DSM 5 has suddenly become a star press attraction. In just the last three weeks, more than 100 news stories featuring DSM 5 appeared in major media outlets located in more than a dozen countries. (For a representative sample see Suzy Chapman's post on Dx Revision Watch.) The explosion of interest started with a flurry when The New York Times published two long DSM 5 articles and three DSM-5-related op-ed pieces, all within a few days. An unrelated press conference in London then generated a widely distributed Reuters story and also many independent pieces. Several other reporters had also been working on their own DSM 5 stories that just happened to arrive at the same time.
The intense press scrutiny of DSM 5 is really just beginning. I know of at least 10 additional reporters who are preparing their work now for publication in the near future. And many of the journalists whose articles appeared during these last few weeks intend to stay on this story for the duration -- at least until DSM 5 is published, and probably beyond. They understand that DSM 5 is a document of great individual and societal consequence -- and that its impact and risks need a thorough public airing.
The press coverage has been almost uniformly and devastatingly negative. The two most common themes are 1) DSM 5 will radically expand the boundaries of psychiatry, medicalising normality and leading to unneeded and harmful treatment; and 2) DSM 5 decisions are being made arbitrarily, based on narrow input and lacking sufficient scientific support. The DSM 5 proposals that have elicited the most concern are changes in the definition of autism and the expansion of major depressive disorder to capture much of normal grief.
The articles sometimes contain small inaccuracies and sometimes emphasize peripheral issues. And the most dangerous DSM 5 proposals get far too little mention. I will discuss in later blogs how DSM 5 will worsen the over-diagnosis of attention-deficit disorder and the over-prescription of antipsychotic mediation. But the press has gotten the main points just right and somehow manages to see the risks of DSM 5 much more clearly than do the people working on it.
Will the American Psychiatric Association finally listen to this concentrated chorus of criticism? At a critical 11th hour, when all else has failed, will the world's reporters save DSM 5 from itself? Is the power of the pen mightier than the thick walls that have so far protected DSM 5 from self-correction? Can the irresistible force of the press move the previously immovable DSM 5 object?
The initial DSM 5 responses are not encouraging -- the usual brew of inaccurate, misleading, and unconvincing statements that never tackle any of the issues in a substantive way. And APA has previously proven itself to be remarkably oblivious, dogged, and stubborn. During these past two years, DSM 5 has made almost no changes in its proposals -- despite their having received widespread criticisms. APA has also casually shrugged off a petition opposing many DSM 5 proposals and requesting that they be subjected to an independent scientific review. The fact that the petition is endorsed by no fewer than 47 different and substantial mental health organizations seems to have carried no weight whatever. And APA dismisses the plan of many previous users to boycott DSM 5 by substituting the alternative coding system of ICD-10-CM (which will be freely available on the Internet).
Will the unfavorable press result in a more favorable DSM 5 outcome? Surely we must hope so -- because so few other corrective options are available. DSM 5 remains steadfast and rigid in its support of really bad proposals with extremely dangerous unintended public health consequences. A very small group of out-of-touch DSM 5 experts is now extremely close to achieving what amounts to a radical coup -- redefining a greatly expanded psychiatry at the expense of a quickly shrinking normality. The many expressions of professional and public opposition from outside this hermetically sealed inner circle have been ignored almost completely.
But I have some hope that this concentrated press barrage may succeed where previous efforts have failed. It is fair to say that DSM 5 has become an object of general public and professional scorn. Perhaps now at last, prodded by the world press, DSM 5 will have to heed the unanimous cautionary warnings. Let's hope it will finally come to its senses and cut its losses by rejecting the worst proposals. This will be a service to psychiatry and, most important, to our current and future patients. Paradoxically, the terribly embarrassing press it is receiving now may save DSM 5 and APA much greater embarrassment in the future and, more importantly, prevent the mislabeling as mentally ill of literally millions of people, and their potential exposure to unnecessary and risky medications.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
Broadening the scope of diagnostics should not be a problem. If someone has schizophrenia, borderline, bipolar, autism, ADHD, or any other diagnosed condition is not a diagnostic problem. These conditions are not an issue if an individual has found a career, relationships, and living life fully with the condition, then the condition is not an issue. It is when a person comes in with problems in their lives. Often, these conditions are the source of their problems and are issues, and they should be diagnosed, addressed, and recieve the best treatment available. By not broadening the diagnosis, a person may leave with issues that are not attended to.
