DSM 5 and Diagnostic Inflation: Reply To Misleading Comments From Task Force: Allen Frances

January 24, 2012 by

Post #132 Shortlink: http://wp.me/pKrrB-1IP

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is currently professor emeritus, Duke University.

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

DSM 5 and Diagnostic Inflation
Reply To Misleading Comments From The Task Force

Allen Frances, MD | January 23, 2012

My biggest concern regarding DSM-5 is that it will dramatically increase the rates of mental disorder by cheapening the currency of psychiatric diagnosis—arbitrarily and carelessly reducing thresholds for existing disorders and introducing new disorders with high prevalence. This would create millions of newly mislabeled “patients,” resulting in unnecessary and potentially harmful treatment, stigma, and wasteful misallocation of scarce resources…

Read on

also at

Psychiatric Times

DSM-5 and Diagnostic Inflation: Reply to the DSM-5 Task Force
Allen Frances, MD | January 23, 2012

Free registration required to access Psychiatric Times article.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

Preventive Psychiatry Can Be Bad for Our Health: Allen Frances on Huffington Post #2

January 20, 2012 by

Preventive Psychiatry Can Be Bad for Our Health: Allen Frances on Huffington Post #2

Post #131 Shortlink: http://wp.me/pKrrB-1I2

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, publishes the second in a series of Huffington Post blogs on his concerns for the forthcoming DSM-5.

Huffington Post

Preventive Psychiatry Can Be Bad for Our Health

Allen Frances | January 19, 2012
Professor Emeritus, Duke University

Preventive psychiatry may someday be of significant service in reducing the burden of human suffering – but only if it can be done really well. And the sad truth is that we don’t yet have the necessary tools. More people will be harmed than helped if psychiatry stretches itself prematurely to do what is currently well beyond its reach. That’s what is so scary about the unrealistic prevention ambitions of DSM-5, the new manual of mental disorders now in preparation and set to become official in 2013. DSM-5 proposes a radical redefinition of the boundaries of psychiatry, giving it the impossible role of identifying and treating mental disorders in their nascent stages before they have fully declared themselves. Tens of millions of people now deemed normal would suddenly be relabeled mentally disordered and subjected to stigma and considerable risks consequent to inappropriate treatment…

Read on

 

Related content:

CDC study quoted in Huffington Post blog #2:

Antidepressant use in persons aged 12 and over: United States, 2005–2008. Pratt LA, Brody DJ, Gu Q, NCHS data brief, no 76. Hyattsville, MD: National Center for Health Statistics. 2011  PDF

America Is Over Diagnosed and Over Medicated: Allen Frances on Huffington Post
Allen Frances, Huffington Post #1, January 09, 2012

Government survey finds that 5 percent of Americans suffer from a ‘serious mental illness’
David Brown, Washington Post, January 19, 2012

SAMHSA News Release
Date: 1/19/2012 12:05 AM
Media Contact: SAMHSA Press Office
Telephone: 240-276-2130

National report finds one-in-five Americans experienced mental illness in the past year
Substance dependence and abuse rates higher among those experiencing mental illness

A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in the past year. The rate of mental illness was more than twice as high among those aged 18 to 25 (29.9 percent) than among those aged 50 and older (14.3 percent). Adult women were also more likely than men to have experienced mental illness in the past year (23 percent versus 16.8 percent).

Mental illness among adults aged 18 or older is defined as having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) in the past year, based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994).

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health also shows that 11.4 million adults (5 percent of the adult population) suffered from serious mental illness in the past year. Serious mental illness is defined as one that resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities.

SAMHSA through its strategic initiative on substance abuse and mental illness prevention and recovery is working to assist states, territories, tribal governments, and communities to adopt evidence-based practices; deliver health education related to prevention; and establish effective policies, programs, and infrastructure to help address these problems. Throughout the nation new programs are underway to strengthen the capacity of communities to better service the needs of those suffering from mental illness.

