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Your Physical Illness May Now Be Labeled a Mental Disorder

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By Toni Bernhard, J.D.

In “Physical Illnesses May Soon Be Labeled ‘Mental Disorders’” (December 27, 2012), I wrote about a disturbing development taking place in the drafting of the fifth edition of the DSM—the manual used to decide if people have a psychiatric disorder or not. Those who use the DSM to diagnose include a wide range of health care practitioners: psychiatrists and other physicians (such as primary care doctors), psychologists, social workers, occupational and rehab therapists. The list is long.

In that December piece, I described Somatic Symptom Disorder, a new mental illness that was being proposed for the new edition of the DSM. I wrote:

"People can be diagnosed with Somatic Symptom Disorder if, for at least six months, they’ve had one or more symptoms that are distressing and/or disruptive to their daily life, and if they have one [only one] of the following three reactions:

Criteria #1: disproportionate thoughts about the seriousness of their symptom(s);

Criteria #2: a high level of anxiety about their symptoms or health; or

Criteria #3: devoting excessive time and energy to their symptoms or health concerns.

Can you see how this diagnosis potentially includes everything from a stomach ache to cancer?

To repeat, this time using a hypothetical: For six months, you’ve had bad gastrointestinal symptoms that have been 'disruptive to your daily life' because you can’t be far from a bathroom. In the subjective view of a health practitioner, you’ve spent 'excessive time and energy devoted' to trying to figure out what to do about it (criteria #3). The result: you may well be diagnosed as suffering from a mental illness called Somatic Symptom Disorder."

This is absurd. (For an analysis of the dangers of being diagnosed with Somatic Symptom Disorder, please read my full piece from December 27th.)

Despite the vehement opposition of many in the health care field—including many therapists—the American Psychiatric Association (who publishes the DSM) has included Somatic Symptom Disorder in the its fifth edition—DSM-5—which will be published in May. The refusal of the APA to even broaden the criteria for coming under Somatic Symptom Disorder is not just a bitter disappointment, but a potentially dangerous mistake for reasons outlined in my previous piece.

Among the professionals who fought hard against the inclusion of this new diagnosis is Allen Frances, M.D. who was the chair of the DSM-4 Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently a professor emeritus at Duke. He has just written a comprehensive article about this development: “Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder.” In it, he says:

"Somatic Symptom Disorder is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia…For reasons that I can't begin to fathom, DSM 5 has decided to proceed on its mindless and irresponsible course. The sad result will be the mislabeling of potentially millions of people with a fake mental disorder that is unsupported by science and flies in the face of common sense."

I hope you’ll read Dr. Frances’ entire piece.

What can we do?

First, I advise against taking a “we v. them” stance. Dr. Frances is himself a psychiatrist and fought long and hard against the inclusion of Somatic Symptom Disorder in the DSM-5. And since I’ve been involved in this issue, I’ve heard from many therapists who are against the creation of this new diagnosis. In addition, blaming the therapeutic profession would be counterproductive because it will only result in our objections being disregarded. Our argument is with the DSM-5, not the therapeutic profession.

Our best hope is to get the press, insurance companies, and our elected officials involved in this issue. If Dr. Frances can show the press that thousands of people are reading and commenting on his articles and on mine, the press may be persuaded to take an interest in this issue.

Elected officials and insurance companies may take an interest if they can be made to see that a diagnosis of Somatic Symptom Disorder will lead to added Medicare, Medicaid, and health insurance costs in the form of unneeded therapy and psychotropic drugs. In addition, this misdiagnosis raises the risk that underlying physical causes of an illness will be ignored and this may lead to an illness going undiagnosed until the point when treatment will result in even more costly medical care. This will drive up health care costs for both government and insurance companies.

If you want to get involved, here's what you can do: share this article with others; contact members of the press (especially medical reporters such as Drs. Sanjay Gupta or Nancy Snyderman); and contact your elected officials. You can use email to do this. As a “sound bite” for those you contact, you could use language like this to get their attention: “Millions of people who suffer from chronic illness will soon be subject to diagnosis as mentally ill.” I’d like to see this as the title of a press release that goes to news sites everywhere.

Finally, know your rights. You have the right to see your medical records and you can even challenge a diagnosis, although Dr. Frances tells me it’s a complicated process and difficult to win. At the very least, in case the issue arises while you’re in a medical setting, have copies of any of Dr. Frances’ or my articles that you think might be helpful to show your health care practitioner.

