Despite being the cause of misery for millions of people worldwide since 2008, Narcissistic Chrometophilia[i] is one of the few new “mental illnesses” that you won’t find in the latest version of the American Psychiatric Association’s latest version of its Diagnostic and Statistical Manual (DSM-5). Narcissistic Chrometophilia – a condition in which the victim desires to accumulate even more money irrespective of the harm this does to those around him (or her, but mostly him) – underlies the MPs expenses scandal, the phone hacking scandal, and most tragically, the banking crisis.
Surely if anything deserves to be treated as a mental illness, it is the pursuit of extra (often unneeded and undeserved) money to the extent that it plunges billions of people into decades of austerity.
One reason why Narcissistic Chrometophilia may not have made it into DSM-5 is that many of those responsible for compiling the manual will recognise the condition in themselves. And while they are content to apply the highly stigmatising label “mentally ill” onto billions of people whom nobody today would see as such, they will not allow the label to be applied to themselves.
At face value, the DSM is an attempt to develop a scientific approach to the diagnosis of mental illness. The reason for its creation is valid enough. Prior to the DSM, people were diagnosed (and incarcerated, doped, and even lobotomised) on the basis of nothing more than an individual psychiatrist’s whims and prejudices. After this was exposed by the now infamous “thud” experiment, the DSM, informed by clinical research, was used to codify the symptoms of mental illnesses. As a result, psychiatrists around the world had an objective manual that they could refer to when making decisions about who was, and who wasn’t, mentally ill.
Unfortunately, the DSM is not “objective”. Rather, it is the outcome of the subjective views of people from within the US psychiatric profession. And psychiatrists are not impartial observers in this process. Revisions of the DSM have been tainted by the corrosive hand of the pharmaceutical industry, which often provided the funding that paid for many of the professionals who sat on committees deciding what constituted a particular mental illness. So, for example, a professional who had done pharmaceutical industry-funded research into antidepressants might turn up on the body deciding which symptoms would be included in the definition of depression. However, this might, in turn, lead the same professional to include those symptoms that are amenable to antidepressant treatment, while excluding those which aren’t. The result is that we arrive at a diagnosis of depression that is overly concerned with biochemistry at the expense of patients’ experiences in the real world. As Prof Peter Kinderman points out:
In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.
Scientific evidence strongly suggests distressing experiences result not from “faulty brains”, but from complex interactions between biological, but more importantly, social and psychological factors.
But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.
Concern about the number of DSM reviewers in the pay of the pharmaceutical industry has surfaced again with the latest revision, and with three-quarters of the 29 work groups receiving funding from the pharmaceutical companies, it should come as no surprise that millions of people in the USA, and billions worldwide will now be eligible for diagnoses of mental illnesses for which there just happen to be existing drugs. For example, an entirely new mental illness – Adult Attention Deficit Disorder – will allow the pharmaceutical industry to make $billions worldwide selling Ritalin (aka “speed” if you want to buy it illegally from a drug pusher) to a new adult market. At the same time, a much less serious version of ADHD in children – Disruptive Mood Dysregulation Disorder (which some critics suggest is little more than your child throwing a temper tantrum) – will now allow the pharmaceutical companies to make a killing (possibly in both senses of the word) from unnecessarily medicating millions of children worldwide.
DSM-5 will also massively increase the criteria for anxiety and depression, causing millions of people with routine, normal, ordinary human worry and unhappiness to be included in the mental health system, allowing billions more prescriptions for antidepressants and tranquilisers to be issued, and intolerable strain to be placed on health services worldwide. As Dr David Healy reminds us:
Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder – melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.
Nor is it just the money to be made from the pharmaceutical industry that has driven the latest revision of the DSM. As Jim Coyne points out, the peculiar operation of the American health system means that psychiatrists can only be paid to treat someone if that person can be shown to have a qualifying illness. Until now, a psychiatrist in the USA could not get funding to prescribe antidepressants to someone who has suffered bereavement because (quite rightly) we should not mistake grief for depression and we do not want to label everyone who suffers the loss of a loved one as being “mental”.
The most worrying new “mental illness” in the DSM-5 is Somatic Symptom Disorder – a posh new name for what we used to call hypochondria. This new condition really does look set to be a killer. The criteria for this new condition are:
- Having been distressed or having your life disrupted by a physical symptom(s) for at least 6 months and one (only one) of:
- disproportionate thoughts about the seriousness of your symptom(s)
- a high level of anxiety about your symptoms or health
- devoting excessive time and energy to your symptoms or health concerns
As Dr Allan Francis, a former chair of the DSM-IV task force 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.
Narcissistic Chrometophilia is not a real mental illness. But when the people who populate a profession whose purpose is meant to be the alleviation of suffering follow their desire for lucre at the expense of the lives of billions of people worldwide, we have a major problem. As US psychiatrist, Shirah Vollmer puts it:
The biases of psychiatric diagnoses are powerful. The more people who are included in a mental disorder, the more research money there will be to fund the science, and the more drug companies have incentive to produce treatments. On the other hand, the more people who are included in a diagnosis, the more suspicious the public becomes about the quality of the diagnostic criteria. No matter how DSM V will be written, it will be flawed. There is no psychiatric diagnosis which has an objective measure. At the moment, all diagnoses are clinical diagnoses, meaning they are subjective….
All of this should not be an issue for people in the UK (our psychiatrists are supposed to follow a different diagnostic manual called the ICD 10). Unfortunately, experience tells us that once a condition is created in the DSM, it does not take long before it makes its way into the ICD. So while neither medical professions nor patients in the UK have had an opportunity to contribute to DSM-V, UK patients’ lives will soon be put at risk by it.
It is now time for our governments to act by establishing our own (more holistic) manual for the diagnosis of mental illness based on the input of independent individuals from a range of professions (including occupational therapy, psychology, social work, etc) and, crucially, people with lived experience of mental illness. This is the only way we can protect ourselves from the Narcissistic Chrometophilia that clearly afflicts so many people in American psychiatry.
[i] Chrometophobia – a fear of money is a recognised psychological condition. It is instructive that unlike many phobias (fears), there is no opposite philia (love of). In our money-driven world, Chrometophilia is not viewed as a mental illness. I leave it to the reader to decide why this should be.