Psychiatric diagnoses are based on a constellation of symptoms that healthy people can also experience. When researchers interviewed 463 people, they found that all of them experienced thoughts, beliefs, moods, and fantasies that, if isolated in psychiatric interview, would support a diagnosis of mental illness.
In 2005, a study reported that about half of Americans will meet the criteria for a DSM-IV disorder sometime in their life.
But today, with DSM-5 that contains many more diagnoses, it is far worse. Because of the very wide diagnostic criteria, almost everyone will develop at least one diagnosable mental disorder during their lifetime.
Some diagnoses have become fashionable. Just think of Attention Deficit Hyperactivity Disorder (ADHD). When I lecture and try out the criteria for the adult ADHD diagnosis on the listeners, it never fails that between one quarter and one half test positive.
Since the criteria for psychiatric diagnoses are so vague and unspecific, it is not surprising that many patients, and also healthy people, will test positive for more than one diagnosis. In psychiatry, this is called co-morbidity, but it is absolute nonsense. If you invented diagnostic criteria for spotting elephants, wildebeests and rhinoceroses that overlapped for these species, you would not say you have spotted an elephant, which is also a wildebeest and a rhinoceros.
Psychologist Paula Caplan was involved with the DSM-IV and fought hard to get the silliest ideas out. In her book, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal, she mentions that the American Psychiatric Association decided to introduce Masochistic Personality Disorder to be used for women who were beaten up by their husbands. Caplan and her colleagues mockingly inventing Macho Personality Disorder (that evolved into Delusional Dominating Personality Disorder) for the violent males, which they suggested would apply if a man fulfilled 6 of 14 criteria, of which the first was “Inability to establish and maintain meaningful interpersonal relationships.”
If all attempts fail in finding a diagnosis for a person, there is an excellent option for these “above normal” people: Adult Symptom Deficiency Disorder (ASDD). It is not yet included in DSM but why not? There are so many silly diagnoses in DSM already.
The oldest mention of Symptom Deficiency Disorder I could find is an undated cartoon by Randy Glasbergen in which a doctor tells a patient, “We can’t find anything wrong with you, so we’re going to treat you for Symptom Deficit Disorder.”
In the spirit of the thinking behind the DSM, I have worked out a test for this new disorder.
Ten-item test for Adult Symptom Deficiency Disorder
|1. I generally trust other people
|2. I am not afraid of giving a speech
|3. I am an optimist by nature
|4. I find it rewarding to meet new people
|5. I find it easy get out of bed in the morning
|6. I don’t have flat emotions, appearing aloof and isolated
|7. I don’t hear voices in my head
|8. I don’t have odd beliefs or magical thinking
|9. People don’t find my behaviour odd or eccentric
|10. I don’t have racing thoughts
Add the scores. The possible range of scores is 10 to 30.
Interpretation of the scores:
10-15 points: You should see a psychiatrist immediately because you likely suffer from one or more serious psychiatric disorders.
16-21 points: You should see a psychiatrist because you might suffer from a treatable psychiatric disorder.
22-25 points: You should see a psychiatrist for regular mental health checks so that if you develop a psychiatric disorder, it can be treated early.
26-30 points: You are in the normal range, which means there is nothing wrong with you. You therefore suffer from ASDD. There is a wide range of treatment options for you, spanning from vitamins you don’t need to prophylactic treatments of all kinds. Health checks don’t work and are likely harmful, but if you are worried that something might be wrong with you, get a health check. In the UK, local authorities have a legal responsibility to offer an NHS Health Check to 100% of their eligible population once every five years. Then, your doctor might tell you to get one or more prophylactic treatments that are ineffective but this is immaterial in modern healthcare where politics is more important than evidence. We call it eminence-based medicine.
If you disagree with four or five of the items 6 to 10, you might suffer from a delusional disorder, which is a type of psychotic disorder. You should consult a psychiatrist immediately. The psychiatrist might ensure that you will be treated, perhaps indefinitely, with neuroleptics, some of the most toxic drugs ever invented, apart from cancer chemotherapy, but don’t worry. It is serious to suffer from delusions.
If you don’t know whether to agree or disagree to 3 or more of the items, you might be demented. There is a wide array of drugs that have no meaningful effects and which are harmful. One of the newest ones, aducanumab (Aduhelm), is hugely expensive, has no documented clinical benefits, and causes swelling and bleeding in the brain. Don’t be deterred by such trifles.
If you feel uncertain about your mental health and wonder if there is a drug that might help you, it could be a good idea to try to get a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or its sibling for those who are too quiet, ADD (Attention Deficit Disorder). This will likely lead to a prescription for a stimulant (a narcotic on prescription, amphetamine or amphetamine-like drugs) that can cheer you up a little. You might also consider getting a diagnosis of depression. After all, it can be a little depressing to be uncertain about yourself, and depression can be treated with esketamine. These types of drugs are opioid-like and hallucinogenic, and the mother substance, ketamine, is abused as a street drug. They could give you a legal kick. And psychiatrists are currently discussing treating people with depression with psychedelics. Perhaps that could be fun, too?
Some people, including me, have come to the conclusion that psychiatric drugs do more harm than good. A survey of 2,031 Australians showed that people thought that antidepressants, antipsychotics, electroshock and admission to a psychiatric ward were more often harmful than beneficial. Don’t be deterred by such evidence. The social psychiatrists who had done the survey were dissatisfied with the answers and argued that people should be trained to arrive at the “right opinion.” Remember that a person who is not on psychiatric drugs is not normal.
