“In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness.”
The Malleus Maleficarum was a 15th century text that instructed Inquisitors on the proper method of identifying, trying, and burning witches. Though it was many years ago that renowned psychiatrist Thomas Szasz (1920-2012) used the example of the Malleus to comment on the diagnostic practices of his fellow physicians, it seems he might have been on to something as today, psychiatrists and educators alike are concerned that the recently completed “Diagnostic and Statistical Manual of Mental Disorders V” (DSM 5) will be responsible for psychiatrists improperly diagnosing millions of Americans as mentally ill.
Produced exclusively by the American Psychiatric Association, the DSM provides physicians with a handy checklist of mental illnesses. Simply fit a patient into a category and a diagnosis follows, complete with treatment and prescribed medication approved by insurers and the federal Medicare bureaucracy.
But with the introduction of a new and broader category of diagnosis under the heading of Somatic Symptom Disorders (SSD), the DSM 5 literally threatens to “…license the application of a mental health diagnosis for all illnesses…” Duke University professor emeritus Allen Frances writes that “…a person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.
In short, should a physician believe a patient to be pre-occupied or overly concerned with a physical illness, a diagnosis of Somatic Symptom Disorder may be added to the patient’s file. The doctor could therefore make a purely “…subjective and fallible judgment that the patient’s life has become ‘subsumed’ with health concerns and preoccupations…”
Dr. Frances voices a fear that should concern current and prospective patients alike:
Do we really want to burden and stigmatize seriously ill people with an additional diagnosis of mental illness, just because they are worried about being sick and are vigilant about their symptoms? Might patients with life threatening diseases become reluctant to report new symptoms that might be early indicators of recurrence, metastasis or secondary disease – for fear of attracting a diagnosis of ‘SSD’?
And what might be the “real world” ramifications of such a diagnosis? Could individuals deemed to be suffering from SSD be denied certain types of work or face difficulties at their current job? Could they be refused future health insurance coverage? Will they be considered hypochondriacs and therefore be placed at medical risk as physicians ignore their complaints of “not feeling well?
ObamaCare is expected to cost Americans $2.6 trillion in its first full decade of existence (2014-2023.) It will also add another trillion in taxes over the same time period. And now, costs associated with healthcare may skyrocket simply because countless patients have been wrongly diagnosed as mentally ill.
Soon, we won’t be able to afford to be sick OR well!
Photo Credit: caroline_1