I am not a psychiatrist,
nor am I a chef. However, it doesn’t take a chef to know when a container of milk has gone sour. I won’t criticize the preparation of a béarnaise sauce, nor will I express an unschooled opinion on the APA’s DSM-5. There are many whose opinions on the DSM-5 call its influence into question. The National Institute for Mental Health (NIMH) withdrew its support for DSM-5 based funding requests. – Carlos
The International Reaction to DSM-5
The intense level of international interest in DSM-5 is a great surprise. Although DSM has become a research standard around the world, it is rarely used by clinicians outside the US and therefore poses a much lesser threat to their patients.
So why all the prominent newspaper, magazine, TV, and radio coverage especially in Germany, the Netherlands, England, Belgium, France, Italy, Australia, Japan, and Brazil?
Partly, there is concern that the noxious effects of DSM-5 may spread beyond our boundaries. The excessive diagnosis of ADD and autism began in the US, but these false epidemics are catchy and have now become a worldwide phenomenon.
A great example: It was announced last week that a team from Cambridge University is going to China to hunt for autism and that they anticipate placing the label on 14 million Chinese. The power of facile labeling never fails to amaze and frighten me.
And beyond the obvious practical consequences, people everywhere wonder about the cultural implications of a suddenly expanding psychiatry that is so rapidly shrinking the realm of normal. What does it say about a society if all its members are defined as sick?
The one thing that is not at all surprising in all the media coverage is its consistent tone of heated DSM criticism. People living in other countries can no more understand the lack of common sense in DSM-5 than they can understand why it remains legal in the US to own an assault rifle.
Here is a telling excerpt from a story that appeared last week in a German national newspaper. The association DGPPN described in the article stands for German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology [the English-language website refers to it as the German Association of Psychiatry, Psychotherapy and Psychosomatics], whose annual meeting is the largest in Europe and almost as large as the one held by the American Psychiatric Association. Its views on DSM-5 will carry considerable weight in Germany and be influential far beyond.
“The specialist organisation DGPPN advises against overdiagnosis in the DSM-5. There is the danger of pathologising ordinary states of suffering as well as natural adaptation and aging processes,” says Wolfgang Maier, president of the DGPPN and director of the psychiatric clinic of the University of Bonn, in a statement on Monday.
“The statement names a number of examples, where the new catalogue shifts the boundaries between health and sickness in an inadmissible way,” according to the DGPPN. Thus, in the DSM-5, a sadness of over 2 weeks after a death shall be diagnosed as depression if it shows its usual symptoms: cheerlessness, lack of drive/energy, indifference, sleeping problems, lack of appetite.
“Such an overdiagnosis constitutes a threat, which is put up with by the APA authors with open eyes,” says DGPPN president Maier. “Their premise is, we prefer false positive diagnoses before we fail to see a real sick person.” But this is, according to Maier, a calculation that doesn’t work, alone for economical reasons, at least not in Germany. One should always take into consideration that a diagnosis entitles the person affected to a provision of medical care through the system, whose resources are limited. The consequence could be that for the psychically truly sick, there will be fewer possibilities for treatment.
The credibility of DSM-5 has been irrevocably compromised by the recklessness of its decisions; the weak scientific support; and the poor reliabilities in the failed DSM-5 Field Trials. I doubt DSM-5 will remain the international standard for research journals; it will almost certainly not gain any clinical following outside the US; and it will also probably lose its role as the lingua franca of American psychiatry.
What can be done now to restore credibility? If APA were really serious about DSM-5 being a living document and subject to correction, it would immediately commission a neutral Cochrane-type review of its changes to evaluate whether they stand up to real evidence-based scrutiny. I am convinced that none would (with the possible exception of autism).
Of course, it would have been far better had DSM-5 heeded much earlier the many calls for an independent review of its scientific justification. Psychiatry would have been saved much embarrassment had DSM-5 been either self-correcting or amenable to outside correction.
But, it is much better to do this far too late than not at all. Better to admit to mistakes and regain credibility, than to soldier on and be ignored.
We must protect against the real danger that all of psychiatry will be tainted by the folly of DSM-5. This would be unfair to clinicians and dangerous for patients. Psychiatry is an essential and successful profession when it sticks to what it does well. DSM-5 was an aberration—not a true reflection of the field.
There is only one possible good that can come from this unfortunate episode. Perhaps the concern over DSM-5 will generate a serious discussion on how best to correct overdiagnosis; overmedication; and the excessive authority that has been given to psychiatric diagnosis in school decisions, disability determinations, benefit eligibility, and in forensics. Psychiatric diagnosis has become too important for its own good.
“Psychiatry often demonizes these “mental ills” by suggesting that persons “diagnosed” are an actual or potential danger, or threat to themselves and/or others, with no more evidence than the labeling description and (inadequate) process itself. It is also often asserted that these “illnesses” are incurable, justifying continued treatment (typically a drug oriented form), and offering no alternatives to drug treatment (or shock). This IS the stigma that tends to result in the conclusion (of those “diagnosed”, and others who know the person has been “diagnosed”) that people so diagnosed don’t get better and are “permanently” disabled.
AND, unfortunately long term psychiatric patients subjected to drug/shock oriented treatment often do become very physically ill, disabled, and possibly violent or suicidal as the result of the treatment, not as the result of a labeled mental illness, as those promoting psychiatric treatment often suggest. Current drug black box warnings evidence this as well as the facts about the mass shooters’ ‘mental health’ histories”- Jim Keiser
“Dr. Edward C. Hamlyn, a founding member of the Royal College of General Practitioners, in 1998 stated, ADHD is fraud intended to justify starting children on a life of drug addiction.”-unk
- ‘Modern psychiatry — with its Diagnostic and Statistical Manuals of non-existing diseases and their coercive cures — is a monument to quackery on a scale undreamed of in the annals of medicine.’ -Thomas Szaz
-“The problem with psychiatric diagnoses is not that they are meaningless, but that they may be, and often are, swung as semantic blackjacks: cracking the subject’s dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but one who wields a psychiatric diagnosis is. daisy @ Thu, 2013-06-27 16:17
The cost to people’s lives in the stigma of a diagnosis of “mental illness” is so encompassing that such a label shouldn’t be used except in exceptional cases.
If someone is accused of a crime there must be an investigation and there must be sufficient evidence; the case goes to trial and the person is listed as “innocent until proven guilty,” if they can’t afford one, a lawyer is appointed.
There are different levels of offense from petty crimes to murder 1. Even when found guilty the case can be appealed.
No such thing exists for people suffering mental distress or whose behavior is socially unacceptable. daisy @ Thu, 2013-06-27 15:43:
I’ve been a practicing psychiatrist and board-certified addictionologist for 20 years. I certainly concur that there are significant reasons to be concerned about DSM-V, as it is at present. For practicing clinicians, the courts, and the law enforcement community, the fact that there is no differentiation between different kinds of schizophrenics is quite problematic. To be more precise, paranoid schizophrenics are significantly different than other types of schizophrenics, and are likely to be far more dangerous. Therefore, it is inappropriate in my humble opinion for the American psychiatric Association and DSM-V to take the stance that they have.
MICHAEL @ Thu, 2013-06-27 11:56