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February 13, 2012
Shyness and Internet Browsing May Soon Be Classified As Mental Illness


Recent research funded by the pharmaceutical industry and the accompanying flood of new drugs for a range of ills threaten to "medicalize" every human condition and behavior. Now, childhood shyness and internet browsing could be reclassified as mental disorders under controversial new guidelines, warn experts.


The advent of genetic screening could eventually mean that apparently healthy people will be labeled "sick" decades before an actual diagnosis.

There is also a fear that depression after bereavement and behaviour now seen as eccentric or unconventional will also become ‘medicalized’. Internet browsing might also become forms of illness.

The threat comes in the form of proposed changes to a U.S. manual of mental disorders, viewed as a bible by some in the field.

Although the changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders would not directly affect every country, experts say it would eventually influence thinking.

Millions of people could be given a psychiatric diagnosis which could ruin their lives, warn psychiatrists and psychologists.

The DSM5 changes are also opposed by many experts in the U.S., some of whom claim they reflect efforts by drug companies to sell more products.



Some call it "disease mongering." In one article, Ray Moynihan, a journalist with Australian Financial Review, and co-authors describe what they see as "informal alliances" among drug companies and some doctors and consumer groups. They argue that drug companies provide medical experts and patient groups offer "victims" to attest to a given condition's severity and draw attention to a new "breakthrough" treatment.

The authors also point to several examples--such as hair loss and excessive shyness--of what can be regarded as normal human conditions that have been made medical conditions because there is a pill available for them.

In another article, Barbara Mintzes of the University of British Columbia in Vancouver, Canada, argues that prescription-drug advertising to consumers--currently allowed only in the US and New Zealand--is helping to medicalize "normal human experience."

"Relatively healthy people are targeted," she writes, "because of the need for adequate returns on costly advertising campaigns."

Many of these advertising dollars, according to Mintzes, are spent on relatively new, expensive drugs intended for long-term use in large groups of people, such as medications for cholesterol, impotence and anxiety.

Intermittent Explosive Disorder. Oppositional Defiant Disorder. Mathematics Disorder. If you've never talked to your doctor about these conditions, it should come as little surprise; they are arguably some of the stranger diagnoses floating around in the medical literature. And although ridiculous to any sane person, many medical professionals say that these disorders are legitimate conditions that often warrant treatment.

"Illness is always a social construct," notes Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and author of the book "Worried Sick: A Prescription for Health in an Overtreated America."

"People have to agree -- both people, in general, and those in the medical community -- that a life experience should be labeled an illness," Hadler says. "For example, the Victorians medicalized orgasm, and we medicalize the lack of it."

Dr. Igor Galynker, director of The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York, says that some psychiatric conditions, in particular, tend to be a target of widespread controversy.

"In psychiatry, part of a disorder is clinically defined and part is societally defined," he says, adding that conditions, such as Attention Deficit Disorder, or ADD, are particularly contentious.

Simon Wessely, of the Institute of Psychiatry, King’s College, London, said: ‘We need to be very careful before further broadening the boundaries of illness and disorder.

‘Back in 1840 the census of the United States included just one category for mental disorder.

‘By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels?

‘Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.’

Peter Kinderman, head of the Institute of Psychology, University of Liverpool, said: ‘It will exacerbate problems that result from trying to fit a medical, diagnostic, system to problems that just don’t fit nicely into those boxes.

‘It will pathologise a range of problems which should never be thought of as mental illnesses. Many who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as “mentally ill”.

‘This isn’t valid, isn’t true, isn’t humane.’

Paraphilic Coercive Disorder -- becoming aroused by sexual coercion -- is one condition proposed for inclusion in DSM5. Professor Kinderman said there was a danger that rapists diagnosed with it would use it as an excuse.

He added that there were ‘huge concerns’ about the changes, which are opposed by the British Psychological Society.

Other experts say the guidelines will straitjacket clinicians into ‘ticking boxes’ that lead to a proscribed diagnosis. Dr Felicity Callard, of King’s College, warned: ‘People’s lives can be altered profoundly -- and sometimes ruinously -- by being given a psychiatric diagnosis.’

Among the U.S. psychiatrists against the changes is Allen Frances, of Duke University, North Carolina.

He warned: ‘DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.’

David Elkins, of Pepperdine University, Los Angeles, said individuals could be ‘labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs’.

Defenders of the American Psychiatric Association guidelines say they will make diagnosis more accurate and scientific.


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