders on the planet. The USA is tumbling down global happiness rankings and the life expectancy of Americans is shortening. Despite their material success and power, Americans are rapidly becoming madder and sadder.
The USA should hardly provide the model for enhancing the mental health of Australians. However, the domination of Australian psychiatric practice by the APA, through the DSM, ensures that is exactly what happens. On key measures – psychiatric drug use, diagnosis rates, measures of national happiness and suicide rates – Australia is following America’s lead.
America remains the home of ADHD child drugging, with about 1 in 10 children (aged 2-17) ever having been diagnosed with ADHD. As American psychologist Dr Leonard Sax pointed out many years ago, given that many of the hypothesised benefits of ‘medicating’ ADHD children relate to education, “you would expect American children to be racing ahead in their school work [but] France, Germany, and Japan continue to maintain their traditional lead over the United States in tests of math and reading ability”.[1] Similarly, if ADHD drugs worked, measures of social functioning such as juvenile crime rates would be lower in countries with high prescribing rates like the USA. Clearly America's 'medicated' children are not doing so well.
Australian rates of child prescribing are considerably lower, but we are trying hard to catch up. More than 100,000 children are taking antidepressants (which are not approved for children, and increase the risk of suicidality) and even more are on ADHD drugs, primarily amphetamines. This is despite the fact that the long-term evidence supporting these aggressive chemical interventions in developing brains and bodies is worse than weak.
Viewed from the perspective of patient and child welfare, this makes absolutely no sense. But if you accept that the fundamental principle of economics (that self-interest drives most human and corporate behaviour) is more powerful than the Hippocratic obligation to ‘do no harm’, it makes perfect sense.
The APA, Big Pharma, and their collaborators in Australia and around the globe are acting in a totally rational (sane) way. By defining more people as mad, and corrupting the evidence base for their drugs, they expand their markets and maximise their profits. They find lazy, greedy and compliant medical researchers and practitioners, and promote and reward them as thought leaders. Even the good medical and psychiatric practitioners (and there are plenty of them) have been naively far too trusting of their less noble and competent colleagues.
Big Pharma and their paid associates are also incredibly good at charming our hapless politicians and limp regulators and gaming the system of drug regulation and subsidisation. So good we that must all stop expecting the system to do the right thing and protect our health and well-being. Furthermore we should stop being shocked by stories of 90 year olds in nursing homes being drugged into a stupor with life ending heavy doses of antipsychotics, or of 7 year olds given amphetamines, antidepressants and antipsychotics and wanting to take their own lives.
We must wake up to the fact that this is all part of the new normal. Perhaps it is even time we all realised that normal is not all it is cracked up to be.
References
[1] Sax, ‘Ritalin: Better Living Through Chemistry?’ (Sax quotes these statistics from Jodie Morse, ‘Summertime and School Isn’t Easy’, Time, 31 July 2000, p. 20. French students scored 23 points above the international average; Japanese students, 94 points above. German students on average were 5 points below the international average; American students, 39 points below.
What is disease-mongering?
Australian health researcher/writer, Dr Ray Moynihan, defined disease-mongering as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments”. According to Moynihan, examples include “pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health”.[1]
The term “disease-monger” was first used in 1992 by health writer Lynn Payer, the author of Disease-Mongers: How Doctors, Drug Companies, and insurers Are making You Feel Sick.[2]
Inspired by the work of Payer and Moynihan, for the purposes of this award, PsychWatch Australia defines psychiatric disease-mongering as:
Identifying what was previously considered within the range of normal human experiences as abnormal, and in need of treatment.
Defining a psychiatric disorder broadly so that the number of people who qualify for a diagnosis is maximised.
Claiming that a psychiatric disorder is caused by a biological factor (e.g. genetic biochemical factor) when there is no means of confirming that.
Conducting a psychiatric disorder ‘awareness campaign’ for conditions with uncertain causes, loosely defined symptoms, no biological markers and/or an uncertain prognosis.
Using statistics that exaggerate the impact of a disorder and/or overstate the benefits, or understate the risks, of treatment.
Attributing improvements in symptoms to treatment when it is likely patients would have got better as quickly (or quicker) if no treatment was given.
Retrospectively diagnosing disorders (and attributing suffering or dysfunction) to previously undiagnosed disorders in dysfunctional populations. (e.g. attributing criminality to undiagnosed ADHD in prison populations)
How is the Disease-Monger of the Month award judged?
Examples of disease-mongering, as defined in 1 to 7 above, will be assessed for their impact and originality.
Impact - What is the likely effect of the disease-mongering? A statement by a Government Minister or a prominent psychiatrist, that validates some spurious claim, is more likely to have an impact than a similar statement by a backbencher, or an obscure clinician. In a similar vein, disease-mongering by a major national media player is much more likely to have an impact than a page 7 item in the East Woop-Woop Community Newsletter. (Weighting 80%)
Originality - Is the disease-mongering the disease-monger's own work? Most disease-mongering involves the unquestioning repetition of previous disease-mongering that often has its origins in the DSM. Sometimes disease-mongering is original work, where innovators have found new ways to define previously sane individuals as mentally ill, or new ways of putting a positive spin on treatments. (Weighting 20%)
Why is disease-mongering more common in mental health than physical health? Disease-mongering occurs for both physical and mental health. However, the boundaries between mental illness and normality are vague, with less hard science involved in the diagnosis of mental illness than physical illness. Despite these differences, it is often asserted that psychiatric disorders, like depression, are illnesses just like any other such as heart disease, diabetes, asthma and cancer. Depression is even sometimes described as a disease.
These descriptions are dangerously misleading. There are fundamental differences in our understandings of physical illness and mental illness. Cancer is diagnosed by observing physical abnormalities of body organs and/or at a cellular level. Diabetes results in observable abnormal fluctuations in blood sugar levels. Despite repeated (broken) promises of imminent scientific breakthroughs, none of the 300+ psychiatric disorders outlined in DSM-5 are diagnosed by observing physical abnormalities.
These are just some of the reasons people are particularly vulnerable to the dangers of psychiatric disease-mongering. PsychWatch Australia looks forward to, on a monthly basis, giving Australia's and the world’s leading psychiatric disease-mongers the recognition they so richly de$erve.
References
[1] Moynihan R, Henry D (2006) The Fight against Disease Mongering: Generating Knowledge for Action. PLoS Med 3(4): e191. Available at https://doi.org/10.1371/journal.pmed.0030191 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030191 (accessed 9 May 2019)
[2] Payer, Lynn (1992). Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick. New York: J. Wiley. ISBN 978-0471543855.