New Scientist, Prospect magazine and Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

New Scientist and Prospect magazine on DSM-5; Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

Post #148 Shortlink: http://wp.me/pKrrB-1Yh

Additional recent coverage of DSM-5 controversies:

Daily Mail

Michael Hanlon’s Science Blog | February 28, 2012

The Madness of American psychiatrists

DSM5 in Distress

Do We Need a DSM-V?
No, says an editorial from the Society of Biological Psychiatry

Allen J. Frances, M.D. | February 27, 2012

New Scientist print and online

New Scientist

There’s no sense in revising the psychiatrist’s bible

Online: Liz Else | February 22, 2012

Magazine issue 2853 (Subscription or paywall for access)

Print edition: Page 31 February 25, 2012

One minute with…Nick Craddock

There’s no sense in simply revising the psychiatrist’s diagnostic bible: it will need to be totally replaced to fit the emerging science…

Nick Craddock is professor of psychiatry at the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff University School of Medicine, and is the director of the Welsh National Centre for Mental Health

Full version (Subscription required for online access)

Prospect Magazine

Issue 192, March 2012 (Subscription required for online access)

Mental disorder

By Anjana Ahuja
Anjana Ahuja is a freelance science journalist

In 1973, the American psychologist David Rosenhan sent eight healthy people, and also himself, to visit mental institutions and claim they were hearing voices. All were certified mad; some were incarcerated for a month. Rosenhan’s paper, “On Being Sane in Insane Places,” created a media sensation and a crisis in psychiatry. Doctors, it seemed, unlike suspicious fellow patients, could not tell a lucid stooge from a lunatic.

The ensuing controversy led to the tightening of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the “psychiatrists’ bible” that lists mental disorders and their symptoms. The DSM, first published in 1952, is produced by the American Psychiatric Association (APA), which, every decade or two, assembles a hundred or so mental health professionals to review disorders in the light of new science or shifting cultural norms…

Full version (Subscription required for online access)

Huffington Post

Allen Frances, MD | 02.24.12

Is Government Intervention Needed to Prevent an Unsafe DSM 5?

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. With her journalist’s instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM 5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn’t mention, one that could be even more powerful. Don’t discount the role of government intervention as a way of influencing the American Psychiatric Association.

I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.

I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill — they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.

The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.

I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations — children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation’s mental health from the excesses of DSM 5.

I do wonder how loudly must the public and the professional mental health community shout, “Stop!”, before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people.”

As I read this, I find it both sad and silly that DSM 5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM 5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM 5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.

Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new “me-too” drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM 5 will lead to widespread misdiagnosis and inappropriate drug use — causing far more damage than could possible be wrought by any new “me-too” drug.

To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

Over 12,000 individuals and organizations have now signed the Coalition for DSM-5 Reform petition

Mental health professionals and mental health organizations can sign the petition here:

http://www.ipetitions.com/petition/dsm5/

For more information on the petition see: 

http://dxrevisionwatch.wordpress.com/coalition-for-dsm-5-reform/

or go to the petition website, here: Coalition for DSM-5 Reform website

http://dsm5-reform.com/

Please note the Coalition for DSM-5 Reform petition is intended for endorsement by mental health organizations and professional bodies and for signing by mental health professionalsnot intended for signing by patients.

Dx Revision Watch has no connection with the Coalition for DSM-5 Reform, its Open Letter initiative or associated petition. All enquiries relating to the Coalition for DSM-5 Reform should be addressed directly to Dr David Elkins, Ph.D., Chair, Coalition for DSM-5 Reform committee.

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Post #146 Shortlink: http://wp.me/pKrrB-1X2

Allen Frances’ Blog at Huffington Post

DSM 5 Freezes Out Its Stakeholders

Allen Frances, MD | February 21, 2012

Scary news. The Chair of the DSM 5 Task Force, Dr. David Kupfer, has indicated that 90 percent of the decisions on DSM 5 have already been made.

Why so scary? DSM 5 is the new revision of the psychiatric diagnosis manual, meant to become official in May 2013. It proposes a radical redefinition of the boundary between mental disorder and normality, greatly expanding the former at the expense of the latter. Understandably, this ambitious medicalization of the human condition has generated unprecedented opposition, both from the public and from mental heath professionals. To top it off, the DSM 5 proposals are poorly written, unreliable, and likely to cause the misdiagnosis and the excessive treatment of millions of people.

