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Yet Another Nail In The Coffin Of Psychiatric Classifications

In this Forbes article by Alison Escalante, she discusses a paper about mental health put forward by physical anthropologists. I have gone back to the original paper and attempted to put it in simpler terms.

The original paper is here:

The Abstract of the paper includes the following:

As the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate‐to‐weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began. Many researchers and theorists are therefore endeavoring to rethink psychiatry from the ground‐up.

In other words, mental disorders now form a large part of disease worldwide, and the causes of them are little-known. The drugs given to combat them aren’t very effective and aren’t targeted at specific disease categories. Nor have those drugs and other treatments reduced the amount of mental disorders except in a few areas. A couple of weeks ago, I posted about the criticism of current mental disorder classifications coming from neurology, the study of the brain.

This time similar criticism is coming from anthropologists.

They come up with an alternative scheme of classification of mental disorders. This is still work in progress:

1. Genetic causes—not very common compared to the others—such as autism and Tourette’s.

2. The brain’s way of coping with nasty events. These are therefore not disorders at all, but the brain doing the best it can under the circumstances.

3. Diseases resulting from getting old.

4. Mismatches between the world our brains were designed to cope with and the one we live in today. Obviously these are not disorders either. For example, ADHD being a mismatch between normal child development and being stuck in a classroom. If (apart from conditions due to genetics and ageing), mental disorders otherwise stem from the brain responding to life events and a mismatch between what we are programmed to do and what society currently expects and finds convenient, then there is much more scope for interventions such as hypnotherapy in treating them. Not that I'm biased, of course...

The authors say that in 1900, about half of all deaths in the United States were due to infectious diseases, but by the end of the century almost none were. They mention the concept of disease burden, the amount of time lost to illness, disability or death. From that perspective, mental disease comes in fifth, after heart disease, infections, diseases of new-born babies and cancer. Depression accounts for around 40% of mental disease, anxiety about 15%, drug use 11%, alcohol 10%, schizophrenia and bipolar disorder about 7% each. The peak age for these problems on average is in our twenties. When you add in suicides and self-harm, mental disease rises to the same level of disease burden as heart disease. The authors quote research showing that ⅔ of suicides are due to mental disorders, and that more people die by suicide than from all wars and homicides combined. Mood and anxiety disorder rates don’t seem to have improved over time, and neither has the suicide rate worldwide.

At the start of the 21st century, there were campaigns to present mental disorders as diseases like any other. This of course suited drug companies, who advanced the concept of mental disorders being caused by chemical imbalance. However, not only were those campaigns not effective in destigmatising mental illness, but neither did the chemical imbalance model work. Nevertheless, the prescribing of antidepressants in Australia increased 3½ times in 10 years from 1990, and doubled again over the following 10 years. Similar increases took place in other more affluent English-speaking countries. Yet the number of cases of mental disorders didn’t lessen anywhere.

The paper states: To summarize, most psychopharmaceuticals are not very effective, their effects have been exaggerated by biased scientific publishing and advertising campaigns, they often have numerous harmful side effects, and the genuine effects that they do have do not provide compelling evidence for any specific etiology of any mental disorder.

The authors suggest that the reason that psychiatry hasn’t actually improved public health is that the classifications are incorrect, and that the DSM (Diagnostic and Statistical Manual), the bible of American psychiatrists, is actually making things worse. We are now on edition V (five). The first two editions actually classified homosexuality as a mental illness.

To put it in a nutshell, mental illness is not becoming less common, unlike the improvements in physical illness. The chemical model is wrong, the accepted categories of mental disorder are probably holding things back, and the drugs don’t work very well. It’s time for all this to be re-examined.

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