There are two fundamental ways that Big Pharma can make money:
- Invent new drugs
- Invent new diseases
The DSM-V is being released on May 22nd, which is the bible of psychiatry where new mental health diseases are described. It’s a very political book and the American Psychiatric Association owns the content. However, writing it is best described as “It is as if J. K. Rowling had produced her Harry Potter sequels in a glass studio with fans looking on and banging the windows whenever she typed something they didn’t like.”
Most people agree that this version extends the role of psychiatry into our daily life even more extensively and will help more of us qualify as patients.
But the real issue is:
“The D.S.M. has enormous impact on the public health. It determines which conditions insurers will cover, which drugs regulators will approve, which children will receive special-education services, and which criminal defendants will be able to stand trial and, in some cases, how they will be sentenced. Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.”
“ACT clients are often encouraged to abandon interest in the literal truth of their own thoughts or evaluations and instead embrace a passionate and ongoing interest in how to carry all of these reactions forward into a process of living according to their values. If a client tells a story of past difficulties the issue will not be “is the analysis correct?” or even “does this story comport with the evidence?” but “what is this way of speaking in the service of?” or “does such talk move my life in a vital direction?” or “can I just have that thought and move forward in the world of behavior?”
-Hayes & Strosahl, 2004
Loving this model of psychotherapy.
Today’s NYTimes article lauding new bipartisan support for “fixing the mental health system” misses the boat, in my humble opinion.
According to the article, new funding will be directed toward “programs that would help detect mental illness in young children, train educators to spot those signs and refer the students to treatment.”
Great. But who determined that our problem lies in detection of mental illness? In my experience, this is not where the system is broken. It’s not that we lack the ability to determine when someone needs help - it’s that there is nothing for us to do once we’ve made that determination. There’s nowhere to send these kids. And if we do manage to get them affordable, short-term “treatment,” we struggle to get them the next round of short-term “treatment” they will need, or the next round, or the next.
Mental illness isn’t something that typically get’s “cured” - it is something that people learn to manage, with the help of various treatments including, in some cases, medication. But medication does not usually “cure” people with psychological challenges. It often takes an immense amount of work over many years on the part of patients, their families and treatment providers to make progress. “Treatment” is expensive and time consuming and often doesn’t work at all (which isn’t to say it can’t work, or doesn’t work for many people).
As a society, we need to face these facts if we’re going to get serious about improving the system. Training teachers to detect mental illness is one thing; figuring out how to actually help those suffering from mental illness is another.