It’s undeniable that antidepressant medications have improved many people’s lives, allowing them to enjoy social functioning and a range of emotional experience that would otherwise be out of reach. I think it’s also indisputable that some people are over-medicated. There’s a multi-billion-dollar pharmaceutical industry that depends upon — we could say exploits — the human tendency to look for a magic pill for everything and doctors who are willing to write a prescription rather than take the time to step back and look at the root cause of physical and mental distress. As the publication date approaches for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the field has been engaging in serious debate about proposed changes in how mental health is categorized and treated. The DSM was created in the interest of establishing industry standards for diagnosing and treating patients, and insurance companies rely heavily on DSM terminology when deciding coverage of claims for treatment. The number of ailments classified as disorders requiring pharmaceutical treatment continues to increase. Although I’m willing to believe that the people making these decisions have good intentions, I’m often distrustful of what seems like a misguided if not sinister impulse to pathologize the human condition — that is, to treat ordinary human emotions such as grief, melancholy, fear, and defiance as if they were illnesses to be eradicated at all costs.
Christopher Lane (above) is one of the major critics of modern psychiatric theory and practice. I recently got around to reading an extensive interview with him that appeared last year in The Sun, one of my favorite literary magazines. Doing research about how the editors of the DSM arrive at their conclusions, Arnie Cooper writes in his introduction to the interview, “Lane was troubled by what he found: evidence of drug-company influence, especially in the promotion of ‘panic disorder’ by Pharmacia & Upjohn, maker of the anti-anxiety drug Xanax. He also uncovered extensive evidence of questionable research (sometimes involving just one patient), sloppy thinking, dismissal of nonmedical approaches to psychiatric problems, and a degree of inventiveness with terms and symptoms that struck him as playing fast and loose with the facts.
“All of this served as the basis for Lane’s 2007 book, Shyness: How Normal Behavior Became a Sickness, in which he observes that behaviors once understood as reactions to one’s environment and upbringing are increasingly seen as innate conditions of brain chemistry, resulting from problematic levels of neurotransmitters, especially serotonin. He suggests that because of the open-ended language in the DSM and the wide range of behaviors it pathologizes, anyone who is shy, as he was as a teenager, now risks being diagnosed as mentally ill. The new disorders were ‘obviously music to the ears of drug companies,’ he says, ‘insofar as they massively increased the market for their products, which the media greeted with incredible enthusiasm.’ ”
The interview is well worth seeking out and reading, considering, critiquing, and discussing. A lengthy excerpt is available online here. As a sex therapist, I took particular interest in this passage (not available online) about the dubious prospects of applying medical criteria to standardize human sexual behavior:
Cooper: Let’s talk about some disorders that have been proposed for the DSM-5. After golfer Tiger Woods’s adultery scandal, we began to hear about “hypersexual disorder.” It’s being considered for inclusion.
Lane: A number of articles have been written that tried to attribute promiscuity or adultery in men to a brain disorder. I find this questionable for a number of reasons.
First, it’s worrying to me that a group of psychiatrists is trying to determine how much sexual activity and how many encounters we can want or fantasize about before we’re considered “mentally ill.” Given the embarrassing history of the DSM revisions and all the shoddy science informing them, why should we trust the APA to dictate yet another norm to us, much less accept its judgment about something so personal and intimate? People have markedly different appetites for sexual experiences. I’m uncomfortable with the idea that the APA would determine implicit guidelines, even quotas, for sexual activity, with a view to pathologizing behavior that is, in its estimation, “excessive.”
Even if you were in favor of creating such a disorder should the parameters for young adults be the same as for retirees with, most likely, much lower sex drives? Would the standard for “excessive” sexual activity be identical for a newly formed relationship and one that’s lasted decades? Why should we see a man’s cheating on his wife with multiple women as a result of brain chemistry rather than, say, marital unhappiness or personal recklessness? Personally I think expecting lifelong fidelity to one partner may be asking too much of certain people who are ill-suited to it, or who simply don’t believe monogamy is the best way to achieve emotional and sexual happiness. That’s surely up to them, isn’t it? Yet there’s an expectation, even a kind of demand, in our culture that one person will meet all of our needs – emotional and sexual. That can happen, and it’s great when it satisfies both parties, but those choices don’t work for everyone, and an organization seeking to pathologize “excessive” sexual activity needs to recognize that. We need broader public discussion of this complex issue rather than the kind of psychiatric judgment and ritualized shaming that goes on right now for those who prefer to remain non-monogamous. Good for them if that’s what they want.
What do you think?