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We’re All Mentally Ill, As Some Would Have It

Published: July 19, 2011

Lets talk about how were all mentally ill, as some would have it.

I was intrigued by a review in New Scientist Magazine of the book Over Diagnosed: Making People Sick in the Pursuit of Health. The authors of this book make note of a new epidemic sweeping our nation, an epidemic of diagnosis. People don’t just have diseases these days, they have “pre-diseases;” pre-hypertension, pre-diabetes, pre-obesity, etc. In the face of one of these “pre-diseases,” otherwise healthy people seek treatment for ailments that they don’t have, and probably never will. While it should be made clear that if someone has symptoms they should check with their doctor, this book argues against the constantly changing thresholds of disease – our habit of defining more and more people as patients and in need of medication or treatment. God knows if you watch late night television you will find some condition which you surely have, and must ask your doctor about medicine x.

The authors of Over Diagnosed note that, when in 1977 the definition of diabetes changed from a fasting blood sugar level of 140 mg/dl to 126mg/dl, 1.6 million Americans became diabetic at the stroke of a pen. Despite cases like the this, some folks think we are actually not diagnosing enough.

Recently, people have been suggesting that we might be missing most cases of autism. Now, autism is a very real thing, a condition which has garnered much attention over the last decade. I have to ask, however, if autism diagnoses are maybe something else – there are such things as “fad” diagnoses.

Diagnosed cases of Autism have been steadily rising in the US, and now supposedly 1 out of every 110 children are autistic. Research done at UC Davis by Irva Hertz-Picciotto shows some evidence that the DNA damage and mutation related to autism might be from the exposure to environmental chemicals and toxins. Now, there may be some truth in that, but maybe there is also some truth in the fact that we as a society just want to diagnose everyone as being autistic – or suffering from ADD, ADHD, OCD, depression, or whatever illness might be topping the headlines of the day. A study cited by the Centers For Disease Control took a look at a group of 55,000 kids between the ages of 7 and 12 in a community just outside Seoul, South Korea. The study was done by Young-Shin Kim, a Yale university psychiatrist, says that 2/3 of the children with autism were under diagnosed and untreated. He claims hat about 1 in 38 school aged students, rather than the currently accepted 1 in 110 students should be diagnosed with autism. The study reportedly used a widely accepted questionnaire to reach these conclusions. I have my doubts about the effectiveness of this “questionnaire.” You think maybe its possible that some kids are just socially awkward, rather than suffering from Asperger’s syndrome? I do love the quote from Kim’s co-author on the study: “if we look hard enough, cases of autism will be found.” I’ve got no argument there.

On a similar note, I have a horrifying headline from medical journal, Family Practice: “ADHD drug studied for the first time in 5 year olds.” Apparently children on Atomoxetine showed that after 8 weeks, their mean total scores on the ADHD-4 rating scale were reduced significantly more in the treatment group than the placebo group. I don’t know about you folks, but I wouldn’t put my full confidence in the “ADHD-4 rating scale.” A friend of mine recently told me a story where her son was recommended for ADHD medication because the teacher just seemed to find that all of the boys in her class needed it. In fact, of the 17 boys in the class, 11 were on ADHD medication, thanks to her astute bird-dogging them to the appropriate psychiatrists and psychologists. My friend denied the medication for her son, suspecting the deficiencies might lie more with the teacher than with the students.

The punch line here, as quoted from Over Diagnosed is, “psychiatric diagnoses and the medications that follow, are prone to faddishness. Perhaps a bit of skepticism here would do us all a lot of good.” I could not agree more. If a psychologist diagnoses your kid over the phone and starts prescribing medicine, I might suggest you look for help elsewhere.

This epidemic of over-diagnosis, especially as it exists among psychological disorders, is a topic we will be keeping an eye on. Expect more on this later.