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Treatments for bipolar disorder include the drugs Depakote, Abilify, and other anti-psychotics. Their long-term effects on young children have not been tested, but their side effects are well known: obesity, diabetes, tics and spasticity, cataracts, and a shorter life expectancy. Eventually, of course, we will also know the long-term effects, because we’ve been using our own children as lab rats.
In addition to the cavalier removal of some diagnoses and the addition of others (binge eating disorder?), there was flagrant sloppiness. Half the field trials were canceled when the book fell behind in its publication schedule, and the trials that did occur cast doubt on some of the newly added disorders — which went into the book anyway.
The APA’s response was to disingenuously remind critics that the DSM’s diagnoses and criteria “are only ‘fictive placeholders’ or ‘useful constructs,’ the best they can do with the knowledge and tools at hand” — a virtual admission that formulating a precise description of any psychological illness is well beyond the profession’s capabilities.
And yet for 60 years, the APA has been able to have it both ways — “to manufacture fiction and yet act as if it were fact.” Nor did the organization raise objections when “fictive placeholders” began to drive real-life decisions about insurance coverage and research budgets.
When his warnings and appeals to the committee were ignored, Frances reluctantly went public, ultimately leading what Greenberg calls “a scorched-earth campaign against his successors.” But the harder he fought, the worse he felt: Frances knows that therapeutic success depends on faith — the patient’s faith that the therapist really does know what is wrong with him and how to fix it. Fighting to rescue the DSM by broadcasting its numerous flaws, Frances worried that he was causing patients to lose faith in therapy.
“Whatever we’ve been doing for five decades, it isn’t working,” Greenberg quotes Thomas Insel, director of the National Institute of Mental Health, as saying. “When I look at the numbers — the number of suicides, number of disabilities, mortality data — it’s abysmal, and it’s not getting any better.”
In April, President Obama announced a huge funding initiative to “map the human brain” — to learn how our minds function biologically. Can a faulty neural connection cause autism, schizophrenia or drug addiction?
If the mind turns out to be the province of neuroscience, as the brain is, all these ethical dilemmas and eternal debates about categories, criteria and causes will be rendered moot. Perhaps the entire field of psychiatry will collapse like the house of cards Greenberg says it is. Everybody will swallow his custom-designed drug cocktail every morning, and we’ll all be perfect.
Hmm. Why does that sound like a horror movie?
Nan Goldberg writes for numerous publications, including the Boston Globe and New York Observer.