The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”
Patients with mental disorders deserve better. NIMH is looking to Transform Diagnosis and has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Read more from NIMH here
in a free-market economy anyway, it’s not such a good idea to let the people who profit from disease define it.
Gary Greenberg’s recently published book “The Book of Woe: The DSM and The Unmaking of Psychiatry”, is said to be a powerful critique of the entire DSM methodology. Greenberg is a practicing psychotherapist who has been referred to as “The Dante of our Psychiatric age,” by Errol Morris, and blogs about the DSM for the New Yorker. With The Book of Woe, written during and after his own participation in the revision process of the DSM-5, Greenberg doesn’t just paint the DSM as irrelevant, but as an arbitrary and totalitarian influence in the treatment of mental and emotional distress. Greenberg makes an unsparing case against the DSM’s hold on the naming rights to our psychic suffering.
We live in an age that pays lip service to history, yet which continually undermines the ties we have to the past. The narrative of human lives is more or less absent in healthcare economies, where symptoms are seen as problems to be treated locally, rather than as signs that something is wrong at a more fundamental level. If the constellation of the manic depressive includes a difficulty in integrating a part of his or her history, society’s neglect of this dimension can only make things worse.
THE STORIES OF ADDICTION
By Jim Jensen, LAC, LCPC
In less than a generation we have gone from a community of fellow alcoholics sitting together in church basements sharing stories, to licensed professionals sitting together in hotel conference rooms sharing studies on the neurochemistry of addiction.
One invites questions. The other stands at the door handing out answers. One engages the brain. The other engages our imagination, emotions, and spirit.
I always enjoy Susan Cheever’s articles for “The Fix” –
“At a popular center for meetings in New York City on most days of the week, an addict can get 12-step help for spending, under earning, sexual compulsiveness, cocaine, co-dependency, crystal meth addiction, debting, overeating, surviving incest and problems with addicted family members. The miracle of the 12 Steps of Alcoholics Anonymous is that they often work when nothing else does. Although few of the more than 50 12-step programs for other addictions are as organized or as effective as AA, they seem to have a good effect on the people who attend them.
Yet their proliferation raises a larger question: What is the difference between being an addict and being a human being? Everyone has some kind of problem. Can a 12-step program help every problem?
Although addictions vary in intensity—some addicts are more addicted than others—there is a difference between an addict—someone who cannot stop—and someone who is not addicted. It is also true that many addicts can switch substances if they need to. “High-functioning alcoholics” are often people who also have other addictions, such as money, food and pills‑all kept more or less in check by spreading the addiction thin. Recovery author Patrick Carnes, PhD, who put sex addiction on the map, calls this “bargaining with chaos.”
In many AA meetings members talk about drug addiction, eating disorders and struggles to stop smoking. Although all addictions are the same in some ways, it is deeply reassuring and comforting to sit with a group of people who have exactly the same problems as you.
In my experience this is also what I have seen –
“Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.”
Michael Moss is an investigative reporter for The Times. He won a Pulitzer Prize in 2010 for his reporting on the meat industry.
Here are some parts that struck me …
Today, one in three adults is considered clinically obese, along with one in five kids, and 24 million Americans are afflicted by type 2 diabetes, often caused by poor diet, with another 79 million people having pre-diabetes. Even gout, a painful form of arthritis once known as “the rich man’s disease” for its associations with gluttony, now afflicts eight million Americans.
Our limbic brains love sugar, fat, salt. . . . So formulate products to deliver these. Perhaps add low-cost ingredients to boost profit margins. Then ‘supersize’ to sell more. . . . And advertise/promote to lock in ‘heavy users.’ Plenty of guilt to go around here!”
… the food industry already knew some things about making people happy — and it started with sugar.
… pioneering work on discovering what industry insiders now regularly refer to as “the bliss point” or any of the other systems that helped food companies create the greatest amount of crave.