Category: Report


Though Sigmund Freud was a trained neurologist, he never liked the idea of other doctors practising psychoanalysis. In a paper written in 1927, he explained that a medical degree was a disadvantage to the aspiring analyst because it would leave his head full of ideas “of which he can never make use”. There was even a “danger of its diverting his interest and his whole mode of thought from the understanding of psychical phenomena”, which ought instead to be informed by “psychology, the social sciences, the history of civilisation and sociology”. Psychoanalysis was not – not on Freud’s watch – to be “swallowed by medicine”.
It is lucky he didn’t see what happened next. Today the most widely accepted method for understanding “psychical phenomena” is one practised by doctors and dependent on concepts derived from the study of physical disease. Pre-eminent in the field is a medical institution, the American Psychiatric Association (APA), whose latest taxonomy of human suffering is published this month.

Just two weeks before DSM-5 is due to appear, the National Institute of Mental Health, the world’s largest funding agency for research into mental health, has indicated that it is withdrawing support for the manual.

In a humiliating blow to the American Psychiatric Association, Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria. Henceforth, the NIMH, which had thrown its weight and funding behind earlier editions of the manual, would be “re-orienting its research away from DSM categories.” “The weakness” of the manual, he explained in a sharply worded statement, “is its lack of validity.” “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

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In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.

The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversybecause of several contentious changes to existing diagnostic criteria.


“The strength of each of the editions of DSM has been ‘reliability’ — each edition has ensured that clinicians use the same terms in the same ways,” reads the announcement from NIMH director Thomas Insel. “The weakness is its lack of validity.” In particular, Insel notes, diagnostic criteria in the DSM are based on symptom clusters, rather than any objective measures. As experts continue to broaden their understanding of genetics and cognitive science, for instance, Insel anticipates the possibility of more rigorous diagnoses. “Patients with mental disorders deserve better,” he added.

To promote those rigorous diagnoses, the NIMH will now focus on funding research that digs into these underlying biological mechanisms. The eventual goal, Insel writes, is to collect “the genetic, imaging, physiologic, and cognitive data to see how all the data — not just the symptoms — cluster and how these clusters relate to treatment response.”

Of course, it’ll be decades before these new research programs inform diagnoses or yield new treatments for mental disorders. But for now, the move — and its timing — suggests that the “bible” of mental health might not merit that moniker for much longer.

In a statement to a session of the United Nations Human Rights Council in Geneva on March 4, the U.N. Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment of Punishment called for a ban on forced psychiatric interventions including forced drugging, shock, psychosurgery, restraint and seclusion, and for repeal of laws that allow compulsory mental health treatment and deprivation of liberty based on disability, including when it is motivated by “protection of the person or others.”

FROM: Mad in America

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs.

For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.

Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as “chemical imbalances”.

This leads us to be blind to the social and psychological causes of distress.

More importantly, we tend to prescribe medical solutions – anti-depressants and anti-psychotic medication – despite significant side-effects and poor evidence of their effectiveness.

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The criteria for “generalised anxiety disorder” would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”

Prof Peter Kinderman
This is wrong. We should not be diagnosing many more people with meaningless “mental illnesses”, telling them these stem from brain abnormalities, and prescribing medication.

Sex addiction
An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.

But this latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.

The new diagnosis of “disruptive mood dysregulation disorder” will turn childhood temper tantrums into symptoms of a mental illness
Normal grief will become “major depressive disorder”, meaning people will turn to diagnosis and prescription as a response to bereavement
The criteria for “generalised anxiety disorder” will be significantly relaxed, making the worries of everyday life into targets for medical treatment
Lower diagnostic thresholds will see more diagnoses of “adult attention deficit disorder”, which could lead to widespread prescription of stimulant drugs
A wide range of unfortunate human behaviours, the subject of many new year’s resolutions, will become mental illnesses – excessive eating will become “binge eating disorder”, and the category of “behavioural addictions” will widen significantly to include such “disorders” as “internet addiction” and “sex addiction”
Stigma of diagnosis
Standard psychiatric diagnoses are notoriously invalid – they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.

In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.

Scientific evidence strongly suggests distressing experiences result not from “faulty brains”, but from complex interactions between biological, but more importantly, social and psychological factors.

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach
There are humane and effective alternatives to traditional psychiatric diagnoses.

It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.

We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.

This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.

