It's always in the last place you look.

After the last post, I thought, "perhaps I was too broad.  Maybe too political, maybe I didn't have enough concrete examples."

Then I opened my mail.

A reader writes:

"I'm from Europe, Romania...you speak about a medicine intended to declare/sell that medicine as "mood stabilizer"... However, are there really so many people with such troubles in your country to make such medicine such an important matter? I didn't think of America as being such a sad/depressed country and a medicine called "mood" something seems to me such a stretch..."

The money is in the C, not the E.

An unsurprising number of adults don't care either way.

And I don't like what I see.

Here's how (not) to read a study.

Depends on your definition. Wovon man...

Certain psychiatrists carry considerable weight in determining the policy, the spirit, of psychiatry.  Henry Nasrallah is one of those men, which is why, if you see him write an editorial called, "Should psychiatry list hubris in the DSM-V?" -- especially if it is tongue-in-cheek--- you should strike yourself in the head with a brick until you are unconscious.  You are about to be manipulated with words, and then it will be too late.

The other 4 cars are now completely fine, thanks to early intervention.

After some dozen years' immersion in intelligence, I still find myself reacting uncomfortably to its rather cavalier disregard for the footnote.

This is an example of why the controversy over Pharma influence on doctors is, while accurate, likely irrelevant.

In case you doubted, here is today's front page of USAToday: Economy's stuck, but business is booming at therapists' offices.

If that was the end of the story-- if people had social troubles and turned to psychiatry for help because of those troubles, it would be a good thing.  Get help where you can.

But the larger problem is that in going to psychiatry, their socioeconomic issues get demoted to "factors" and the feelings become pathologized.  Psychiatry doesn't explain, it identifies.  You're not depressed because you lost your house; you have depression, and one of the triggers is losing your house.  See the difference?

You'll say this doesn't happen all the time, maybe not even the majority of the time.  But even if it doesn't happen to a specific individual, it still happens to enough people that it bolsters  psychiatry's role as the necessary player in managing suffering of any kind.

A 20% increase in therapy visits will be interpreted by psychiatry as a 20% increase in depression and anxiety.  It will say depression has a prevalence of X, it will say it is underdiagnosed and undertreated, etc. And it will creep into the social consciousness that these are pre-existing diseases with triggers, not the consequences of external events.

Society needs that illusion, it needs that lie, because it has created unrealistic expectations in people and no way of fulfilling them.   Here's what a society looks like under the similar economic conditions, but without psychiatry:

The absence of hope

Today's popular frustrations over flat-lining living standards have been building for years. The recent boom, felt only by the already well-off, has done little to change that discontent. Labor unrest has been growing for months; violent protests erupted... corporate taxes will be raised and gasoline subsidies cut... The move was designed to take the steam out of boiling anti-government sentiment.

The above article, also from USAToday, has a slightly different title: Egypt's economy soars; so does misery.

And with good reason.

Yes, you read that right.  Drink a big glass of OJ and put away your blotter paper, you won't need 'em in here.

Agreed.  And then let's rename the DSM The Book of Fantastikal Magickal Pixies and incorporate it into the Monster Manual.   And let Mad Libs publish the assessment tools.

And I am ashamed.

Belated, anyway.

In which appears the phrase, "the sticky pages of the New England Journal."