“Mental illnesses can be managed successfully, and people do recover,” said SAMHSA Administrator Pamela S. Hyde. “Mental illness is not an isolated public health problem. Cardiovascular disease, diabetes, and obesity often co-exist with mental illness and treatment of the mental illness can reduce the effects of these disorders. The Obama Administration is working to promote the use of mental health services through health reform. People, families and communities will benefit from increased access to mental health services.”

The economic impact of mental illness in the United States is considerable—about $300 billion in 2002. According to the World Health Organization, mental illness accounts for more disability in developed countries than any other group of illnesses, including cancer and heart disease.

In terms of treatment statistics, the report indicates that about 4 in 10 people experiencing any mental illness in the past year (39.2 percent) received mental health services during that period. Among those experiencing serious mental illness the rate of treatment was notably higher (60.8 percent).

The report also noted that an estimated 8.7 million American adults had serious thoughts of suicide in the past year – among them 2.5 million made suicide plans and 1.1 million attempted suicide. Those in crisis or knowing someone they believe may be at immediate risk of attempting suicide are urged to call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or http://www.suicidepreventionlifeline.org . This suicide prevention hotline network funded by SAMHSA provides immediate free and confidential crisis round-the-clock counseling to anyone in need throughout the country, everyday of the year.

According to the report, rates for substance dependence were far higher for those who had experienced either any mental illness or serious mental illness than for the adult population which had not experienced mental illness in the past year. Adults experiencing any mental illness in the past year were more than three times as likely to have met the criteria for substance dependence or abuse in that period than those who had not experienced mental illness in the past year (20 percent versus 6.1 percent). Those who had experienced serious mental illness in the past year had even a higher rate of substance dependence or abuse (25.2 percent). “These data underscore the importance of substance abuse treatment as well,” said SAMHSA Administrator Pamela S. Hyde.

“Mental illness is a significant public health problem in itself, but also because it is associated with chronic medical diseases such as cardiovascular disease, diabetes, obesity, and cancer, as well as several risk behaviors including physical inactivity, smoking, excessive drinking, and insufficient sleep,” said Ileana Arias, Ph.D., Principal Deputy Director of CDC. “Today’s report issued by SAMHSA provides further evidence that we need to continue efforts to monitor levels of mental illness in the United States in order to effectively prevent this important public health problem and its negative impact on total health.”

The report also has important findings regarding mental health issues among those aged 12 to 17. According to the report 1.9 million youth aged 12 to 17 (8 percent of this population) had experienced a major depressive episode in the past year. A major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994).

In addition, the report finds that young people aged 12 to 17 who experienced a major depressive episode in the past year have more than twice the rate of past year illicit drug use (37.2 percent) as their counterparts who had not experienced a major depressive episode during that period (17.8 percent).

The complete survey findings from this report are available on the SAMHSA Web site at http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/

The 2010 National Survey on Drug Use and Health is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s premier source of statistical information on the scope and nature of many behavioral health issues affecting the nation.

For more information about SAMHSA visit: http://www.samhsa.gov

SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Last updated: 1/18/2012 2:53 PM

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

Two commentaries from Allen Frances in response to APA field trial documents

January 19, 2012 by

Two commentaries from Allen Frances in response to APA field trial documents

Shortlink Post #130: http://wp.me/pKrrB-1GX

Allen Frances, MD, chaired the DSM-IV Task Force and a former chair of the Department of Psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

 

References and resources

DSM-5 document: Q & A on DSM-5 Prevalence and Reliability January 12, 2012

DSM-5 document: Reliability and Prevalence in the DSM-5 Field Trials January 12, 2012

based on the The American Journal of Psychiatry article DSM-5: How Reliable Is Reliable Enough? Helena Chmura Kraemer, Ph.D.; David J. Kupfer, M.D.; Diana E. Clarke, Ph.D.; William E. Narrow, M.D., M.P.H.; Darrel A. Regier, M.D., M.P.H. January 01, 2012, Vol. 169. No. 1

