Paying Forthe Newpsychiatry

Article excerpt

Psychiatry has always been the troubled child at the table of medical specialists. Psychiatric labels are based on deviations of "normal," which change with trends in moral and intellectual attitudes. Mental health is back at the top of public attention in the wake of shootings and uncertainty over health care and who pays for it.

"Psychiatric bible" is an oxymoron, but that's what the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, has come to be called. The fifth edition, or DSM-5, has just been released and the experts are already arguing over how many psychiatric patients can dance on the head of a pin.

It's the medical manual of diagnoses for mental disorders, and it's meant to be a treatment guide for doctors. Unfortunately, it has become required reading for insurance companies to determine what they will pay for.

Taxpayers and an expanding number of patients question how the diagnoses outlined in the DSM are used. The ancient sin of gluttony has become "binge eating disorder," and "self-control" is eliminated as a proper mechanism to resist it. Restless children can now be diagnosed as suffering from "attention deficit disorder" and given drugs that may or may not be appropriate for helping them sit still.

Many severe psychiatric symptoms are out of a person's control, but when there's money available from an outside source, like the U.S. government, to pay for drugs and programs, it's amazing how symptoms multiply. Discrimination disappears and the need for careful examination evaporates when there's an insurance company ready with a "diagnostic number" for reimbursement.

This is the argument of Dr. Allen J. Frances in his new book, "Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. …