In most branches of medicine, illnesses are things that doctors have encountered over the millenia, tried to understand, and sometimes learned to treat. In psychiatry, illnesses are decided by committees. No matter how bad you feel, you can’t have one unless you meet the requirements the committees have established.
I’m talking, of course, about the Diagnostic and Statistical Manual of Mental Disorders. You might think you’re depressed, but if you don’t meet the criteria in the manual, nobody else will think so–including, notably, your physician and your insurance company.
I could go on–I’ve written about this cookbook-recipe approach to medicine before, and I always enjoy it. But I learned something today that I didn’t know about the DSM-IV, as fans and detractors refer to it. (The fourth edition is the most recent, hence the IV. I’m not sure whether the Roman numerals are an attempt to add an imposing classical flourish, or meant to subliminally suggest the Superbowl.)
Here’s what I learned:
Roughly 35,000 Americans commit suicide each year–more than die from prostate cancer or Parkinson’s disease. Another 1.1 million people make attempts, while 8 million have suicidal thoughts. Among those aged 15 to 25, it is the third leading cause of death. Yet researchers know astonishingly little about how to treat people who contemplate killing themselves. The subject has been so roundly ignored that the 900-page bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders IV, offers no advice for doctors on how to assess suicide risk.
That, to me, was a stunning revelation. I’ve spent a fair amount of time with the DSM, and I’ve read plenty of articles about what’s in it, what isn’t in it, what should be in it, and so forth. But I hadn’t known that it largely overlooked suicide.
The revelation comes not from one of the old reliable medical news sources, but from what I’m coming to believe is one of the new reliable medical news sources. Or maybe new to me, if all the rest of you have been avidly reading it and making sure I never found out about it.
The source? Forbes. Yup; the business magazine. Check out “The Forgotten Patients,” a story by Robert Langreth and Rebecca Ruiz on why the mental health industry ignores the 35,000 people a year who commit suicide, and how a few researchers are trying to change that.
The prevailing view, according to the Forbes reporters, is that suicide is a symptom of a mental illness. Cure the illness, and you prevent the suicide. But some are challenging that, saying, based on a few new studies, that it’s better to target the suicide directly–and that it can often be prevented.
The push for this new treatment is coming not from well-intentioned mental health advocates, as you might suspect, but from the military. In 2009, a record 244 active and reserve soldiers killed themselves, according to Langreth and Ruiz. They report that the military is spending $50 million on a study to try to predict and prevent suicides among its troops.
It’s a comprehensive story, rich in detail–but not bogged down by detail. Langreth is also dispensing it in bits on his Forbes blog, which is where I first saw the piece.
You might argue that this single article is not enough to conclude that Forbes is a useful medical news site, but a separate post by Langreth called my attention to a Forbes story on the nation’s 25 most-profitable hospitals. They are not necessarily who you think they are. The story, by David Whelan, is a nice example of what can happen when medical reporting is combined with business reporting. A medical reporter who didn’t concern himself or herself with the business side of things would never find this story. And it’s a good one.
So I say we should keep watching Forbes. Agreed?
– Paul Raeburn