..”.no regulatory entity of any kind oversees the creation and publishing of psychiatric categories, psychiatric diagnosis is not grounded in high-quality science, its use does not improve outcome (does not reduce human suffering), and it carries enormous risks of harm. The kinds of harm include but are by no means limited to the loss of custody of a child, a job, one’s health insurance (or having skyrocketing premiums), and the right to make decisions about one’s medical and legal affairs. People diagnosed as mentally ill often receive poor care for their physical problems, because their reports of physical symptoms are explained away as the imaginings of a disordered brain. Victims of sexual assault are too often pathologized — often diagnosed with Bipolar Disorder, Borderline Personality Disorder, or both — rather than receiving the respectful, compassionate care they deserve. As a result, their utterly understandable upset about having been attacked is used to “prove” that they are mentally ill. Furthermore, being diagnosed makes it easy for the perpetrator to claim that the victim imagined the attack, lied about it, or brought it on herself.”

Wouter Basson is currently getting headlines for his role in waging chemical warfare for the apartheid military. But less well known is the case of apartheid doctor Aubrey Levin, who is alive and well and, until last year, was still practicing psychiatry in Canada. By REBECCA DAVIS.

They called him ‘Dr Shock’. Levin, chief psychiatrist in the apartheid-era military, earned the nickname for his belief that homosexuality could be cured by electric shock treatment. Levin’s involvement in this line of work began in the late 1960s. In 1967 the UK passed its Sexual Offences Act, which decriminalised certain homosexual acts, and the apartheid government mooted the possibility of doing the same. But into the breach stepped Levin, who wrote to the parliamentary committee in charge of considering the idea, to inform them that there was no need to take this legislative route because he could “cure” gayness.

Accordingly, Levin was appointed to Ward 22 at the Voortrekkerhoogte military hospital in 1969. The ward was notorious because it was set aside for the treatment of “deviants”, a category which included not just homosexuals of both genders, but also conscientious objectors. Homosexuals were treated by Levin with electroconvulsive aversion therapy. Here Levin would strap electrodes to the arms of his subjects, and show them pictures of naked men (if they were men) or naked women (if they were women).

Levin encouraged the subjects to fantasise about the images, and then subjected them to increasingly painful shocks. They were then shown heterosexually appropriate pornographic material, without any shocks administered. We know all this largely thanks to the testimony of a brave intern who worked with Levin, who took the name of Trudi Grobler to give evidence. She had witnessed Levin shock a woman being treated for lesbianism so hard that her shoes flew off her feet. Grobler was so horrified that she reported Levin to her superiors. For this act, Levin had her removed from the ward. And those gay soldiers who suffered the electric shocks may have been the lucky ones. The TRC heard from investigators that more than one gay soldier had been chemically castrated by Levin.

Levin’s activities were not confined to homosexuals. He also worked with men who objected to serving in the military on moral grounds. In these cases he administered the patients the so-called “truth drug”: sodium pentathol, known to lower inhibitions. Author Terry Bell, who wrote a book on the TRC called “Unfinished Business”, interviewed a man who underwent this procedure. He revealed how Levin would strap down the subject and drip feed them the drug, proceeding then to psychologically goad them until their “thoughts, fantasies and fears were laid bare”. All of this was taped and later played back to the patient, who in this case heard himself “howling like an animal”.

Levin refused to appear before the TRC, who heard that he was guilty of “gross human rights abuses”. News of this appears not to have reached Canada, who welcomed him as an émigré in 1995. In an interview with The Guardian in 2000, Levin said he’d left South Africa “because of the high crime rate”. Levin is believed to have suppressed the truth about his past in Canada by threatening lawsuits against media agencies who tried to discuss it. He did this with so much success that he was able to work as a psychiatrist at the University of Calgary’s medical school for 15 years.

That is, until March 2010, when he was arrested – but not for any offence connected with his apartheid past. The doctor who had tried to cure homosexuality with torture was arrested for sexually abusing a male patient. The plaintiff secretly filmed the psychiatrist making sexual advances on him. By July 2010 a further 20 counts of sexual assault had been laid against Levin by other male patients who came forward with similar allegations. Levin pleaded not guilty to all charges at the first hearing two weeks ago, and the judge has now set the two-week trial by jury to begin in October 2012.

What is truly astonishing, however, is that the Canadian press appears still ignorant of Levin’s past. The Calgary Herald concluded their account of the initial hearing with the neutral words: “He previously practised psychiatry in South Africa”