March 1, 2010

More prominent voices join chorus of DSM5 critics

With the unveiling of the draft DSM5, the chorus of well-aimed criticisms flying in from all sides is becoming truly spectacular. The latest voices are prominent scholars writing in the eminently respectable Wall Street Journal, Los Angeles Times, and Washington Post.

All three focus on what most critics agree is an especially troubling aspect of the proposed manual -- the "wholesale medical imperialization" that eventually will label nearly every human being with one or more psychiatric pathologies. The authors of the DSM, critics assert, have appointed themselves as the arbiters of what is normal and what is not.

Wall Street Journal: Psychiatry in demise

Edward Shorter, a University of Toronto professor and preeminent scholar of the history of medicine, gives a historical overview of the DSM's development to support his verdict that the latest draft manual illustrates a discipline in demise.
To flip through the latest draft of the American Psychiatric Association's Diagnostic and Statistical Manual, in the works for seven years now, is to see the discipline's floundering writ large. Psychiatry seems to have lost its way in a forest of poorly verified diagnoses and ineffectual medications. Patients who seek psychiatric help today for mood disorders stand a good chance of being diagnosed with a disease that doesn't exist and treated with a medication little more effective than a placebo.
Los Angeles Times: Overdiagnosis gone berserk

Allen Frances, chairman of the DSM-IV task force, has been sounding the alarm over this new manual far and wide of late. This latest essay is perhaps his most eloquent to date, and of direct relevance to forensic practice in that it focuses on the proposed sexual disorders that will be used pretextually in civil commitment proceedings:
The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day -- despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

The sexual disorders section is particularly adventurous. "Hypersexuality disorder" would bring great comfort to philanderers wishing to hide the motivation for their exploits behind a psychiatric excuse. "Paraphilic coercive disorder" introduces the novel and dangerous idea that rapists merit a diagnosis of mental disorder if they get special sexual excitement from raping….
Frances urges the public to pay attention and voice opposition to psychiatry's "recklessly expansive suggestions" before the juggernaut becomes unstoppable:
This is a societal issue that transcends psychiatry. It is not too late to save normality from DSM-V if the greater public interest is factored into the necessary risk/benefit analyses.
Washington Post: George Will weighs in

Finally, prominent political columnist George F. Will weighed in on the moral implications of the proposed diagnostic expansions. Will expressed worries about the legal consequences of excusing amoral conduct as a symptom of uncontrollable illness.
The 16 years since the last revision evidently were prolific in producing new afflictions. The revision may aggravate the confusion of moral categories.

Today's DSM defines "oppositional defiant disorder" as a pattern of "negativistic, defiant, disobedient and hostile behavior toward authority figures." Symptoms include "often loses temper," "often deliberately annoys people" or "is often touchy." DSM omits this symptom: "is a teenager." …

[C]onfusion can flow from the notion that normality is always obvious and normative, meaning preferable. And the notion that deviations from it should be considered "disorders" to be "cured" rather than stigmatized as offenses against valid moral norms.
Now that just about every major news outlet in the United States has run highly critical analyses, the question becomes: Will the American Psychiatric Association listen? Or, like an individual in the throes of a manic episode, will it continue its pell-mell rush to diagnose all human behaviors, creating an ever-broader assortment of bizarre pathologies?

Hat tip: Bruce


Anonymous said...

But there is a bigger problem here. Namely, if you can't justify the new categories of mental illness how do you justify *any* of them. The real problem for the APA is that if it says no to the DSM V then how does it respond when the categories in the DSM-IV come under attack? (And they will come under attack because they came under attack in the past). There is a cogent argument that a good offense is the best defense.

Personally, I wouldn't mind if the whole DSM is put in the trash never to be seen again. But I don't think that is a realistic answer on so many levels because the DSM--for better and for worse-- is ingrained in the administrative structure of America.

So what do you do? Where is the honorable way forward? I think that's the biggest challenge facing critics (like myself) of the new revisions.

Neuroskeptic said...

Two very smart people, and George Will, today attacked DSM-V.

Anonymous said...

So, basically, this means that if a person were to question or challenge known authorities then he or she has a "mental disorder"?

Two questions: (1) How did this get entered into DSM in the first place? (2) Why hasn't it subsequently been removed?

It would seem to me that society is forcing people to think and behave a certain way, lest they be civilly committed until "treatment" for said "disorder" ensures that they unquestionably comply. This frightens me.

Anonymous said...

"Frances urges the public to pay attention and voice opposition to psychiatry's "recklessly expansive suggestions" before the juggernaut becomes unstoppable . . ."

In light of "Oppositional Defiant Disorder," we all appear to have a psychopathology for questioning such suggestions.

On which psychiatric or scientific premise would this supposed 'disorder' be based? What evidence substantiates this stance as mentally aberrant?

By the way, I see and agree with Frances' suggestions. I just do not want anyone to misconstrue my sarcasm.