DSM-5 Field Trials page

Consumer-Friendly Frequently Asked Questions about DSM-5 Field Trials
Frequently Asked Questions about DSM-5 Field Trials in Large, Academic Settings
DSM-5 Field Trial Protocol for Large, Academic Settings
DSM-5 Field Trial Protocol for Routine Clinical Practice Settings
APA’s Request for Proposals for Potential Field Trial Sites
DSM-5 Field Trials in Routine Clinical Practice Settings
Supplemental Material for Clinician Application to Own Institutional Review Board (IRB)

Inside DSM-5 Field Trials, Flyer, American Psychiatric Association Practice Research Network, December 2011

Commentary: DSM-5 Disorganization, Disarray, and Delays, Dr Dayle Jones, PhD, January 3, 2012

 

Two commentaries from Allen Frances, MD

Two Fallacies Invalidate the DSM-5 Field Trials
APA telegraphs that DSM 5 will be unreliable.

Allen Frances, MD | January 16, 2012

The designer of the DSM-5 Field Trials has just written a telling commentary in the American Journal of Psychiatry. She makes two very basic errors that reveal the fundamental worthlessness of these field trials and their inability to provide any information that will be useful for DSM-5 decision making.

1) The commentary states: “A realistic goal is a kappa between 0.4 and 0.6, while a kappa between 0.2 and 0.4 would be acceptable.” This is simply incorrect and flies in the face of all traditional standards of what is considered ‘acceptable’ diagnostic agreement among clinicians. Clearly, the commentary is attempting to greatly lower our expectations about the levels of reliability that were achieved in the field trials – to soften us up to the likely bad news that the DSM-5 proposals are unreliable. Unable to clear the historic bar of reasonable reliability, it appears that DSM-5 is choosing to drastically lower that bar – what was previously seen as clearly unacceptable is now being accepted.

Kappa is a statistic that measures agreement among raters, corrected for chance agreement. Historically, kappas above 0.8 are considered good, above 0.6 fair, and under 0.6 poor. Before this AJP commentary, no one has ever felt comfortable endorsing kappas so low as 0.2-0.4. As a comparison, the personality section in DSM III was widely derided when its kappas were around 0.5. A kappa between 0.2-0.4 comes dangerously close to no agreement. ‘Accepting’ such low levels is a blatant fudge factor – lowering standards in this drastic way cheapens the currency of diagnosis and defeats the whole purpose of providing diagnostic criteria.

Why does this matter? Good reliability does not guarantee validity or utility – human beings often agree very well on things that are dead wrong. But poor reliability is a certain sign of very deep trouble. If mental health clinicians cannot agree on a diagnosis, it is essentially worthless. The low reliability of DSM-5 presaged in the AJP commentary confirms fears that its criteria sets are so ambiguously written and difficult to interpret that they will be a serious obstacle to clinical practice and research. We will be returning to the wild west of idiosyncratic diagnostic practice that was the bane of psychiatry before DSM III.

2) The commentary also states: “one contentious issue is whether it is important that the prevalence for diagnoses based on proposed criteria for DSM-5 match the prevalence for the corresponding DSM-IV diagnoses” …. “to require that the prevalence remain unchanged is to require that any existing difference between true and DSM-IV prevalence be reproduced in DSM-5. Any effort to improve the sensitivity of DSM-IV criteria will result in higher prevalence rates, and any effort to improve the specificity of DSM-IV criteria will result in lower prevalence rates. Thus, there are no specific expectations about the prevalence of disorders in DSM-5.”

