What exactly is normal human behavior?
We are facing in medicine the epidemic of diagnosis in all fields. And Psychiatric field is one of the most fertile. The most proficient way to increase the amount of diagnosis is to “lower” the diagnostic threshold. And this is what is happening in psychiatry…and not only (the same is happening for blood cholesterol, blood pressure, etc.)
A central aim of the DSM (Manual of Mental Disorder) task force was to set appropriate cut-off points between what is considered “normal” from what is “pathological,” in order to treat the individuals belonging to the latter category. The criteria set for cut-offs between “normal” and “pathological” (e.g., number of symptoms, frequency and duration of symptoms, and nature/duration of dysfunction associated with the proclaimed disorder) are “arbitrary” and subjective. And there is no laboratory test or biological markers to set the more appropriate boundaries between “normal” and “pathological.” In addition, there is not scientific link between basic science (e.g., cognitive, neurological and social science) and clinical psychiatry. Second, cultures differ dramatically in their conception of normality; what is “normal” in one culture can be considered “abnormal” or “pathological” in another one. In addition, there are significant within-and-between cultural differences in the manner in which diagnostic categories are interpreted and diagnostic labels are used.
The DSM was created to enable mental health professionals to communicate using a common diagnostic language. The DSM was first published in 1952 when the US armed forces wanted a guide on the diagnosis of servicemen. The first version had many concepts and suggestions that would be shocking to today’s mental health professional. Infamously, homosexuality was listed as a “sociopathic personality disorder” and remained so until 1973.
What is interesting is how the numbers of mental disorders have been increasing over the five versions of DSM:
- DSM I edition (1952): the number of mental disorders were 108
- DSM II edition (1968): the number of mental disorders went to 182
- DSM III edition (1980): the number of mental disorders went up to 265
- DSM IV edition (1994): the number of mental disorders went up to 354
- DSM V edition (2013): the number of mental disorder remained almost the same of DSM4, but the the criteria (threshold) of diagnoses were “heavily” lowered, leading to an inflation of diagnosis (up to 28%)
In the latest version, the DSM-5 added 15 new mental disorders. These included:
- caffeine withdrawal,
- restless legs syndrome
- premenstrual dysphoric disorder
Only 13.4 million Americans took antidepressants in 1999-2000, ballooning to 34.4 million in 2013-4.
And the most scaring data, that should set an immediate alarm is : 67% of the DSM task force (18 out of 27 members) had direct (and declared) links to the pharmaceutical industry!
Almost 60% of biomedical research and development in the US is funded from private sources, mainly drug companies. In some areas of medicine, like the testing of drugs for depression, the figure is closer to 100 per cent. Almost all the clinical trials of the new antidepressants were funded by their manufacturers rather than public or not-for-profit sources. And this industry-sponsored research evidence is discussed and disseminated in thousands scientific meetings, events and conferences sponsored by the industry.
The continuing medical education, the refresher courses that physicians are strongly encouraged and formally required to attend, is a billion-dollar enterprise, with close to half of that funding flowing directly from the pharmaceutical industry. Doctors are being ‘educated’ about how to “spray” drugs on the population, in venues sponsored by their makers, by key opinion leaders who are on drug-company payroll (the same senior clinician who makes the guidelines).