By Allen Frances, MD

Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake — that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM-5. Her website is the best available resource for finding just about everything you need to know about DSM-5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM-5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis’ (http://wp.me/pKrrB-29B )

Ms Chapman writes:

…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ — SSD).

Continue reading “Mislabeling Medical Illness”

By JEFFREY SWANSON & JOHN PETRILA

May is Mental Health Month, a good time to remember the ten million adult Americans who suffer from a serious mental illness such as depression, bipolar disorder, or schizophrenia.  Without proper treatment, psychiatric disorders put an enormous strain on affected individuals, family members and on society at large.

In the mid-1950s, state mental hospitals housed about a half a million people with mental illness. Many held patients against their will for decades in understaffed and deteriorating wards.

Today, most of those hospitals have been shuttered; the ones remaining hold fewer than 50,000 patients.

Taking people out of psychiatric institutions would have marked an extraordinary leap in social progress, if only it had been accompanied by a proportionate and continuing public investment in community-based mental health care. Instead, we now have a public system of mental health care that is fragmented and grossly underfunded. Continue reading “Using Laws to Help Solve the Public Health Crisis of Mental Illness”

By MAGGIE MAHAR

At last weeks Health 2.0 Conference Maggie Mahar, author of HealthBeatBlog got more than a little feisty about Al Waxman’s suggestion that we make people with bad health behaviors pay more. She said that 95% of smokers had some form of mental illness, and therefore we were punishing the mentally ill. Really? Read on for Maggie’s explanation (lifted at her request from a comment elsewhere).–Matthew Holt

According to the New England Journal of Medicine,

“The link between smoking and anxiety also helps explain why smoking is so strongly correlated with mental illness. “smoking rates have been reported to be over 80 percent among persons suffering from schizophrenia, 50 to 60 percent among persons suffering from depression, 55 to 80 percent among alcoholics, and 50 to 66 percent among those with [other] substance-abuse problems.”

Poverty is highly correlated with smoking because poverty is stressful. U.S. soldiers also smoke in greater numbers than the population as a whole–even if they didn’t smoke before joining the army The NEJM reports:

“Serving in the military is a risk factor for smoking even for those who did not start smoking prior to the age of 18. Smoking is the number-one health problem for vets,” says Dr. Steven Schroeder, former President of the Robert Wood Johnson Foundation, where he focused on smoking cessation.  “And reports are showing that many US soldiers serving in Iraq are turning to smoking to relieve their stress.”

At the  Health 2.0 conference, Al Waxman asked the audience how many thought that smokers should be “penalized” for smoking, presumably by paying more for insurance. I pointed out that the vast majority of adult smokers are poor; many suffer from some form of mental illness.Do we really want to punish people who are living in poverty and are mentally ill?

Continue reading “Smoking and Mental Illness”