If claims in the non-professional media can be believed, there is a “raging epidemic of mental illness” in the US, if not world-wide—and, in one version of this narrative, psychiatric treatment itself is identified as the culprit.
Ronald W. Pies, MD
Much of the controversy on the relationship between grief and depression following recent bereavement has focused on whether the so-called “bereavement exclusion” in DSM-IV should be eliminated, as some have proposed, in the DSM-5.
The New York Times ran a front-page story regarding numerous controversies surrounding the DSM-5, most notably, the issue of eliminating the so-called bereavement exclusion in diagnosing a major depressive episode. Here, Dr Pies responds to Dr John Grohol, Psychologist and Editor of the Psychcentral Web site.
Some months ago, I received a stern admonition from my family doctor. My fasting blood sugar of 99 mg/dL was “right on the border”, he said, and I had better work on bringing it down. “But,” I protested, “when I was in medical school (in the 70s), the normal FBS range went up to 110 mg/dL!” "Well,” he replied a bit huffily, “they changed the criteria!”
When I was a first-year resident, a revered supervisor of mine made the statement—half-facetiously—that, “In psychiatry, you can do biology in the morning and theology in the afternoon!”
I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.
Dear Mrs. —— You have asked me about the cause of your mood disorder, and whether it is due to a "chemical imbalance."
The legend of the “chemical imbalance” should be consigned to the dust-bin of ill-informed and malicious caricatures.
Although the foundational and antifoundational traditions differ in their language and claims, both call into question the legitimacy of psychiatric diagnosis and treatment.
If telling patients they have “pre-clinical Alzheimer’s” or “MCI due to Alzheimer’s Disease”—absent effective treatment—produces more emotional suffering than it relieves, a difficult ethical question arises; namely, can such a disclosure be justified under the foundational principle of non-malfeasance?