Across the nation, the vast majority of mental health care professionals refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “The Bible” for diagnosing and treating psychological disorders. The manual is vague, ignoring situational circumstances, cultural differences, and overgeneralizing disorders. This proposal seeks to shed light on the problems within the current categorical approach and offer alternative methods that would benefit citizens financially, physically, and psychologically. America’s Mental Health Clinicians’ impetuous methods of treating mood disorders are detrimental to establishing efficient treatment and delay potential recovery. Misdiagnosed disorders waste valuable funds on ineffective and harmful prescription drugs; to provide optimal treatment and reduce rates of therapies creating adverse results, clinicians should shift away from conventional diagnostic methods and practice caution by applying thorough methods of analysis. These methods should assess all human dimensions and extraneous factors before treatment is implemented. Behavioral inventories and brain scans are beneficial to identify the underlying issue, yet, no two individuals or disorders are identical, thus further investigation is vital to treatment. As an undergraduate college graduate pursuing a master’s degree in clinical mental health counseling, and a doctorate in clinical psychology, I am often questioned on why I am pursuing degrees in two different areas. It is because I understand the importance of considering all situational, environmental, and developmental factors that impact a person.
The DSM-5 contributes to the frequency of misdiagnosed disorders. It lacks thresholds that specify the severity of symptoms, creates false positives and places unnecessary stigmatizing labels on normal functioning people. Individuals experiencing normal stages of grief in response to a negative circumstance will most likely meet the criteria for a chronic depression diagnosis. The DSM-5 removed the provision preventing a person from being diagnosed with depression within 2 months of losing a close family member or friend, implying every person who experiences sadness upon the death of a loved one is clinically depressed.
Noting the lack of caution used to disperse medication for mental illness, Rief, Frances, and Wittchen (2013) report:
“In the USA, 25% of the population already qualify for a psychiatric diagnosis in any given year; 50% will face a psychiatric diagnosis in their lifetime. 20% of the population take psychotropic medication and 80% of the prescriptions are written by nonpsychiatrists with little training and an average of only 7 minutes to spend per patient.”
The American Psychiatric Association created the first edition of the DSM to establish qualifications for prescribing pharmaceuticals to treat mental health. Contributing members of the committee have strong ties with the psychiatry industry and signed a disclosure agreement, agreeing to never discuss how they determined the criteria listed in the manual (Khoury, Langer and Pagnini, 2020). These circumstances create speculation about the ethical standards and scientific basis used to establish its principles.
The increase in the distribution of controlled substances is detrimental to the safety of American citizens. The possibilities of worsening symptoms, contracting health issues, or developing a substance addiction are too perilous to omit thorough evaluation. According to Brownlee, as of 2012, 15 percent of Americans reported taking at least five prescription drugs every day which is nearly a 7 percent increase from 2000. In 2018, inimical side effects from medications contributed to the hospitalization of over 250 thousand Americans in late adulthood; if this trend continues experts estimate the issue will contribute to the hospitalization of 4.6 million Americans over the age of 65, and approximately 150 fatalities (2019).
In addition to the hazardous impacts on human health, prescription drugs are extremely expensive, constituting one of the most rapidly increasing expenses in US health care, costing Americans over 29 billion dollars in 2018 (Grohol, 2019). If citizens continue investing a considerable amount of resources towards pharmaceuticals, consumers should be confident that pharmacotherapy is the most profitable alternative. Clinicians can practice prudence by incorporating Prescription Drug Monitoring Programs (PDMP). PDMPs are resources that give prescribers access to the patients’ pharmaceutical history and serves to identify any past instances of substance abuse, avoid negative interactions with other medications and prevent prescribing medications that place the prospective patient at risk for health issues or addiction (Yokell, 2012). Despite the advantages of these programs, Dr. Michael A. Yokell notes that although PDMPs are available in 47 of the 50 American states, majority of clinicians omit using to avoid the hassle of ensuring they are not liable for potential privacy issues. While paperwork and legal matters are certainly tedious, states who take advantage of PDMPs when prescribing controlled substances show decreased rates of substance abuse (2012).
When it comes to treating mental illness, time is of the essence. For some, mental illness compromises productivity in the workplace and tarnishes relationships with peers and family members. Absence or unprofitable performance in one’s occupation can create longstanding consequences. Likewise, the damage mental distress can have on relationships are often irreversible. Early intervention drastically improves the symptoms associated with mood disorders in the long term. Effectiveness and risk of treatment vary case by case, hence no firm rulebook for proper treatment can be applied to every individual with mental illness. It is important to note, antidepressants, mood stabilizers and other medications used for mental illnesses can take up to 6 weeks to reach its full effect. If the medication is not suitable, it takes up to six more weeks to completely abandon the body. This time frame cannot be adjusted if a doctor plans to introduce a new medication because the two medications could interact. This time-consuming process and can worsen conditions or introduce additional negative symptoms. After one medication fails to improve the condition, feelings of hopelessness often arise, severely impeding the recovery process. Cognitive-behavioral therapy exercises directed to enhance cognitive function, in-patient programs, and social support, along with a plethora of other therapeutic practices prove to alleviate symptoms. Coping skills put power in the hands of the patient, enabling them to deal with their adversities independently and strengthening their internal locus of control. According to Caroline Miller, the editorial director of the Child Mind Institute, introducing proper treatment within 2 to 3 years of an individual’s first episode lowers the chance of the instance reoccurring by over 50 percent (2020). Some wait until their symptoms are unbearable to seek professional help. Instead of using the fragile human mind to practice trial and error, an investigation should occur before treatment.