I am deeply disappointed and concerned about this development.

~Source: Psychology Today, January 17, 2013.

Toni Bernhard is the author of the award-winning How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers. Her new book, How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow, is available for pre-order and will be released in September. Until forced to retire due to illness, Toni was a law professor at the University of California—Davis, serving six years as the dean of students. Her blog, “Turning Straw Into Gold” is hosted on the website of Psychology Today. She can be found online at www.tonibernhard.com.

Reprinted with the kind permission of Toni Bernhard.

 © 2013 Toni Bernhard www.tonibernhard.com

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8 thoughts on “Your Physical Illness May Now Be Labeled a Mental Disorder”

  1. IanH says:

    They could have added that taking nutritional supplements in the belief that they will reduce symptoms or treat the illness they have is clear criterion for Somatic Symptom Disorder. After all they have no effect and the people who take them think they do.

    No No No!

  2. Northumbrian says:

    The article suggests, “Our best hope is to get the press, insurance companies, and our elected officials involved in this issue.”

    It’s my guess that the insurance lobby is substantially to blame for this move. As I understand it, people with a psychiatric diagnosis are substantially limited in the support which they get from insurance companies, especially when it comes to Long Term Disability.

    This re-classification in DSM-5 will make it possible for insurance companies and their tame psychiatrists to deny disability benefits to anyone with CFS/ME, FM, IBS and even RSI and a whole host of other conditions which are poorly understood. I know that on my side of the Atlantic there have been some long and persistent efforts to re-classify these conditions as psychiatric.

    The psychiatrists involved – collectively know as “the Wessely group after their (recently knighted) intellectual and PR leader Simon Wessely – have been trying for years to achieve this re-classification in the WHO classification. Most of them have considerable contacts with big insurance companies – Unum and Swiss RE, amongst others – for whom this has long been a goal.

    Although there will undoubtedly be extra costs for therapy (which is the preferred method of treatment for Somataform disorders) there are savings over and above the biggest, which is the time limitation on sickness and disability benefits. For one thing, it is urged that primary care physicians faced with someone who can be made to fit in this category should avoid pandering to (“inadvertently re-enforcing”) the patient’s belief in their “illness”.

    This means that they should not send the patient for lots of extra expensive tests. If you have someone who you believe probably has ME/CFS, then don’t go through batteries of blood test, or send them for MRI scans – this will be bad for them as they will only make them spend more time thinking they are ill. Immediate referral for a short course of Cognitive Behaviour Therapy is probably the best option. If the patient doesn’t improve, then maybe a longer course until they give up or at least cease bothering the medical profession and – crucially – their insurers (especially their employers insurers).

    That all of this will lead to cases of MS or early-onset Parkinsons, for example and many other serious illnesses about which there is no dispute being missed is obvious. But since that becomes a matter of “genuine medical uncertainty”, the physicians possibly and the insurers certainly can wash their hands of the results.

    I am also certain that this re-classification by the American Psychiatric Association is just a precursor to a re-writing of the WHO classification. Wessely et al have been trying to achieve this for more than an decade. Indeed at one point our local WHO psychiatric centre actually maintained that this was already the case and had to rapped over the knuckles by WHO for unauthorised tampering. The APA work will certainly strengthen their hand immeasurably.

    In 2004 those of the newly created UnumProvident Centre for Psychosocial and Disability Research at Cardiff University were bullisn. Professor Peter Halligan who had forged the partnership with UnumProvident was ambitious: ‘Within the next five years, the work will hopefully facilitate a significant re-orientation in current medical practise in the UK’.

    “Disease is the only objective, medically diagnosable pathology. Sickness is a temporary phenomenon. Illness is a behaviour – ‘all the things people say and do that express and communicate their feelings of being unwell’ (p39). [Disability Benefit] trends are a social and cultural phenomenon rather than a health problem. The solution is not to cure the sick, but a ‘fundamental transformation in the way society deals with sickness and disabilities’ (p123). The goal and outcome of treatment is work.” (Jonathan Rutherford, “New Labour and the End of Welfare”)

    This new sweeping definition will see many people who do in fact have an easily-identifiable disease, such as MS, treated as having an “illness” – a psychological disorder. This will certainly mean that many cancers, metabolic disorders and serious neurological illnesses will be overlooked. The further these conditions progress, the sooner the patients will die and – once more – the money men will win.