This is also a fudge. For completely unexplained and puzzling reasons, the DSM-5 field trials failed to measure the impact of its proposals on rates of disorder. These quotes in the commentary are an attempt to justify this fatal flaw in design. The contention is that we have no way of knowing what true rates of a given diagnosis should be – so why bother to measure what will be the likely impact on rates of the DSM-5 proposals. If rates double under DSM-5, the assumption will be that it is picking up previous false negatives with no need to worry about the risks of creating an army of new false positives.

This is irresponsible for two reasons. First off, we are already suffering from serious diagnostic inflation. Rates of psychiatric disorder are already sky high (25% in the general population in any year; 50% lifetime) and we recently have experienced three runaway false epidemics of childhood disorders in the past 15 years. Second, drug company marketing has been so abusive as to warrant enormous fines and so successful as to result in widespread misuse of medication for very questionable indications. Recent CDC data suggest that the severely ill remain very undertreated, but that the mildly ill or not ill at all have become massively overtreated, especially by primary care physicians.

The DSM-5 proposals will uniformly increase rates, sometimes dramatically. Not to have measured by how much is unfathomable and irresponsible. The new diagnoses suggested for DSM-5 will (mis)label people at the very populous boundary with normality. Mixed anxiety depression and binge eating disorder will likely have astounding high rates between 5-10% – that’s tens of millions people now considered ‘normal’ suddenly converted into mentally ill by arbitrary DSM-5 fiat. Psychosis risk and disruptive mood disorder will be extremely common in the young; minor neurocognitive among the elderly. Legions of the recently bereaved will be misdiagnosed as clinically depressed; rates of generalized anxiety and addiction will mushroom; and ADD which has already almost tripled will find even more room at the top. The field trial developers seem either unaware or insensitive to the unacceptable risks involved in creating large numbers of false positive, pseudo-patients.

Indeed, quite contrary to the blithe assertions put forward in the commentary, we should have rigorous expectations about prevalence changes triggered by any DSM revision. Rates should not be wildly different for the same disorder UNLESS there is clear evidence of a serious false negative problem and firm protections against creating a massive false positive problem. And new disorders with high prevalences should not be included without substantial scientific evidence and convincing proof of accuracy, reliability, and safety. We have known since they were first posted that none of the DSM-5 proposals comes remotely close to meeting a minimal standard for accuracy and safety. And now, the AJP commentary seems to be softening us up for the bad news that their reliability is also lousy.

The workers on DSM-5 ignore the often dire implications of drastically raising the prevalence of an existing disorder or adding an untested new disorder with high prevalence – i.e., the misguided and potentially harmful treatment, the unnecessary stigma, and rising health care costs that also cause a misallocation of very scarce resources. Just two examples. Do we really want even more antipsychotic medications prescribed for children, the elderly, and returning war veterans when these are already being used so loosely and inappropriately? Isn’t the current legal and illegal overuse of stimulant medications already a big enough problem without introducing a drastically lowered set of criteria for diagnosing ADD? Sad to say, DSM-5 has failed to do an adequate risk/benefit analysis on any of its suggestions. Every one of its changes is designed to chase elusive false negatives; none protects the interests of mislabeled false positives.

Given our country’s current binge of loose diagnostic and medication practice (particularly by the primary care physicians who do most of the prescribing), DSM-5 should not be in the business of casually raising rates and offering inviting new targets for aggressive drug marketing. Instead, DSM-5 should be working in the opposite direction – taking steps to increase the precision and specificity of its diagnostic criteria. And the texts describing each disorder should contain a new section warning about the risks of overdiagnosis and ways of avoiding it. It is impossible to say what is the “right” prevalence of any disorder, but it is careless and reckless to so dramatically increase the prevalences of mental disorders without evidence of need or proof of safety.

The DSM-5 field trials have cost APA at least $3 million (perhaps a whole lot more). They started off on the wrong foot by asking the wrong question – focusing only on reliability and completely ignoring prevalence. The deadlines for starting the trials and for delivering results have been repeatedly postponed because of poor planning, an excessively cumbersome design, and disorganized implementation. The results will be arriving at the very last minute when decisions should have already be made. And now we get a broad hint that the reliabilities, when they are finally reported, will be disastrously low.