I am sorry to all the anti-drug people out there, but that is where the future is heading and they do save lives.
If you really want to pitch the bitc_h, gripe to the insurance companies that will pay for drugs, but not for counseling. Many drugs are ineffective in treatment without counseling. If insurance companies readily covered counseling, we would see more recoveries. It is the system, not the APA that is the problem.
Currently, autism is often used to label a whole spectrum of conditions, like aspergers. I could understand why well defined autism would be given a narrow diagnosis in favor of giving newer terminologies for conditions more on the edges of the present autism spectrum. If so, a child with the new label should not lose funding. Insurance and mental health programs need to be brought to speed dealing with redefined conditions. We did this some time ago with schizophrenia.
I have more fear of how insurance companies are going to deal with changes than what the APA decides to do.
I do have a concern about how broad the input will be from the psychological community in creating these changes. Broader input on changes would alleviate concerns, even if they are not what a journalist would like to hear.
- Jeff Kane, MD
healthcareasthoughpeoplematter.blogspot.com
And then please show to me that only such scientists can be absolutely neutral.
Dr. Frances, by the way, was also the recipient of large industry grants and has been smeared in just the same way.
JFYI
:-)
I am sure there must be some. So why can't anybody here take the time and cite them for their cause?
How about it?
In any case... early versions of the manual characterised homosexuality as a disorder... and it took quite an effort to remove this from the manual. So the past was not always better. Shouldn't you know that as an ardent defender of that past? Or maybe that's just the kind of DSM you WANT?
:-)
Thank you.
In scientific discourse you exchange arguments based on DATA, you do not appeal to the press to beat your opponent to submission.
Sorry if you can't understand that, despite your "35 years of experience".
However, maybe YOU want to start citing medial journal articles that prove that the new DSM definitions are plain wrong?
Or should we believe that the psychologist on either side of this "debate" prefer chest-beating ("I have more clinical experience than you!") over proper scientific discourse?
Or do you basically want to claim that I have to do your homework to prove that what you are telling me is correct? What kind of attitude is that?
How hard is that? Pick any one. We are listening. We would love to hear it. Forget about the press. Treat us like you would treat an audience of peers and write a short scientific rebuttal to it.
You would help your case much more if you did that, than to continue this childish mud slinging that has been going on for the past weeks on Huffpo.
I will be waiting... although I do have a strong feeling that I will be waiting for naught.
Do the math, sir: If, as it has been accepted for decades, we assume the prevalence of ADHD in the general population falls within the 8-11% range, then based on a population of 300 million, there should be approximately 30 million people with ADHD in America.
THE NUMBER OF PERSONS DIAGNOSED WITH ADHD IS FAR BELOW THAT NUMBER.
This writer, like so many, fall into the logical fallacy that presumes that if "more" people are being diagnosed now than previously, then the extras must by the product of "over-diagnosing." BUT, what if this population has spent a century being UNDER-diagnosed? (Check what the Journal of the American Medical Association opined on the subject—they also found little evidence to support the "over-diagnosis" claim.)
Surely, there are mistakes being made in evaluations for attention problems, but in the years I've devoted to studying this condition, I've come to realize that more diagnoses are MISSED than are mistaken.
To present the idea that otherwise is the case constitutes an error in logic called "begging the question." This topic deserves more serious consideration than a half-hearted and ill-conceived logical fallacy promulgated by someone whose motivations are unclear.