Sunday, June 6, 2010

Are We all Head Cases?

With the issue of the new Diagnostic and Statistical Manual of Mental Disorders- V (DSM-V, for short) it seems like nearly 9 out of 10 Americans are now regarded as candidates for either psychotherapy, or psychopharmacology. As Edward Shorter, Professor oin the Faculty of Medicine at the University of Toronto recently put it ('Why Psychiatry Needs Therapy', WSJ, Feb. 27-28, p. W3):

"DSM-V accelerates the trend of making variants on the spectrum of everyday behavior into diseases: turning grief into depression, apprehension into anxiety and boyishness into hyperactivity"

Among the new entries or ramped up old ones with which we need to be aware:

- Intermittent Explosive Disorder (or IED) - recognized by bouts of explosive anger out of all proportion to the cause.

- Temper Dysregulation Disorder with Dysphoria (a new definition for all children with outbursts of temper, i.e. any brat or rug rat pitching a temper tantrum)

-Minor Neuro-cognitive Disorder (Betrayed by any evidence of even mild cognitive decline from a previous level of performance.) Good luck to all those over 50 for whom this is expected!

- Mixed Anxiety Depression - any symptoms of major depression accompanied by anxiety or distress.

More problematic is the extension of schizophrenia to more in the general population via "psychosis risk syndrome". ( I really want to include my pastor brother in that and report him to the American Psychiatric Association, based on his hellfire sermons and glorifying the odious Billy Sunday to the level of a rock star? Maybe not.)

Why this dramatic expansion of defined symptoms? Is the intent to make everyone in the country a confirmed head case or suspected one? if so, what could be the reason? Well - how about profit?

In the New Yorker article Head Case (March 1) author Louis Menand observes:

"There is suspicion that the pharmaceutical industry is cooking the studies that prove that anti-depressant drugs are safe and effective, and that the industry's direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases, like shyness"

This may well apply, and one cannot discount the possibility of a cozy relationship between psych practitioners and Big PhRma's drug peddlers, any different from what we behold with medical practitioners in general. (Being wined and dined by the drug companies to entice the physicians to offer their wares as "samples" - then get patients hooked.)

We already know, as projected in a FORTUNE magazine article last year, that the expansion of the use of statin drugs may well preserve drug company market share into the far future. Provided at least 5 million new users are added each year. Well, the latest "research" reports that these wonder drugs now can help prevent Alzheimer's too!What they won't tell you is how the statistics showing the benefits of statins are gamed (e.g. between the control group not using them and a group that does, there is 3% to 2% heart attack incidence. This is spun into "33% less chance of heart attack" since (3-2)/3 x 100% = 1/3 x 100% = 33%. Go figure! Or not! )

What they also won't tell you is that 1 in 20 long time statin users experience some form of liver problem, with 1 in 100 reporting liver failure. Newer research also shows 1 in 75 experiencing kidney failure too. A possibly high price to pay to lower cholesterol, especially when high cholesterol per se is not the proximate cause of heart attacks. The proximate cause is actually inflammation and the best test to indicate or show that is the one for c-reactive protein. But because it's so much more costly than simple lipid panels most insurance companies won't cover it, and 99% of physicians won't ask for it.

According to at least one author (Gary Greenberg, 'Manufacturing Depression') quoted in the New Yorker piece, the push to re-label more of us as off the beam may be part of a capitalist plot. As the article puts it, he (Greenberg):

"basically regards the pathologizing of melancholy and despair, and the invention of pills designed to relieve people of those feelings, as a vast capitalist conspiracy to paste a smiley face over a world that we have good reason to feel sick about. The aim of the conspiracy is to convince us it's all in our heads...specifically, our brains. That our unhappiness is a chemical problem, not an existential one."

But what if it is existential? What if melancholia and despair are rational responses to an insidious, insane and toxic culture? What if the people taking the "happy pills" are the ones running from reality?

There is more than a grain of truth in this. First, we already know that capitalism is a system that functions on the basis of wanton destruction. It pitilessly leaves lives in ruins, as jobs are lost by the millions and replaced only with scut work that pays minimum wages, even while it gets the government to game unemployment stats to make the damage appear less (by dropping everyone unemployed for more than 6 months off the BLS rolls).

Right now, according to the financial press (WSJ, Financial Times) 7.4 million jobs have been lost since 2007 and no where near coming back. Instead of hiring Americans, many companies are offloading even more of their production to India or China: cheaper labor. What's not to be depressed about for a guy who's been without a decent paying job for 27 months or more?

Yeah, sure, the guy could stand in line to work at Mickey D's, but the chances of even getting hired there are slim and none when the manager has to choose between a perky twenty-something and a 60+ year old with worn suit and downcast eyes.

