Finally, a revolt against the Editors of the DSM (Manual of Mental Disorders)

Reply Thu 9 Feb, 2012 11:45 pm
LONDON — Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and "tick-box" diagnosis systems were at best "silly" and at worst "worrying and dangerous."
Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medicalising behaviors most people would consider normal or just mildly eccentric, the experts said.
At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.
The DSM is published by the American Psychiatric Association (APA) and has descriptions, symptoms and other criteria for diagnosing mental disorders. It is used internationally and is seen as the diagnostic "bible" for mental health medicine.
More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.
"The proposed revision to DSM ... will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don't fit nicely into those boxes," said Peter Kinderman, a clinical psychologist and head of Liverpool University's Institute of Psychology at a briefing about widespread concerns over the book in London.
He said the new edition - known as DSM-5 - "will pathologise a wide range of problems which should never be thought of as mental illnesses."
"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill," he said. "It's not humane, it's not scientific, and it won't help decide what help a person needs."
Simon Wessely of the Institute of Psychiatry, King's College London said a look back at history should make health experts ask themselves: "Do we need all these labels?"
He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognizing 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.
Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would "radically and recklessly expand the boundaries of psychiatry" and result in the "medicalisation of normality, individual difference, and criminality."
As an unintended consequence, he said an emailed comment, many millions of people will get inappropriate diagnoses and treatments, and already scarce funds would be wasted on giving drugs to people who don't need them and may be harmed by them.
Nick Craddock of Cardiff University's department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM's broad categories were going wrong.
Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.
Other examples of diagnoses cited by experts as problematic included "gambling disorder," "internet addiction disorder" and "oppositional defiant disorder" - a condition in which a child "actively refuses to comply with majority's requests" and "performs deliberate actions to annoy others."
"That basically means children who say 'no' to their parents more than a certain number of times," Kinderman said. "On that criteria, many of us would have to say our children are mentally ill."


It is about damn time,,,,the DSM some time ago became more a political document of the victim culture advocates than it is a medical treatment guide.
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Reply Fri 10 Feb, 2012 08:36 am
I've been reading quite a bit of criticism about the revisions.

Jon Ronson's book "The Psychopath Test" gives a brief history of the DSM and how pharmaceutical companies have been a major player in getting more and more conditions labeled as mental illness. I think there could be some truth to that, maybe a lot of truth to that.

It also serves the psychiatric profession to have more things to diagnose and treat.

Despite all the fanfare about "outliers" we certainly seem to look for ways to normalize everyone.
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Reply Fri 10 Feb, 2012 09:10 am
**** andy warhol and his 15 minutes of fame, everybody get's a syndrome instead
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Reply Fri 10 Feb, 2012 08:47 pm
I was diagnosed with aspergers syndrome, a neurodevelopmental 'disorder', which deviates from typical neurology, it is of autistic spectrum 'disorders'.

Yet, by definition, my intelligent quotient is measured in a moderate to high continuum.

I do not personally interpret social science valid, it is greedy reductionalism and normative arguementation.

I am glad that I am atypical, are athletes or high intelligence typical?

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Reply Sat 11 Feb, 2012 02:04 am
It is about damn time,,,,the DSM some time ago became more a political document of the victim culture advocates than it is a medical treatment guide.

It's about damn time for what?

These objections are simply to the inclusion or exclusion of certain diagnoses from the next edition of the DSM. For instance, excluding bereavement as a normal grieving process, which is how it is now classified, and instead labeling the symptoms of grieving as depression, which would make it a mental disorder. Or eliminating autism spectrum disorders, which currently includes Asperger's Syndrome, altogether from the next edition. Something like oppositional defiant disorder isn't a new proposal, it's in the current DSM-IV.

The DSM is not a "medical treatment guide" nor was it really ever intended to be such a guide. It's a classification system for mental disorders that allows for the gathering of statistical information, but its primary use is for insurance reimbursement and the provision of other services to the mentally ill. If the condition isn't listed in the DSM, insurance companies won't reimburse the treatment. And that not only affects patients, it affects the income of psychiatrists.
And, the current controversy about whether to eliminate the autism spectrum disorders centers on just those issues--many of those currently receiving psychiatric treatment, or special education services, would be deprived of such things if this diagnostic category was eliminated from the next edition as has been proposed. But is it a valid diagnostic category reflective of a true mental disorder? That's what the debate is about.

This has nothing to do with "victim culture". It has to do with whether or not the diagnostic categories describe specific clearly differentiated disorders, rather than vague entities that are "catch-alls", and whether certain behaviors should even be considered "mental disorders".

And a great deal of political in-fighting within the field of psychiatry enters into these debates. Will certain behaviors be labeled as mental illness so psychiatrists will be able to treat a new group of potential patients? Will there be benefits to the pharmaceutical manufacturers, as well as to psychiatrists, for including new diagnoses for which meds can then be prescribed? Will insurance companies save money if certain diagnoses are eliminated? A great many consequences of what will be excluded or included in the DSM-5 are monetary, and financial considerations and pressures, whether overt or covert, affect the debate about what to include and exclude from the DSM-5.

In addition, the concept of mental illness has become increasingly medical/physiological/neurological within the field of psychiatry, predisposing toward pharmaceutical drug treatments, a conceptual framework that not all psychiatrists share, and that those in allied mental health professions may also not share. So those factors also enter into the current debate about what to include or exclude from the DSM-5. Different mental health professionals can view mental illness, and what constitutes mental illness, from very different perspectives. While there are considerable agreements, there are also disagreements, and there may be no clear-cur scientific basis for resolving the differences.

I've followed some of the debate regarding the autism spectrum disorders in the New York Times, and I will read the information on the petition link you posted,
But I'm not sure that any of this qualifies as a real "revolt" that's any different than the usual cantankerous debate that always accompanies any revision of the DSM--there are always loud and vocal disagreements because there are competing interests and competing factions, and competing ideas. And the voices of dissent are often ignored, or only minimally appeased. The only difference this time round seems to be the use of the internet to disseminate information and gather signatures on a petition. It remains to be seen whether that will exert a significant influence of any sort.

I can't say that I see any validity, at all, to this statement
the DSM some time ago became more a political document of the victim culture advocates...

I can't see how "victim culture advocates" enter into this at all. What on earth are you talking about?
It's more about political power struggles within the field of psychiatry itself, and between psychiatry and other allied mental health professions, in terms of what gets classified as a mental disorder.

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Reply Mon 30 Apr, 2012 12:21 am
Psychiatry’s bible, the DSM, is doing more harm than good

It would be less troubling if such diagnoses helped patients, but getting a label often hinders recovery. It can lead a therapist to focus on narrow checklists of symptoms, with little consideration for what is causing the patient’s suffering.

The marketing of the DSM has been so effective that few people — even therapists — realize that psychiatrists rarely agree about how to label the same patient. As a clinical and research psychologist who served on (and resigned from) two committees that wrote the current edition of the DSM, I used to believe that the manual was scientific and that it helped patients and therapists. But after seeing its editors using poor-quality studies to support categories they wanted to include and ignoring or distorting high-quality research, I now believe that the DSM should be thrown out


Paula J. Caplan, a clinical and research psychologist, is a fellow in the Women in Public Policy Program at Harvard’s Kennedy School of Government. She is the author of “They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.
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