CHICAGO芝加哥 - America美国 has reached a point where almost half its population is described as being in some way mentally ill, and nearly a quarter of its citizens - 67.5 million - have taken antidepressants.达到了一个点，那里几乎有一半的人口是被描述为在某种程度上患有精神病，而有将近四分之一的公民-6 7500000-已采取抗抑郁药。

These statistics have sparked a widespread, sometimes rancorous debate about whether people are taking far more medication than is needed for problems that may not even be mental disorders.这些统计数字都激起了广泛的，有时相差甚大辩论，是否有人正在远远超过用药需要的问题，甚至可能没有精神失常。 Studies indicate that 40% of all patients fall short of the diagnoses that doctors and psychiatrists give them, yet 200 million prescriptions are written annually in America to treat depression and anxiety.研究报告显示， 40 ％的患者都属于短期的诊断，医生和精神病医生给他们，但200000000处方书面每年在美国治疗抑郁和焦虑。 Those who defend such widespread use of prescription drugs insist that a significant part of the population is under-treated and, by inference, under-medicated.那些捍卫这种广泛使用的处方药坚持的一个重要部分的人口是治疗不足，并通过推理，下药。 Those opposed to such rampant use of drugs note that diagnostic rates for bipolar disorder, in particular, have skyrocketed by 4,000% and that overmedication is impossible without over-diagnosis.那些反对这种猖獗使用药物的注意，诊断率为双相情感障碍，尤其是飞涨4000 ％ ，而该过量是不可能的，没有过多的诊断。

To help settle this long-standing dispute, I studied why the number of recognized psychiatric disorders has ballooned so dramatically in recent decades.以帮助解决这个长期存在的争端，我研究了为什么一些公认的精神病已经膨胀得那么厉害，在最近几十年里。 In 1980, the Diagnostic and Statistical Manual of Mental Disorders added 112 new mental disorders to its third edition, DSM-III. 1980年，诊断与统计手册精神失常补充说： 112新的精神疾病，其第三版局， DSM -三。 Fifty-eight more disorders appeared in the revised third edition in 1987 and fourth edition in 1994. 58多失常出现在第三次修订版于1987年第4版是在1994年。

With over a million copies in print, the manual is known as the bible of American psychiatry; certainly it is an invoked chapter and verse in schools, prisons, courts, and by mental-health professionals around the world.拥有超过100万本，印刷的，这本手册称为圣经的美国精神病学;当然这是一个引用章和韵文在学校，监狱，法院，由心理健康专业人员世界各地。 The addition of even one new diagnostic code has serious practical consequences.加上连一个新的诊断代码已经造成严重的实际后果。 What, then, was the rationale for adding so many in 1980?那么，到底是什么是理加入这么多，在1980年呢？

After several requests to the经过多次请求给 American Psychiatric Association美国精神病学协会 , I was granted complete access to the hundreds of unpublished memos, letters, and even votes from the period between 1973 and 1979, when the DSM-III task force debated each new and existing disorder. ，我是理所当然的完全接触到数以百计的未发表的备忘录，信件，甚至从票日期间， 1973年和1979年，当DSM的三专责小组，进行每一项新的和现有的障碍。 Some of the work was meticulous and commendable.有些工作是细致和称道。 But the overall approval process was more capricious than scientific.不过，整体而言审批程序更加反复无常，比科学化。

DSM-III grew out of meetings that many participants described as chaotic. DSM的III型的前身是会议的许多与会者形容为一片混乱。 One observer later remarked that the small amount of research drawn upon was “really a hodgepodge - scattered, inconsistent, and ambiguous.” The interest and expertise of the task force was limited to one branch of psychiatry: neuropsychiatry.一位观察员稍后表示，少量的研究后得出的是"真正的大杂烩-分散，不一致，模糊的"兴趣和专长的工作队是有限的，以一间分行的精神病：神经精神科。 That group met for four years before it occurred to members that such one-sidedness might result in bias.该工作组举行了四年前，它发生在各位委员，这种片面性，可能会导致偏见。

Incredibly, the lists of symptoms for some disorders were knocked out in minutes.难以置信的是，名单上的症状，有些失常被淘汰，在分钟。 The field studies used to justify their inclusion sometimes involved a single patient evaluated by the person advocating the new disease.该领域的研究用来证明其列入有时涉及一个单一的病人评价的人鼓吹新的疾病。 Experts pressed for the inclusion of illnesses as questionable as “chronic undifferentiated unhappiness disorder” and “chronic complaint disorder,” whose traits included moaning about taxes, the weather, and even sports results.专家敦促列入疾病商榷"慢性未分化的不满紊乱" ， "慢性投诉错乱" ，其特征包括：喉咙堵约税费，天气，甚至体育的成果。

