CHICAGO芝加哥 - America美國 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.達到了一個點，那裡幾乎有一半的人口是被描述為在某種程度上患有精神病，而有將近四分之一的公民-6 7500000-已採取抗抑鬱藥。

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.這些統計數字都激起了廣泛的，有時相差甚大辯論，是否有人正在遠遠超過用藥需要的問題，甚至可能沒有精神失常。 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.研究報告顯示， 40 ％的患者都屬於短期的診斷，醫生和精神病醫生給他們，但200000000處方書面每年在美國治療抑鬱和焦慮。 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.那些捍衛這種廣泛使用的處方藥堅持的一個重要部分的人口是治療不足，並通過推理，下藥。 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.那些反對這種猖獗使用藥物的注意，診斷率為雙相情感障礙，尤其是飛漲4000 ％ ，而該過量是不可能的，沒有過多的診斷。

To help settle this long-standing dispute, I studied why the number of recognized psychiatric disorders has ballooned so dramatically in recent decades.以幫助解決這個長期存在的爭端，我研究了為什麼一些公認的精神病已經膨脹得那麼厲害，在最近幾十年裡。 In 1980, the Diagnostic and Statistical Manual of Mental Disorders added 112 new mental disorders to its third edition, DSM-III. 1980年，診斷與統計手冊精神失常補充說： 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多失常出現在第三次修訂版於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.擁有超過100萬本，印刷的，這本手冊稱為聖經的美國精神病學;當然這是一個引用章和韻文在學校，監獄，法院，由心理健康專業人員世界各地。 The addition of even one new diagnostic code has serious practical consequences.加上連一個新的診斷代碼已經造成嚴重的實際後果。 What, then, was the rationale for adding so many in 1980?那麼，到底是什麼是理加入這麼多，在1980年呢？

After several requests to the經過多次請求給 American Psychiatric Association美國精神病學協會 , I was granted complete access to the hundreds of unpublished memos, letters, and even votes from the period between 1973 and 1979, when the DSM-III task force debated each new and existing disorder. ，我是理所當然的完全接觸到數以百計的未發表的備忘錄，信件，甚至從票日期間， 1973年和1979年，當DSM的三專責小組，進行每一項新的和現有的障礙。 Some of the work was meticulous and commendable.有些工作是細緻和稱道。 But the overall approval process was more capricious than scientific.不過，整體而言審批程序更加反复無常，比科學化。

DSM-III grew out of meetings that many participants described as chaotic. DSM的III型的前身是會議的許多與會者形容為一片混亂。 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.一位觀察員稍後表示，少量的研究後得出的是"真正的大雜燴-分散，不一致，模糊的"興趣和專長的工作隊是有限的，以一間分行的精神病：神經精神科。 That group met for four years before it occurred to members that such one-sidedness might result in bias.該工作組舉行了四年前，它發生在各位委員，這種片面性，可能會導致偏見。

Incredibly, the lists of symptoms for some disorders were knocked out in minutes.難以置信的是，名單上的症狀，有些失常被淘汰，在分鐘。 The field studies used to justify their inclusion sometimes involved a single patient evaluated by the person advocating the new disease.該領域的研究用來證明其列入有時涉及一個單一的病人評價的人鼓吹新的疾病。 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.專家敦促列入疾病商榷"慢性未分化的不滿紊亂" ， "慢性投訴錯亂" ，其特徵包括：喉嚨堵約稅費，天氣，甚至體育的成果。

Social phobia, later dubbed “social anxiety disorder,” was one of seven new anxiety disorders created in 1980.社交恐懼症，後來被命名為"社會焦慮症" ，是一個7個新的焦慮障礙創造於1980年。 At first it struck me as a serious condition.起初，它給我的，因為一人傷勢嚴重。 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年代專家們把它稱為"無序的十年中， "堅持有多達五分之一的美國人患有它。 Yet the complete story turned out to be rather more complicated.然而，完整的故事，最終被證明，而不是更加複雜化。 For starters, the specialist who in the 1960s originally recognized social anxiety -首先，專家，他們在20世紀60年代最初承認的社會焦慮- London倫敦 -based基於 Isaac Marks艾薩克標誌 , a renowned expert on fear and panic - strongly resisted its inclusion in DSM-III as a separate disease category.一位著名的專家對恐懼和驚慌-堅決抵制其列入D SM的第三階段作為一個單獨的疾病種類。 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.名單上的共同行為與混亂令他猶豫不決：害怕獨自吃在餐館，避免公廁，並關注用顫抖的雙手。 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.經過一段時期的修訂工作隊補充說，不喜歡在公眾場合演講，在1987年，無序似乎不夠彈性，以包括幾乎所有的星球。

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.為了對付印象是，它在談到共同的恐懼到可治療的情況下， DSM的第四階段增加了一項條款，規定社交焦慮的行為，已被"損害" ，才診斷是可能的。 But who was holding the prescribers to such standards?但誰是持有處方，以這樣的標準呢？ Doubtless, their understanding of impairment was looser than that of the task force.毫無疑問，他們的理解減值是鬆散比的專責小組。 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.畢竟，儘管減值條款，焦慮症，如雨後春筍;到2000年，它是第三個最常見的精神障礙在美國，僅次於抑鬱和酗酒等。

Over-medication would affect fewer Americans if we could rein in such clear examples of over-diagnosis.過度用藥會影響美國人少，如果我們能夠懸崖勒馬，在這種明顯的例子，過度診斷。 We would have to set the thresholds for psychiatric diagnosis a lot higher, resurrecting the distinction between chronic illness and mild suffering.我們將要設定門檻，為精神科診治了大量較高，復活區分慢性疾病和溫和的痛苦。 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.不過，有激烈的抵抗，這是由那些說他們正在爭奪嚴重的精神障礙，而這些藥物是唯一可行的治療。 Failure to reform psychiatry will be disastrous for public health.不改革，精神科將是災難性的，為市民的健康。 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.認為冷漠，過度購物，和過度使用互聯網，都認真對待，列入下一版的用電需求管理，由於出現在2012年。 If the history of psychiatry is any guide, a new class of medication will soon be touted to treat them.如果歷史上的精神病學是任何指導，一類新的藥品將很快推出對待他們。 Sanity must prevail: if everyone is mentally ill, then no one is.理智必須佔上風：如果每個人都患有精神病，那麼沒有人。

Mr. Lane, a professor of English at 先生裡，一位教授英語的 Northwestern University 西北大學 , is the author of “Shyness: How Normal Behavior Became a Sickness.” ，是作者的"害羞：如何一反常態成了疾病" 。

CHRISTOPHER LANE 克里斯托弗裡

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