HALF A MILLION DOWNLOADS REACHED - Helping Safeguard children from psychiatric drug harm due to possible severe toxic side effects. We need alternatives like psychological interventions, physical activity, or mindfulness training as a first course of action. Let's 'Enable not Label' kids to give them better futures - - - - - - - - -"There can be no keener examination of a society's soul than the way it chooses to treat its children." - - - - -
- Nelson Mandela
liveliest debate in psychiatry
today is where to draw the line between mental disorder and mental health.
much rides on the decision- who gets treated and how; who pays for it; whether
a criminal is deemed mad or bad; whether someone gets damages in tort cases;
who qualifies for disability payments and eligibility for extra school
services; whether someone can adopt a child- and there's a whole lot more.
here is the big problem. No bright line marks the boundary between illness and
health. At the extremes it is easy to diagnose mental illness accurately and to
distinguish it from normality. At the fuzzy border, it is impossible.
is true now and will remain true into the distant future- until we finally have
biological tests in psychiatry. In a few years, there will be lab tests for Alzheimer's,
but the pipeline for the other disorders is dry.
problem with precisely defining normal has been recognized almost since the
beginning of psychiatry as a separate profession in the nineteenth century.
Peter Kinderman, the British psychologist who has become one of leaders in
opposition to DSM-5, has unearthed two wonderful quotes from 150 years ago that
state the issue much more eloquently than anything that has been written since.
first comes from an editorial in the London Times of Saturday July 22nd, 1854.
can be more slightly defined than the line of demarcation between sanity and
insanity. Physicians and lawyers have vexed themselves with attempts at
definitions in a case where definition is impossible. There has never yet been
given to the world anything in the shape of a formula upon this subject which
may not be torn to shreds in five minutes by any ordinary logician. Make the
definition too narrow, it becomes meaningless; make it too wide, the whole
human race are involved in the drag-net. In strictness, we are all mad as often
as we give way to passion, to prejudice,
to vice to vanity; but if all the passionate, prejudiced, vicious, and vain
people in this world are to be locked up as lunatics, who is to keep the keys
to the asylum?”
second equally telling quote is from the 1888 novella "Billy Budd" by
in the rainbow can draw the line where the violet tint ends and the orange tint
begins? Distinctly we see the difference of the colors, but where exactly does
the one first blendingly enter into the other? So with sanity and insanity. In
pronounced cases there is no question about them. But in some supposed cases,
in various degrees supposedly less pronounced, to draw the exact line of
demarcation few will undertake tho' for a fee some professional experts will.
There is nothing namable but that some men will undertake to do it for
writing has a subtlety and grace of expression rarely found in our more
utilitarian modern modes of speech. But the puzzle of defining the boundary
between normal and illness is just as problematic today as it was then.
on where to draw the line must necessarily rest not on any abstract definition
that clearly separates the two, but rather on practical consequences. Will
including a new disorder in DSM, or changing the threshold for an existing one,
result in more harm or more good?
is a brass standard, but will have to do in the absence of a gold one. Clearly,
we currently have an imbalance. Loose definitions and even looser application
of them under the pressure of Pharma marketing,
have expanded psychiatry beyond its competence and have made normal an
is time for a correction back to a reasonable Goldilocks balance. To get there,
we need a tighter diagnostic system and an end to Pharma marketing.
close with one final great quote, this time from Isaac Newton: "I can
calculate the motions of the heavens, but not the madness of men." We
can't do a very precise job of this either, but we can certainly do a lot
better than we are now.