Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes

by Joel Paris

Overview

Dr. Joel Paris' Overdiagnosis in Psychiatry takes a much-needed look at the dangerous epidemic of unnecessary or incorrect treatments in contemporary psychiatry. The last 30 years of psychiatry have seen the development of a system of classification aimed at establishing greater scientific credibility. Unfortunately, the current categories are based entirely on signs and symptoms rather than on causes, which remain unknown. This has inevitably made diagnosis imprecise and uncertain. The result is that well-meaning professionals can have problems separating psychopathology from normality, can be unduly influenced by diagnostic fads, and can ultimately wind up prescribing treatments that do more harm than good. Paris examines prominent examples of overused diagnoses including major depressive disorder, ADHD, bipolar-II disorder, autism spectrum disorders, and PTSD. This new edition expands on Dr. Paris' argument and offers a new section on the link between aggressive psychopharmacology and current diagnostic practices, as well as on transdiagnostic approaches to classification of mental disorders.

Product Details

ISBN-13:	9780197504277
Publisher:	Oxford University Press
Publication date:	08/18/2020
Edition description:	2nd ed.
Pages:	240
Product dimensions:	8.20(w) x 5.40(h) x 0.60(d)

About the Author

Joel Paris, MD, was born in New York City, but has spent most of his life in Canada. He is Professor of Psychiatry Emeritus at McGill University and served as Department Chair for ten years. An award-winning educator who has supervised psychiatric evaluations with residents for over 40 years, Dr.
Paris is currently a Research Associate at the Jewish General Hospital, and heads personality clinics at both the McGill University Health Center and Jewish General Hospital. Dr. Paris' research focuses on borderline personality disorder, its causes, and long-term outcome. He is a former
Editor-in-Chief of the Canadian Journal of Psychiatry, has published over 200 peer-reviewed articles, and authored 23 books and 50 book chapters.

Table of Contents

Preface
Acknowledgments
Introduction
Part I. Background
1. Diagnosis in Psychiatry
2. The DSM and Its Discontents
3. Overdiagnosis and Over-Treatment
4. Science, Philosophy, and Diagnosis
Part II. Categories Most Likely to Be Overdiagnosed
5. How Major Is Major Depression?
6. Bipolar Disorders
7. Post-traumatic Stress Disorder
8. Attention Deficit Hyperactivity Disorder
9. Personality and Personality Disorder
10. Other Disorders in Which Overdiagnosis Is a Risk
PART III: CLINICAL IMPLICATIONS
11. The Rise of Aggressive Psychopharmacology
12. Transdiagnostic Approaches
Part IV. Diagnosis and Normality
13. How Do We Know What Is Normal?
14. Where Do We Go From Here?
References
Index

Editorial Reviews

Reviewer: Brett C. Plyler, M.D.(Northwestern Memorial Hospital)
Description: This is the author's polemic against normality becoming psychopathology and the overprescription of psychiatric medications and diagnoses.
Purpose: The author's purpose is to address the problem of overdiagnosis in psychiatry.
Audience: The book is written for mental health practitioners, patients, and the lay public interested in psychiatry, according to the author.
Features: The book begins with the author's prologue, which reveals the motivation behind the title and the book. The first section is background concerning the DSM and important chapters on why overdiagnosis happens in medicine in general and in psychiatry specifically. The second portion of the book examines five distinct psychiatric diagnoses and how/why they have become overdiagnosed. Each chapter looks at the progression from the DSM III until now, as well as discussing the role of the pharmaceutical industry. The third and final section focuses on normality and how we determine what is and what is not normal. The last chapter is the expected "Where do we go from here?" and includes the author's thoughts on how to get psychiatry back on track.
Assessment: I am always interested in reading what Dr. Paris has to say and this book is no exception. I agree with his fears of overdiagnosis/prescribing by "biologically minded" psychiatrists who do not take the time to consider the psychosocial aspects of patient distress, although I may not be as strident on the subject as he is. His place in the history of the DSM gives him a unique perspective on how this occurred, and I think these are the most interesting parts of the book. He delineates how psychiatry as a field wanted to be "real" medicine (leading to overdiagnosis) and how the advent of psychopharmacological advances led to the overprescription problem. The individual chapters on specific diagnoses, such as major depression, are excellent, case-in-point examples that support his argument. Dr. Paris touts a return to diagnostic validity, scientific rigor, and a better understanding of the individual patient — wonderful goals but difficult to achieve. I would highly recommend this book for anyone interested in psychiatry and, in particular, concerned about the pathologizing of normality.

Doody's Review Service

"Dr. Paris is a psychiatrist who knows his onions and so can make you weep. He weeps at the failure to recognize strengths in people rather than weaknesses, and after reading his book we should all gain from one of its key sentences 'it would probably be better to define mental health, not as happiness, but as resilience in the face of adversity'." - Peter Tyrer, Professor of Community Psychiatry, Centre for Mental Health, Imperial College, London

"Most discussions of diagnosis focus on problems with missed diagnoses or misdiagnosis. Dr. Paris does the field a great favor by focusing on the problem of overdiagnosis, and showing how it is as great a problem as underdiagnosis." - Mark Zimmerman, Professor of Psychiatry and Human Behavior, Brown Medical School, Providence, RI

"Too much medicine can be bad for your health- over-diagnosis and over-treatment are now serious public health problems. Dr Paris has provided an important pebble in the David vs Goliath battle to contain the medical-industrial complex." - Allen Frances, Professor Emeritus and former Chair Duke University and author of Saving Normal

"Dr. Joel Paris has written a wonderfully provocative book that will irritate some readers and delight others. With opinions based on his many years working in the trenches, Dr. Paris points out the problems of overdiagnosis, misdiagnose, and diagnostic epidemics that have been fueled in part by overenthusiasm for the DSM. Written in an accessible style, this book is bound to become a classic in the field." - Donald W. Black, MD, Professor, Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA

"I would highly recommend this book for anyone interested in psychiatry and, in particular, concerned about the pathologizing of normality. " — Brett C. Plyler, M.D., Doody's

From the Publisher