Under normal circumstances the DSM 5 team would have taken the many criticisms to heart, gone back to the drawing board, and improved the quality and acceptability of their product. After all, the customer is very often right. But this DSM process has been strangely secretive, unable to self-correct, and stubbornly closed to suggestions coming from outside. As a result, current DSM 5 proposals show very little improvement over poorly done first drafts posted in February 2010.

Is there any hope of a last-minute save? I have gathered opinions from three well-informed DSM 5 watchers. They were asked to assess the current state of DSM 5 and offer suggestions about future prospects. The first comment comes from Suzy Chapman, a public advocate, whose website provides the most comprehensive documentary source on the development of DSM 5 and ICD-11. Ms Chapman writes:

DSM 5 consistently misses every one of its deadlines and then fails to update its website with a new schedule. The Timeline was finally revised a couple of weeks ago, but we are still no nearer to a firm date for the final period of invited public comment. We’ve known since November that DSM 5 is stuffed as far as its planned January-February comment period and that Dr Kupfer now reckons “no later than May” – but all the website says is “Spring.” That’s no use to those of us who need to alert patient groups and their professional advisers…

Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

ICD-10-CM Delay Removes Excuse For Rushing DSM 5 Into Premature Publication: Time needed to avoid harmful document

Allen Frances, MD | February 22, 2012

Until yesterday, there were only two reasons to stick with the projected date of DSM 5 publication (May 2013): 1) the need to coordinate DSM 5 with ICD-10-CM coding, which was scheduled to start Oct 2013; and, 2) the need to protect APA publishing profits in order to meet budget projections.

The first reason just dropped out. Health and Human Services (HHS) Secretary Kathleen G. Sebelius has announced that the start date for ICD-10-CM has been postponed. It is not yet clear for how long, but most likely a year (see http://www.dhhs.gov/news/press/2012pres/02/20120216a.html ).

also on Psychiatric Times

Registration required for access

ICD-10-CM Delay Removes Excuse For Rushing DSM-5 Into Premature Publication

and Education Update

Psychology Today

DSM5 in Distress

DSM 5 to the Barricades on Grief

Defending The Indefensible

Allen Frances, MD | February 18, 2012

The storm of opposition to DSM 5 is now focused on its silly and unnecessary proposal to medicalize grief. DSM 5 would encourage the diagnosis of ‘Major Depressive Disorder’ almost immediately after the loss of a loved one—having just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy would earn the MDD label (and all too often an unnecessary and potentially harmful pill treatment). This makes no sense. To paraphrase Voltaire, normal grief is not ‘Major’, is not ‘Depressive,’ and is not ‘Disorder.’ Grief is the normal and necessary human reaction to love and loss, not some phony disease.

All this seems perfectly clear to just about everyone in the world except the small group of people working on DSM 5. The press is now filled with scores of shocked articles stimulated by two damning editorial pieces in the Lancet and a recent prominent article in the New York Times.

The role of public defender of DSM 5 has fallen on John Oldham MD, president of the American Psychiatric Association…

Psychology Today

DSM5 in Distress

Allen Frances, MD | February 17, 2012

Lancet Rejects Grief As a Mental Disorder: Will DSM 5 Finally Drop This Terrible Idea

The Lancet is probably the most prestigious medical journal in the world. When it speaks, people listen. The New York Times is probably the most prestigious newspaper in the world. Again, when it speaks, people usually listen. The Lancet and The New York Times have both spoken on the DSM-5 foolishness of turning grief into a mental disorder. Will DSM-5 finally listen?

Here are some selected quotes from today’s wonderful Lancet editorial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Previous DSM editions have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder. In the draft version of DSM-5 , however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.”

“Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed…”

Psychology Today

DSM5 in Distress

DSM 5 Minor Neurocognitive Disorder: Let’s Wait For Accurate Biological Tests

Allen Frances, MD | February 16, 2012

Within the next 3-5 years, we will likely have biological tests to accurately diagnose the prodrome of Alzheimer’s disease (AD). Much remains to be done in standardizing these tests, determining their appropriate set points and patterns of results, and negotiating the difficult transition from research to general clinical practice. And, given the lack of effective treatment, there are legitimate concerns about the advisability of testing for the individual patient and the enormous societal expense with little tangible benefit. Despite these necessary caveats, there is no doubt that biological testing for prodromal AD will be an important milestone in the clinical application of neuroscience.

