The DSM5: Helpful Guide or Adding to  Confusion? 

The Diagnostic Statistical Manual of Mental Disorders has now been in its fifth revision for a week and the controversy
swirling around it continues. Dr. Francis Allen of Duke University has cautioned physicians to use the DSM-5 “cautiously if at all.”[i]The problem as he sees it is the issue of “diagnostic inflation.” The DSM converts behaviors that have normal explanations into disease. Dr Frances sites several including somatic symptom disorder (worry over
having a medical illness), binge eating disorder (overeating) and disruptive mood dysregulation disorder (childhood tantrums). He notes that patients who are grieving the loss of a loved will be misdiagnosed with major depressive disorder and that “the already overused diagnosis of attention-deficit disorder will be even easier to apply to adults
thanks to criteria that have been loosened further.”

The problem this presents for patients is that these changes can be used to promote “…the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form.”  As I read this article, I have been preparing to teach a seminary course at Baptist Bible College in Springfield, Missouri and one of the topics we will examine is what makes Biblical counseling Biblical. The difference between a DSM approach to problems of behavior and thinking and a Biblical counseling approach
could not be clearer.

The DSM turns normal human behavior into disease. It turns normal sadness into depressive disorder. It turns childhood tantrums into a medical ailment that will certainly end in a pharmaceutical treatment. It turns the self focused worry over illness into disease. Historically the expansion of diagnostic categories has led to the expansion of
medical treatment and that would be problem enough. But, the real trouble with this “diagnostic inflation” is that it draws our attention away from the real solution to most of the labels in the DSM. 
 
Tantrums, worry, sadness over loss, over-eating and many behaviors like them in the DSM are problems for which the
Bible has real answers. When we can find troublesome behavior described in the Bible, there will be a solution that will be effective, without adverse side effects, and free! If the original intent of the DSM was to bring order to the
confusion that was Freudian psychiatry in 1950, I would tell you that the DSM and the committee have lost their way.  

The solution to this growing confusion is to return the diagnosis of disease back to requiring pathologic changes at the cell level to define it. Instead of seeing every inconvenient behavior as a disease and then looking for a pill to fix it, we can find real solutions for matters of the heart. Those solutions are free and require no prior authorizations for all comers and can be found in the one book that changelessly describes human behavior.  







[i] http://annals.org/article.aspx?articleid=1688399This is a really good article. 


 
The DSM 5: France, Parenting and  ADHD
 
As I was driving to work this morning, the radio newsman announced that today was the big day for the release of the DSM 5.  The Diagnostic Statistical Manual of Mental Disorders is now in its fifth revision, but it does not come without controversy. In fact, most of the comment on the radio was about the idea that the American Psychiatric Association is turning somewhat normal human behavior into diseases that will need treatment. 
 
Several examples of overreach were given including diagnosing widows with major depression after a couple of weeks, binge eating disorder, and disruptive mood dysregulation disorder. Until today, widows were allowed at least 2 months to grieve the loss of their husbands and now they will be considered depressed when they meet the criteria in as little as two  weeks. Binge eating is something that I can relate to going back to the days when my mother would make whole plates of oatmeal cookies that would be washed down with ice cold milk. But, I draw the line at disruptive mood dysregulation disorder.  
 
That is professional jargon for a tantrum. I understand tantrums entirely as I have 12 wonderful grandchildren. I think I have seen them all manifest the problem at one time or another. Their behavior was not a disease and did not require anything more than some loving attention from their parents. In all 12 cases the symptoms were short lived and responded quickly to parental guidance. 

The question posed by the radio announcer is a valid one. Do we need to turn every difficult struggle that we face into a disease? And, even further, do we need a prescription solution for it? Not all parts of the civilized world deal with behavior and emotional problems the way we do. 

In “Psychology Today” Marilyn Wedge has written an interesting article that addresses the difference between children raised in France and in the U.S when it comes to the diagnosis of ADHD.[i] The amazing difference is that while 9% of children in the US are diagnosed and medicated for ADHD, in France around a half percent of
children are diagnosed. Her question was why doesn’t ADHD exist in France as it does here? 

Her answer was that parenting in France is different than it is here today.  Remarkably, the French pay more attention to the boundaries around their children’s behavior. They set them and then they enforce them with discipline. Wedge also noted that the French psychiatric community deals with childhood behavior issues differently. They have refused to follow the DSM since the third revision and have their own criteria. Those criteria discount the idea that ADHD
is only a biological issue and instead looks at the family/social setting to find the cause and cure for the behavior. And, the French are quite happy with it. 