    My only hope is that the patients’ own lawyers will manage to sue the hell out any physician who wrongly diagnoses this “Somatic Symptom Disorder”.

    As someone seriously affected by CFS, I can just see my support – financial, medical and psychological – going down the pan, the minute this document is adopted over here. Which is, of course, the whole idea.

    1. lochner says:

      This negative situation re CFS and insurance companies is 100% true as far as my experience is concerned. My dr’s office made an appointment for me to have a very basic heart test. I then received a call from the heart clinic canceling my appointment because my dx includes CFS. I asked what the test would cost me as a direct pay and was told that they only deal with insurance companies. Okay, I said, just suppose??? Was then told it would be about $1,000 but again told that they only deal with insurance companies and insurance companies will not cover me.
      My dr’s office took CFS off my dx and resubmitted me for the heart test. I had the test, no problem. Medicare and my supplemental paid for it. It was less than $200.

      I understand that CFS and perhaps other dx can be removed from your records after five years. It has been determined that I have the hidden lung worm, C. Pulmoni, a respiratory infection, and not CFS. Dr Klinghardt has stated that about 80% of people dx with CFS actually have C. Pulmoni, also called Klapowi. Drs will want to run tests on feces & urine. What is it about LUNG worm they don’t get??? It’s not in feces & urine. As far as I know, there is no test for it — and there never will be as long as they can pretend it is a mental disorder.

      Barbara Lochner

    2. solargirl451 says:

      I wonder how much of this is stemming from obamacare? Re-labeling and controlling people. Not good!

    3. lochner says:

      I was dx with Chronic Fatigue Syndrome and Fibromyalgia almost twenty years ago. Long before Obamacare was thought about. I have been mistreated this entire time. My dr at Kaiser Permanente in Ca told me that if I didn’t take his rx of pain killers and anti-depressants then not to come back. Another dr asked me about my early sexual relationship with my father. A fibro doctor fired me because he decided I didn’t have fibro – but had no clue what it was, so ‘go away’.

      Fortunately Dr Larry Klapow made a presentation to the International Association of ME/CFS re the
      parasite C. Pulmoni in Sept 2011 and I now know that I have this ‘hidden lung worm’. Not CFS/Fibro.

      This terrible, awful, miserable treatment of CFS has been around for a very very very long time.
      I don’t see a presidential connection but I firmly believe that Center for Disease Control, other government health agencies, have been paid off by insurance companies, and it looks like it will just get worse. This is true no matter which party has been elected to office.

    4. welltrvld says:

      If you are not familiar with this iconic early 20th century composer, I recommend you check out the life and death of George Gershwin. He certainly would have been victimized further by this medieval like protocol. As it was, his death at 39 might not have been necessary, if he had only been taken seriously.

    5. Thora234 says:

      Although I am Canadian, and not American, I can see the potential effects of this even in Canada. When I was asked by my insurer to see a therapist for disability testing I was shocked when this therapists comments were used to disqualify me. It was the same rationale being used here. Luckily, I was successful in appealing my disqualification and was reinstated, but the facts remain – this mentality by insurers and their co-conspirators the world over (this happened in the UK) is a deadly and costly mistake. Fight, fight, fight to stop it!

  3. joyhselak says:

    I can speak from personal experience that this is indeed a troubling development. While working to get a long term disability claim approved, I was sent by my insurer to an ‘independent medical examiner’ who diagnosed me with a somatic disorder and wrote I was ‘overly concerned with being sick’. Had his diagnosis stuck, my claim would have been paid at a lower percentage of earned income than a physical disability. Fortunately my doctors fought back to discount the diagnosis, citing their own medical tests and diagnoses, and flaws in the reasoning and interpretation of his.
    During the two long years it took to get my claim approved, I learned a few important lessons that helped in my case and write about them in our book. I made sure my physicians would be willing to support my claim. I took an advocate and observer with me to all meetings ordered by insurance company, usually my husband. Finally, I assigned medical power of attorney to my husband, so the insurers had to deal with a person who was healthy and fully functioning, rather than one who was ill, fog-brained and vulnerable.
    Joy H Selak, author with Dr. Steven Overman of You Don’t LOOK Sick! Living Well with Invisible Chronic Illness

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