How does this impact on the DSM 5 proposal to include a Minor Neurocognitive Disorder as a presumed prodrome to AD…

Psychology Today

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse: DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 09, 2012

In preparing DSM IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts. They did an excellent job, but all of us missed one seemingly small mistake– the substitution of an ‘or’ for an ‘and’ in the paraphilia section that lead to serious misunderstandings and the questionably constitutional preventive psychiatric detention of sexual offenders.

DSM 5 is about to make a very different, less crucial, but still consequential forensic mistake. The proposed A criterion for PTSD includes the following wording…

Psychology Today

DSM5 in Distress

Documentation That DSM 5 Publication Must Be Delayed because DSM 5 is so far behind schedule

Allen Frances, MD | February 07, 2012

I wrote last week that DSM 5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013. My blog stimulated two interesting responses that illustrate the stark contrast between DSM 5 fantasy and DSM 5 reality. Together they document just how far behind its schedule DSM 5 has fallen and illustrate why publication must be delayed if things are to be set right.

The first email came from Suzy Chapman of http://dxrevisionwatch.wordpress.com

also on Psychiatric Times

Registration required for access

Documentation That DSM-5 Publication Must Be Delayed

Additional coverage of DSM-5 controversies

Sidney Morning Herald

About-turn on treatment of the young

Amy Corderoy | February 20, 2012

CONCERNS about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Professor McGorry has been part of a team researching pre- and early-psychosis, and his work in the latter helped secure a massive $222.4 million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia…

Sidney Morning Herald

Suffer the children under new rules

Kathryn Wicks | Opinion | February 20, 2012

Canberra Times

A new chapter for psychiatrists’ bible

Amy Corderoy | February 19, 2012

Madness is being redesigned. The Diagnostic and Statistical Manual of Mental Disorders (DSM) will be updated this year, meaning what counts as a psychiatric disorder will change.

Frances, one of the architects of the current manual, DSM-IV, published in 1994, knows the results of his changes to the definitions of mental illness.

“We were definitely modest, conservative and non-ambitious in our approach to DSM-IV,” he says. “Yet we had three epidemics on our watch…”

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

Post #144 Shortlink: http://wp.me/pKrrB-1V2

Previous Post #143:

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Bloggers

Christopher Lane, Ph.D.:  Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning, Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

Allen Frances, MD: Lancet Rejects Grief As a Mental Disorder, Will DSM 5 Finally Drop This Terrible Idea

———————–

Media

———————–

Libby Purves, columnist and author, lost a son in his late teens to suicide.

The Times

Why must grief be a sign of mental illness?

Libby Purves | February 20, 2012

Treating the bereaved for depression after two weeks typifies our urge to medicalise everyday experience…

Content behind sub or paywall

———————–

Medscape

From Medscape Medical News > Psychiatry

Lancet Weighs in on DSM-5 Bereavement Exclusion

Megan Brooks | February 16, 2012

February 16, 2012 — An editorial that appears in this week’s Lancet expresses concerns about the proposed elimination of the bereavement exclusion to major depression in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association (APA)…

Read on

———————–

Daily Mail

Lancet urges doctors to treat grief with empathy, not pills

Lauren Paxman | February 17, 2012

‘Grief is not a mental illness that should be treated with pills': Doctors hit back at creeping medicalisation of life events

Treatment of grief with antidepressants is ‘dangerously simplistic’, experts say

Backlash follows the American Psychiatric Association’s reclassification of grief as a mental illness. In an unsigned editorial in the influential medical journal The Lancet, experts argue that grief does not require psychiatrists and that ‘legitimising’ the treatment of grief with antidepressants ‘is not only dangerously simplistic, but also flawed.’ 

Read on

———————–

ABC News Radio

February 17, 2012

Grief: Normal, Not A Mental Illness

(NEW YORK) — Grief following the death of a loved one isn’t a mental illness that requires psychiatrists and antidepressants, according to editors of The Lancet, who oppose “medicalizing” an often-healing response to overwhelming loss.

Routinely legitimizing the treatment of grief with antidepressants “is not only dangerously simplistic, but also flawed,” says the unsigned lead editorial appearing in Friday’s edition of the influential international medical journal. “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.”

