The argument that healthcare professionals have a tendency to over-diagnose patients has rumbled on for decades. It’s estimated that a staggering 4 per cent of the US population has at some stage been prescribed methylphenidate (commonly referred to by its trade-name Ritalin), lending credence to the claim that misdiagnosis for mental health conditions is common. You may have had first-hand experience of the damaging effect of a psychiatric (mis)diagnosis on one of your patients or relatives.
Neuropsychiatrist Dr Gualtieri has coined the term spectrum of innocents to describe people who were misdiagnosed with depression, anxiety, autism or attention deficit disorder (ADD) and prescribed Ritalin, whereas in actuality they ‘only’ had obsessive compulsiveness (OC). In his book he sets out to debunk the myth of a contemporary epidemic of narcissism, autism and ADD. A key contention of his is that OC may in fact not be properly considered, while it is found in 30 per cent of us. While not a disorder, it can nevertheless positively or negatively impact people’s lives.
It is a dimensional trait, characteristic of a highly active analytical mind endowed with intelligence and sensitivity. People with OC are typically fussy, perfectionist, anxious, eccentric, rigid and controlling – but often very smart. Dr Gualtieri provides an exhaustive account of the different types of people displaying OC, explaining the brain mechanisms that produce and sustain it. He also makes it clear that this is not a self-help book and does not offer any indication of treatment.
Obsessive Compulsions is a well-written and frequently insightful examination of OC, but in focusing purely on the neuroscientific perspective, it perhaps neglects the person. A symptom cannot be simply read as an altered circuit in the brain, divorced from the personal and social context of the patient. Its meaning and function should be interpreted within the complexities inherent in the construction of their personality. As a standalone piece of work, it risks a rather reductive understanding of OC.
- Reviewed by Dr Lucia Giombini, Senior Clinical Psychologist
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