Drug companies rubbing their hands with glee at the 'discovery' of three new mental illnesses?

This week the American Psychiatric Association (APA) announced the updated fifth edition of their Diagnostic and Statistical Manual of Mental Disorders (DSM) and it appears they have identified three new illnesses: "mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder."

My only experience with mental illness is as follows: I was having a pretty shit day because I couldn't breath. I think feeling miserable about that is a pretty bog-standard normal reaction. I happened to be going to the doctors to update my prescription list and he said I looked rather down and did I think I was depressed and started asking me if I ever felt low or cried for no reason. Which made me cry.

So there he is thinking I'm depressed when actually I was only crying because I found the whole situation confusing and I was scared that maybe I was depressed and hadn't noticed it, which confused me even more. Anyway I turned down his suggestion of some mild anti-depressants but it completely shocked me at the ease that these drugs can be obtained. I mean, Jesus, girls cry all the time, it's just our way of venting frustration.

So of the new illnesses outlined in the APAs' manual lets just think about psychosis risk syndrome. By the psychiatric association's own admission this isn't even an illness. Its basically saying to someone they're at risk of developing a mental illness because they're experiencing abrupt personality changes. And from experience, someone telling you you might be mentally ill is incredibly stressful, and truly makes you question your sanity. There is a great article outlining the effects of over-diagnosis here.

So what's the point of the APA's manual? Well give this some thought:
"The US Senate Finance Committee has investigated at least 16 APA psychiatrists over their undisclosed financial ties to drug companies, including the APA’s own President, Alan Schatzberg who has stepped down as principal investigator of a National Institute of Health (NIH) funded study after months of Congressional scrutiny into his ties to the drug he was studying.  He was found to have actually initiated the patent application of the drug he was studying to “treat psychotic depression.” You can read more about this here.

Another investigation published in April last year by people working for three major US universities, including Harvard medical school, found :
"Ninety percent of the authors of 3 major clinical practice guidelines in psychiatry had financial ties to companies that manufacture drugs which were explicitly or implicitly identified in the guidelines as recommended therapies for the respective mental illnesses. None of the financial associations of the authors were disclosed in the clinical practice guidelines."

Drug companies make shed loads from selling drugs. In 2007 it was estimated that drug company GlaxoSmithKline made £1 billion per year in profit from anti-depressant Seroxat. According to Forbes, at its peak, drug company Eli Lilly made $3 billion dolllar profits from Prozac in 2000 (profits fell subsequently when it lost its patent protection).

So the more illnesses that can be discovered, the more drugs can be invented to cure it. And more over, as the drop in profit from Prozac shows, there is a continual need for new drugs to be created as a drug company's patent only lasts a prescribed period of time before it must give up its secrets to a generic drug maker.

No wonder there is a concern over the conflict of interest between APA members and drug companies.

And although it's a US manual the DSM is used worldwide as a basis for diagnosis, research and medical education. I'm not saying that your local GP has a conspiracy going with GSK but a recent study by Rethink reveals that over two-thirds of GP's don't feel equipped to take responsibility for mental health - perhaps indicating they might rely on the APA's mental health 'bible' more than they should?

Patients are being offered antidressants or other drugs for mental illness when they're normally at they're lowest ebb, and most likely to doubt their own opinions, especially when they conflict with those of a doctor. But don't feel that drugs are your only option. Ask about therapy, counselling, the documented benefits of exercise in helping mental illness. Rest and exercise may create zero profit for a drug company but they can be fantastically valuable to a patient.

"Things I once thought unbelievable in my life..."

Listening to 6 Music as I start to write about a new test that may be able to accurately predict the onset of a woman's menopause and suddenly PJ Harvey's voice pulls my attention to her lyrics: "Things I once thought unbelievable in my life have all taken place...."

But rather than it make me think about the benefits of this new medical innovation, it turned my thoughts to the limitations of it.

Iranian doctors believe that by measuring levels of a hormone called Anti-Mullerian Hormone (AMH), they can accurately predict within 4 months when a woman may go through menopause, offering women better control over their fertility and giving them a more informed choice of when to start a family.

As menopause alone is not the only factor limiting a woman's fertility (according to one expert, fertility begins to drop from the age of 28, and by 30 one in three embryos will be genetically flawed), I really can't see the benefits of this test. If anything it just provides a false sense of security, when in fact life is anything but predictable.

When I was growing up in the eighties, there was a lot of talk about finding a genetic cure for CF. Well its now 2010 and there still isn't one. In fact, there isn't a single cure for any genetic illness to date. Thankfully even in my early teens I never pinned my hopes on a cure. I just knew I had to live the life I had available to me in the best way I knew how. This was nevertheless more problematic than it might seem. The life expectancy of CF has never been something to be happy about, but even knowing it is limited doesn't actually mean much as some CF patients die very young while some make it to a pretty decent age and even have children. The variability is massive.

So you end up trying to straddle two life philosophies simultaneously - living life for the moment as well as planning for an unpredictable future. So do you jack in the job you hate to go travelling since life is too short to waste on being miserable? Or stick it out in the hope that it leads to a better job in a year's time which would provide more long-lasting happiness than a two-month jaunt around Thailand? I don't know the answers, just that you always somehow find a solution to the new challenges life throws at you.

So back to the issue of fertility. It's a precious thing, and it becomes even more precious as you get older. Innumerous medical tests can't actually come close to predicting the unexpected nature of life. Meeting the right person, getting pregnant from a one-night stand, losing a stable income, getting a great new job, losing a parent and a future loving grandparent, getting cancer, IVF that works, IVF that fails. All this stuff of life is just as important as how many eggs you have left. Perhaps having a baby should be more about what you'd need to sacrifice at any given moment to have a child and whether that sacrifice is worth it for you in comparison to a potential future without children. (And, as an aside, surely society would be better off investing in flexible working patterns and innovative child care solutions to reduce the sacrifice a woman must make when it comes to employment prospects, rather than focus on ever-new ways to extend a woman's fertility beyond its natural peak?).

Even as someone so dependent on medicine to stay alive, for me science alone has never been able to deal with the real difficulties of living. And it brings me back to PJ Harvey's lyric: information and imagination alone won't let you create a future. The real life-affirming question is: "What do you choose?"