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"Inside the Battle to Define Mental Illness", psychiatry as an imperfect science

Posted Feb 06 2011 12:00am

"Take schizophrenia and bipolar disorder: For more than a century, those two illnesses have occupied separate branches of the psychiatric taxonomy. But research suggests that the same genetic factors predispose people to both illnesses, a discovery that casts doubt on whether this fundamental division exists in nature or only in the minds of psychiatrists."
-Gary Greenberg, Wired Magazine

As someone whose has been diagnosed both with Bipolar Disorder and Paranoid Schizophrenia, and who diagnosis was later changed to Schizoaffective Disorder (a combination of the two, basically), I take interest in the above paragraph. Apparently the formulation of the new DSM-5, the Diagnostic and Statistical Manual of Mental Disorders in its newest, upcoming form, is fraught with conflict . Some doctors believe that there are all sorts of problems with this new edition of the manual. And one, Allen Frances, who was lead editor of the fourth edition of the manual, disagrees whole-heartily with the way it is being written and several of the new diagnoses in it.

His primary reason for this disagreement? New disorders and being created which will, inevitably, lead to many new diagnoses being given, and therefore, many new psychotropic drugs being sold. Essentially, a new diagnosis means millions of new dollars for drug companies. I have a problem with this.

Drug companies are, in many ways, the thugs of modern medicine. They profit on our suffering. They influence research. They influence the DSM, and they influence our leading organizations, such as the National Alliance on Mental Illness of which I am proud to be a member, but a member who is critical of this aspect of the organization. (Drug companies sponsor many of NAMI's fundraisers and programs in a variety of ways that are not completely clear to me, but for example, they sponsor our local fundraisers and newsletter all the time.)

I am grateful for my medication. I am not grateful that if I didn't have Medicare, these medications would be costing literally thousands of dollars a month which I do not have, and therefore, I would not be getting them. Not getting these necessary medications would lead to my death, as it almost did many times in the past, or, at least, to my homelessness and extended horrible misery, as it also did in the past. That bothers me.

There are many people in the United States who cannot afford their psychotropic medications. I have some of these people in my own family. If you have insurance, it does you very little good when the co-pays are too high for you to be able to pay them, so you can't get the medication you need. If you don't have insurance, the only hope you have is to get into a prescription plan run by a pharmaceutical company whereby they will supply you with medication, but the minute you get health insurance of any kind, you lose the ability to participate in one of those programs. So you have to forgo any insurance you might be able to get which you might need to cover other health problems. If you have an income that is not poverty level, you also lose the ability to participate in most of those programs. If you do not keep up with all the paperwork to get approved and to stay in the program, then you'll never be a part of it. So many people are left without medications they need. This is why we have millions of people walking around (and if not millions at least thousands), without the medications they need to function and lead a decent life. This is why we have homeless people lining our streets, suffering from mental illnesses, and not knowing at all what can be done about it, if they even have enough insight to know they are ill in the first place, as many unmedicated people do not.

Medications are not a cure-all, of course. There are many people for whom the meds simply do not work. There are many others who have no desire to take them and choose not to do so, believing that the side effects and dangers far outweigh the benefits. I'm not one of those people. I'm afraid of the side effects - I'm already pre-diabetic thanks to metabolic syndrome caused by my antipsychotic medications, and I am afraid of the long-term effects of these drugs which are as yet unknown, since nobody has been on them for a lifetime yet.

But I know that they have made a monumental difference in my life, taking away most of the psychosis that used to torment me, destroy my life, and eliminate my ability to fully function in the world. They have taken away suicidal depressions too. They have left me able to function as a person who is stable enough to do so, free of the torment of psychotic delusions and hallucinations that confused me and destroyed me in the past to the point that I was not living in the real world. Because of medication, I have a roof over my head, a college degree, a part-time job, a current college career, a few friends, the ability to do some volunteer work, and relative stability. I am not living a perfectly normal life, by any means. But I am far better than I was sans meds. I don't wish to go back to those days without meds, ever, unless some other method of treatment that would work for me becomes available.

Yet, like I said, I am afraid. There is much to be afraid of, and much to be skeptical about. I know there are increasing numbers of people who criticize the pharmaceutical industry and its incestuous relationship with mental health treatment. I know that many people are put on medications because those medications are new, and therefore are making billions of dollars for a drug company which pushes doctors around the country to prescribe them. This has been done to me many times. I went to my first psychiatrist as a teenager, and as soon as a new antidepressant came out, he put me on it. He did not seem to care what the side effects were, and assumed that if something was new, then it was inherently better - a fact I have learned from experience is not true, though it seems to be believed true by many doctors.

I think we all need to keep our fingers on the pulse of medicine. We need to be aware of disagreements like those listed in this article about the new DSM-5 . We need to be aware that psychiatry is a very imperfect science, one fraught with discord, and our best hope is to educate ourselves as much as we can about our illnesses and the treatments available.
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