In a foreword to "The Loss of Sadness," Dr. Robert L. Spitzer, a leading figure in psychiatry, acknowledges the imprecision of the DSM, "especially the question of how to distinguish disorder from normal suffering." But he also defends the widening of psychiatry's safety net.
"I'm more concerned with people who could benefit from treatment not getting diagnosed -- with under-treatment -- than with overdiagnosis," he says. "If you need the drug, it's pretty awful if you don't get it."
If notions of what's normal for kids have changed, he adds, "I don't know that that's necessarily bad." More is known now, he says, about how things can go wrong with human functioning.
Dr. Robert Hendren, president of the American Academy of Child and Adolescent Psychiatry, says he is acutely aware of the overdiagnosis debate. Among the many possible explanations, he says, is that many psychiatric drugs appear effective in treating kids' problematic behavior. "When you believe the medications work, you're awfully tempted," he says. "But we must not be seen as pill-pushers."
The profession, he adds, will need better research to justify the growth in diagnoses.
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Making a decision
That research will come too late to help Katie judge what's best for her daughter.
She fears that the proposed antipsychotic medication will exacerbate the child's weight problem and "deaden her spirit."
She looks up bipolar disorder on the Internet and sees that while many of the symptoms described are "spot on," many don't fit her daughter at all -- or worse, could fit any child with a difficult temperament, a flair for drama or a challenging family situation.
As she wavers at the threshold of a decision, Katie leans toward acceptance of her daughter's diagnosis and the pills that will probably come with it. "I've struggled to come up with an answer. This is at least something I can do," she says.
She is sad but resigned to choosing without full information. "All I can do, in the end, is love her and make the best decisions I can at the time," she says. "That's the blessing and curse of being a parent. It's never going to be perfect."
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melissa.healy@latimes.com
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Fine-tuning all those labels
