Calling for a little reflection on this whole paraphilia-hebephilia-whateverphilia diagnostic craze is Scientific American columnist Jesse Bering, a research psychologist at Queen's University Belfast:
Predicting a flawed manual that "will haunt psychiatry for many years to come," the chair of the DSM-IV Task Force has issued an urgent call to the American Psychiatric Association to change course on its revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) before it is too late.
Allen Frances' strongly worded appeal in the Psychiatric Times predicts the DSM-V -- scheduled for publication in May 2012 - will usher in a flood of new mental disorders that will medicalize normality, producing "a bonanza for the pharmaceutical industry but at a huge cost to the new false-positive patients caught in the excessively wide DSM-V net."
"In my experience, experts on any given diagnosis always worry a great deal about missed cases but rarely consider the risks of creating a large pool of false positives—especially in primary care settings. The experts' motives are pure, but their awareness of risks is often naive. Psychiatry should not be in the business of inadvertently manufacturing mental disorders."
Frances makes special note of the potential for "unpredictable and consequential" unintended consequences in forensic settings:
"Years after the DSM-IV was completed, we learned about the enormous unintended impact of a seemingly slight wording change we made only for technical reasons in the section on paraphilias. A misreading of our intentions in making the change had led to great confusion -- with forensic evaluators using the diagnosis of paraphilia not otherwise specified to justify the sometimes inappropriate lifetime psychiatric commitment of rapists who had no real mental disorder."
This prediction is prophetic in light of current lobbying efforts by the paraphilias subworkgroup to create a new "pedohebephilic disorder" category that could vastly expand sex offender diagnosis, proving a bonanza for the sexual offender civil commitment industry.
Frances is highly critical of the "inexplicable secrecy and the lack of openness to outside influence and criticism" surrounding the DSM-V revision process.
"Restricting the free flow of ideas creates enormous blind spots that greatly increase the risk of damaging unintended consequences…. The advisory group is far too small and select to reduce, rather than encourage, heated debate. In producing a new edition of the DSM, your harshest critics eventually turn out to be your best friends because they are most likely to help you avoid pitfalls."
He is urging the American Psychiatric Association to create an external committee to review what is going on with the DSM and make recommendations to avoid serious negative consequences in the future.
Frances' important article, A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences, is available HERE.
An accompanying Q&A, DSM-V Badly Off Track, is HERE.
A spate of media coverage of wacky U.S. sex offender policies is encouraging a sense of smug superiority among the British public. From sex offenders dumped under bridges on one side of the country to those locked in high-tech prevention detention facilities on the other, it isn't the most flattering portrait of the Land of the Free.
Most recently, BBC aired a special report on the ongoing disaster under the Julia Tuttle Causeway in Florida (which I’ve blogged about several times over the past two years). The community living in squalid conditions in makeshift huts and tents under the bridge, with no running water, electricity or toilets, has hit about 70 and just keeps growing.
"Welcome to American justice," Dr. Pedro Jose Greer of Florida International University told the visiting European journalist. "This is the stupidest damn law I have ever seen…. We have people living together with mental and physical illnesses in an environment where people can't possibly sleep because of the cars going by overhead -- where you can smell the urine and see the trash mounting all around us."
If that dirty laundry isn't bad enough, the other recent coverage of U.S. sex offender policies is no more flattering to us Yanks.
Filmmaker Louis Theroux, a quirky British-American best known for his television series Louis Theroux's Weird Weekends, was granted unprecedented access to the infamous Coalinga State Hospital in California, home to about 800 men serving "indefinite sentence for offences that they haven't yet committed and might never," in the words of the review in the (London) Independent.
The resultant documentary aired on BBC, "A Place for Paedophiles," depicts "a Kafkaesque place" where not just the sex offenders but also many members of the staff look pretty darned "creepy," says the Independent.
A Sun profile of Theroux and his film took the opportunity to paint an even kookier picture for the British public:
"They have karaoke nights, put on plays, and on their birthday are thrown a party with cake, ice-cream and gifts…. [They] spend their days at the £268 million centre playing ping-pong or watching DVDs, and they even stage Coalinga Idol contests based on Simon Cowell's talent show American Idol."
After experiencing Coalinga up close and personal, Louis expressed doubt that the Americans know what they are doing when it comes to sex offenders:
"The British system is that when an offender finishes his sentence, he is released on the sex offenders' register. If he then puts a foot wrong he is hauled back to prison. It's a lot cheaper than a system like Coalinga -- and a little bit more realistic."
"Coalinga is the weirdest place I've ever been to," Theroux says in the film. "I can't quite believe it exists. In America this is the latest way of getting a handle on sex offenders…. You assume the people who run this place know what they are doing, but you do question it."
