Saturday, 1 July 2006

Guest Slapper of the Month VI

Red Queen of She'll be feverish after so much thinking and I have been cyber-friends for several years: we usually laugh at and get annoyed by the same things. She has a lot of common sense and a light touch. She radiates kindness, but when something gets her goat...

Mad enough to slap someone? It’s not your fault.

Yes, fellow slappers, finally, a plausible defense for our inordinate rage – we may be suffering from Intermittent Explosive Disorder (IED).

IED has been described in The Diagnostic and Statistical Manual of Mental Disorders, that bible of mental health professionals, since its 1980 edition. It is classified as an impulse control disorder, along with kleptomania, pyromania and pathological gambling. However, IED is in the news lately because a team of researchers from Harvard Medical School and The University of Chicago have found the “disease” to be far more prevalent than was previously thought, afflicting as many as 16 million Americans. They are saying IED may be to blame for the rise in “road rage” plaguing our culture.

Huh. Aren’t we all angry from time to time with the stressors of modern life? I have been known to curse at other drivers (within the confines of my own vehicle), give my PC a good whack upside when it’s acting hinky, engage in a primal scream in response to endless automated phone menus. But we’re not talking about plain old losing one’s temper. IED anger is “grossly out of proportion to any precipitating psychosocial stressors.”

Persons with IED exhibit “several discrete episodes of failure to resist aggressive impulses that result in serious acts of assault or destruction of property” over the course of a lifetime. According to the Harvard and UC researchers, IED costs sufferers an average of $1359 in property damage. That’s not much. Heck, I only need to toss my bleeping computer out the window one time to meet that figure.

Anybody buying this theory yet? The researchers have linked IED to low serotonin levels. (Serotonin is a neurotransmitter that helps mediate the body’s production of adrenaline – think “fight or flight” response.) So if IED is a disease caused by a discrete neurochemical deficit, it can be treated with – you guessed it – medication!

I’ll admit I’m frustrated with my own “industry” of mental health professionals for making it all too easy for people to avoid taking responsibility for their behavior. Such disease-mongering has been an identifiable problem for at least three decades. They doubtless deserve a slap. But my experience is that these individuals are well-meaning. I believe they as much misled as misguided. So let’s dig a little deeper and ask, Qui bono?

The study I mention was funded by the National Institutes of Mental Health, a US government agency. Sounds like it might be legit. But keep in mind that pharmaceutical companies comprise the most powerful lobby in Washington DC, with enormous influence on how government research dollars are spent. (EU members, don’t pat yourselves on the back too vigorously – roughly half of the largest drug companies are European, so this is a global problem.) According to the Henry J. Kaiser Family Foundation, in 1990 the big pharmaceutical companies allotted approximately 11 percent of sales revenues to research and development of new drugs, while more than three times that much – 36 percent – went toward “marketing and administration.” The investment is certainly paying off for them: From 1960 to 1980, prescription drug sales were fairly static as a percent of US gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year, with by far the largest increase being among neuropsychological medications.

Are you good and mad now? It’s not your fault. You’ve been provoked – 200 billion dollars’ worth. SLAP! Take that, drug companies!


  1. Actually, under the astute leadership of our current Washington administration, NIMH was prodded to yank funding from psychologists whose work wasn't directly related to biochemical processes (that is, processes that can be directly influenced by medication). The folks at NIMH were outraged by this, but since it's a national organization spending governmental money, they were between a rock and a hard place. I don't actually know what came of it (the story centered around two investigators whose work, mid-grant, was suddenly deemed low-priority, and I don't know if they retained their funding or had to give it up), but it caused ripples of alarm among the research psychology community.

    Anyway, the thing about the DSM-pick-your-version that amuses me is that it gives official names to stuff we've observed all along, but that's about it. I do think the causes of such disorders are biochemical, but not in a strictly inherited sense. I'm a big believer in recent research exploring the interaction of genes and environment. I just returned from a conference where a big name in such research was presenting studies linking schizophrenia to cannabis use in adolescence among people with two alleles of a certain gene; their risk is something like 3 times higher. Me, I'm inclined to think these men (and yes, of course they're mostly men) are at risk genetically, but multiple factors in their environment push them over the edge. And yes, I think they have control over these things, like diet and stress management habits, for instance. I'm not arguing that they're hapless victims.

    Anyway, very interesting, and a slap to the drug companies from me too, along with one to our fearless leaders, who find it more important to put money into medication than into preventive measures that would make life better for everyone (including the victims of these ragers, who might avoid being harmed if the ragers in question were able to minimize their rage BEFORE acting out rather than taking medication after the harm's already done.) As always, penny wise, pound foolish.

  2. I have a child in my class who's on Ritalin. Just the one. He's a lovely kid and it seems so wrong to dope him out of whatever behaviour was deemed unacceptable before he came to me. There are usually reasons why people react and behave in the ways they do. To medicate everyone into submission is an insult to the marvellous variety of human existence. Anything for a dollar (or Euro, Pound, Yen etc)

    Slapping with you!