Social phobia, later dubbed “social anxiety disorder,” was one of seven new anxiety disorders created in 1980.社交恐惧症，后来被命名为"社会焦虑症" ，是一个7个新的焦虑障碍创造于1980年。 At first it struck me as a serious condition.起初，它给我的，因为一人伤势严重。 By the 1990s experts were calling it “the disorder of the decade,” insisting that as many as one in five Americans suffers from it.到了1990年代专家们把它称为"无序的十年中， "坚持有多达五分之一的美国人患有它。 Yet the complete story turned out to be rather more complicated.然而，完整的故事，最终被证明，而不是更加复杂化。 For starters, the specialist who in the 1960s originally recognized social anxiety -首先，专家，他们在20世纪60年代最初承认的社会焦虑- London伦敦 -based基于 Isaac Marks艾萨克标志 , a renowned expert on fear and panic - strongly resisted its inclusion in DSM-III as a separate disease category.一位著名的专家对恐惧和惊慌-坚决抵制其列入D SM的第三阶段作为一个单独的疾病种类。 The list of common behaviors associated with the disorder gave him pause: fear of eating alone in restaurants, avoidance of public toilets, and concern about trembling hands.名单上的共同行为与混乱令他犹豫不决：害怕独自吃在餐馆，避免公厕，并关注用颤抖的双手。 By the time a revised task force added dislike of public speaking in 1987, the disorder seemed sufficiently elastic to include virtually everyone on the planet.经过一段时期的修订工作队补充说，不喜欢在公众场合演讲，在1987年，无序似乎不够弹性，以包括几乎所有的星球。

To counter the impression that it was turning common fears into treatable conditions, DSM-IV added a clause stipulating that social anxiety behaviors had to be “impairing” before a diagnosis was possible.为了对付印象是，它在谈到共同的恐惧到可治疗的情况下， DSM的第四阶段增加了一项条款，规定社交焦虑的行为，已被"损害" ，才诊断是可能的。 But who was holding the prescribers to such standards?但谁是持有处方，以这样的标准呢？ Doubtless, their understanding of impairment was looser than that of the task force.毫无疑问，他们的理解减值是松散比的专责小组。 After all, despite the impairment clause, the anxiety disorder mushroomed; by 2000, it was the third most common psychiatric disorder in America, behind only depression and alcoholism.毕竟，尽管减值条款，焦虑症，如雨后春笋;到2000年，它是第三个最常见的精神障碍在美国，仅次于抑郁和酗酒等。

Over-medication would affect fewer Americans if we could rein in such clear examples of over-diagnosis.过度用药会影响美国人少，如果我们能够悬崖勒马，在这种明显的例子，过度诊断。 We would have to set the thresholds for psychiatric diagnosis a lot higher, resurrecting the distinction between chronic illness and mild suffering.我们将要设定门槛，为精神科诊治了大量较高，复活区分慢性疾病和温和的痛苦。 But there is fierce resistance to this by those who say they are fighting grave mental disorders, for which medication is the only viable treatment.不过，有激烈的抵抗，这是由那些说他们正在争夺严重的精神障碍，而这些药物是唯一可行的治疗。 Failure to reform psychiatry will be disastrous for public health.不改革，精神科将是灾难性的，为市民的健康。 Consider that apathy, excessive shopping, and overuse of the Internet are all serious contenders for inclusion in the next edition of the DSM, due to appear in 2012.认为冷漠，过度购物，和过度使用互联网，都认真对待，列入下一版的用电需求管理，由于出现在2012年。 If the history of psychiatry is any guide, a new class of medication will soon be touted to treat them.如果历史上的精神病学是任何指导，一类新的药品将很快推出对待他们。 Sanity must prevail: if everyone is mentally ill, then no one is.理智必须占上风：如果每个人都患有精神病，那么没有人。

Mr. Lane, a professor of English at 先生里，一位教授英语的 Northwestern University 西北大学 , is the author of “Shyness: How Normal Behavior Became a Sickness.” ，是作者的"害羞：如何一反常态成了疾病" 。

CHRISTOPHER LANE 克里斯托弗里

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