Capitalism not only destroys individual lives but the national common purpose as well. The sense of community and feeling we're all in this together. Because capitalist policies and the lawmakers beholden to them (via our corrupt lobby system) continually choose winners and losers (by virtue of feral tax laws, exceptions, zoning policies etc.) people are forever placed at war with each other. The immigrant issue is only the most recent manifestation of conflict, but many others exist. For example, oldsters are refusing to vote on any and all property tax hikes in many cities, forcing communities to cut school funding, lay off police or - in the case of Colorado Springs- cut bus service. But when so many elderly face exploding medical costs and live on fixed incomes, can anyone blame them? Maybe if someone got rid of the "doughnut hole" in Medicare, more elderly would cast votes to support local schools, etc.

What is the outcome of all this economic fear? Well, in such a capitalist-driven, consumerist organizational economic model, wherein the resource “pie” for the non-wealthy underclass grows ever smaller, the young are threats to oldsters, as oldsters are threats to them, as neighbor is to neighbor. It can't be otherwise. This capitalist model has seen fit, in other words, to destroy our areas of commonality and common cause. Replacing neutral civic space with demeaning commercial space and commercialist, capitalist values that inveigh against cooperation.

Charles Reich (Opposing the System, Crown Books, p. 103), expresses it well:

"When society itself comes to be modeled on economic and organizational principles, all of the forces that bind people together are torn apart in the struggle for survival. Community is destroyed because we are no longer 'in this together' because everyone is a threat to everyone else. "

Reich then describes (op. cit.) the visceral 'dog-eat-dog', endless economic warfare that ensues between people in the never ending quest to 'make it' and not be left behind. A tragic game wherein every one, every man, woman and child has a 'market value' and all abiding principles, social or moral, are reduced to economics and economic gain. Will I be the winner or loser?

Name the issue and the question heralding conflict emerges:

Immigration reform - Will I be the winner or loser?

Health reform - Will I be the winner or loser?

Property tax hikes- Will I be the winner or loser?

Carbon taxes to control global warming- Will I be the winner or loser?

Thus, each issue becomes the background for another war between whichever side believes it will "lose" something, and the side that believes it must win. Alas, the cost resides in devastated marriages, families and communities.

In this landscape, who wouldn't expect melancholia and despair to be a byproduct? Yet the Psych mavens want to blot it out and turn everyone into smiley -faced morons by the expedient of labeling their normal reaction with a pathology.

Of course, the psychiatric sector is assisted by many Americans themselves, who refuse to part ways with their stupid over-optimism, especially on economic issues. A case in point was a survey conducted by The Economic Policy Institute some four years ago. It asked generally where people thought they were in the economic spectrum: upper 1% (earning $350,000 year or more); upper 5% (> $80,000) or where.

A full 19% in this random survey claimed they were in the privileged class of the top 1%! A virtual statistical impossibility in any random study.In fact, internal survey cross-check questions on income category showed many of these working at a little above minimum wage, and even the highest at barely $44,000/yr.

Nowhere near the 1% threshold (over $350,000/yr) . Other commentators on this study (e.g. Froma Harrop, Ellen Goodman) have pointed to this ignorance as a basis for supporting such crap as the Bush tax cuts. Thus:

A) They didn't know where they themselves fit, and indeed inflated their wealth and positions and

B) they actually believed they'd be millionaires one fine day and be able to partake of the tax cuts. (Or 'death tax' benefits).In fact, they are deliriously out of touch with reality.

As author Michael Parenti has noted ('The Dirty Truth') 94% of all wealth comes by way of inheritance not paid work. So, they are fooling themselves.

In line with this, Barbara Ehrenreich.[1] notes American mass culture is saturated by a saccharine “cult of positivity,” with children brainwashed from an early age that they can do anything, and adults brainwashed to believe if they just work hard and long enough they’ll become super millionaires like Donald Trump. That no one has slain the insipid “Horatio Alger "myth up to now is really a testament to America’s individualist hubris and false optimism.

My point here is that these egregious cultural tropes reinforce and feed into the yen of the psychiatric elites to improve upon the population to the extent that everyone ought to be smiley-faced instead of surly-faced. Why do you think everywhere you go - if you don't happen to be naturally gregarious- you're told to "lose the scowl" (which may just be your natural expression, look at Pastor Mike!) or "not be such a grump"?

What should the American Psychiatric Association and its practitioners (especially the authors of the DSM-V) take away from this?

1) That some of us will be naturally grumpy or even melancholic, for whatever reason. Don't offer us a damned pill to make us happy! Try, instead, to help eradicate the causes embedded in a fundamentally toxic society which places more value on profits (or economic self-protection, for individuals) than people.

2) Treat the ones who can't otherwise function day to day and are real risks to themselves.

But don't invent conditions to make us (the realist segment) think we need your anti-depressant prescriptions! (which according to experts cited in the same New Yorker piece, work no better than placebos.)

[1] Barbara Ehrenreich: “Pathologies of Hope” in Harpers, Feb., 2007.

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