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October 17, 2000

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Misdiagnosing Mental Illness By Nicholas Regush.

Some So-Called "Psychiatric Diseases" May Not Have A Biological Basis, So Do
Drugs Really Help?

      [Commentary By Nicholas Regush.]

      Psychiatry has become a heavily drug-company influenced edifice which
often trumpets highly speculative biological science.
      There are signs many Americans are disturbed by the insidious
evolution of psychiatry as a shill for pharmaceuticals and a tool for
behavior control
      Two class-action lawsuits filed last month allege the American
Psychiatric Association and Ritalin's maker, Novartis Pharmaceutical Corp
(formed through the merger of Ciba-Geigy and Sandoz) encouraged
overdiagnosis of behavioral disorders in children
      Congress also recently convened hearings about whether Ritalin is
overprescribed to children who are diagnosed as having Attention
Deficit/Hyperactivity Disorder (ADHD).  Is It Intrinsic or Culture?
      These are children who purportedly have disorder-related symptoms such
as short attention span, impulsive behavior and restlessness. Some
undoubtedly have these difficulties and need some help, but these days it
would appear that when a child too often twitches in school, cracks a few
jokes, or gazes off, bored stiff, he or she can be slapped with an ADHD
      This "diagnostic" enthusiasm has gone way off the deep end. Now,
finally, there are serious calls to investigate
      Part of the problem lies in psychiatry's disorder classification
system. I'm referring here to the American Psychiatric Association's
Diagnostic and Statistical Manual for Mental Disorders, or DSM. It is at the
core of modern-day psychiatric practice and influences how the entire field
of mental health deals with patients and research.
Fidgeting Is a Sign of Illness
      The latest DSM edition's description of ADHD is truly something to
behold. In the inattention category, for example, one symptom is "Has
difficulty sustaining attention." Another is: "Does not appear to listen."
      One symptom in the hyperactive/impulsive category is: "Fidgets with
hands or feet or squirms in chair." Another is: "Blurts out answers before
questions have been completed."
      If these types of symptoms occur frequently and appear to be severe,
then the child has a good chance of being branded ADHD
      The problem is, some of the symptoms listed could point to a wide
variety of stimuli: Insufferably boring teachers. An out-of
touch-with-reality academic curriculum. This is, after all, the Internet Age
in which the flow of ideas and facts are fast and furious. And what about
learning patterns at home that might play a role in how a child behaves at
      To give so many children a drug such as Ritalin presupposes that
specific biological problems underlie ADHD. And in psychiatry, this gets
about as murky as you can possibly imagine.
      The recent orgy of drug-giving to so-called ADHD children is no
historical accident. It comes at a time when there is increasing pressure
within psychiatry to focus more attention in the DSM on biological causes of
Biology vs. Psychological Causes
      Much of the history of psychiatry boils down to a duel between those
who have attempted to relate mental disorders to specific brain functions
(the biological approach) and those who have attempted to explain disorders
in psychological terms (the mind approach).
      As long as biological psychiatry had few treatments to bank on,
psychology more or less held sway. But that changed considerably in the
1970s when moderately effective treatments for mental illness appeared on
the market. That gave biological psychiatry a huge shot in the arm and it
has grown in stature and power ever since.
      But here's the rub. The brain has proved to be far more vastly complex
than some of the biological enthusiasts have imagined. To be sure, there has
been progress, but much of what is considered mental illness still is poorly
understood and many drugs offer scattershot rather than well-targeted
treatment. And that often translates into patients suffering serious drug
side effects.
      It is indeed very telling that psychiatry's disorder classification
system, the DSM, still remains, as the section on ADHD shows - primarily a
manual of descriptions of psychological states and symptoms - and not a
manual pointing to disorders with specific underlying biological conditions.
Assumed ADHD Is Biologically Caused
       Yet, in the case of ADHD, for example, there is clearly an unstated
assumption that symptoms of inattention and hyperactivity have some
biological cause. But the behavior that is described may have non-biological
or social causes, such as bad parenting, poor schools and poverty.
      There is certainly no indication in the DSM's description of ADHD that
the "disorder" can be viewed as arising from a difficult or non-conformist
relationship between an individual and his culture.
      In other words, rather than spotlight problems in the culture, the
subtle message in the DSM is that ADHD is biological in origin and therefore
mental health professionals should opt for drugs to quell some ill-defined
inner disruption
      There is little in the way of worthy biological data available on
something termed "ADHD" to make a scientific case for so much drugging of
      Now, if either the current president of the American Psychiatric
Association or the chief science officer of Novartis would enjoy debating me
on this point, I'm sure we can arrange a public forum and an Internet
      I'll even allow them to debate as a tag team.
[Nicholas Regush produces medical features for ABCNEWS. In his weekly
column, published Thursdays, he looks at medical trouble spots, heralds
innovative achievements and analyzes health trends that may greatly
influence our lives. His latest book is The Virus Within.]

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