Yesterday, under the headline “Psychologists seek authority to prescribe psychotropic medications,” The Washington Post published a re-hash of a familiar frame story, one which I like to call the “undiagnosed and untreated” frame. It goes something like this:
1. Lots of people — adults and kids, American or otherwise — are suffering from mental illness; and many of them are not being treated (the implication typically being that “treatment” = primarily drug therapy). Something must be done.
2. People don’t have proper access to mental health experts, folks who can provide them with the treatment [medications] they require. That’s because a. states are cutting spending on mental health services and b. there just aren’t enough psychiatrists, especially in non-urban areas. Something must be done.
3. Mental illness is serious and real [insert mention of chronic physical illness like “diabetes” here]. After all, “people with serious mental illness die 25 years earlier, on average, than the rest of the population.”* Something must be done.
4. Finally, after the case for doing something has been so irrefutably established, the recommendation is usually along the lines of making medication more accessible, either by reforming insurance reimbursement practices, integrating mental health care with primary health care, or (as is the case in this article) recommending that all psychologists – not just clinical psychologists with training in psychopharmacology – be allowed to prescribe medications.
This frame story presents undiagnosed/untreated mental illness almost as a human rights issue. From this point of view, it is a basic human right to a. be informed that you are suffering from a mental illness [this fact being objectively determined, of course] and b. be medicated, therapized, or in some other way treated for that disease [the treatments being scientifically proven to address those aforementioned objective diagnoses]. Keeping in mind the funny way that informed consent operates in mental health “care,”** it’s fair to say that it doesn’t really matter if you agree with the label you’re given or the means of addressing that label [treatment]. For your own good, and the good of society, you must be treated; otherwise harm to yourself or others is the inevitable result – or so we’re told. The glut of editorials following the Tuscon shooting warning that untreated mental illness will lead to violence (not supported by any evidence beyond conjecture) is an excellent example of this particular misconception at play.
Case Study: the right of children to be bipolar
A recent study from the Archives of General Psychiatry, detailing the prevalence of diagnosed bipolar spectrum disorders in different countries, showed the following results: essentially, the United States has the highest rate of diagnosed bipolar disorders (4.4%), almost twice the estimated worldwide average (2.4%).
click to enlarge
[citation: Merikangas, K.R. et al (2011). Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68(3), pp 241-251.]
The interpretation of this data was another homage to the “undiagnosed and untreated” frame story; bipolar disorders are real but they’re not being diagnosed properly worldwide (just look at the disparity between the US and other countries!). Folks in under-developed countries are being denied their basic human right! Something must be done.
In fact, before the 1990s, the US’s rate of bipolar disorder was much lower, mainly because the phenomenon of childhood bipolar disorder was unknown. It was something a clinician could expect to see maybe “once or twice in his lifetime.” But then in 1994 two influential child psychologists from Harvard University, Dr. Joseph Biederman and Dr. Janet Wozniak, hypothesized that the disease is common in children – and is often misdiagnosed as ADHD.
Overnight, bipolar disorder diagnoses in children soared; there was a 40-fold increase between 1993 and 2003 in bipolar labeling (4000%!).
This precipitous increase in diagnosis (and corresponding increase in profits for the manufacturers of medications used to “treat” the disorder) doesn’t look… natural. Especially when you have child psychiatrists admitting on primetime TV that the whole thing is an “experiment.” So there’s been a bit of a backlash, and the DSM-V [Diagnostic and Statistical Manual, 5th Edition, currently in development] will address the problem—a new diagnosis for what is now called “childhood bipolar disorder” has been invented. They’re calling it “Temper Dysregluation Disorder.” It is a “biological dysfunction,” to be treated with medication, of course.
I fear that we’ll soon be meeting individuals who insist that they suffer from “Temper Dysregulation Disorder,” that the label finally puts a face to the beast of the problems they’ve been facing for years. Maybe so — but I won’t be able to stop myself from remembering the days when that label was just the figment of a DSM-V editor’s imagination…
A pertinent question
If this new diagnostic category does indeed become the psychiatric law of the land in the DSM-V, what will this mean for the thousands of children who suddenly had the human right of being bipolar thrust upon them? Will it be their new human right to be “reclassified” into another diagnostic/pathologic category?
Will we soon be informed that the rates of “Temper Dysregulation Disorder” diagnosis are pathetically low in foreign countries, and that those poor suffering individuals need to have their human right to diagnosis and treatment met, whether they like it or not?
One thing is certain; as long as new psychiatric disorders are invented solely in the US (and it appears that for now at least the APA has a monopoly on that activity), the rest of the world is just going to have to put up with shrill condemnations of their human rights violations. Unless, of course, they have the money, time, and will to subject their populations to the kind of psychiatrization so popular here in the US.
[to make comments visit the original post here]
* Bonus points if you can spot the inaccuracies surrounding the Washington Post’s presentation of this statistic…
** Someone who says “yes” to treatment is almost always “competent to give consent;” someone who says “no” is demonstrating his pathology, inability to make good judgments about his own care, legally incompetent – and subject to involuntary treatment and confinement. Like the case of Paul Henri Thomas, to cite just one example.