Tag Archive: DSM


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.

http://www.ft.com/cms/s/2/25391482-c2f5-11e2-bbbd-00144feab7de.html#ixzz2VcRRLOzc

http://www.guardian.co.uk/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist

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.

“PATIENTS WITH MENTAL DISORDERS DESERVE BETTER.”

“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.

http://www.theverge.com/2013/5/3/4296626/nimh-abandons-controversial-bible-of-psychiatry

http://www.alternet.org/story/153588/are_psychiatrists_inventing_mental_illnesses_to_feed_americans_more_pills?page=1

http://www.offthegridnews.com/2010/10/08/is-free-thinking-a-mental-illness/

Problem diagnosis

 

https://www.youtube.com/v/dEYlGEvqb-0&hl=en_US&feature=player_embedded&version=3

The dust-up over DSM-V, the upcoming diagnostic bible for shrinks.

Psychiatrists are having one of their periodic dust-ups over the question of diagnosis. The back-and-forth has to do with the development, by the American Psychiatric Association, of a new diagnostic bible, DSM-V, the manual that will determine how mental health professionals in this country divide wellness from disorder and, in the disorder category, one condition from another. The updating is always controversial. Outright opponents of psychiatry find any change suspect: How is it that a person might be judged ill in one era and healthy in another?

In this case, the critics, Allen Frances and Robert Spitzer, are psychiatrists who have been responsible for just that sort of shift. They led, respectively, the task forces that developed the two prior diagnostic and statistical manuals, DSM-IV and DSM-III. In effect, the old guard says that the new undertaking is too secretive—scholars reshaping the DSM categories have signed nondisclosure commitments, a highly unusual step in the academic world, where the science of diagnosis resides. The critics also claim that the time is not ripe, that research results do not yet justify the adoption of a new framework for classifying mental illnesses.

REST OF ARTICLE HERE

Psychiatry’s latest DSM goes too far in creating new mental disorders

Allen Frances

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” – attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

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 manual, prepared by the American Psychiatric Association, is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.

Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status – to say nothing of stigma and the individual’s sense of personal control and responsibility.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The recklessly expansive suggestions go on and on. “Attention deficit disorder” would become much more prevalent in adults, encouraging the already rampant use of stimulants for performance enhancement. The “psychosis risk syndrome” would use the presence of strange thinking to predict who would later have a full-blown psychotic episode. But the prediction would be wrong at least three or four times for every time it is correct-and many misidentified teenagers would receive medications that can cause enormous weight gain, diabetes and shortened life expectancy.

A new category for temper problems could wind up capturing kids with normal tantrums. “Autistic spectrum disorder” probably would expand to encompass every eccentricity. Binge drinkers would be labeled addicts and “behavioral addiction” would be recognized. (If we have “pathological gambling,” can addiction to the Internet be far behind?)

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.

Defining the elusive line between mental disorder and normality is not simply a scientific question that can be left in the hands of the experts. The scientific literature is usually limited, never easy to generalize to the real world and always subject to differing interpretations.

Experts have an almost universal tendency to expand their own favorite disorders: Not, as alleged, because of conflicts of interest-for example, to help drug companies, create new customers or increase research funding-but rather from a genuine desire to avoid missing suitable patients who might benefit. Unfortunately, this therapeutic zeal creates an enormous blind spot to the great risks that come with overdiagnosis and unnecessary treatment.

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.

Allen Frances is professor emeritus and former chairman of the department of psychiatry at Duke University. He wrote this for the Los Angeles Times

Is nonconformity and freethinking a mental illness?  According to the newest addition of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), it certainly is.  The manual identifies a new mental illness called “oppositional defiant disorder” or ODD.  Defined as an “ongoing pattern of disobedient, hostile and defiant behavior,” symptoms include questioning authority, negativity, defiance, argumentativeness, and being easily annoyed.

The DSM-IV is the manual used by psychiatrists to diagnose mental illnesses and, with each new edition, there are scores of new mental illnesses.  Are we becoming sicker?  Is it getting harder to be mentally healthy?  Authors of the DSM-IV say that it’s because they’re better able to identify these illnesses today.  Critics charge that it’s because they have too much time on their hands.

New mental illnesses identified by the DSM-IV include arrogance, narcissism, above-average creativity, cynicism, and antisocial behavior.  In the past, these were called “personality traits,” but now they’re diseases.

And there are treatments available.

All of this is a symptom of our over-diagnosing and overmedicating culture.  In the last 50 years, the DSM-IV has gone from 130 to 357 mental illnesses.  A majority of these illnesses afflict children.  Although the manual is an important diagnostic tool for the psychiatric industry, it has also been responsible for social changes.  The rise in ADD, bipolar disorder, and depression in children has been largely because of the manual’s identifying certain behaviors as symptoms.  A Washington Post article observed that, if Mozart were born today, he would be diagnosed with ADD and “medicated into barren normality.”

According to the DSM-IV, the diagnosis guidelines for identifying oppositional defiant disorder are for children, but adults can just as easily suffer from the disease.  This should give any freethinking American reason for worry.

The Soviet Union used new “mental illnesses” for political repression.  People who didn’t accept the beliefs of the Communist Party developed a new type of schizophrenia.  They suffered from the delusion of believing communism was wrong.  They were isolated, forcefully medicated, and put through repressive “therapy” to bring them back to sanity.

When the last edition of the DSM-IV was published, identifying the symptoms of various mental illnesses in children, there was a jump in the diagnosis and medication of children.  Some states have laws that allow protective agencies to forcibly medicate, and even make it a punishable crime to withhold medication.  This paints a chilling picture for those of us who are nonconformists.

Although the authors of the manual claim no ulterior motives but simply better diagnostic practices, the labeling of freethinking and nonconformity as mental illnesses has a lot of potential for abuse.  It can easily become a weapon in the arsenal of a repressive state.

http://offthegridnews.com/2010/10/08/is-free-thinking-a-mental-illness/

A Canadian newspaper has published report carried by reuters about criticism of the DSM

http://www.ottawacitizen.com/health/Mental+health+experts+Will+anyone+normal/3327992/story.html