First of all, I see that Marcia Angell walked her rhetoric back somewhat in her response to the letters that predictably followed those articles, some of which (predictably) were just as specious as what they were critiquing, if not more so.
So. Credit where due: Her last line...
[i}t is no favor to desperate and vulnerable patients to treat them with drugs that have serious side effects unless it is clear that the benefits outweigh the harms.
...is so true that I don't really understand why it's so rarely framed that way. At least nine-tenths of my objections to most anti-psychiatry rhetoric would evaporate if it included some nod in the direction of there being a non-iatrogenic problem of some sort. Or really, ANY sort. (Not psychiatric, IOW.)
This, on the other hand...
Friedman and Nierenberg are right that the National Comorbidity Survey showed very little change in the prevalence of three particular types of mental disorders in adults between 1991 and 2003, although the increase in the percentage of people treated was dramatic. But the frequency of some diagnoses, such as bipolar disease and autism, has soared. Moreover, the survey showed a prevalence of mental illness of about 30 percent, which surely represents either a major epidemic or rampant overdiagnosis. One of the most remarkable findings was that 20 percent of randomly selected adults were undergoing treatment for emotional disorders at the time of the later survey, about half of whom did not even meet the DSM-IV criteria for a mental disorder.
...is just DISHONEST.
As far as the general stats go:
- * The prevalence rate for mental disorders in the United States has been about thirty percent for decades. It's not showing any signs of changing.
* About twenty percent of those people (.06 percent of the total population)**** received treatment in 1991. And about thirty percent (.09 percent of the total population)**** did in 2003. While I guess that's arguably a dramatic increase, it's not exactly the most dramatic statistical truth in the picture.***
* It's true that overall, twelve percent of the total population received some kind of treatment for a mental disorder from somebody, somewhere (ie -- from a GP, social services, a psychiatrist, other mental health professional, or alternative practitioner) in 1991, versus twenty percent in 2003. And that's dramatic. But half of that increase was made up of people who didn't have mental disorders. And the sector on the delivery side that had the biggest boom was "General Medical." So it's kind of equivocating to cite it as evidence that psychiatry WANTS YOU. (Although it might, for all I know.)
* I don't know why Angell feels that thirty percent must represent rampant overdiagnosis or an epidemic. I mean, maybe it does. But since that figure includes all cases of alcoholism, substance abuse, PTSD, eating disorders, et cetera -- a lot of things that would maybe have a 3- to 5-ish prevalence rate individually (most of which are never treated, and many of which are transient) I don't see what's so incredibly outlandish about it. And she doesn't provide clue one. So it's a mystery.
FWIW, prevalence for "serious mental illness" is about eight percent. That, to me, sounds high. But I don't know how they're defining it.
* I already covered the twenty percent thing.
Shorter version: WRT the epidemic of mental illness, there is none. Most people who qualify for treatment don't receive any. Some of them might not need any. But some might. No way to say. That's a problem. But I don't know what kind. Misallocation of resources, I guess.
WRT overdiagnosis and overtreatment of mental illness among people who don't qualify for either, that's a real trend and a real problem. But it has virtually nothing to do with the desire of psychiatry to catch and keep you in its butterfly net. So you can't address it by raging at that. It won't help.
WRT raging at the many lapses of psychiatric treatment, whether pharmaceutical or otherwise: I'm all for it, in theory. Most of the .09 percent*** ofpeople who receive it for something resembling a reason get bad care, even when it's not abusive. And sometimes it is, of course. The system sucks.
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Full letters exchange on the Angell piece here. And one full overview-type write-up of the NCS survey results with tables and stuff is here. But that's a lot of data, there are reams of more specific studies based on it, too.
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***ON EDIT: That .06 and .09 just can't be right. Too low. I don't have time to check it now. But I think I must have gotten outplayed by a two-digit number. That happens sometimes.
****ON SECOND EDIT: It seems wrong whatever way I look at it. The figures that are still there are right (ie, according to the survey), though.