What should be done now as DSM-5 enters its depressing endgame? There really is no rational choice except to drop the many unsupportable DSM-5 proposals and to dramatically improve the imprecise writing that plagues most of the DSM-5 criteria sets.

DSM-5: How Reliable Is Reliable Enough?
DSM 5 is willing to except poor quality.

Allen Frances, MD | January 18, 2012

This is the title of a disturbing commentary written by the leaders of the DSM 5 Task Force and published in this month’s American Journal of Psychiatry. The contents suggest that we must lower our expectations and be satisfied with levels of unreliability in DSM 5 that historically have been clearly unacceptable. Two approaches are possible when the DSM 5 field trials reveal low reliability for a given suggestion: 1) admit that the suggestion was a bad idea or that it is written so ambiguously as to be unusable in clinical practice, research, and forensics; Or, 2) declare by arbitrary fiat that the low reliability is indeed now to be relabeled ‘acceptable’.

In the past, ‘acceptable’ meant kappas of 0.6 or above. When the personality disorders in DSM III came in at 0.54, they were roundly derided and given only a reluctant bye. For DSM 5, ‘acceptable’ reliability has been reduced to a startling 0.2-0.4. This barely exceeds the level of agreement you might expect to get by pure chance.

Previously in its development, DSM 5 has placed great store in its field trials. This quote is from the Chair of the DSM 5 Task Force: “There’s a myth that all the decisions have been made, when in fact, all the decisions haven’t been made. Just because things have been proposed doesn’t necessarily mean they’ll end up in the DSM-5. If they don’t achieve a level of reliability, clinician acceptability, and utility, it’s unlikely they’ll go forward.”

And this quote is from a 2010 interview given to a science writer by the head of the DSM 5 Oversight Committee: “It’s going to be based on the work of the field trials – based on the assessment and analysis of them. I don’t think anyone is going to say we’ve got to go forward if we get crappy results.”

The DSM 5 tune has now changed dramatically. The commentary written for AJP by the leadership of DSM 5 Task Force appears to be suggesting that they will, in fact, “go forward,” and with sub par reliabilities of 0.2-0.4. Now consider that the original field trial plan was to have a second phase to permit fixing those diagnostic criteria that were found to have unacceptable reliability in the first phase. These would go back to the workgroups who could then rewrite the offending criteria and retest the new version in the second phase of the field trial. But poor planning and administrative foul-ups kept pushing back the field trials so that they are now at least 18 months late in completion. As time was running out, DSM 5 leadership quietly dropped the second phase of the field trials, removing any reference to it from the timeline posted on the DSM-5 website. Their Plan B substitute for adequate field testing appears in AJP- To wit: a drastic lowering of the bar for what is ‘acceptable’ reliability.

Can ‘accepting’ unacceptably poor agreement uphold the integrity of psychiatric diagnosis? Poor reliability degrades our ability to communicate with one another clinically, and prohibits meaningful research. ‘Accepting’ as reliable kappas of 0.2-0.4 is to go backwards more than thirty years to the days of DSM II. Before DSM III, Bob Spitzer and Mel Sabshin saw the need to develop a criterion based system that could achieve reasonable diagnostic agreement. This is the very minimum condition necessary for current clinical work and future progress in psychiatry.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

New DSM-5 Development docs: Reliability and Prevalence in the DSM-5 Field Trials

January 13, 2012 by

New DSM-5 Development documents: Reliability and Prevalence in the DSM-5 Field Trials

Post #128 Shortlink: http://wp.me/pKrrB-1F1

Two new documents have been posted on the American Psychiatric Association’s DSM-5 Development website.