It's not terribly uncommon to hear of a woman succumbing to the allure of a ruggedly masculine prisoner.
Sometimes, the love bug bites an attorney. Other times, a female guard. Here in California, I regularly hear about female staff members from various professions caught trysting with civilly committed sex offenders at the state hospital.
Every so often, the passion overwhelms all reason, and the woman helps her boyfriend escape. Last year, we heard the odd saga of a deputy warden's wife in Oklahoma who had been living in a trailer with an escaped convict for more than a decade. (Bobbi Parker is back living with her husband while awaiting trial in that case.)
As with everything, psychologists and other professionals have tried to pigeonhole the women's motivations through labeling -- "the Bad Boy Syndrome," "the Florence Nightingale Syndrome," the abuse victim afraid of intimacy. Of course, as with most human conditions, the motivations are more complex and multidetermined than such labels can capture.
Whatever the reasons, the love bug just bit closer to home.
A 35-year-old prison psychologist has been arrested for allegedly helping in the escape of a 42-year-old killer from Frontenac Institution, a minimum-security prison in Canada where she worked.
Authorities believe Erin Danto, a U.S. citizen from Pennsylvania who had worked in the prison for about a year, had a romantic relationship with Andrew John Wood, serving time for the 1989 murder of a former friend. The two were caught together last Thursday.
In a comment to one of the news articles, someone who knows Dr. Danto called her a "true professional."
Dr. Danto's sad story is a reminder for all of us forensic and correctional psychologists. Be compassionate, but not too passionate. Don't forget the “B” word -- boundaries.
First, click the image above to watch this ad for Despondex, the first-ever prescription depressant. It brilliantly captures how the pharmaceutical industry pathologizes human conditions, mints formal diagnoses to label them, and markets lucrative medications to treat them.
Take bipolar disorder in children.
It has gone from a rare condition to a common diagnosis. In an 8-year period (1994-2002), the number of children diagnosed as bipolar increased by 4,000 percent. Yes, that's right. Four thousand percent. As with the ADHD craze a few years ago, with the diagnostic labeling has come medications for about two-thirds of the newly bipolar. Medications that cause severe long-term health consequences, such as obesity and diabetes.
Now, show me a child who doesn't have radical mood swings. As Christopher Lane describes in Shyness: How Normal Behavior Became a Sickness, the steps to creating a disorder are straightforward:
Conduct a study.
Discover a previously overlooked problem.
Label it.
Create a formal diagnosis.
Promote a treatment.
Marginalize the critics.
Through this process, the prevalence of a disorder can be made to "rise and fall as erratically as the stock market" (to quote Kutchins & Kirk from Making Us Crazy) through adjustments to the wording, symptom duration, and the number of criteria required for diagnosis.
Indeed, we are witnessing this manufacturing process in the current effort to create a bizarre new diagnosis of "pedohebephilia" for the DSM-V, as I have blogged about more than once.
But has the psychiatric-pharmaceutical juggernaut gone too far? I am probably being overly optimistic, but I find this past week's developments mildly encouraging.
First came the research study published in the June 17 issue of the Journal of the American Medical Association, announcing flaws in the much-touted 'Depression Risk Gene' study upon which so much of our popular culture's notion of mental illness rests.
That followed exposes, such as one in the Miami Herald, of pharmaceutical drugmakers' use of ghostwriters to produce ''a huge body of medical literature that society can't trust.''
Just today came two more entries in the series of critical articles about psychiatric diagnosis and the pharmaceutical industry, in newspapers on separate continents -- the London Times and the San Francisco Chronicle.
The Chronicle's lead story focused on the diagnosis of bipolar disorder among children. The London Times article promotes a new book by the brilliant Richard Bentall (whose 1994 book, Madness Explained, deservedly won the British Psychological Book Of The Year award).
Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? pulls no punches: It "paints a stark picture of a mental health system riddled with corruption and incompetence, in which shrinks live it up on pharmaceutical company cash while patients are disrespected, dehumanised and drugged to the eyeballs."
Bentall isn't some foaming-at-the-mouth anti-psychiatry extremist. He offers rational argument and scientific evidence to back up his claims about the ineffectiveness of modern psychiatric "treatment" and the weaknesses in its underlying biomedical model.
Bentall is not optimistic about change, though, because psychiatry and drug companies "have a vested interest in keeping things are they are."
I am afraid he may be right. Even in the midst of critiques pointing out the long-term harm, more people than ever are popping pills and allowing their children to pop them too. The latest rage, bipolar disorder, has so inundated popular and youth culture that it's even become an aggressive verb on the playground, as in:
"You don't watch out, man, I'm gonna go bipolar on you!"
If we don't watch out, that will be the newest mental defense to violent crime.