The growing ‘grey’ population may be raking in the cash for drug companies, but look at the other end of the age spectrum and you’ll also see burgeoning trade. The number of children diagnosed with mental disorders, including attention-deficit/hyperactivity disorder (ADHD), depression and bipolar disorder, has skyrocketed over the last few years, bolstering sales of psychotropic medications such as stimulants, antidepressants, tranquillisers and antianxiety drugs.
But is this truly an epidemic of insidious ‘brain disease’ sweeping across the paediatric population, leading them to act in ways that are considered ‘challenging’ or ‘abnormal’?
The answer, as WDDTY has found out, is no. The real problem lies with the increasingly ubiquitous practice of assigning psychiatric labels, based on loose diagnostic criteria, to children - some barely out of their diapers - who show any signs of emotional upset, misbehaviour or learning difficulties.
While physical disorders such as cancer or diabetes have tests that show concrete results to confirm the diagnosis, ‘mental’ disorders are still diagnosed largely by subjective opinion - usually that of the physician making the analysis. The popular claim that mental disorders are caused by biochemical imbalances in the brain has, so far, not been substantiated by objective scientific evidence. Asking your doctor for a test to reveal the biochemical abnormality behind your child’s ADHD or manic-depressive symptoms will draw a blank stare - there are no such tests.
Yet, psychiatric disorders continue to be diagnosed as if they have a physical cause, and are classified according to standardised criteria. However, these medical models of ‘abnormality’ are little more than simple checklists of behavioural quirks and anomalies - and notoriously un-reliable. The subjectivity of a doctor’s interpretation of the symptoms means that two psychiatrists can easily diagnose the same patient with two different disorders.
A landmark study in the early ‘70s by young psychology graduate David Rosenhan underscored the fallibility of the psychiatric diagnostic classification system (Science, 1973; 179: 250-8). In this experiment, eight sane people - including Rosenhan himself - attended various hospitals, complaining that they were hearing voices that repeatedly said words like ‘empty’, ‘hollow’ or ‘thud’. No other aspects of their behaviour, personal history or circumstances (except their names) were changed. According to the then latest edition of the US Diagnostic and Statistical Manual of Mental Disorders (DSM-II), seven of the eight pseudopatients were diagnosed with schizophrenia and admitted to a mental institution. During their stay, they reverted back to normal behaviour, but their sanity was never once detected by staff. Even worse, the psychiatric label mistakenly slapped on them continued to stick even after their release, with all but one pseudopatient given a new diagnosis of ‘schizophrenia in remission’.
Rosenhan’s study shook the psychiatric profession. In response, a task force of clinicians and researchers was set up to expunge all signs of ambiguity, psychobabble and subjectivity, and to tighten diagnostic criteria by setting up strict guidelines for the duration and frequency of symptoms.
However, instead of bringing more scientific credibility to psychiatry, the resulting tome - which has gone on to become the best-selling psychiatric bible and currently in its fifth major edition - seems to have done even more harm, with its ever-expanding definitions of mental disorders. The net has now been cast so wide that it’s little wonder so many children are being given such diagnoses.