On this inaugural day for the DSM 5 there are important questions that we need to ask and answer. Do we really want to make another acronym diagnosis out of normal childhood behavior? Do we really want another 9% of our children taking a mood stabilizer medication because we or they cannot regulate their disruptive moods? Or, is it time that we like the French part company with the DSM and take a long hard look at how raising children in the U.S. has changed over the past 5 decades? 

Maybe a good solution would start with the final  observation that Dr Wedge made concerning the difference between French and American Children. “…it makes perfect sense to me that French children don't
need medications to control their behavior because they learn self-control early in their lives. The children grow up in families in which the rules are well-understood, and a clear family hierarchy is firmly in place. In French  families, as Druckerman describes them, parents are firmly in charge of their  kids—instead of the American family style, in which the situation is all too  often vice versa.”[ii]  
 
Prior to 1960, American children we raised much the same way. Maybe what we are seeing is not an epidemic of disease, but a  paradigm shift in parenting. I suspect the solution is not more diagnostic categories and more medication but a return to normal parenting. 
   
 
[i] http://www.psychologytoday.com/em/89888“Why French Kids Don’t Have ADHD,”
Marilyn Wedge.  
[ii] Ibid.

 
I have posted a new blog on Mental Illness and Compassion. It can be found at the Biblical Counseling Coalition website or through this link.  http://bit.ly/13kSYo5
Much has been said in the past month about the lack of compassion to be found in the Church for people who are identified as having mental illness.  I hope what I have written will help clarify the issues involved.

The website for the Biblical Counseling Coalition is biblicalcounselingcoalition.org

 
Diagnosing Depression & Medical
Marijuana,


The news this week has been just full of  interesting things that relate to earlier blogs at Goodmoodbadmood.com. The first is an article on Medscape.com titled “Marijuana not Medicine: Addiction Experts Say.” The author says what anyone with a little good common sense might know. Marijuana is addictive and it has no proven use in medicine at this time. “There is no such thing as medical marijuana,” so says Stuart Gitlow MD president of the American Society of Addiction Medicine. The article goes on to say that Marijuana is the number one addictive illicit drug in the United States today. The word addictive pretty much says it all. But, if you need more, Paul in Ephesians 5:18 reminds us that we are not to be controlled by any substance, but instead by the Holy Spirit. 

I only bring this up because in reading comments from a recent speaking event, I had one dear soul who opined that if the “government makes marijuana legal that Christians ought to be able to use it just like vicodin.” I suppose that might be true if there were actually a research proven use for the drug that another non-addictive medicine could not
provide. Christians should not be looking for excuses to assume the destructive habits of the world.[i]

 Another news flash this week came from a CBS news story that referenced research that examined how often the diagnosis of depression is being made in our country. It also examined how often the diagnosis met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for making the diagnosis.[ii]  What it found was something that I have  suspected for years. Depression in this country is over-diagnosed and
over-treated.

The research was done at Johns Hopkins University’s Bloomberg School of Public Health. It looked at people who were diagnosed with depression in an outpatient setting between 2009 and 2010. The question was whether or not
they met the DSM criteria required to make the diagnosis of depression. The answer was yes for 38.4% of them! 
That meant that 61.6% of the study participants who had been labeled with depression did not meet the required DSM standard to make the diagnosis. 
 
The study went on to find that over half of all of the participants were treated with medication and that nearly 70% of
those who did not meet the criteria for the diagnosis were treated. Numbers like this sometimes confuse me! But, of all the patients in the study 6 out of 10 were misdiagnosed with depression and 4 out of 10 were treated with medicine that they probably did not need and most likely would not help them. 
 
As I wrote in “Good Mood Bad Mood” it is likely that today that we are simply treating people who are normally sad over loses that are common to all of us in life. We end up treating people with medication for diseases that they do not have and giving them side effects that complicate their lives without doing them much good. 
 
I wrote about these two subjects together because there is a common thread between Medical Marijuana and the over diagnosis and over treatment of depression. It is our society’s infatuation with the idea that we can solve most of our problems with medicine. This is fine idea  as long as we are talking about high blood pressure or diabetes. It does not work nearly so well when we take it into matters of the heart and soul. 
  
[i] Medscape news article  http://www.medscape.com/viewarticle/803318?nlid=31063_329&src=wnl_edit_medn_psyc&uac=16048SY&spon=12 
 
[ii]CBS News Article   http://philadelphia.cbslocal.com/2013/05/01/study-depression-may-be-overdiagnosed-and-overtreated/