What is Big Think?  

We are Big Idea Hunters…

We live in a time of information abundance, which far too many of us see as information overload. With the sum total of human knowledge, past and present, at our fingertips, we’re faced with a crisis of attention: which ideas should we engage with, and why? Big Think is an evolving roadmap to the best thinking on the planet — the ideas that can help you think flexibly and act decisively in a multivariate world.

A word about Big Ideas and Themes — The architecture of Big Think

Big ideas are lenses for envisioning the future. Every article and video on bigthink.com and on our learning platforms is based on an emerging “big idea” that is significant, widely relevant, and actionable. We’re sifting the noise for the questions and insights that have the power to change all of our lives, for decades to come. For example, reverse-engineering is a big idea in that the concept is increasingly useful across multiple disciplines, from education to nanotechnology.

Themes are the seven broad umbrellas under which we organize the hundreds of big ideas that populate Big Think. They include New World Order, Earth and Beyond, 21st Century Living, Going Mental, Extreme Biology, Power and Influence, and Inventing the Future.

Big Think Features:

12,000+ Expert Videos

1

Browse videos featuring experts across a wide range of disciplines, from personal health to business leadership to neuroscience.

Watch videos

World Renowned Bloggers

2

Big Think’s contributors offer expert analysis of the big ideas behind the news.

Go to blogs

Big Think Edge

3

Big Think’s Edge learning platform for career mentorship and professional development provides engaging and actionable courses delivered by the people who are shaping our future.

Find out more
Close

Diagnostic Inflation: Do You Really Have a Mental Disorder?

May 13, 2012, 3:28 PM
Phrenology

This lecture on "diagnostic inflation" or the over-diagnosis or mental disorder by Allen J. Frances, the chair of the DSM-IV task force, is important. Watch it. Frances lays out absolutely staggering levels and rates of change in the recent diagnosis of mental disorder and argues that there is nothing other than diagnostic inflation capable of accounting for it. Rates of diagnosed anxiety disorder, mood disorder, childhood bipolar disorder, autism, ADD and more have boomed in just a few years. Consider ADD. Frances says:

The diagnosis of attention-deficit disorder used to be about 3 - 3 1/2%. Now it's 10%. And 4% of kids in American schools are getting medication. A recent Canadian study really indicates the nature of the problem. It was found that -- and this was a very large number of kids, in Canada -- it was found that one of the strongest predictors of whether you had ADD or not was your birthday. If you were born in December, you are much more likely to have ADD than if you were born in January. The only reason for this could be the school year. That the kids who were younger in the classroom, less mature, instead of being accepted as less mature are being medicalized as having attention-deficit disorder and are all too frequently given medication. A tripling of ADD in just ten years.

The ADD birth lottery example nicely captures how perfectly normal variation -- the fact that slightly younger kids will tend to be less mentally and emotionally developed than slightly older kids -- is now regularly interpreted as evidence of pathology. Frances goes on the explain how very small changes in the diagnostic criteria can lead to an explosion in diagnosis. Even very small proposed but rejected changes can create an inflationary shift in diagnostic norms.

Even if you want to squelch the [tendency toward over-diagnosis in the] system as much as possible, it leaks. Diagnostic inflation is like economic inflation: it's very hard to keep under control; it has many causes; not all of those causes are within your control. The book as written may be very different than the book as used. And once the genie is out of the bottle and the book is published, people can use it their own way, which may be radically different from what you intended.

Frances goes on to explain why he thinks the new DSM-V, focused on prevention, will only make things worse and lead to millions more people being misdiagnosed with mental disorders for perfectly normal and totally healthy psychological conditions. This is a terrific talk stuffed with interesting facts and important insights about the nature of the psychiatric diagnostic system and the incentives at play in the definition of diagnostic categories and the application of these categories to healthy people. Highly recommended, especially if you or someone you care about has been diagnosed with a mental disorder.

If you're interested in these issues, I discuss them further in my Reason review of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorderby Allan V. Horwitz and Jerome C. Wakefield.

 

Diagnostic Inflation: Do Yo...

Newsletter: Share: