In 1964, the then leader of China, Mao Zedong, published a book of quotations. It appeared in the West as the Little Red Book and, in all its forms, it became the most widely distributed book of the twentieth century. Think of it as the equivalent of the Bible for anyone interested in the Chinese version of communism. Every group writes a set of rules for itself when it gets into a position of power. Membership of the group depends on accepting the rules. The power of the group lies in the enforcement of the rules. So it is we come to the American Psychiatric Association (APA). Its rule book is called the Diagnostic and Statistical Manual (DSM). It is now in its fourth edition, last being reviewed in 1994. Why then is the blandly titled DSM so important? Well, this is the formal classification of what constitutes a mental disorder and it lists all the basic types of disorder. This has profound consequences.
If a person is merely “eccentric”, he or she will retain their liberty. But if a person has a mental disorder, he or she may be considered a danger to the community and this will justify loss of liberty and compulsory treatment. For anyone interested in the idea of civil liberties, the DSM should be compulsory reading. It is also of critical importance to the profitability of the pharmaceutical industry. It spends billions of dollars developing drugs to treat all the behavior identified as a disorder in the DSM. If the APA were to declassify behavior as a disorder, at a stroke, this could wreck the market for several high-profile drugs. Every revision of the DSM is therefore highly controversial as different interest groups dispute the latest diagnoses of disorder and all the drug companies lobby for more behavior to be classified as a disorder. This means there is a real conflict of interest within the APA, and that the DSM itself is a political rather than a medical document.
As it stands, there are proposals to reclassify some anxiety disorders and Obsessive-Compulsive Disorder. The current classification reflects the general reality that anxiety is a common denominator to many types of disorder and, for better or worse, they are all listed together. Because a neurological basis for OCD has been identified, it is proposed to treat it as a classification on its own. Some simplification is proposed by consolidating the different forms of panic disorder into one, while creating a separate classification for agoraphobia. But the proposals follow a general trend to pathologize behavior wherever possible and define it as a disorder. Thus, although anyone with agoraphobia will panic if suddenly moved into the open, treating it as a separate disorder gives the drug companies the chance to specifically target it with a new drug.
None of this political debate will have any direct effect on the sale and distribution of xanax. No matter how you define anxiety or panic, the need for a highly credible treatment is obvious. Thus, whether you get a prescription or buy xanax online, you will be getting a safe and effective treatment for what can be a seriously disruptive condition. No-one who has ever experienced out-of-control anxiety or real panic can doubt the need for this drug. No matter what ends up in the DSM 5.0, sales of this excellent drug will continue and keep anxiety and panic under control.
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