Unlike in
conventional medicine where objective diagnoses and
treatments are made based on observable biological
evidence, psychiatrists get together every so often to
decide what should or should not be considered a “mental
illness.” And they do not always agree, as evidenced by
the more than 13,000 professionals from around the world
who recently signed an open letter demanding that
the upcoming edition of the psychiatry industry’s
“diagnostic manual” be put on hold and reconsidered.
As the elite of the nation’s psychiatric establishment
work in the shadows to fully revise the highly
controversial handbook labeling
various behaviors and emotional states as “illnesses,”
experts across the board are crying foul. A
handful of new potential mental disorders and the
revised definitions for others have caused a
particularly fierce uproar among some psychiatrists and
mental health professionals. At least 25,000 comments
have already been submitted about the proposals.
The debate and its resolutions, of course, will have
serious repercussions. Depending on the outcome of the
ongoing conflict, millions of people may suddenly find
out that they are afflicted with newly created
“diseases,” while others — especially certain
individuals diagnosed with forms of autism — may no
longer qualify under the new definitions. Tens of
millions more may soon be officially considered
“addicts” under the revised definition for addiction,
too.
The proposed changes would have broad implications
affecting everything from treatment regimens to welfare
programs, criminal law, and even education. But around
the world, psychiatrists and mental health professionals
are fighting back hard, urging the American Psychiatric
Association (APA) to hold off on the revisions until
more discussion and research can take place.
Known as the “Diagnostic and Statistical Manual of
Mental Disorders” (DSM), the controversial handbook is
widely used around the globe by the mental health
industry, governments, insurance companies, and more. If
all goes as planned, the fifth edition of the so-called
“Bible” of psychiatry is set to be distributed in May of
next year after the first major revision in over a
decade.
However, if some of the more controversial proposed
changes are not reconsidered — and the controversies
addressed in an adequate manner — the manual’s influence
is expected to wane significantly. And even as it stands
today, not all experts are convinced about its
usefulness or reliability in the field.
"[The DSM] is wrong in principle, based as it is on
redefining a whole range of understandable reactions to
life circumstances as 'illnesses,' which then become a
target for toxic medications heavily promoted by the
pharmaceutical industry," clinical psychologist Lucy
Johnstone with a Health Board in Wales told Reuters. "The
DSM project cannot be justified, in principle or in
practice. It must be abandoned so that we can find more
humane and effective ways of responding to mental
distress."
Countless other experts agree, according to recent news
reports, with many questioning whether a private group
of individuals who stand to benefit by creating more
diseases should really be writing the manual in the
first place. Among the most vocal critics of the new
proposals is Duke University psychiatry Prof. Allen
Frances, who told the New York Times that the overly
broad and vague definitions would create more “false
epidemics” and increase the “medicalization
of everyday behavior.”
“The DSM is distinct from all other diagnostic manuals
because it has an enormous, perhaps too large, impact on
society and millions of people’s lives,” explained Dr.
Frances, who oversaw the writing of the current version
of the diagnostic handbook and also worked on previous
editions. “Unlike many other fields, psychiatric
illnesses have no clear biological gold standard for
diagnosing them.”
Predictably, his criticism has attracted a vicious
response from the APA, which has been suggesting that he
may have ulterior motives for questioning the latest
revision process. But the negative publicity surrounding
the updated manual has become so serious that the APA
actually hired a public-relations expert who previously
worked at the Department of Defense to drum up support
for the controversial new DSM while attacking critics
like Dr. Frances.
“This is an appropriate choice for an association that
substitutes a fortress mentality and warrior bluster for
substantive discussion,”observed Dr. Frances in a
piece for Psychology Today about the
group’s decision to go on a PR offensive using a former
DoD propagandist. “My motivation for taking on this
unpleasant task is simple — to prevent DSM 5 from
promoting a general diagnostic inflation that will
result in the mislabeling of millions of people as
mentally disordered.”
And despite the attacks, Frances — noting that
misdiagnosing people often results in unwarranted
“treatment” with dangerous medicines — is not backing
down. In his recent piece about the ongoing controversy,
he again raised 12 serious questions that APA has so far
refused to properly address. And he is hardly alone in
demanding answers.
One of the most vigorously contested new “diseases”
proposed for the new edition would have been called “attenuated
psychosis syndrome.” If it had been approved, it would
have been used to label and “treat” and medicate people
believed to be at risk of developing mental illness at
some point in the future. The furious outcry, however,
led the APA to back down on including the new “illness”
last week.
Another highly controversial label — “mixed anxiety
depressive disorder” — would have resulted in a
diagnosis of a new mental illness in people who
exhibited relatively mild symptoms of both “depression”
and “anxiety.” But with the reduced threshold, experts
blasted the proposal as unscientific and unneeded. Last
week, APA backed down on that one as
well.
The definition of depression was modified slightly, too,
in an effort to placate critics who say too many normal
people are being diagnosed as “mentally ill” merely for
feeling temporary sadness over an event or loss in their
lives. But despite the minor revisions to deal with
opponents, countless experts are still not satisfied.
"Fundamentally, it remains a bad system," clinical
psychology Prof. Peter Kinderman at Britain's Liverpool
University told Reuters, adding
his voice to the growing chorus of thousands of
professionals who are speaking out. "The very minor
revisions ... do not constitute the wholesale revision
that is called for."
Another area that has caused serious debate surrounds
the APA’s agreement to revise and expand the definition
of “addictions,” a decision which the New York Times reported could be one of
its most far-reaching yet. Not only would the changes
lower the threshold for what constitutes an addiction —
possibly classifying tens of millions more people as
addicts with broad consequences for health insurers and
taxpayers — the proposal also seeks to label excessive
gambling as an addiction for the first time.
Meanwhile, a new category of addiction dubbed
“behavioral addiction — not otherwise specified” would
serve as a sort of catch-all diagnosis for a broad range
of activities. According to news reports, experts fear
that psychiatrists might abuse the new classification to
misdiagnose people who simply spend a lot of time
shopping, using the Internet, or playing video games as
“addicts.”
“The chances of getting a diagnosis are going to be much
greater, and this will artificially inflate the
statistics considerably,” saidpsychiatric
epidemiologist Thomas Babor at the University of
Connecticut, who also serves as an editor for the
international journalAddiction.
“These sorts of diagnoses could be a real
embarrassment.”
Others experts also worry about conflicts of interest
among the people on the panels rewriting the manual.
Some two-thirds of the DMS’s “advisory task force,” for
example, reported financial conflicts such as links to
"Big Pharma," which countless analysts believe could
influence their decisions on creating new illnesses for
the benefit of their drug-pushing clients.
“The ties between the DSM panel members and the
pharmaceutical industry are so extensive that there is
the real risk of corrupting the public health mission of
the manual,” explained Dr. Lisa Cosgrove, a fellow at
the Edmond J. Safra Center for Ethics at Harvard, who
published a widely cited study this year exposing some
of the conflicts of interest among the APA’s panels.
An open letter from 13,000
health experts around the world raised similar concerns.
“We believe it is time for an independent group of
scientists and scholars, who have no vested interest in
the outcome, to do an external, independent review of
the controversial portions of the DSM-5,” they wrote.
“We consider this especially important in light of the
unprecedented criticism of the proposed DSM-5 by
thousands of mental health professionals, as well as
mental health organizations, in the United States and
Europe.”
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