(“What’s New” box on right of Home page)

 

                    Q & A on DSM-5 Prevalence and Reliability January 12, 2012

                    Reliability and Prevalence in the DSM-5 Field Trials January 12, 2012

Based on the The American Journal of Psychiatry article 

                    DSM-5: How Reliable Is Reliable Enough?

The American Journal of Psychiatry | January 01, 2012

Helena Chmura Kraemer, Ph.D.; David J. Kupfer, M.D.; Diana E. Clarke, Ph.D.; William E. Narrow, M.D., M.P.H.; Darrel A. Regier, M.D., M.P.H. January 01, 2012, Vol. 169. No. 1

 

Commentary from Allen Frances, MD, Psychiatric Times, January 09, 2012:

Two Fallacies Invalidate the DSM-5 Field Trials
By Allen Frances, MD | 09 January 2012

(Free registration required to view Psychiatric Times.)

“The designer of the DSM-5 Field Trials has just written a telling commentary in the American Journal of Psychiatry (AJP). She makes what I consider to be 2 basic errors that reveal the fundamental worthlessness of these Field Trials and their inability to provide any information that will be useful for DSM-5 decision making…”

Read on

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech: Allen Frances

January 12, 2012 by

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech by Allen Frances

Post #127 Shortlink: http://wp.me/pKrrB-1ER

Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D. (Chair, DSM-IV Task Force and currently professor emeritus at Duke.)

DSM 5 Censorship Fails
Support From Professionals and Patients Saves Free Speech

Allen Frances, M.D. | January 12, 2012

Last week I described the plight of Suzy Chapman, a well respected UK patient advocate forced to change the domain name of her website by the heavy handed tactics of the publishing arm of the American Psychiatric Association. The spurious legal excuse was commercial protection of the ‘DSM 5’ trademark; the probable intent was to stifle one of the internet’s best sources of DSM and ICD information. This bullying could not have come at a worse time – just as final decisions are being made on highly controversial DSM 5 proposals and with the third and final draft due for release this spring. This is precisely when a ragged and reckless DSM 5 can most benefit from the widest and most open discussion.

Though APA’s trademark claims were patently absurd, Ms Chapman did not have the necessary resources for a protracted fight against a well staffed legal department. Visits plummeted drastically to her new web address (reaching a nadir of just one hit per day) and the site faced months of slow recovery. But the good news is that APA’s clumsy attempt at censorship has backfired, free speech will prevail, and the site is now more popular than ever.

Suzy Chapman writes:

“I want to thank the many psychiatrists, allied mental health professionals, and science writers who have spoken out in opposition to what they see as arrogant censorship on the part of the American Psychiatric Association. Their outpouring of concern has generated considerable interest on websites, blogs and social media platforms. This has increased the traffic on my site by many hundreds of visitors per day. The support of professionals and patient groups illustrates the power of the internet to resist suppression of patient advocacy and to promote free speech.”

“The purpose of my site is to raise public and stakeholder awareness of the forthcoming revisions of both DSM-5 and ICD-11. I endeavor to provide timely and accurate information about DSM-5, including: internet commentaries on proposals; flag ups of journal papers and editorials; news releases and other media statements; and updates on changes to the DSM-5 timeline. I also cover progress on ICD-11, including activities of the Revision Steering Group; documents, presentations and videos; and updates on the ICD-11 timeline. I report on developments with the forthcoming US ICD-10-CM and proceedings of a US federal Advisory Committee to HHS in relation to coding issues. Finally, I follow the advocacy campaigns and initiatives relating to DSM and ICD classificatory issues. My objective is to help stakeholders understand the issues so that they may provide the most useful feedback to the revision process.”