My new fake diagnosis is not far from some of the silly diagnoses in DSM, and I shall provide two examples.
Oppositional Defiant Disorder
These are the criteria in DSM-III for Oppositional Defiant Disorder in children:
“A disturbance of at least six months during which at least five of the following are present:
- Often loses temper.
- Often argues with adults.
- Often actively defies or refuses adult requests or rules, e.g., refuses to do chores at home.
- Often deliberately does things that annoy other people, e.g., grabs other children’s hats.
- Often blames others for his or her own mistakes.
- Is often touchy or easily annoyed by others.
- Is often angry and resentful.
- Is often spiteful and vindictive.
- Often swears or uses obscene language.”
These criteria are totally subjective and arbitrary, and “often” occurs in all of them. How often is “often” supposed to be? Many children fulfil all nine criteria, and yet only five are needed for the diagnosis. For what purpose? As far as I can see, this is pretty normal behaviour.
Schizotypy is a very strange construct. I came across this diagnosis because a Danish filmmaker I worked with who made the film “Diagnosing Psychiatry,” got the diagnosis when she became stressed over a difficult divorce.
She jokes about this diagnosis in her film, and I looked it up on the Internet where there was a screening test for schizotypal personality disorder. The test reflects quite well how this construct is described on the Mayo Clinical website and by the DSM. There were nine questions and you should reply true or false, or yes or no, to each one.
- “Incorrect interpretations of events, such as a feeling that something which is actually harmless or inoffensive has a direct personal meaning.” This is a very vague question, and many people interpret events incorrectly or take them personally.
- “Odd beliefs or magical thinking that’s inconsistent with cultural norms.” That’s an interesting one. In Denmark, a young psychiatrist disagreed with the odd cultural norm at the department, which was to institute preventative treatment with neuroleptics for schizotypy. Is this psychiatrist then abnormal?
- “Unusual perceptions, including illusions.” Most psychiatrists would need to say yes to this question. Just think about the illusion called the chemical imbalance.
- “Odd thinking and speech patterns.” Surely, most psychiatrists display odd thinking, maintaining the lie about the chemical imbalance and many other lies, and also denying totally what other people see clearly, including their own patients, e.g. that psychiatric drugs do more harm than good.
- “Suspicious or paranoid thoughts, such as the belief that someone’s out to get you.” If you are detained in a psychiatric department, such a reaction is normal and understandable. The staff surely is out to “get you,” namely to treat you forcefully with neuroleptics against your will. When psychiatric leaders use terms about their opponents such as “antipsychiatry” and “conspiracy,” can it then be considered a “yes” to item 5?
- “Flat emotions, appearing aloof and isolated.” This is what psychiatric drugs do to people, so if they weren’t abnormal to begin with, the psychiatrists will ensure that they become abnormal.
- “Odd, eccentric or peculiar behaviour or appearance.” One definition of madness is doing the same thing again and again expecting a different result, which is what psychiatrists do all the time. I would call that an odd, eccentric and peculiar behaviour.
- “Lack of close friends or confidants other than relatives.” This is what psychiatric drugs do to people, particularly neuroleptics. They isolate people and can make zombies out of them.
- “Excessive social anxiety that doesn’t diminish with familiarity.” If you are detained in a psychiatric department, such a reaction is normal and understandable.
There was no explanation about the number of points needed for a diagnosis, so I tried the test a couple of times. If you have 5 out of 9 positive replies, you are told: “You are suffering from Schizotypal Personality Disorder … You must talk with a professional mental health expert.”
If you have 4 out of 9, the message is: “You have some symptoms and might be suffering from this disorder. You have got few points but according to DSM if you agree with three or four questions on this test, you might have developed this personality disorder. Please check with your mental expert.”
This test for schizotypy is bogus. Amusingly, many psychiatrists would be suspected of having this disorder because they test positive for items 3, 4 and 7, and they would then need to consult a “mental expert” who would likely also have 3 positives if tested. What is less amusing is that the test provides circular evidence for the patients who, even if they are normal, might test positive when they have been treated inhumanely by psychiatrists, including being forcefully treated with neuroleptics.
Psychiatric diagnoses are grossly unreliable and label many normal people with one or more psychiatric diagnoses. If you disagree, then try the adult ADHD test. If you are a dynamic and interesting person, you might very well test positive. If you still think the ADHD diagnosis has any merit, then please see this amusing satire, which is close to the truth.
I shall end with another video that will make you laugh. If not, I have a couple of diagnoses ready for you.
Motivational Deficiency Disorder
A new epidemic – motivational deficiency disorder – was first announced by Ray Moynihan in the BMJ’s 1 April issue in 2006, and some people believed the disease existed. In its mild form, people cannot get off the beach or out of bed in the morning, and the most severe form can be lethal as the sufferer may lose the motivation to breathe. Moynihan says: “All my life people have called me lazy. But now I know I was sick.” The drug is Indolebant, and its champion, neuroscientist Leth Argos, reports how a patient’s wife telephoned him and was in tears. After using Indolebant, her husband had mowed the lawn, repaired the gutter and paid an electricity bill – all in one week.
I showed this video as an introduction to my talk about overdiagnosis and overtreatment when I lectured for over 100 psychiatrists in 2012. They laughed out loud but not when I added that what they had just seen wasn’t far from their everyday practice.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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