Self-reported data alone is unreliable, due to rater bias, the patient’s inability to assess oneself accurately, and accounts of exaggerated or under-reported symptoms. Yet, when used in collaboration with biomedical measures, behavioral observations and self-reported information can be useful. Positron emission tomography (PET), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and computerized axial tomography (CAT), are all neuroimaging techniques that supply clinicians with information about the activity in sections of the brain associated with mood disorders (Savitz, Rauch and Drevets, 2020). Recently Neuropsychology expert Dr. Dominik Moser and his colleagues investigated findings from 226 neuro-imaging studies, including over 9 thousand human subjects. These studies consistently saw significant changes in regions and circuits in the brain responsible for regulating behavior and emotions in the brains of individuals with mood, behavioral and phobic disorders (2019). Combining brain imaging techniques with self-reported data regarding symptoms, family and personal history, allows clinicians to reduce the subjectivity of diagnosis. The accumulated information collected from these methods of analysis help professionals to determine if prescribing medication that stimulates or inhibits brain activity in certain brain regions is warranted, or if behavioral therapy alone is sufficient. According to researcher Deah Abbott and colleagues, when combined with other methods of assessment, measuring eye movement, blinking rate, and focal behavior in response to emotional stimuli proves to measure indicators of depression, anxiety, and other mental disorders. Furthermore, electrocardiographs (ECG) measure heart rate and a sphygmomanometer can blood pressure, abnormal rates of heart rate or blood pressure have strong correlations with anxiety or intense stress. Additionally, using methods of biofeedback can provide information to guide clinicians when selecting to use pharmaceuticals to treat the symptoms. For instance, norepinephrine and serotonin reuptake inhibitors commonly used to treat symptoms of depression and anxiety significantly raise the consumer’s heart rate. Therefore, someone who has an elevated heart rate or blood pressure is at higher risk for health complications when taking some commonly prescribed medication. Often patients are not aware of their health risks; it is the clinicians’ responsibility to consider risk factors and identify any potential health risks that could be problematic in treatment.
Certainly, neuroimaging is a costly procedure, but by properly identifying the issue at hand and lowering the chance of misdiagnosing an illness, America saves expenses by increasing participation in the workforce, improving health and reducing funds allocated towards institutionalizing individuals with chronic mental illness. A study by The Lancet Psychiatry shows that every dollar spent on treating common mental illnesses, four dollars are returned through improved health and increased involvement in the workforce (Chisholm, et al., 2016). Rehabilitation services and services required to reverse the unfavorable health and psychological effects of misusing medication are also ultra-expensive. Lowering the dispersion of prescription drugs decreases the chances of potential drug abuse and addiction.
Accurately diagnosing mood and behavior disorders is by no means a simple task. For this reason, it is imperative for professionals diagnosing and treating mental illness to take caution and meticulously assess their patients. Incorporating neurobiological findings with behavior analysis and self-reported data will strengthen credibility within the mental health field, consequently reducing the financial and psychological problems associated with misevaluated disorders and premature treatments in America.
Abbott, D., Shirali, Y., Haws, J. and Lack, C. (2017). Biobehavioral Assessment of the Anxiety Disorders: Current progress and future directions. World Journal of Psychiatry, 7(3), pp.133-147.
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Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415–424. doi: 10.1016/s2215-0366(16)30024-4
Grohol, J. M. (2019, December 15). Top 25 Psychiatric Medications for 2018. Retrieved from https://psychcentral.com/blog/top-25-psychiatric-medications-for-2018/
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Khoury, B., Langer, E. J., & Pagnini, F. (2014). The DSM: Mindful science or mindless power? A critical review. Frontiers in psychology, 5, 602. doi:10.3389/fpsyg.2014.00602
Miller, C., & Child Mind Institute. (2020). First Psychotic Episode: Why Early Treatment is Critical. Retrieved from https://childmind.org/article/first-episode-psychosis-early-treatment-critical/
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Yokell, M. A. (2012). Prescription Drug Monitoring Programs. Jama, 307(9), 912. doi: 10.1001/jama.307.9.912-b
Author: Joanna Crifasi
My name is Joanna Crifasi and I am a senior at Louisiana Tech University, pursuing a Bachelor’s degree in psychology, a minor in English and a minor in Human Development and Family Science. After graduation, I plan to continue my education at the graduate level focusing on clinical psychology and research. As an advocate for victims of sexual assault, I have experience working with chronic mental illnesses and recognize the impact a disorder can have on one’s life. I am passionate about making a difference in the lives of those living with mental illness and plan to do so by emphasizing the importance of experience, caution, and thorough assessment in the mental health field. My work on PTSD has previously been published on the Sexual Trauma Awareness and Response Center’s website.