“Despite all the controversies, despite the calls for independent review, despite all the delays and limitations of its field trials, DSM-5 hurtles forward towards publication in May 2013. During this final, decisive year of DSM 5 decision making, I shall continue to publish information, updates and commentaries to promote the widest possible dialogue around the drafting of this most important publication. My new site, ‘Dx Revision Watch – Monitoring the development of DSM-5, ICD-11, ICD-10-CM’ can be found at: https://dxrevisionwatch.wordpress.com/

“This experience has taught me that the APA trademark claims were not only misguided, but probably legally indefensible. ‘Nominative fair use’ is permitted those who are publishing criticism within texts if use of the trademark is relevant to the subject of discussion or necessary to identify the product, service, or company. Courts have found that non-misleading use of trademarks in the domain names of critical websites (like walmartsucks.com) is to be considered ‘fair use’ by non-commercial users – so long as there is no intent to misrepresent or confuse visitors to the site and when it is clear that the site owner is not claiming endorsement by, or affiliation to, the holder of the mark.”

“Everything I have read suggests that my clearly non-commercial use of my previous subdomain name (dsm5watch.wordpress.com) – with its prominent disclaimer and no intent to mislead – falls well within the concept of ‘fair use’. This then raises the obvious question – what grounds did APA have for serving me with demands and threats of possible legal action? Several people have independently sent me materials on ‘SLAPP’ lawsuits (strategic lawsuit against public participation). These are threats of legal action intended to censor, intimidate, and silence critics by burdening them with the cost of a legal defense – so that they will abandon their criticism or opposition.”

“If you are interested in learning more about ‘SLAPP’ lawsuits, there is a good summary at
http://en.wikipedia.org/wiki/Strategic_lawsuit_against_public_participation

“The Electronic Frontier Foundation is also a very useful resource for legal advice on trademark law for blog and website owners. See http://www.eff.org/issues/bloggers/legal/liability/IP

“The surprisingly spirited and unanimous internet reaction provoked by the APA’s actions will probably discourage it from future pursuit of other ‘fair use’ site owners. I certainly hope so. But if other site owners are issued inappropriate ‘cease and desist’ claims, I do hope they have the resources to seek legal advice before complying.”

“I am very grateful for all the support received in the past week and the many emails thanking me for the work I do. It is gratifying to hear that not only do patients, caregivers and patient organizations rely on my carefully researched and presented content, but that so many professionals are also following my site and find it useful. This experience has been stressful, but I can now say confidently that APA’s actions have definitely backfired –  the many hundreds of additional viewers discovering the site each day will expand its audience and its usefulness.”

All of us owe great thanks to Ms Chapman and to the internet community whose ringing endorsement has allowed her not only to maintain, but also to enlarge, her readership. Ms Chapman will continue to provide the field with the most current and most accurate reporting on DSM 5 during its endgame. I strongly recommend her website as the best clearinghouse for information on DSM 5.

I join Ms Chapman in hoping that this embarrassing episode will discourage APA from all future efforts at abusive censorship – whether they are related to trademark, copyright, or confidentiality agreements. The field must remain vigilant in its efforts to contain APA commercialism and persistent in trying to penetrate APA’s secrecy and inbred decision making. APA must finally come to realize that DSM 5 is an open public trust, not a private business enterprise.

 

Related material:

DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality, Allen Frances, M.D., Psychology Today, January 03, 2012

Further media coverage of the APA cease and desist v DSM-5 Watch website issue collated here:  Post #123

Article on “cease and desist” issue: Pity the poor American Psychiatric Association, Parts 1 and 2 by Gary Greenberg

 

Legal information and resources for bloggers and site owners:

1] Wipedia article: Cease and desist
http://en.wikipedia.org/wiki/Cease_and_desist

2] Wipedia article: Strategic lawsuit against public participation (SLAPP)
http://en.wikipedia.org/wiki/Strategic_lawsuit_against_public_participation

3] Electronic Frontier Foundation (EFF)
http://en.wikipedia.org/wiki/Electronic_Frontier_Foundation
http://www.eff.org/