Read On

———————–

The Australian

Individual difference suffers in the neverending explosion of mental illness

Frank Furedi | February 18, 2012

YOU may be suffering from a mental illness that you never realised existed. The American Psychiatric Association has just published a draft version of the updated edition of its Diagnostic and Statistical Manual. According to this diagnostic bible, called DSM-5, shyness in children and confusion over gender is likely to be labelled as a mental disorder.

Read on for subscribers

———————–

TIME

Depression

Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry

A proposed new definition of depression would include normal bereavement. Why that’s a bad idea.

Maia Szalavitz | @maiasz | February 17, 2012

The editors of the forthcoming fifth edition of the Diagnostic and Statistical Manual — psychiatry’s diagnostic handbook — are having a hard time. They’ve been attacked by autism advocacy groups for proposing to eliminate the Asperger’s diagnosis. They’ve been slammed for adding a diagnosis, or “prediagnosis,” for people determined to be “at high risk” of developing schizophrenia. And, now, they’re being pummeled for introducing a provision to diagnose grief as depression…

Read on

———————–

Telegraph

Grief is not an illness, warns The Lancet

Stephen Adams Medical Correspondent | February 17, 2012

Bereaved relatives overcome by grief should not be given pills and treated as if they are clinically depressed, a leading medical journal warns today (Fri).

“Grief is not an illness”, say the journal’s editors in an impassioned editorial, which argues that “medicalising” such a normal human emotion is “not only dangerously simplistic, but also flawed”.

Doctors tempted to prescribe pills “would do better to offer time, compassion, remembrance and empathy”, they write.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing.

Their fears have been prompted by the publication of a new draft version of the psychiatrists’ ‘bible’, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5…

Read on

———————–

Inside Ireland

The Lancet: Grief is not an illness

Sarah Greer | February 17, 2012

A leading medical journal has today warned that bereaved relatives should not be given pills and treated as if they are clinically depressed.

“Grief is not an illness,” the journal’s editors say. They argue that ‘medicalising’ such a normal human emotion is ‘not only dangerously simplistic, but also flawed’, and say doctors who are tempted to prescribe pills ‘would do better to offer time, compassion, remembrance and empathy’.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing…

Read on

———————–

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Post #143 Shortlink: http://wp.me/pKrrB-1Um

Update:

Christopher Lane Ph.D. has blogged at Side Effects at Psychology Today

Side Effects
From quirky to serious, trends in psychology and psychiatry.
by Christopher Lane, Ph.D.

Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning

Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

Published on February 17, 2012 by Christopher Lane, Ph.D. in Side Effects

Allan Frances, MD, former chair of DSM-IV Task Force has blogged in DSM5 in Distress at Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

Lancet Rejects Grief As a Mental Disorder

Will DSM 5 Finally Drop This Terrible Idea

Published on February 17, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

 

This week in the Lancet

The lead Editorial in this week’s Lancet expresses concerns about specific proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

The misclassification of grief as a mental illness

An Editorial expresses concerns about the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While previous editions of DSM have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder, the current draft of this fifth edition fails to do that. In this week’s The Art of Medicine Arthur Kleinma reflects on his own personal experiences of grief and continues the discussion on the classification of grief as a mental illness. Finally, a Comment asks if attenuated psychosis syndrome should be included in DSM-5.

Lancet Editorial: Grief is not an illness and should not be routinely treated with antidepressants (Full text)

The Lancet, Volume 379, Issue 9816, Page 589, 18 February 2012 doi:10.1016/S0140-6736(12)60248-7 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Also includes reference to ICD-11:

“WHO’s International Classification of Diseases, currently under revision as ICD-11, is debating a proposal to include “prolonged grief disorder”, but it will be another 18 months before that definition will be clear.” Editorial, The Lancet, Page 589, 18 February 2012

Essay: Culture, bereavement, and psychiatry (Full text)

The Lancet, Volume 379, Issue 9816, Pages 608 – 609, 18 February 2012 doi:10.1016/S0140-6736(12)60258-X
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60258-X/fulltext

Comment: Should attenuated psychosis syndrome be included in DSM-5? (Subscription or payment required)

The Lancet, Volume 379, Issue 9816, Pages 591 – 592, 18 February 2012 doi:10.1016/S0140-6736(11)61507-9
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61507-9/fulltext

Previous Lancet article on DSM-5

The first flight of DSM-5 | Niall Boyce

The Lancet, Volume 377, Issue 9780, Pages 1816 – 1817, 28 May 2011 doi:10.1016/S0140-6736(11)60743-5

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