Friday, April 18, 2014

Has psychiatric diagnosis has become way too loose?

Today, 25 percent of Americans meet the criteria for a diagnosis in any given year. Twenty percent of us take psychotropic medication; that’s one in five people. We now have more deaths in emergency rooms from prescription drugs than from street drugs. Pill popping is rampant, along with all the unnecessary side effects of drugs.
How did psychiatry get itself into that situation?

Obviously there are any number of causes, but a key turning point goes back over 30 years to the enormous popularity of DSM-III. Before that, psychiatric diagnosis was fairly irrelevant, but once DSM-III became such a bestseller year after year, it attained tremendous influence beyond the therapy room, affecting decisions regarding school placements, disability decisions, courtroom verdicts, who could adopt a child, even who could fly a plane. All sorts of things in society are now determined by diagnosis.

A second major factor was the rise of Prozac in the 1980s and the tremendous profitability of psychiatric drugs. Drug companies, with their expensive marketing efforts, began to have more and more influence in shaping the practice habits of doctors, and later of the public, by convincing people that they were sick.

Third was the insurance company requirement that a doctor give a diagnosis if he wanted to get paid for a patient visit. As a result, doctors began seeing people for only about seven minutes before making a diagnosis. A psychiatric diagnosis is a critical moment in a person’s life, like getting married or buying a house. It shouldn’t be made after seven minutes.

A fourth factor was the drug companies’ market-driven realization that, while there were only about 40,000 psychiatrists, there are more than half a million primary care doctors. So they started pushing psychiatric diagnosis and the prescription of medication onto primary care. They began with the message that psychiatric diagnosis was really simple and the result of chemical imbalances. So increasingly, primary-care doctors began diagnosing in a few minutes and handing patients a prescription or, even better, a free sample. So we’ve gotten into a position where most of the psychiatric diagnosis is being done in just a few minutes, often by a primary-care doctor with little psychiatric training, and with tremendous encouragement by drug companies. This has been the perfect storm that’s led to loose diagnosis and excessive medication.

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