A fifth edition of the American manual, known as DSM-V, is being prepared, and a preliminary copy has generated a storm of criticism from mental-health professionals. A group of prominent psychologists is circulating a petition urging that independent authorities on mental disorders review the draft.
Apathy syndrome
They have two major concerns. One is the higher number of conditions classified as mental illnesses, including "Internet addiction disorder," "apathy syndrome," and "parental alienation syndrome." The other, more serious issue is that the new manual fosters the view that all mental disorders have a biological basis, and that medication is the preferred treatment.
Certainly, for some disorders, appropriate medication, by itself or in combination with psychotherapy, is the best course. For other conditions, however, the evidence shows counseling or psychotherapy alone to be equally or more effective, and without the danger of drug dependence, side effects, or adverse reactions.
In psychotherapy, people typically learn better ways to deal with anxiety, depression, and sources of stress and confusion. It usually involves changing habitual ways of responding to life's challenges and frustrations. It involves work, and it takes time, but people are usually pleased with the outcome.
Ideally, the treatment for a given disorder should be one that research has shown to be most effective. Unfortunately, the evidence is often unclear or even contradictory. What works for one person under one set of circumstances may be ineffective or counterproductive for another under different conditions.
Moreover, pharmaceutical companies are a major source of support for research. Not surprisingly, studies they sponsor are more likely to report superior results for drug treatment.
Sea of sickness
Unfortunately, some mental-health professionals, pharmaceutical firms, health-insurance companies, and government agencies are more interested in increasing profits than they are in improving treatment. And a whale-size bundle of money is floating in this sea of mental illness.
Pharmaceutical companies have become the leading offenders under the federal False Claim Act, accounting for 25 percent of settlements under the law over the past decade, often for promoting drugs for unapproved uses. One striking example is Johnson & Johnson, which has agreed to or was ordered to pay more than three-quarters of a billion dollars to three states, Texas, Louisiana, and South Carolina. The states claimed that the New Jersey-based pharmaceutical giant, whose worldwide sales of the drug Risperdal exceeded $24 billion as of 2010, had marketed it for treating children and for mental disorders for which it had not proven effective, rather than focusing on its demonstrated value in treating schizophrenia. Four other pharmaceutical firms have paid a total of $2.7 billion to date to resolve similar government accusations. Like J&J, they say they have done nothing wrong.
The charges against J&J stem from a whistle-blower lawsuit filed in 2004 by a Pennsylvania state investigator, Allen Jones, who claimed the company had developed a program that paid mental-health officials, doctors, and university professors to tout the drug for use in the public sector throughout the country. Jones, who was fired from his job in Pennsylvania after he spoke to the New York Times, says he was ordered to soft-pedal his findings because of J&J's powerful political connections.
Drug companies are certainly politically connected: Their executives and political action committees have made at least $134 million in campaign contributions since 2001.
For that and other reasons, mental-health professionals and consumers have reason to fear that more people will be considered mentally ill under the new DSM, and more and more will be treated with drugs.
John J. Rooney is a professor emeritus of psychology at La Salle University. He can be reached at rooney@lasalle.edu.
