Why Life in America Can Literally Drive You Insane

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The New York Times reported in 2007 that the number of American children and adolescents treated for bipolar disorder had increased 40-fold between 1994 and 2003. In May 2013, CDC reported in “ Mental Health Surveillance Among Children—United States, 2005–2011,” the following: “A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing.”

Over-Diagnosis, Pathologizing the Normal and Psychiatric Drug Adverse Effects

Even within mainstream psychiatry, few continue to argue that the increase in mental illness is due to previous under-diagnosis of mental disorders. The most common explanations for the mental illness epidemic include recent over-diagnosis of psychiatric disorders, diagnoses expansionism, and psychiatry’s pathologizing normal behavior.

The first DSM ( Diagnostic and Statistical Manual of Mental Disorders), psychiatry’s diagnostic bible, was published by the American Psychiatric Association in 1952 and listed 106 disorders (initially called “reactions”). DSM-2 was published in 1968, and the number of disorders increased to 182. DSM-3 was published in 1980, and though homosexuality was dropped from it, diagnoses were expanded to 265, with several child disorders added that would soon become popular, including oppositional defiant disorder (ODD). DSM-4, published in 1994, contained 365 diagnoses.

DSM-5 was published in May, 2013. The journal PLOS Medicine reported in 2012, “69% of the DSM-5 task force members report having ties to the pharmaceutical industry.” DSM-5 did not add as many new diagnoses as had previous revisions. However, DSM-5 has been criticized even by some mainstream psychiatrists such as Allen Frances, the former chair of the DSM-4 taskforce, for creating more mental patients by making it easier to qualify for a mental illness, especially for depression. (See Frances’ “ Last Plea To DSM-5: Save Grief From the Drug Companies.”)

In the last two decades, there have been a slew of books written by journalists and mental health professionals about the lack of science behind the DSM, the over-diagnosis of psychiatric disorders, and the pathologizing of normal behaviors. A sample of these books includes: Paula Caplan’s They Say You’re Crazy (1995), Herb Kutchins and Stuart Kirk’s Making Us Crazy (1997), Allan Horwitz and Jerome Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (2007), Christopher Lane’s Shyness: How Normal Behavior Became a Sickness (2008), Stuart Kirk, Tomi Gomory, and David Cohen’s Mad Science: Psychiatric Coercion, Diagnosis, and Drugs (2013), Gary Greenberg’s The Book of Woe: The DSM and the Unmaking of Psychiatry (2013), and Allen Frances’ Saving Normal (2013).

Even more remarkable than former chair of the DSM-4 taskforce, Allen Frances, jumping on the DSM-trashing bandwagon has been the harsh critique of DSM-5 by Thomas Insel, director of the National Institute of Mental Health (NIMH). Insel recently announced that the DSM’s diagnostic categories lack validity, and that “NIMH will be re-orienting its research away from DSM categories.” And psychiatrist Robert Spitzer, former chair of the DSM-3 task force, wrote the foreword to Horwitz and Wakefield’s The Loss of Sadness and is now critical of DSM’s inattention to context in which the symptoms occur which, he points out, can medicalize normal experiences.

So, in just two decades, pointing out the pseudoscience of the DSM has gone from being an “extremist slur of radical anti-psychiatrists” to a mainstream proposition from the former chairs of both the DSM-3 and DSM-4 taskforces and the director of NIMH.

Yet another explanation for the epidemic may also be evolving from radical to mainstream, thanks primarily to the efforts of investigative journalist Robert Whitaker and his book Anatomy of An Epidemic (2010). Whitaker argues that the adverse effects of psychiatric medications are the primary cause of the epidemic. He reports that these drugs, for many patients, cause episodic and moderate emotional and behavioral problems to become severe, chronic and disabling ones.