  3. Winterwheat, I'm appalled along with the NIMH folks at that bit of sleight-of-funds.

    As for the DSM name-game - it is part of another national disgrace, the insurance industry. "Disease" must be codified so that it can be billed for and coverage quantified. Clinicians are pretty much forced to label any maladaptive behavior as a disease in order to receive payment for treatment, be it cognitive-behavioral therapy or medication. And of course, med outcomes are so much easier to measure, not dependent on the skill of the therapist, etc. Just a much slicker way into the pocketbook.

    JVS, don't even get me started on ADHD! How the human species ever survived before the advent of Ritalin, I just can't understand (sorry, you can't hear the dripping sarcasm in this statement!). Could it have anything to do with the number of hours we 'train' children's brains with split-second flashing images from the boob tube for 5 years before we send them to school? Or the fact that they are denied any outlet for their immense physical energy, since free play/recess is now considered too dangerous? That's a whole 'nuther slap!

  4. The whole "Anger Management Disorder" thing has me wondering. I've met about a four different men who were in programs for "My Anger Management Issues". I do believe that people have unresolved problems from the past, the thing is none of these men seemed to be getting better.

    Don't really know what to make of all of this. On the one hand these men are owning up to their problems and seeking help, which is good. On the other hand, I haven't seen a change. Maybe it takes a lot of time to work things out.

    I think that red-queen made a Dead On and excellent point about all the new labels. A lot of this all comes down to what the Insurance company need to help people. No Special label- No-MONEY.

    Don't get me started about the Attention Deficit Disorder. I've met so many mothers whose children have been put on meds to make them "Normal". They go from somewhat rambunctuous kids to little zombies. It's a damn shame, and I really feel in my heart that a lot of these children are just bored in school, or are depressed or anxious. Stuff going on in their lives that most of them probably do not need to be drugged for. What about talk therapy and other methods?

    I personally know of a very well known (in his field) Psychiatrist who would drug up Anybody unitl they have as much personality as a Potted long as they are "Nice and Calm". He is a "hero" in his field. The whole thing makes me want Very angry and makes me just want to cry. This well-respected man is in the drug companies pockets and is always testing new drugs out on whoever will be his guinea pig. I think a lot of doctors like this are out there. Pharmaceuticals are very lucrative. I hope there is a special hell for doctors like this.

    Sorry so long. Hit a nerve. Very good,wothwhile topic. I think pretty soon there will be a Disoder/Label and a matching drug for everyone breathing. To think people once just had "quirks" or were very sensitive. Guess there's no money in that.....

  5. I don't know anything statistical about mental health drugs, so this is only my feeling about society - which is that we seem not to be able to tolerate being ordinarily miserable any more. The pursuit of happiness is all very well, but I know many people who are just - well, upset to a perfectly reasonable and understandable level about something that is wrong in their lives, and when it resolves itself they feel better. Like having a difficult job, or splitting up with a partner. Yet still they go to the doctor to demand SSRIs, etc. I'm not against them feeling better, if it's possible, but I believe sometimes it stops you from solving the actual problem. I once took valium to deal with a job that had me working from 9am till 3 in the morning, with unreasonable deadlines and a lazy boss who dumped all her work on me and tried to pretend she didn't know I was working those hours (and worrying myself to death the rest of the day). I took the pills and met the deadlines. I should have resigned or fought for my boss to be removed, but the valium made me efficient and calmer and so I carried on in the bad situation.

    The same with anger management - surely there are just some people who are simply more bad-tempered than others? And I do also feel that a lot of the 'you lookin' at ME?' aggression that we get on the street daily in London is because young people have been taught endlessly about their 'rights' and nothing about their responsibilities or about citizenship and communal living. Expecting so much from life and getting so little, usually, and (in the UK anyway) given very few skills in the way of articulacy to express it in any way other than violent, no wonder they feel frustrated and furious. None of these societal issues needs medication, but it sure is easier.

    I also slap the fact that billions of dollars are spent on developing new medecines for invented middle class diseases in the first world while ignoring third world diseases that actually kill or disable people because no one wants or would be able to pay for them.

  6. Since I developed IBS I haven’t been able to take any painkillers (for backache or migraine, for instance), antibiotics or anti-histamine tablets (although I have hay fever every spring) because they all aggravate my problem. I’m scared of getting an illness that absolutely requires that kind of medication. The only thing that I can take is Valium, which sometimes works for mild pain. I only take it when there is no alternative – the problem is that these days most UK doctors refuse to prescribe it at all (do I look as if I want to live my life in a constant state of euphoria? LOL!)

    At the time of Jamie Oliver’s experiment with school dinners, everyone discovered how much children’s behaviour was influenced by what they ate. There is strong evidence that most of them are allergic to colourings and preservatives, etc. After a few weeks on wholesome food they were able to come off Ritalin and put aside their inhalers. Unfortunately, there’s nothing we can do about the lives some of them have at home (with parents who can only communicate by yelling at each other and everyone else; a constantly blaring TV; rubbishy food at every meal...) – anyone would become ‘hyper’ in such circumstances.

    After what happened to those poor people who nearly died recently when taking part in a trial for a new medicine for arthritis and may not get compensation because the company has just declared itself bankrupt, I have no hesitation in joining in this Slap.


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