Pathologizing the norm: Follow-up

For those of you who are interested in this debate, there's a great new two-part article in the New York Review of Books by Marcia Angell questioning "The Epidemic of Mental Illness". The articles summarize three new books concerned about the prescription frenzy we are in the midst of and how this reliance on psychoactive medication came about. She addresses the problem of dealing with psychiatric disorders as chemical imbalances and the dubious efficacy of these drugs at actually improving symptoms at all. I highly recommend this read, as well as the second part in the series on "The Illusions of Psychiatry", for anyone concerned about our mental health system. One of the most resounding points she makes in this second piece is the perpetual expansion of the diagnoses listed in the American Psychological Association's Diagnostics and Statistical Manual (DSM). With every publication of the DSM there are more and more "disorders" that we have pathologized and created, and with the upcoming publication of the DSM-V it is certain that there will be a slew of new problems we can claim for ourselves and put a name to. Angell succinctly describes this problem stating, "Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology."

Finally, she brings to task the drug companies who are more involved in psychiatric treatment than in any other medical field. This applies not only to clinicians or psychiatrists with private practices, but also the research institutions, hospitals, universities, policy makers, patient advocacy groups, educational organizations and the APA itself.

Angell's writing takes a good hard look at the system of mental health, and while at time she makes some uncomfortable points, these are important questions that need to be addressed.

(Thanks to Emily Barnet for the Angell articles.)

Dana Smith

PhD student in Experimental Psychology at the University of Cambridge