1 Boring Old Man

Psychiatric Group Push to Redefine Mental Illness Sparks Revolt
Bloomberg
By Elizabeth Lopatto
January 24, 2012

An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health-care professionals in the U.S. and the U.K. A panel appointed by the American Psychiatric Association is proposing changes to the industry’s guide for mental illnesses, which determines how patients are diagnosed and treated, and whether insurers pay for care. The new edition of the Diagnostic and Statistical Manual of Mental Disorders is scheduled to be published next year. The draft is sparking a backlash among practitioners concerned the expanding mandate will increase the number of patients treated with drugs. The guide would loosen diagnostic criteria on some existing ailments and brand as mental disorders some common behaviors, including having temper tantrums three times a week or a lack of sexual arousal. The changes may spur unneeded and dangerous treatment of the healthy, said Allen Frances, a psychiatrist who helped write the current guidelines.

Everyday disappointments, sufferings and eccentricities are being redefined as psychiatric disorders, and that could lead to medication treatment,” said Frances, a professor emeritus at Duke University who lives in San Diego, California. “This is expanding the boundaries of psychiatry.” In many cases, family doctors will use the new definitions to treat patients, Frances said by telephone. Pressure from drugmakers to use medications can combine with media representations to create “an epidemic,” he said. “Once primary care doctors and patients have the idea that they saw a certain condition on TV, it becomes real.”

Darrel Regier, the psychiatric group’s research director, characterized critics as being unconvinced medical treatment is better than counseling. The idea of “medicalizing normality comes from a perspective that there are no psychiatric disorders, and you need to avoid stigmatizing people by giving them one,” he said in a telephone interview…

But there’s another logical fallacy – The Straw Man Fallacy that pervades Dr. Regier’s comments [both here and elsewhere]. It’s a common rhetorical trick. First create a caricature of the person you are debating [someone who is "unconvinced medical treatment is better than counseling"]. And then point out the absurdity of of the argument made by this caricature. There’s an even better example in the next sentence "The idea of “medicalizing normality comes from a perspective that there are no psychiatric disorders, and you need to avoid stigmatizing people by giving them one,” he said in a telephone interview." The critic who talks about "medicalizing normality" is Dr. Allen Frances. Dr. Frances is the Emeritus Chairman of Psychiatry at Duke. He was in charge of the DSM-IV Revisions that were filled with "psychiatric disorders" – more than in the DSM-III that preceded it. He has been an active member of the mainstream of the organized psychiatric community throughout his career. Still is. It is beyond ludicrous to portray him as being a person with the "perspective that there are no psychiatric disorders." What is Dr. Regier talking about? And none of the Psychologist organizations who have supported the petition in the upper left portion of this blog are arguing that there are "no psychiatric disorders." Dr. Regier’s comment is about a pseudocommunity that may exist in his own mind [or in his argument], but has no representation in the real world of critics he’s responding to. There are people in the world who think those thoughts, I suppose. I remember some from the 1960s and 1970s, but I haven’t seen any such people for a very long time.

The trap at this point would be to either make a Straw Man out of Dr. Regier, or to argue with his argument as he states it. The only reasonable course would be to speculate about why he would respond to a Bloomberg reporter with two obvious logical fallacies – known to be fallacies since the Greek philosophers first walked around in robes pondering such things. Why would he answer a question by creating a False Dichotomy or a Straw Man, instead of addressing the actual questions on the table? Criticism is painful – that’s one possibility. Maybe he’s an overly sensitive person who can’t hear criticism as constructive. Or maybe he’s an arrogant person who doesn’t recognize that the opinions of others are as valuable as his own. We could make up things like that for hours, but we know it would be a waste of time, an exercise in psychological speculation of the kind that has itself been criticized in recent years. The reason that we know it would be a waste of time is that Dr. Kupfer and Dr. Regier always respond this way – evasion, placation, logical fallacies. They never engage the criticisms directly. I don’t even feel called to document being so categorical – like I’m creating a Straw Man. If you’ve kept up with this topic, you already know what I’m saying is true – always, never.