EFF Bloggers’ Rights
https://www.eff.org/bloggers

EFF Legal Guide for Bloggers
https://www.eff.org/issues/bloggers/legal

4] Chilling Effects
http://en.wikipedia.org/wiki/Chilling_Effects_(group)

http://chillingeffects.org/

Chilling Effects FAQ on Trademark Law
http://www.chillingeffects.org/trademark/faq.cgi#QID251

Chilling Effects on Protest, Parody and Criticism Sites
http://www.chillingeffects.org/protest/

5] U.S. Trademark Law, Rules of Practice & Federal Statutes , U.S. Patent & Trademark Office, November 2011 http://www.uspto.gov/trademarks/law/tmlaw.pdf

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, ICD-10-CM, ICD-11 Tagged with , , , , , , , , ,

Psychologists call for independent review of DSM-5

January 10, 2012 by

Psychologists call for independent review of DSM-5

Post #126 Shortlink: http://wp.me/pKrrB-1DC

The Coalition for DSM-5 Reform is calling on the American Psychiatric Association to submit its draft proposals for new categories and criteria for DSM-5 to independent scientific review.

An Open Letter and Petition sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association), in alliance with several other American Psychological Association Divisions, attracted nearly 7000 signatures in its first three weeks. Since launching the petition, on October 22, over 10,300 mental health and allied professionals have signed up with over 40 organizations publicly endorsing the Open Letter.

You can view the Open Letter and iPetition here

Yesterday, January 09, Division 32 Open Letter Committee sent another call to the American Psychiatric Association Board of Trustees and DSM-5 Task Force to submit controversial proposals for DSM-5 to independent scrutiny.

PSYCHOLOGISTS CALL FOR INDEPENDENT REVIEW OF DSM-5

January 9, 2012

ATTENTION:                                                                                                                                                                                    David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Regier, M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

We appreciate your opening a dialogue regarding the concerns that the Division 32 Open Letter Committee and others have raised about the proposed DSM-5.  Your willingness to do this suggests that both the Task Force and our committee are in basic agreement that we both want the DSM-5 to be empirically grounded, credible to mental health professionals and the public, and safe to use.  In keeping with this spirit of open dialogue, we are writing in regard to what we view as a critically important issue.

You will recall that the Division 32 Open Letter Committee, along with the American Counseling Association, recently asked the DSM-5 Task Force and the American Psychiatric Association to submit the controversial portions of the proposed DSM-5 for external review by an independent group of scholars and scientists who have no ties to the DSM-5 Task Force or the American Psychiatric Association.

As you know, it is common practice for scientists and scholars to submit their work to others for independent review.  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.  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.

Will you submit the controversial proposals in DSM-5 to an independent group of scientists and scholars with no ties to the DSM-5 Task Force or the American Psychiatric Association for an independent, external  review?  

We respectfully ask that you not respond again with assurances about internal reviews and field trials because such assurances, at this point, are not sufficient.  We believe an external, independent review is critical in terms of ensuring the proposed DSM-5 is safe and credible.  If you are unwilling to submit the controversial proposals for external, independent review, we respectfully ask that you provide a detailed rationale for your refusal.  Because the DSM is used by hundreds of thousands of mental health professionals, we are publicly posting this letter and will also post your response.   We believe mental health professionals, along with concerned mental health organizations, in the United States and Europe will be very interested in this important exchange.

Sincerely,

David N. Elkins, PhD,  Chair of the Division 32 Open Letter Committee   Email:  David Elkins

Frank Farley, PhD, Member of Committee
Jonathan D.  Raskin, PhD, Member of Committee
Brent Dean Robbins, PhD,  Member of Committee
Donna Rockwell, PsyD, Member of Committee

Resources
 
 

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook

Coalition for DSM-5 Reform website

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter    @HumanisticPsych

The Society for Humanistic Psychology on Facebook

Filed under American Psychiatric Association (APA), British Psychological Society, Coalition for DSM-5 Reform, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-5 Petitions, DSM-V Tagged with , , , , ,

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